Sexually Transmitted Diseases (STD) Syndromic Management (AIDSCAP/FHI, 1997, 54 p.): OTHER COMPONENTS OF COMPREHENSIVE STD CASE MANAGEMENT: Training

Sexually Transmitted Diseases (STD) Syndromic Management (AIDSCAP/FHI, 1997, 54 p.)

(introduction...)

HOLOGRAPHIC OVERVIEW

INTRODUCTION

(introduction...)

HIV and STD Global Burden

Role of STD on HIV Transmission

STD SYNDROMIC MANAGEMENT

(introduction...)

Definition

Theoretical Foundation

Advantages and Disadvantages

Cost-Effectiveness

DESIGN OF STD FLOWCHARTS

(introduction...)

Common Flowcharts

(introduction...)

Urethral Discharge Syndrome in Men

Vaginal Discharge Syndrome in Women

Pelvic Inflammatory Disease: The Management of Lower Abdominal Pain

Genital Ulcer Disease

Validity Testing of a Flowchart: Sensitivity and Specificity

OTHER COMPONENTS OF COMPREHENSIVE STD CASE MANAGEMENT

(introduction...)

Partner Treatment

Health Education

Condom Distribution

Adding Strategies

Syphilis Screening and Treatment

Training

INTRODUCTION OF STD SYNDROMIC MANAGEMENT IN LAC

(introduction...)

Haiti

Jamaica

Brazil

Honduras

Dominican Republic

LESSONS LEARNED

(introduction...)

Building Consensus and Communication

Development and Implementation of STD Flowcharts

Improving Access to STD Care

Detecting Asymptomatic STDs

RECOMMENDATIONS

REFERENCES

Training

Most traditional health care training is based on an etiologic model. Thus, the syndromic approach to STD management is a new concept to most health care workers. Therefore, the retraining of health care clinicians, whether they are physicians, nurse practitioners or public health nurses, is an important component of initiating this approach into a public health system.

Clinical training of STD personnel can be difficult and must reflect reality and be problem-oriented. Flowcharts are useful training tools for this purpose because they are based on the presenting symptoms and show the path of diagnostic reasoning to reach a proper diagnosis and to prescribe the best treatment. The skills of history taking and physical examination must not be neglected in this approach. Health care workers must still learn to ask the most relevant questions, including questions on sexual behavior, and to look for the most important physical signs. Active participation of students in the logical, step-by-step construction of flowcharts is educationally beneficial and facilitates their acceptance and use.

The following are important components of training in the syndromic approach to STD management:

- National STD guidelines and flowcharts must be established before training and should be the basis of the training module.

- Local data and local examples are important to convince participants of the utility of the training.

- Careful and proper training of the trainers is essential for a high quality transfer of ideas.

- All training must be followed up with frequent supervisory visits. It has been proven in numerous instances that merely providing training without follow-up reinforcement will produce poor results.