RECOMMENDATIONS

AIDSCAP proposes the following steps as a comprehensive approach to syndromic STD management to establish improved, client-centered STD service delivery:

- Gather existing data or conduct studies to describe local STD prevalence, antimicrobial susceptibility patterns, and STD beliefs and practices.

- Convene local health personnel to review epidemiological data and reach consensus on national STD syndromic treatment guidelines.

- Design, conduct and evaluate training of local providers in syndromic management.

- Provide supportive supervision for trainees and evaluate service provision.

- Train regional, national and local managers in program management and evaluate the results of the training.

- Work to ensure required drugs are available.

- Given the high level of self-treatment and lack of access to effective STD treatment found in many countries, STD and HIV/AIDS control programs should supplement efforts to improve traditional STD services with alternatives, such as training of pharmacists in syndromic management and selling prepackaged STD therapy in pharmacies and health facilities.

- Greater emphasis on behavior change communication is also needed in both clinic-based STD services and community out-reach to encourage early treatment seeking.

- STD programs should institute partner referral in order to detect and treat asymptomatic STDs, particularly in women.

- All pregnant women attending ante-natal clinics should be screened for syphilis and treated.

- Health care workers without any laboratory experience can be trained to use the rapid, inexpensive diagnostic test for syphilis with high levels of accuracy.