Fact Sheet No
WOMEN AND SEXUALLY TRANSMITTED INFECTIONS
Problems specific to women
Drawbacks of syndromic approach for managing gonorrhoea and chlamydia in women
The syndromic approach for managing STIs uses simple clinical algorithms based on patient signs and symptoms to determine antimicrobial treatment so that the patient can be managed in a single visit in settings where laboratory facilities for etiological testing are unavailable. The antimicrobial regimens are chosen to cover the major pathogens responsible for the syndromes in the specific geographical area.
However, the algorithm for vaginal discharge is the least satisfactory in terms of sensitivity and specificity. Vaginal discharge is not a good indicator of cervical infections (gonorrhoea and chlamydia).
In low prevalence settings the choice is whether to overtreat or not to treat at all.
Work has been done to improve the sensitivity of the algorithms by incorporating risk assessment. This has only been partially successful; and achieved 50% sensitivity in a study in Tanzania and Malawi.
Exploring means of rationalising utilisation of the algorithms for vaginal discharge is a priority as the syndromic approach is cost effective.
World Health Organization (WHO) work
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