syndromic approach to sti/rti

1.  MADE BY: AVINASH BAINS &
DILJOT SINGH
 ROLL NO. 27 & 31

2. What is RTI/STI ?
 Reproductive Tract Infections (RTIs):
Any infection of reproductive tract in male and female
 Sexually Transmitted Infections (STIs):
STIs are infections caused by germs such as bacteria,
viruses, or protozoa that are passed from one person to
another through sexual contact.

3. Factor contributing to RTI/STI spread
•Human behaviour
•Lack of access to healthcare
•Lack of awareness about STIs
•Migrating population
•Healthcare providers not adequately
trained
•Poor medical services
•Hygiene and environmental factors
•Hormonal and other factors

4. High risk groups
 Adolescent boys and girls
 Women who have multiple partners
 Sex workers and their clients
 Men having sex with men
 Partners of various high risk groups

5. Syndromic Approach
 Syndrome – is group of symptoms patient complains about
and clinical signs that a physician observes during
examination
 Syndromic diagnosis:
 Identification of consistent group of symptoms and
easily recognised signs (syndromes)
 Syndromic treatment:
 Treat the main organisms responsible for causing
the syndrome

6. Identifying Syndromes
SYNDROME MOST COMMON CAUSE
Vaginal discharge Vaginitis (Trichomoniasis, Candidiasis, Bacterial
Vaginitis)
Cervicitis (Gonorrhea, Chlamydia)
Urethral discharge Gonorrhea, Chlamydia
Genital ulcer Syphilis, Chancroid, Herpes
Lower abdominal pain Gonorrhea, Chlamydia, Mixed Anaerobes
Scrotal swelling Gonorrhea, Chlamydia
Inguinal bubo LGV, Chancroid
Neonatal conjunctivitis Gonorrhea, Chlamydia

7. Syndromic Management-
Advantages
 Pt. diagnosed and treated in one visit.
 Highly effective for most of the syndromes.
 Relatively inexpensive
 No need for patient to return for lab results.
 All possible STIs are treated at once.
 Scientifically tested in many part of the world.
 Easy for health workers to learn and practice for patients.
 Integrated into primary health care services more easily.
 Can be used by providers at all levels.

8. Syndromic Management- Limitations
 Not useful in asymptomatic individuals.
 Over-treatment in patient with one STI that causes a syndrome.
 Financial cost of over-treatment, side- effects.
 Increases potential for antibiotic resistance especially if full
course not completed.

9. The Five Steps in Syndromic STI Case
Management
 History taking and examination
 Syndromic diagnosis and treatment, using flow
charts
 Education and counseling on HIV testing and
safer sex, including condom promotion and
provision
 Management of sexual partners
 Recording and reporting

10. Syndromic Management
Flowcharts
Module 4

11. Yes
Patient complains of urethral
discharge or dysuria
Take history and
examine
Milk urethra if necessary
TREAT FOR GONOCOCCAL INFECTION
AND CHLAMYDIA TRACHOMATIS
Educate and counsel
Promote condom use and provide condoms
Manage and treat partner
Offer HIV counselling and testing if both
facilities are available
Ask patient to return in 7 days if symptoms
persist
Use appropriate flow chart
Educate and
counsel
Promote condom
use and provide
condoms
Offer HIV
counselling and
testing if both
facilities are
available
Review if symptoms
persist
Discharge
confirmed?
Any other
genital
disease?
Yes
No No
Urethral Discharge

12. Man complains of scrotal swelling and
pain
Painful scrotal swelling confirmed
Treatment for Gonorrhoea and
Chlamydia.
Patient Education, counselling
 Provide and promote condom
Partner management
Testes rotated/ elevated
or history of trauma
Refer immediately for a
surgical opinion
Take history & examine
Testes normal. No history of
trauma
Cured Return in 7 days if
symptoms persist
No improvement
Refer to higher care center
SCROTAL SWELLING

14. Partner Management
Module 10

15. Partner Treatment
Syndrome of index patient Treatment for partner/s
Urethral discharge Treat partner/s for gonorrhea and
chlamydia
Genital ulcer Treat partner/s for syphilis and
chancroid
Vaginal discharge:
Patient treated for vaginitis and
cervicitis
Patient treated for vaginitis
Treat partner/s for gonorrhea and
chlamydia
Not necessary for partners to be
treated unless there is recurrent
discharge
Pelvic inflammatory disease Treat partner/s for gonorrhea and
chlamydia
Scrotal swelling Treat partner/s for gonorrhea and
chlamydia
Inguinal bubo Treat partner lymphogranuloma
venereum
Neonatal conjunctivitis Treat both parents for gonorrhea
and chlamydia

16. KIT COLOUR
KIT 1 GREY : URETHRAL DISCHARGE, CERVICITIS
KIT 2 GREEN : VAGINITIS
KIT 3 WHITE : GENITAL ULCERS
KIT 4 BLUE: GENITAL ULCERS
KIT 5 RED : GENITAL ULCERS
KIT 6 YELLOW : LOWER ABDOMINAL PAIN
KIT7 BLACK : SCROTAL SWELLING
COLOUR CODED STI/RTI DRUG KITS ACCORDING TO SYNDROME
AVAILABLE AT SURAKSHA CLINICS

17. To sum up ………
 Syndromic management is a scientific and proven approach.
 Syndromic approach does not deny use of lab tests, it can
supplement the approach (Enhanced syndromic approach).
 This approach ensures correct and complete treatment of all most
common organisms responsible for a particular syndrome.
 Syndromic management goes beyond pharmaceutical treatment to
include client education and counseling.
 The clinical skills of a doctor are well utilized in syndromic
approach.