Background: World health organization (WHO) has placed emphasis on syndromic approach for an STI case management, especially in areas having inadequate laboratory facilities and transport facilities. The study evaluates the validity of syndromic management and correlation with clinical and laboratory based management of STIs.
Methods: Patients numbering 251 presenting with complaints of STIs who attended the STI clinic from September 2010 to December 2011were included. The three treatment approaches - clinical, laboratory based and syndrome based were evaluated for sensitivity and specificity. These parameters were also evaluated for individual syndrome. Data was analysed using the Statistical Package for Social Sciences, Version 19.0 of Microsoft Office (Excel 2007).
Results: Out of 251 patients, 118 female (47.01%) patients had vaginal discharge syndrome, 49 males (19.52%) had urethral discharge syndrome, 53males (21.1%) and 31females (12.3%) had presented with genital ulcer disease (GUD). Syndromic management of urethral discharge had high validity with 100% sensitivity. The sensitivity, specificity of clinical approach of gonorrhoea was 92.5% & 95.45% respectively and of non gonococcal urethritis was 88.8% & 62.5% respectively but the clinical approach may have missed few cases and would have led to over-treatment in some cases of non-gonococcal urethritis. The sensitivity of syndromic approach for GUD for herpes and syphilis was 100% & 92.4% while specificity was 90% & 40% respectively. The sensitivity, specificity of syndromic approach for vaginal discharge was 89.65% , 61.66% whereas it was 87.93% & 66.66% by clinical approach.
Conclusions: Syndromic management of urethral discharge stood highly validated and was better than clinical or laboratory based treatment. Syndromic management for GUD was also highly suitable in comparison to clinical and laboratory based approach. The sensitivity of the syndromic approach for vaginal discharge was high, but had low specificity thereby causing unnecessary increase in the cost of treatment.