Using the Syndromic Approach

1. Classification by syndrome

In this approach, STIs are classified by syndrome. Each syndrome is made up of a combination of symptoms and clinical signs identified upon examination. The four main syndromes are: 

• Urethral discharge: men
• Lower abdominal pain: women
• Vaginal discharge: women
• Genital ulcer: men or women

These syndromes apply to possible STIs/RTIs as shown here:

Syndromic management can be used only with people who have symptoms and signs of an STI/RTI. It is not an appropriate screening tool for people who are asymptomatic (without symptoms or signs of infection). There is often confusion around this point; keep in mind that if there are no symptoms or signs, there is no syndrome on which to base diagnosis and treatment.

2. Use of algorithms

A variety of algorithms (flowcharts) have been designed to help providers determine which treatment to prescribe when using the syndromic approach. The following is an example of a genital ulcer algorithm:

These algorithms may be adapted to local situations based upon prevalence rates of STIs, drug supplies, and other factors. The use of algorithms supplemented by local data can help reduce overtreatment. For example, in the algorithm presented above, if chancroid is very rare in the region, a treatment recommendation might focus on syphilis since this will be the most likely cause of genital ulcers in that setting.

3. Treatment and counseling

When providers use the syndromic approach, no definitive diagnosis is made and clients are treated for all possible infections that could cause the syndrome. (In contrast, using the etiological or clinical approaches, providers would treat for a single infection in most cases.)

In addition to treatment, counseling and education are a critical part of client care. (For more on this topic, see Module 5: Treating STIs/RTIs and Module 6: Preventing STIs/RTIs.) A dialogue between health care workers and clients helps clients understand and complete their treatment, understand the importance and use of condoms, change risky sexual behavior, and convince their partners to get treatment.

4. Treatment of partners

Breaking the cycle of infection is a critical part of STI prevention, and so the client should be encouraged to refer his or her partner(s) for treatment. When it is likely that  a partner has been exposed to a treatable STI or when a partner is the likely source of the client’s infection, appropriate treatment should be provided, even when no clinical signs of infection are evident. Providers should advise clients to notify their partners (including those without symptoms) of their exposure and encourage them to seek treatment. If this is not possible for the client, or if it will expose the client to risk of violence or other detrimental reactions, partner notification can be provided.

Partner notification should be a voluntary process, done with sensitivity and only with the full consent of the client, and all possible efforts must be made to protect the confidentiality of the client and his or her partner(s). (See Module 5: Treating STIs/RTIs for more information about issues surrounding partner notification.)

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