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When Should Syndromic Management Be Used?
Advantages outweigh disadvantages for these three syndromes. However, several problems with syndromic management limit its utility in women with vaginal discharge since this syndrome may be related to either vaginitis (i.e., bacterial vaginosis [BV], vaginal yeast infection, and trichomonas infection) or cervicitis (chlamydia and gonorrhea). Studies have shown that syndromic management is only modestly better than random treatment in predicting cervical infection (infection with chlamydia, gonorrhea, or both). Because gonorrhea and chlamydia are so often asymptomatic, syndromic management will not have a significant impact on their prevalence. Vaginal discharge is much more often due to vaginal infections than the more serious cervical infections caused by STIs; therefore, using the syndromic approach results in overtreatment for many women who do not have an STI. In addition, telling a woman she is being treated for an STI when she may not have one raises serious concerns in terms of partner management and potential relationship problems, including domestic violence. However, despite the concerns and disadvantages of syndromic management for vaginal discharge, in settings where appropriate laboratory diagnostic services are not available, some form of syndromic management is the only option for women who present with this syndrome. This is a major unresolved issue in the field. In settings where the prevalence of gonorrhea and chlamydia is low, it may make sense to modify syndrome algorithms to treat for vaginal infections. In settings where clients are likely to be able to return to the clinic for repeat visits, some programs are trying a two-step process to address vaginal discharge: Women are first treated for vaginitis, and then if the symptoms do not resolve, they are treated for cervical infections.
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Syndromic management is effective
and recommended for use in: