5.1 Objectives of assessing syndrome etiologies

5.1 Objectives of assessing syndrome etiologies

Dysuria is a very common symptom that is associated with significant morbidity and is sometimes associated with serious medical disorders. gonorrhoeae if local prevalence is high or sexual contact occurred in a region with high prevalence. Consent forms were received and a questionnaire was applied. Affect females more. Sexual contact with commercial sex workers is an exceptionally high-risk behaviour. Majority of the infections are transmitted by asymptomatic patients and the partner is usually unaware of any sexually transmitted disease. Sexually transmitted infections (STIs) are one of the most under-recognized health problems worldwide.
5.1 Objectives of assessing syndrome etiologies

In female patients with vaginal discharge, the sensitivity was 90.8%, specificity 46.9%, positive predictive value 50.9%, and negative predictive value 89.3% for the diagnosis of gonorrhea and/or chlamydial infection by syndromic approach. The first example (Figure 2) is a simple syndromic management, treating every man with a complaint of urethral discharge for gonorrhea and NGU. A sequential treatment (first, treatment for gonorrhea and if this fails, treatment for NGU) has been the policy in the past in some countries in order to limit unnecessary treatments. However, because of a large proportion of missed chlamydial infections, and because many patients fail to come back, this approach can no longer be recommended. Genital herpes simplex virus infection is a recurrent, lifelong disease with no cure. Depending on the result of the Gram stain, a syndromic treatment or a treatment for NGU will be given. Collaboration with a well-equipped laboratory can help to further assess the contribution of chlamydial infection to urethral discharge, and chancroid and herpes to genital ulcer disease.

Syphilis serologic testing alone provides an incomplete assessment of genital ulcer etiology because many patients with ulcers due to chancroid and HSV can have reactive syphilis serologic tests from previously treated or untreated (latent) infections, and a substantial proportion of patients with primary syphilis (10%-30%) will not yet have developed a serologic response to infection. In each country where patients are managed syndromically, and where syndromic STI case reporting is used, syndrome etiologies should be reassessed about once every two to three years or more frequently if the need arises (for example, in a setting with a new outbreak of genital ulcer disease). Sample size depends on the specific etiology and the expected prevalence of pathogens. For most purposes, a minimum sample size of 50 or 100 specimens from consecutive patients with the specified syndrome (or other type of systematic sample) will provide adequate information for useful analyses. Data on syndrome etiologies are important for interpreting STI syndromic case reporting data, and in particular, for estimating the burden of disease by pathogen. The data from the assessment of syndrome etiologies should be reported along with case reporting data to provide ongoing support for syndromic management algorithms. These data can be especially useful for supporting recommendations for treatment of urethral discharge for both gonorrhoea and chlamydia, for treatment of genital ulcers for both syphilis and chancroid, and for providing counselling for patients likely to have genital herpes.

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