This document discusses reproductive tract infections (RTIs) and sexually transmitted infections (STIs), their causes and spread, high-risk groups, and the syndromic approach to diagnosis and management. The syndromic approach involves identifying consistent groups of symptoms and signs to diagnose common conditions like vaginal discharge, urethral discharge, and genital ulcers. Patients are treated for the most likely causes, educated on prevention, and partners also receive treatment. While it has advantages like low cost and integrating care, limitations include overtreatment and potential antibiotic resistance. Color-coded drug kits are available for different syndromes.
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Syndromic approach
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
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
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
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.