STD CARE IN ZAMBIA - AN EVALUATION OF THE GUIDELINES FOR CASE-MANAGEMENT THROUGH A SYNDROMIC APPROACH

Clinical diagnosis of STDs is unreliable and therefore constitutes a p oor basis for choice of treatment. A syndromic approach has been sugge sted to increase effectiveness of treatment in resource poor settings. Algorithms for the treatment of STD syndromes were evaluated. A total of 436 patients were followed; cure rates were defined and estimated for genital ulcer disease (GUD), urethral and vaginal discharge. Cure rates for the discharge syndromes were high, 97-98%, for both sexes. T he cure rate for GUD was 83% for female and 69% for male patients. A h igher prevalence of syphilis in the female study population probably c ontributed to this. It is likely that a large proportion of the treatm ent failures were due to decreased susceptibility of Haemophilus ducre yi to trimethoprim-sulpha. The determination of cure rates met with a number of methodological problems. This makes it difficult to evaluate the algorithms as part of routine activities, as suggested earlier by WHO.