THERAPEUTIC ALGORITHMS FOR THE MANAGEMENT OF SEXUALLY-TRANSMITTED DISEASES AT THE PERIPHERAL LEVEL IN COTE-DIVOIRE - ASSESSMENT OF EFFICACYAND COST

In the acquired immunodeficiency syndrome (AIDS) era, adequate managem ent of sexually transmitted diseases (STDs) is a primary concern in Af rica. Assessed in this study is the clinical efficacy and feasibility of WHO-recommended therapeutic algorithms for genital discharges and u lcers, diagnosed without laboratory tests, for use at the primary heal th care level. Drugs were sold on a cost-recovery basis and included i ntramuscular ceftriaxone and oral ciprofloxacin for single-dose therap y of gonorrhoea and chancroid. During April 1993 in 10 peripheral heal th care centres in Abidjan, Cote d'lvoire, a total of 207 patients wer e followed up, including 89 cases of male urethritis, 92 cases of vagi nal discharges and 26 cases of genital ulcers; clinical success, asses sed 7 days after the onset of therapy, was, respectively, 92%, 87%, an d 100%. Less than 10% of the 207 patients were referred to the next ca re level, an acceptable rate from a public health point of view. Medic al adherence to the algorithms was excellent for urethral discharges a nd genital ulcers but poor for vaginal discharges, partly because of i ntentional therapeutic modifications, without detriment to success. Fo r drugs, the average cost per cure was 1546 francs CFA (US$ 5.60) (max imum, 2980 francs CFA (US$ 10.70)). Effective and affordable treatment s for STDs are necessary for their realistic case management in Africa .