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Women and sexually transmitted infections

Problems specific to women

  • Women are much more vulnerable biologically, culturally, socioeconomically
  • Majority of sexually transmitted infections (STIs) are asymptomatic in women (60-70% of gonococcal and chlamydial infections)
  • Consequences of STIs very serious in women, sometime fatal (eg cervical cancer, ectopic pregnancy, sepsis) and in their babies (stillbirth, blindness)
  • Tend not to seek treatment, in addition to having no symptoms, more stigma is attached to STIs in women, often have neither time nor money for health care.

Drawbacks of syndromic approach for managing gonorrhoea and chlamydia in women

The syndromic approach for managing STIs uses simple clinical algorithms based on patient signs and symptoms to determine antimicrobial treatment so that the patient can be managed in a single visit in settings where laboratory facilities for etiological testing are unavailable. The antimicrobial regimens are chosen to cover the major pathogens responsible for the syndromes in the specific geographical area.

However, the algorithm for vaginal discharge is the least satisfactory in terms of sensitivity and specificity. Vaginal discharge is not a good indicator of cervical infections (gonorrhoea and chlamydia).

In low prevalence settings the choice is whether to overtreat or not to treat at all.

Work has been done to improve the sensitivity of the algorithms by incorporating risk assessment. This has only been partially successful; and achieved 50% sensitivity in a study in Tanzania and Malawi.

Exploring means of rationalising utilisation of the algorithms for vaginal discharge is a priority as the syndromic approach is cost effective.

World Health Organization (WHO) work

  • Assessment of the benefits of integrating STD management into family planning services
  • Evaluation of syndromic management of vaginal discharge and research and exploration into ways of rationalising its use based on STI prevalence and other demographic factors.
  • Promotion of development of simple bedside diagnostics to further evaluate vaginal discharge and improve management of these conditions in women
  • Evaluation of effectiveness of also doing bimanual and speculum examinations, and risk assessment (in addition to the algorithms/flowcharts)
  • Surveillance. Sex and age disaggregated data now
  • Health education/life skills etc.

Sources: US Department of Health; The World Health Organization


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