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 poor basis for choice of treatment. A syndromic approach has been suggested 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. The cure rate for GUD was 83% for female and 69% for male patients. A higher prevalence of syphilis in the female study population probably contributed to this. It is likely that a large proportion of the treatment failures were due to decreased susceptibility of Haemophilus ducreyi 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.
Hanson
S
S
Department of International Health and Social Medicine, Karolinska Institutet, Stockholm, Sweden.
Sunkutu
R M
RM
Kamanga
J
J
Höjer
B
B
Sandström
E
E
D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000628:therapy*; D015024:Zambia