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.
Department of International Health and Social Medicine, Karolinska Institutet, Stockholm, Sweden.
S
S
Hanson
R M
RM
Sunkutu
J
J
Kamanga
B
B
Höjer
E
E
Sandström
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