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Guidelines for the Management of Symptomatic Sexually Transmitted Infections

Sexually transmitted infections (STIs) remain a chronic issue worldwide; the WHO estimates that 1 million STIs are acquired daily.1 The testing and treatment of STIs are an under-prioritized component of sexual and reproductive health (SRH) services in most settings; these problems are only exacerbated in humanitarian and crisis-affected contexts.

Syndromic management, or the provision of treatment based on symptoms of STIs, remains the standard for treatment when laboratory capacity or diagnostic testing is unavailable, limited, or takes multiple days for results. It is often easier to train providers in syndromic management, as it uses flowcharts to visually guide treatment decisions in one visit. As such, syndromic management should be the standard for treatment in most humanitarian and crisis-affected contexts, where resources are limited, facilities are difficult to access, and providers are overburdened.

The World Health Organization updated and released its Guidelines for the Management of Symptomatic Sexually Transmitted Infections on 15 July 2021 at a special session of the STI & HIV World Congress. They contain detailed recommendations on managing five common symptoms of STIs, as well guidance on diagnostic testing and its implementation alongside syndromic management. They are intended for SRH program managers, STI prevention and control specialists at the national level, and frontline healthcare providers at primary, secondary, and tertiary health facilities.

The STIs and HIV sub-working group strongly recommends the updated guidelines be used by any implementing organizations, governments, and clinicians operating in SRH in humanitarian settings. These should be used in combination with the MISP in acute settings to achieve objective three, the prevention of HIV and other STIs and reduction of related morbidity and mortality. In protracted settings, they can be included as part of comprehensive SRH services. The sub-working group also recommends that all clinical staff, even those with consistent laboratory capacity and diagnostic testing availability, be trained in syndromic management as part of emergency preparedness measures and that the guidelines be included in national and regional preparedness plans.

  1. Rowley, Jane, et al. "Chlamydia, gonorrhea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016." Bulletin of the World Health Organization 97.8 (2019): 548.

Sexual and reproductive health services remain critical during COVID-19

IAWG members and partners are producing clinical and programmatic guidance, assessments, policy papers, and statements to ensure continued prioritization of sexual and reproductive health and rights throughout COVID-19 response in humanitarian settings.