The objectives of these guidelines are to provide updated, evidence-informed clinical and practical recommendations on the case management of people with symptoms of STIs; and to support countries in updating their national guidelines for the case management of people with symptoms of STIs. These guidelines include the management of symptomatic infections related to urethral discharge syndrome, including persistent urethral discharge syndrome; vaginal discharge syndrome, including persistent vaginal discharge; anorectal infection; genital ulcer disease syndrome; and lower abdominal pain syndrome. These guidelines are intended for program managers for STI prevention and control at the national level and the healthcare providers at the frontline – primary, secondary, and tertiary health care.
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.
- 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. ↩