Gupta Vishal, Sharma Vinod Kumar
Department of Dermatology and Venereology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Natl Med J India. 2019 May-Jun;32(3):147-152. doi: 10.4103/0970-258X.278691.
The syndromic approach has been the cornerstone of management of sexually transmitted infections (STIs) in developing countries. This strategy has had a considerable impact in decreasing the burden of STI in society. It offers the advantages of treating the infection at the first visit itself, reducing the risk of complications, non-reliance on laboratory diagnostics, and easy integration into the primary healthcare system. Nonetheless, it is not without limitations, most often criticized for its inability to treat asymptomatic cases. Syndromic management has been found to be satisfactory for genital ulcer disease and urethral discharge in several settings. However, its performance is not as good in the treatment of vaginal discharge syndrome, as it does not allow a distinction between cervicitis and vaginitis. Diagnostic validation and a review of its performance should be done periodically to keep abreast of the changing aetiology of various syndromes and patterns of drug susceptibility. Supplementing the syndromic approach with point-of-care tests and simple laboratory tests where available can improve its results. Further, healthcare professionals should be imparted training for optimum patient care. This narrative review critically appraises the syndromic approach to STIs, discusses the challenges that it faces, and offers suggestions to improve its performance.
综合征法一直是发展中国家性传播感染（STIs）管理的基石。这一策略在减轻社会中性传播感染负担方面产生了相当大的影响。它具有在首次就诊时就能治疗感染、降低并发症风险、不依赖实验室诊断以及易于融入初级卫生保健系统等优点。然而，它并非没有局限性，最常受到批评的是无法治疗无症状病例。在一些情况下，综合征管理已被证明对生殖器溃疡疾病和尿道分泌物是令人满意的。然而，它在治疗阴道分泌物综合征方面的表现并不理想，因为它无法区分宫颈炎和阴道炎。应定期进行诊断验证并审查其性能，以跟上各种综合征不断变化的病因和药物敏感性模式。在可行的情况下，用即时检验和简单的实验室检测来补充综合征法可以改善其结果。此外，应为医护人员提供培训，以实现最佳的患者护理。这篇叙述性综述对性传播感染的综合征法进行了批判性评估，讨论了它面临的挑战，并提出了改善其性能的建议。
