Sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) remain a public health problem
Increasing cases of syphilis, gonorrhea, chlamydia, and trichomoniasis
Neisseria gonorrhoeae and Chlamydia trachomatis are the predominant etiological agents associated with urethral and vaginal discharge that can progress to upper genital tract infection in women and could lead to infertility in both men and women
Gonorrhea was the highest reported STI in Malaysia, followed by syphilis and chancroid
Common problem with STI and the syndromic management approach
- The control of STIs is a public health priority and one that has become of even higher priority with the HIV epidemic
- Since STIs and HIV share many behavioural risk factors, efforts have been intensified to encourage individuals to modifysexual behaviours and adopt safer sexual practices
- The World Health Organisation developed and advocated the syndromic management approach
- The syndromic approach uses clinical algorithms based on an STI syndrome, the constellation of patient symptoms and clinical signs to determine antimicrobial therapy
- Advantages of syndromic management of STI: 1) early care 2) Treatment at the 1st visit 3) Cost Saving (not using expensive laboratory test) 4)higher patient satisfaction
- Disadvantages of syndromic management of STI: 1) Cost over diagnosis 2) Cost of over treatment when multiple anti-microbials given to patient with none or only one infection 3) may cause less precise diagnosis 4) may cause antibiotic resistant if not manage properly
METHODOLOGY
Current STI reporting format in Malaysia
- In Malaysia only three STIs namely syphilis, gonorrhoea and chancroid are notifiable under the CDC Act 342, 1988 for disease surveillance
- The three STIs are to be notified by the doctors who treat the patients, regardless whether they were seen at private or government clinics
- Doctors will notify the nearest District Medical-Officer-of-Health
Introduction of “Modified Syndromic Approach of STI Management” in Malaysia
- Ministry of Health decided to adapt the syndromic approach of STI management, on a trial basis in twenty primary care clinics in 1997
- Initially, three syndromes namely the genital ulcer syndrome, urethral discharge syndrome, and vaginal discharge syndrome
- All the chosen health centers, simple laboratory investigations were made available using simple test kits
- Counselling is emphasised as part of the management, and the patients were given follow-up dates to review the results
- Based upon the syndromes and history of the patients, provisional diagnoses should be made and patients given treatment on the same day, either by the clinic staff or doctors.
- Should the need arise, specimens are sent to the nearest hospital for culture and sensitivity or other elaborate tests.
- All the staff in the participating clinics were given relevant training using the same module which was adapted from WHO by the training officers and programme managers
