Management of patients with sexually transmitted diseases : report of a WHO Study Group [meeting held in Geneva from 3 to 6 July 1990]

Abstract

Sets out practical measures for dealing with the growing public health problems caused by sexually transmitted diseases, including HIV infection. Addressed to the clinicians and auxiliary health workers who diagnose and treat patients, the book concentrates on the many things that can be done, even under highly imperfect conditions, to help realize the twin goals of reducing transmission and preventing morbidity. Although recommended lines of action have universal relevance, the book pays special attention to conditions in developing countries, where use of existing primary health care services promises to be the most realistic way to attract and treat more patients. Throughout, improved diagnosis and treatment are regarded as the cornerstone for better control, though readers are reminded that transmission will be reduced only when patient management is supported by counselling, health education, and partner notification. To this end, the book presents four basic strategies for the control of sexually transmitted diseases and then discusses these in terms of the clinical and support services needed to reach more patients with higher-quality care. While stressing the advantages gained when services are integrated with primary care or with programmes for the prevention of HIV infection and AIDS, the book also alerts its readers to the many obstacles to be overcome in countries where funds and facilities are limited, where patients often seek treatment outside the official health services, and where many low-cost treatments have been rendered useless by the spread of antimicrobial resistance. To improve management, even under such circumstances, the main part of the book presents model management protocols for each of 15 clinical syndromes and problems commonly seen at the primary health care level. These syndrome-based protocols, which were finalized after close to ten years of field testing and revision, are intended to help the non-specialist clinician make a diagnosis and initiate treatment based on the epidemiological, clinical and therapeutic information available. Each protocol, which is presented in the form of a flow-chart, is accompanied by a brief definition of the syndrome, a note about its importance, and a description of etiological features, followed by a summary of the clinical observations and laboratory findings that should guide management plans. Where appropriate, alternative management protocols are provided for use in facilities lacking basic laboratory support. Other sections explain how to adapt and implement the model protocols, describe several cost-effective tests that can facilitate case finding, and provide guidelines for partner notification, for counselling and health education, and for choosing among the various methods of case-reporting and surveillance. Further practical information is provided in a series of five annexes. The most detailed of these set out recommended laboratory and microscopic diagnostic tests that should be available at different levels of health care, and outline treatment schedules for twelve common diseases. The remaining annexes present a simplified algorithm for the detection and management of HIV infection, provide model forms for etiology-based and comprehensive syndrome-based reporting, and outline the instructions that should be given to condom users