SYNDROMIC MANAGEMENT
The World Health Organization (WHO) developed and advocates the use of syndromic management to address the limitations of both aetiological and presumptive aetiological diagnosis and management of symptomatic STDs.The principle behind this approach is that patients are treated at the first visit with a combination of antimicrobials that will treat the local probable aetiological agents. Syndromic management flow charts for the management of genital ulcers have been prepared which provide simple instructions to health providers on how to manage the patient and his/her sexual contact(s) (fig 3). The process requires little or no clinical description of the ulcer itself and does not require laboratory identification of the causative pathogen(s). Syndromic management has been proved to be more successful than a hierarchical algorithm or clinical diagnosis in the management of genital ulcer disease in Rwanda.It is envisaged that M-PCR will have an important role in validating syndromic algorithms for the management of genital ulcer disease as the aetiology of this syndrome varies geographically and over time. It may be appropriate to perform laboratory diagnostic and antimicrobial susceptibility testing on specimens from ulcers of patients failing to respond to antimicrobial therapy in situations where reinfection from an untreated partner has been excluded.
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