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Leituras recomendadas:

 

• C M Lowndes, K A Fenton. Surveillance systems for STIs in the European Union: facing a changing epidemiology

Sex Transm Infect 2004;80:264–271

• K A Fenton C M Lowndes. Recent trends in the epidemiology of sexually transmitted infections in the in the European Union.

Sex Transm Infect 2004;80:255-263

• P Mayaud, D Mabey. Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges. Sex Transm Infect 2004;80: 174-182

Abordagem sindromica das ITS, excertos de "P Mayaud, D Mabey. Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges. Sex Transm Infect 2004;80: 174-182"

"STI case management
Early diagnosis and effective treatment of STIs is an essential component of STI control programmes. Syndromic case management is an approach based on the recognition of STI associated syndromes (easily identifiable group of symptoms and clinical findings), followed by treatment targeting the common causes of the syndrome. Management is simplified by the use of clinical flowcharts and standardised prescriptions. The approach is particularly suited to settings where diagnostic facilities will be either lacking or unreliable. Moreover, syndromic management leads to immediate treatment, and does not rely on the patient returning for results. It has proved generally to be cost effective, except for the management of women with cervical infections, in whom this simplified approach is neither sensitive nor specific. The advantages and disadvantages of syndromic management are shown in table 2.

Syndromic management guidelines need to be adapted for local use, depending on the prevalent causes of the common syndromes, and the antimicrobial susceptibility of local isolates of Neisseria gonorrhoeae and Haemophilus ducreyi. A laboratory is needed to monitor these parameters, which may change rapidly."

Table 2 Advantages and disadvantages of syndromic management of STIs

Advantages Problem orientated (responds to patient's symptoms) High sensitivity for the detection of infections among symptomatic patients, and does not miss mixed infections Treatment given at first visit Provides opportunity and time for education and counselling Avoids expensive laboratory tests Avoids unnecessary return visit for laboratory results Curtails referral to specialist centres Can be implemented at primary care level Disadvantages Over-diagnosis and over-treatment with the following consequences:     Increased drug costs     Possible side effects of multiple drugs     Changes in vaginal flora     Potential for increased drug resistance     Domestic violence Requires (re)training of staff Possible resistance to its introduction from medical establishment Cannot be used to detect infections among asymptomatic individuals