Syndromic approach to STD case management: where do we go from here?

In the absence of aetiological tests for the diagnosis of individual sexually transmitted diseases (STD), the syndromic approach has been developed as an effective and appropriate case management strategy. Algorithms provide guidance to healthcare workers and ensure standardised approaches to case management. The syndromic approach, utilising currently available algorithms, works well in the management of people with symptomatic urethritis, genital ulcer disease, and vaginitis. Owing to the frequently asymptomatic nature of gonococcal and/or chlamydial cervicitis, and the lack of specific defining risk factors and/or signs and symptoms, the syndromic approach performs less well in the identification and management of women with cervicitis. The syndromic approach can and should be adopted for the management of patients with urethral discharge, genital ulceration, vaginal discharge, and cervical signs. Further research is needed to improve the identification and management of cervical infections; to guide policy makers in selecting the most appropriate disease control strategy; to improve utilisation of available and future tests; to develop affordable, rapid, and simple diagnostic tests; and to develop STD vaccines.