1. Kingdom of Bahrain Ministry of Health ( Syndromic Mangement ) Adopted from : IPPF MEDICAL AND SERVICE DELIVERY GUIDELINES FOR SEXUAL AND REPRODUCTIVE HEALTH SERVICES-2004 W.H.O GUIDELINES -2004 Prepared By : Dr. Huda AI - Ebrahim

2. The syndromic approach bases treatment on groups of symptoms (client complaints) and signs (client and provider observations) which can be explained by more than one possible infection. These groups are called syndromes. This approach requires that providers of health care know the most common causative organisms for each syndrome and the appropriate anti-microbial treatment.

3. Syndromic management enables providers of the health care to offer treatment when services sites lack laboratory facilities or skills that would allow the specific causative organism to be identified Providers of primary health care can start treatment immediately, instead of referring the client to a more complex service facility which may not be easily accessible.

4. In the syndromic case management approach people with STD are provided with the total care "package" and not simply antibiotics for the infection. The total management package should be given in order to make sure that the patient understands his/her illness and can take steps to avoid acquiring the infection again in future. In providing care for persons with STD all health care providers should make sure that the patient is managed comprehensively.

5. The various components of comprehensive syndromic case management include the following steps. 2-Give the patient the appropriate antibiotics for the STD syndrome. 1- Make a syndromic diagnosis through history taking and examination. 3- Assess the patient's personal risk status for STD.

6. - The nature of the infection and possible complications. 4-Provide health education on: - The relationship between HIV infection and other STDs..- The importance of treatment compliance. - Risk reduction through safer sexual behavior and safer sex acts.. - Arrange for afollow –up examination. - Arrange for partner (s) to receive treatment.

7. The most relevent STD syndrome are -Urethral discharge -Genital ulcer -Vaginal discharge -Lower abdominal pain

9. Suggested treatment : Cefriaxon 250 my intramuscularly (IM) in a single dose, or Spectinomycin 2g IM in a single does, or Ciprofloxacin 500 mg orally in a single dose, or Cefixime 400 mg orally in a single dose,or Kanamycin 2g IM in single dose, or Thiamphenicol 2.5g orally daily for 2 daily for 2 days, or Sulfamethoxazole 400 mg/trimethoprim 80 mg 10 tables orally daily for 3 days

10. Plus : Doxycycline, 100 mg by mouth 2 times daily for 7 days; OR azihromycin, l g by mouth single does: OR TETRACYCLINE, 500 mg by mouth 4 times daily for 7 days for chlamydia

12. Suggested treatment : Benzathine penicillin G for syphilis, 2.4 million IU in 2 intramuscular injections during 1 clinic visit ; give 1 injection into each buttock. Plus : Ciprofloxacin, 500 mg by mouth 2 times daily for three days; OR azithromycin, 1g by mouth as a single dose; OR erythromycin, 500 mg by mouth 4 times daily for 7 days for chancroid

13. Suggested treatment : There is no cure for genital herpes but symptoms should be treated as follows : advise clients to wash genital area regularly with soap and water. Prescribe paracetamol ( acetaminophen ), If available you may provide acyclovir treatment.

20. Suggested treatment : Use any of the single – dose therapies recommended for uncomplicated gonorrhea, OR ceftriaxone, 250 mg single dose intramuscular injection. if single – does therapy for gonorrhoea is not available give trimethoprim 80 mg / sulfamethoxazole 400 mg ( co – trimoxazole), 10 tabltes orally once daily for 3 days and then 2 tablets orally twice daily for 10 days. Plus : doxycyline, 100 mg by mouth 2 times daily for 14 days; OR tetracycline, 500 mg 4 times daily for 14 days ; Plus : metronidazole, 400-500mg by mouth 2 times daily for 14 days.

21. Follow-up care When clients return for follow-up, ask the following: Do they have any symptoms of an STD? Have they completed their course of treatment? Have their partner(s) been treated?

22. Treatment failure STD management and treatment may fail for the following reasons: - The client may have failed to take the full course of medication. - The client may have been re-infected because the partner was not treated. -The causative organism is resistant to the treatment regimen. -The treatment was not appropriate. ( Syndromes management does not address all Causative arganisms as in the case of common infections (e.g,tymphogranuloma venereum and donovanosis that canse ulceration )