New updated guidelines for the management of symptomatic sexually transmitted infections (STIs) are launched today at a Satellite session at 24th STI and HIV 2021 World Congress. These Guidelines are intended to support countries in updating their national guidance for the management of people with symptoms of STIs. Worldwide, more than a million curable STIs are acquired every day. WHO estimated 374 million new cases of chlamydia, gonorrhoea, syphilis and trichomoniasis in 15–49-year-olds in 2020.
Since the publication of the WHO Guidelines for the management of sexually transmitted infections in 2003, changes in the epidemiology of STIs and progress in prevention, diagnosis and treatment of STIs and HIV have necessitated changes in approaches to STI prevention and management. In most resource-limited settings the syndromic management (management based on patients’ signs and symptoms) flowcharts remain the standard of care for managing people with STIs symptoms, where laboratory diagnosis is not available or, where available, results take several days.
The key pillars to eliminate STIs as a public health threat are to prevent people from being infected and provide treatment and care for infected people in order to avoid further transmission of STIs. The 2016- 2021 Global Health Sector Strategies for HIV, viral hepatitis and STIs makes a strong case for expanding the provision of quality STI prevention and care more widely into the areas of primary health care, sexual and reproductive health, and HIV prevention and care services.
The new Guidelines aim to raise the quality of managing people with symptoms of STIs through providing evidence-based, practical recommendations. “Strengthening STI case management that ensures access to high-quality services, based on simplified and standardized interventions and services that can be taken to scale, especially in resource-limited settings is a priority,” said Dr Meg Doherty, Director of the WHO Global HIV, Hepatitis and STI Programmes.
STI treatment based on laboratory diagnosis (molecular assays) are recommended in settings with quality assured molecular assays in laboratories with fully operational quality management systems. However, in settings where molecular testing is limited or point of care is not available, modified syndromic management is being recommended. The guidelines include the management of people with symptoms related to a urethral discharge, vaginal discharge, anorectal infection, genital ulcer disease, and lower abdominal pain syndromes. They also provide guidance on how to use rapid diagnostic tests in settings in which they are accessible.
We recommend that programme managers for STI prevention and control at the national level and the health-care providers at the frontline – at the primary health-care level, secondary health-care level and at the tertiary health-care delivery point adapt these guidelines to ensure the delivery of adequate, acceptable and equitable STI care for all populations in need of STI services.