Syndromatic or Syndromic Treatment Treats STDs Based on Symptoms

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A person with Jaundice caused by acute Hepatitis infection. You can see how the whites of his eyes are yellowed. Photo courtesy of CDC/Dr. Thomas F. Sellers/Emory University (1963)

What is Syndromatic or Syndromic Treatment?

Syndromatic treatment refers to the practice of treating people for sexually transmitted diseases based on their symptoms. It is usually done in low-resource settings. In other words, it's used where the cost of testing is prohibitive or where it is difficult to get people to come back for test results. Unfortunately, there are two main problems with syndromatic testing.

  1. Many sexually transmitted diseases are asymptomatic. Many people with chlamydia, gonorrhea, herpes, and other STDs won't have symptoms for years. In fact, they may never have them at all.
  2. The symptoms of sexually transmitted diseases can be aggravatingly unspecific. A liquid discharge, in particular, can be caused by many different types of pathogens. That means that it can be very hard to figure out what the best treatment is. For that matter, it can be very hard to figure out what any effective treatment is.

In the United States,  STD testing is pretty widely available. That means syndromatic treatment is less common in this country. That's a good thing. Treating infections with the wrong antibiotics is not only ineffective. It may also increase the risk of developing antibiotic resistant strains of disease.

NOTE: The fact that it is so difficult to diagnose most STDs based on their symptoms is one of the reasons why I refuse to diagnose individuals over the Internet. First of all, I'm not a medical professional. However, even if I were one, it would be difficult to make such diagnoses accurately. That's why screening is so important. The only way to know whether you have an STD is to get tested for one. 

Syndromic Treatment  Is Better than Nothing

There are circumstances where syndromic treatment can be useful. In general, in areas where testing isn't available, syndromic treatment is better than no treatment. Syndromic treatment may also be cost effective in countries that only provide screening for individuals who have symptoms.

For example, a study in Taiwan found that it was far cheaper than standard testing. However, they only looked at the costs for people who had symptoms. They didn't investigate how many asymptomatic cases were being missed. 

When you take those missed cases into account, the evidence for syndromic treatment is bad. In Kenya,  for example, researchers found that it missed many cases of STDs in high risk women. It also led to large amounts of over treatment for STDs that didn't actually exist. In other words, it was problematic in both directions. It failed to treat important infections while also giving drugs to women who didn't need them. These problems have been reported time and time again. 

In short, syndromic treatment is better than nothing. It's not better than any form of more reliable and universal screening program. 

Sources:

Djomand G, Gao H, Singa B, Hornston S, Bennett E, Odek J, McClelland RS, John-Stewart G, Bock N. Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya. Int J STD AIDS. 2016 Jan;27(1):19-24. doi: 10.1177/0956462415568982.

Korenromp EL, Sudaryo MK, de Vlas SJ, Gray RH, Sewankambo NK, Serwadda D, Wawer MJ, Habbema JD. What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic? Int J STD AIDS. 2002 Feb;13(2):91-101.

Otieno FO, Ndivo R, Oswago S, Ondiek J, Pals S, McLellan-Lemal E, Chen RT, Chege W, Gray KM. Evaluation of syndromic management of sexually transmitted infections within the Kisumu Incidence Cohort Study. Int J STD AIDS. 2014 Oct;25(12):851-9. doi: 10.1177/0956462414523260.

Tsai CH, Lee TC, Chang HL, Tang LH, Chiang CC, Chen KT. The cost-effectiveness of syndromic management for male sexually transmitted disease patients with urethral discharge symptoms and genital ulcer disease in Taiwan. Sex Transm Infect. 2008 Oct;84(5):400-4. doi: 10.1136/sti.2007.028829.

van Liere GA, Hoebe CJ, Niekamp AM, Koedijk FD, Dukers-Muijrers NH. Standard symptom- and sexual history-based testing misses anorectal Chlamydia trachomatis and neisseria gonorrhoeae infections in swingers and men who have sex with men. Sex Transm Dis. 2013 Apr;40(4):285-9. doi: 10.1097/OLQ.0b013e31828098f8.

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