CONTENTS

Syndromeic Approach Page Number

Urethral Discharge 5

Persistent/ Recurrent
7
Urethral Discharge

Genital Ulcers 9

Inguinal Bubo 13

Scrotal Swelling 15

Vaginal Discharge 17

Lower Abdominal Pain 21

Neonatal Conjunctivitis 23

Annex 25

- Summary Table 25

- STI Reporting Pathway 31

- STI Forms 32

3
INTRODUCTION
Etiological diagnosis of STIs is problematic for health care
providers in many settings. It places constraints on their time
and resources, increases costs and reduces access to treatment.
In addition, the sensitivity and specificity of commercially
available tests can vary significantly, affecting negatively the
reliability of laboratory testing for STI diagnosis. Where laboratory
facilities are available they must be staffed by suitably qualified
personnel with adequate training to perform technically
demanding procedures, and the establishment of external
quality control must be made mandatory.
STI case management is the care of a person with an STI-related
syndromee or with a positive test for one or more STIs. The
components of case management include: history taking, clinical
examination, correct diagnosis, early and effective treatment,
advice on sexual behavior, promotion and /or provision of condoms,
partner notification and treatment, case reporting and clinical
follow-up as appropriate.
Thus, effective case management consists not only of antimicrobial
therapy to obtain cure and reduce infectivity, but also comprehensive
consideration and care of the patient’s reproductive health.
WHO developed a simplified generic tool which includes flowcharts
for the management of Sexually Transmitted Infections using
Syndromeic Approach.

4
URETHRAL DISCHARGE

Use appropriate flow chart

Yes

Patient Any • 4 C s Protocol

complains of other genital • Ask patient to
urethral discharge
No return if symptoms
syndrome?
and/or dysuria persist

No

Take history and

Discharge
examine. (Milk
is
urethra
if necessary) confirmed?

Yes

Treat for Gonorrhoea and Chlamydia

• 4 C s Protocol
• Ask patient to return in 7 days if symptoms persist

4Cs Protocol
Counsel and educate on STIs.
Promote and provide Condoms.
Offer HIV Counseling and testing.
Manage and treat the partner (Contact) if necessary.

5
Treatment Options for Gonorrhoea
Ceftriaxone 250 mg/ IM/ single dose OR 400
Cefixime mg/ oral/ single dose OR
Spectinomycin 2 g/ IM/ single dose OR
Ciprofloxacin 500 mg/ oral/ single dose

NOTE:
• Ciprofloxacin is contraindicated in pregnancy and not recommended for use
in children & adolescents.
• Quinolone resistant Neisseria gonorrhoea has become common across the globe.

Treatment Options for Gonorrhoea

oxycycline 100 mg/ oral/ 12hours/ 7days OR
Azithromycin 1 g/ oral/ single dose
Alternative Regimen
Amoxycillin 500 mg/ oral/ 8 hours/ 7 days OR
Erythromycin 500 mg/ oral/ 6hours/ 7 days OR
Ofloxacin 300 mg/ oral/ 12 hours/ 7 days OR
Tetracycline 500 mg/ oral/ 6 hours/ 7 days
During Pregnancy
Erythromycin base or Erythromycin 500 mg/ oral/ 6 hours/ 7 days OR
ethylsuccinate
Amoxycillin 500 mg/ oral/ 8 hours/ 7 days

NOTE:
• Doxycycline and other Tetracyclines are contraindicated during pregnancy
and lactation.
• Erythromycin should not be taken on an empty stomach.

6
PERSISTENT/ RECURRENT URETHRAL DISCHARGE

Use appropriate flow chart

Patient complains Yes

of persistent/
recurrent urethral
Any other
discharge and/or syndromes? No 4C s Protocol
dysuria

Take history No Treat for

& examine.
Trichomoniasis
(Milk urethra if
Discharge • 4 C s Protocol
necessary)
is • Ask patient to
confirmed?
return in 7 days
if symptoms
Yes persist
No
Does
history confirm
re-infection or Improved? No Refer
poor
compliance? Yes

Yes 4C s Protocol

Repeat Urethral discharge treatment for

• Gonorrhoea • Chlamydia

4Cs Protocol
Counsel and educate on STIs.
Promote and provide Condoms.
Offer HIV Counseling and testing.
Manage and treat the partner (Contact) if necessary.

7
Treatment Options for Gonorrhoea
Ceftriaxone 250 mg/ IM/ single dose OR
Cefixime 400 mg/ oral/ single dose OR
Spectinomycin 2 g/ IM/ single dose OR
Ciprofloxacin 500 mg/ oral/ single dose

NOTE:
Ciprofloxacin is contraindicated in pregnancy and not recommended for use in children & adolescents.
• Quinolone resistant Neisseria gonorrhoea has become common across the globe.

Treatment Options for Chlamydia

oxycycline 100 mg/ oral/ 12hours/ 7days OR
Azithromycin 1 g/ oral/ single dose
Alternative Regimen
Amoxycillin 500 mg/ oral/ 8 hours/ 7 days OR
Erythromycin 500 mg/ oral/ 6hours/ 7 days OR
Ofloxacin 300 mg/ oral/ 12 hours/ 7 days OR
Tetracycline 500 mg/ oral/ 6 hours/ 7 days
During Pregnancy
Erythromycin base or Erythromycin 500 mg/ oral/ 6 hours/ 7 days OR
ethylsuccinate
Amoxycillin 500 mg/ oral/ 8 hours/ 7 days

NOTE:
• Doxycycline and other Tetracyclines are contraindicated during pregnancy and lactation.
• Erythromycin should not be taken on an empty stomach.

Treatment Options for Trichomoniasis

Metronidazole 2 g/ oral/ single dose OR
Tinidazole 2 g/ oral/ single dose
Alternative Regimen
Metronidazole 400 mg or 500 mg/ oral/ 12 hours/ 7days OR
Tinidazole 500 mg/ oral/ 12hours/ 5 days

NOTE:
• Treatment of sexual partners simultaneously increases the cure rate in women from 82-88% to 95%.
• Metronidazole is generally not recommended for use in the first trimester of pregnancy, yet treatment may be given
where early treatment has the best chance of preventing adverse pregnancy outcomes. In this instance a lower dose
should be used (2 g/ oral/ singe dose) rather than a long course.

8
GENITAL ULCERS
Patient complains
of genital sore/ 4 C s Protocol
ulcer • Ask patient to return
in 7 days
Take history
and examine

- Treat for HSV2

Only
vesicles Yes - Treat for Syphilis
present? if indicated *

No

- Treat for Syphilis and

Sore or Chancroid -TreatforHSV2 **
Ulcer Yes - Treat for Granuloma Ingui-
Present?
nale or LGV if indicated ***

No

4C s Protocol

4Cs Protocol
Counsel and educate on STIs.
Promote and provide Condoms.
Offer HIV Counseling and testing.
Manage and treat the partner (Contact) if necessary.
* Indications for Syphilis treatment: RPR Positive and patient has not been treated for Syphilis recently.
** Treat for HSV2 where prevalence is 30% or higher or adapt to local conditions.
*** The decision to treat for Chancroid, Granuloma Inguinale or LGV depends on the local epidemiology of infection.

9
 4C s Protocol

Yes

Only
vesicles
present?

No

Only
vesicles No Refer
present?

Yes

Continue treatment for 7 days

4C s Protocol

10
Treatment Options for Genital Herpes
Recommended regimen for the first clinical episode
Acyclovir 200 mg/ oral/ 5 times per day/ 7days OR
Acyclovir 400 mg/ oral/ 3 times per day/ 7days OR
Valaciclovir 1 g/ oral/ 2 times per day/ 7 days OR
Famciclovir 250 mg/ oral/ 3 times per day/ 7days

Recommended regimen for recurrent infection

Acyclovir 200 mg/ oral/ 5 times per day/ 5 days OR
Acyclovir 400 mg/ oral/ 3 times per day/ 5 days OR
Acyclovir 800 mg/ oral/ 2 times per day/ 5 days OR
Valaciclovir 500 mg/ oral/ 2 times per day/ 5 days OR
Valaciclovir 1000 mg/ oral/ once per day/ 5 days OR
Famciclovir 125 mg/ oral/ 2 times per day/ 5 days
Recommended regimen for suppressive therapy
Acyclovir 400 mg/ oral/ 2 times per day/ continuously
Valaciclovir 500 mg/ oral/ once per day OR
Valaciclovir 1000 mg/ oral/ once per day OR
Famciclovir 250 mg/ oral/ 2 times per day

NOTE:
Discontinue Acyclovir after one year of continuous use for reassessment of recurrence rate.

Recommended regimen in severe Herpes simplex lesions with coinfection with HIV
Acyclovir 400 mg/ oral/ 3-5 times per day/ until
clinical resolution is attained.
Treatment Options for Syphilis
Benzathine benzylpenicillin 2.4 million IU/ IM/ single session. Because
of the volume involved, this dose is usually
given as two injections at separate sites
Alternative Regimen
Procaine benzylpenicillin 1.2 million IU/ IM/ 24 hours/ 10 days

11
Alternative regimen for Penicillin-allergic non-pregnant patients
Doxycycline 100 mg/ oral/ 12 hours/ 14 days OR
Tetracycline 500 mg/ oral/ 6 hours / 14 days
Alternative regimen for Penicillin-allergic pregnant patients
Erythromycin base or 500 mg/ oral/ 6 hours/ 14 days
Erythromycin ethylsuccinate
Treatment Options for Chancroid
Ciprofloxacin 500 mg/ oral/ 12 hours/ 3 days OR
Erythromycin base 500 mg/ oral/ 6 hours/ 7 days OR
Azithromycin 1 g/ oral/ single dose
Alternative Regimen
Ceftriaxone 250 mg/ IM/ single dose
Treatment Options for Granuloma Inguinale (Donovanosis)
Azithromycin 1 g/ oral/ on the first day, then 500
Doxycycline mg/ oral/ 24 hours OR
100 mg/ oral/ 12hours
Alternative Regimen
Erythromycin 500 mg/ oral/ 6 hours OR
Tetracycline 500 mg/ oral/ 6 hours OR
Trimethoprim 80mg
Sulphamethoxazole 400mg 2 tablets/ oral/ 12 hours/ for
a minimum
of 14 days
NOTE:
• Follow Up: Patients should be followed up clinically until signs and symptoms have resolved.
• Treatment should be continued until all lesions have completely epithelialized.

Treatment Options for LGV

Doxycycline 100 mg/ oral/ 12 hours/ 14 days OR
Erythromycin 500 mg/ oral/ 6 hours/ 14 dayst
Alternative Regimen
Tetracycline 500 mg/ oral/ 6 hours/ 14 days
NOTE:
• Doxycycline and other Tetracyclines are contraindicated during pregnancy and lactation.
• Fluctuant lymph nodes should be aspirated through healthy skin. Incision and drainage or excision of nodes may
delay healing.

12
INGUINAL BUBO

Patient complains
of inguinal swelling Use appropriate flowchart

Take history and Yes

examine

Any other
Inguinal
/femoral
No syndromes?
bubo(s)
present?

No
Yes
4C s Protocol

Ulcer(s)
present? No

Treat for Lymphogranuloma Venerium & Chancroid

Yes
• 4 C s Protocol
Use genital • Ask patient to return in 7 days and continue
ulcer flowchart treatment if improving or refer if worse

4Cs Protocol
Counsel and educate on STIs.
Promote and provide Condoms.
Offer HIV Counseling and testing.
Manage and treat the partner (Contact) if necessary.

13
Treatment Options for LGV
Doxycycline 100 mg/ oral/ 12 hours/ 14 days OR
Erythromycin 500 mg/ oral/ 6 hours/ 14 days
Alternative Regimen
Tetracycline 500 mg/ oral/ 6 hours/ 14 days

NOTE:
• Doxycycline and other Tetracyclines are contraindicated during pregnancy and lactation.
• Fluctuant lymph nodes should be aspirated through healthy skin. Incision and drainage or excision of nodes may
delay healing.

Treatment Options for Chancroid

Ciprofloxacin 500 mg/ oral/ 12 hours/ 3 days OR
Erythromycin base 500 mg/ oral/ 6 hours/ 7 days OR
Azithromycin 1 g/ oral/ single dose
Alternative Regimen
Ceftriaxone 250 mg/ IM/ single dose
Recommended syndromeic treatment (combined)
Ciprofloxacin 500 mg/ oral/ 12 hours/ 3 days
Plus
Doxycycline 100 mg/ oral/ 12 hours/ 14 days OR
Erythromycin 500 mg/ oral/ 6 hours/ 14 days

14
SCROTAL SWELLING
Patient complains
of scrotal
swelling/pain

Swelling
Take history
*and examine
/pain No
confirmed?

• Reassure patient
& educate
Yes • Analgesic if
necessary
• 4C s Protocol
Testis
rotated or
elevated or
history of
trauma? No
Yes

Treat for Gonococcal infection & Chlamydia

Refer to 4C s Protocol
surgical opinion • Adjuncts to therapy is bed rest and scrotal support
until local inflammation and fever subside.
• Review in 7 days or earlier if necessary,
if worse refer.

4Cs Protocol
Counsel and educate on STIs.
Promote and provide Condoms.
Offer HIV Counseling and testing.
Manage and treat the partner (Contact) if necessary.
* Exclude Scrotal Swelling due to Non STIs
- Brucellosis
- Mumps
- Testiculer Tumors

15
Treatment Options for Gonorrhoea
Ceftriaxone 250 mg/ IM/ single dose OR
Cefixime 400 mg/ oral/ single dose OR
Spectinomycin 2 g/ IM/ single dose OR
Ciprofloxacin 500 mg/ oral/ single dose

NOTE:
• Ciprofloxacin is contraindicated in pregnancy and not recommended for use in children & adolescents.
• Quinolone resistant Neisseria gonorrhoea has become common across the globe.

Treatment Options for Chlamydia

Doxycycline 100 mg/ oral/ 12hours/
Azithromycin 7days OR
1 g/ oral/ single dose
Alternative Regimen
Amoxycillin 500 mg/ oral/ 8 hours/
Erythromycin 7 days OR
Ofloxacin 500 mg/ oral/ 6hours/ 7 days OR
Tetracycline 300 mg/ oral/ 12 hours/ 7 days OR
500 mg/ oral/ 6 hours/ 7 days
During Pregnancy
Erythromycin base or Erythromycin ethylsuccinate 500 mg/ oral/ 6 hours/ 7 days OR
Amoxycillin 500 mg/ oral/ 8 hours/ 7 days
NOTE:
• Doxycycline and other Tetracyclines are contraindicated during pregnancy and lactation.
• Erythromycin should not be taken on an empty stomach.

16
VAGINAL DISCHARGE

Use appropriate flowchart for additional treatment

Yes

Patient complains
of vaginal Any other 4C s Protocol
syndromes? No
discharge, vulval
itching or buring

No

History taking Abnormal

discharge or
and examine * Vulval
Riskassessment ** erythema?

Yes

Lower
abdominal No
tenderness?

Yes

Use flowchart of Lower Abodminal pain

4Cs Protocol
Counsel and educate on STIs.
Promote and provide Condoms.
Offer HIV Counseling and testing.
Manage and treat the partner (Contact) if necessary.

17
 4C s Protocol

Treat for
No Candida

Yes

Vulval
Treat for Bacterial oedema / curd
like discharge,
Vaginosis & excoriation
Trichomoniasis present?
erythema,

No

High Treat for

Gonococcal
or Chlamydial
Gonococcal
prevalence Yes nfection,
setting or risk Chlamydial
assessment
positive?**
infection, Bacterial
Vaginosis &
Trichomoniasis

* Predisposing Factors for Candidiasis

• Antibiotic use • Corticosteroid use
• The use of Antibiotic/Antiseptic vaginal preparations ** Risk Factors
• Uncomplicated Diabetes mellitus • Personal sexual history
• Immunosuppression • Community factors such as STI prevalence

18
Treatment Options for Gonorrhoea
Ceftriaxone 250 mg/ IM/ single dose OR
Cefixime 400 mg/ oral/ single dose OR
Spectinomycin 2 g/ IM/ single dose OR
Ciprofloxacin 500 mg/ oral/ single dose

NOTE:
• Ciprofloxacin is contraindicated in pregnancy and not recommended for use in children & adolescents.
• Quinolone resistant Neisseria gonorrhoea has become common across the globe.

Treatment Options for Chlamydia

Doxycycline 100 mg/ oral/ 12hours/ 7days OR
Azithromycin 1 g/ oral/ single dose
Alternative Regimen
Amoxycillin 500 mg/ oral/ 8 hours/ 7 days OR
Erythromycin 500 mg/ oral/ 6hours/ 7 days OR
Ofloxacin 300 mg/ oral/ 12 hours/ 7 days OR
Tetracycline 500 mg/ oral/ 6 hours/ 7 days
During Pregnancy
Erythromycin base or Erythromycin 500 mg/ oral/ 6 hours/ 7 days OR
ethylsuccinate
Amoxycillin 500 mg/ oral/ 8 hours/ 7 days
NOTE:
• Doxycycline and other Tetracyclines are contraindicated during pregnancy and lactation.
• Erythromycin should not be taken on an empty stomach.

Treatment Options for Trichomoniasis

Metronidazole 2 g/ oral/ single dose OR
Tinidazole 2 g/ oral/ single dose
Alternative Regimen
Metronidazole 400 mg or 500 mg/ oral/ 12 hours/
7days OR
Tinidazole 500 mg/ oral/ 12hours/ 5 days
NOTE:
• Treatment of sexual partners simultaneously increases the cure rate in women from 82-88% to 95%.
• Metronidazole is generally not recommended for use in the first trimester of pregnancy, yet treatment may be given
where early treatment has the best chance of preventing adverse pregnancy outcomes. In this instance a lower dose
should be used (2 g/ oral/ singe dose) rather than a long course.

19
Treatment Options for Bacterial Vaginosis
Metronidazole 400 mg or 500 mg/ oral/ 12 hours/ 7 days
Alternative Regimen
Metronidazole 2 g/ oral/ single dose OR
Clindamycin 2% vaginal cream, 5 g intravaginally/
at bedtime/ 7 days OR
Metronidazole 0.75% gel, 5 g intravaginally/ 12 hours/ 5 days OR
Clindamycin 300 mg/ oral/ 12 hours/ 7 days
Recommended regimen for pregnant women
Metronidazole 200 or 250 mg/ oral/ 8 hours/ 7 days
(after the first trimester)
Metronidazole 2 g/ oral/ single dose (if treatment is imperative
during the first trimester of pregnancy)
Alternative Regimen
Metronidazole 2 g/ oral/ single dose OR
Clindamycin 300 mg/ oral/ 12 hours/ 7 days OR
Metronidazole 0.75% gel, 5 g intravaginally/ 12 hours/ 7 days

NOTE:
Follow up: Patients should be advised to return if symptoms persist as re-treatment may be needed.

Treatment Options for Vulvo-vaginal Candidiasis

Miconazole or Clotrimazole 200 mg/ intravaginally/ 24 hours/ 3 days OR
Clotrimazole 500 mg/ intravaginally/ single dose OR
Fluconazole 150 mg/ oral/ single dose
Alternative Regimen
Nystatin 100,000 IU intravaginally/ 24 hours/ 14 days

NOTE:
During pregnancy, only topical Azoles should be used to treat pregnant women.

Recommended topical application regimen for Balanoposthitis (Partner Treatment)

Clotrimazole 1% cream/ 12 hours/ 7 days
Miconazole OR 2% cream / 12 hours/ 7 days
Alternative Regimen
Nystatin cream/ 12 hours/ 7 days

20
LOWER ABDOMINAL PAIN
• Appropriate surgical or gynecological referral
• Set up an IV line before referral

Patient Yes
complains of lower
abdominal pain Any of the
following present?
Missed/over due period/
Recent delivery/abortion/
Take history miscarriage
Abdominal guarding
(including and/or rebound,
Gynecological) tenderness/
and examine Abnormal vaginal
bleeding/ Abdominal
(abdominal & mass?
vaginal)
No

Manage for PID Is there

cervical Any other
Review in 3 days Yes excitation
No genital
tenderness, or syndrome?
lower abdominal
tenderness &
vaginal
Patient discharge?
has No Refer
improved?

Continue treatment until completed Manage

• 4CsProtocol appropriately
Yes • Askpatienttoreturnasneeded

4Cs Protocol
Counsel and educate on STIs.
Promote and provide Condoms.
Offer HIV Counseling and testing.
Manage and treat the partner (Contact) if necessary.

21
Out Patient Treatment Options of Lower Abdominal Pain or PID
Ceftriaxone 250 mg/ IM/ single dose
Plus
Doxycycline 100 mg/ oral/ 12 hours/ 14 days OR 500 mg/
Tetracycline oral/ 6 hours/ 14 days
Plus
Metronidazole 400-500 mg/ oral/ 12 hours/ 14 days

NOTE:
• Tetracyclines are contraindicated during pregnancy.
• If PID should occur with an IUD in place, treat the PID using appropriate antibiotics. There is no evidence that removal
of IUD provides any additional benefit. If the individual does not want to keep the IUD, removal is recommended and
contraceptive counseling is necessary.

22
NEONATAL CONJUNCTIVITIS
Neonate with
eye discharge
Bilateral
or unilateral • Reassure mother
History taking • Advice to return if
swollen eyelids No
and examine with purulent necessary
discharge?

Yes

• Treat neonate for Gonorrhoea & Chlamydia

• Treat mother and partner(s) for Goorrhoea and Chlamydia
- Educate mother
- Counsel mother
- Advice to return in 3 days

Patient
improved? No Refer

Yes

Continue treatment until completed

Reassure mother

4Cs Protocol
Counsel and educate on STIs.
Promote and provide Condoms.
Offer HIV Counseling and testing.
Manage and treat the partner (Contact) if necessary.

23
Treatment Options for Neonatal Gonococcal Conjunctivities
Recommended Regimen
Ceftriaxone 50 mg/ kg/ IM/ single dose, to a maximum of 125 mg
Alternative regimen where Ceftriaxone is not available
Kanamycin 25 mg/ kg/ IM/ single dose, to a maximum of 75 mg OR
Spectinomycin 25 mg/ kg/ IM/ single dose, to a maximum of 75 mg
NOTE:
• Follow up: patients should be reviewed after 48 hours.

Treatment Options for Neonatal Chlamydial Conjunctivitis

Recommended Regimen
Erythromycin syrup/ 50 mg/ kg/ day/ oral in 4 divided doses/ 14 days
Alternative Regimen
Trimethopim 40mg/ oral/ 12 hours/ 14 days
Sulfamethoxazole 200mg
NOTE:

Treatment Options for Gonorrhoea (For mother and partner(s))

eftriaxone 250 mg/ IM/ single dose OR
Cefixime 400 mg/ oral/ single dose OR
Spectinomycin 2 g/ IM/ single dose OR
Ciprofloxacin 500 mg/ oral/ single dose
NOTE:

Treatment Options for Chlamydia (For mother and partner(s))

Doxycycline 100 mg/ oral/ 12hours/ 7days OR
Azithromycin 1 g/ oral/ single dose
Alternative Regimen
Amoxycillin 500 mg/ oral/ 8 hours/ 7 days OR
Erythromycin 500 mg/ oral/ 6hours/ 7 days OR
Ofloxacin 300 mg/ oral/ 12 hours/ 7 days OR
Tetracycline 500 mg/ oral/ 6 hours/ 7 days
During Pregnancy
Erythromycin base or Erythromycin ethylsuccinate 500 mg/ oral/ 6 hours/ 7 days OR
Amoxycillin 500 mg/ oral/ 8 hours/ 7 days
NOTE:

24
ANNEX
SUMMARY TABLE

Most
Syndromee Symptoms Signs common
causes

Vaginal
Discharge

Urethral
Discharge

Genital Ulcer

Lower
Abdominal
Pain

Scrotal
Swelling

Inguinal
Bubo

Neonatal
Conjunctivitis

25
NOTES
To be successful in limiting the transmission of STIs, any
approach to partner management must have these three
features:
• Treatment of all a patient’s sexual partners.
• Treatment for the same STI as the patient.
• Treatment of any new STI identified.
Notice that if a female patient with vaginal discharge is diagnosed
syndromeically as having vaginitis but not cervicitis, her partner
need not be treated unless the vaginitis is recurrent. In this
case treatment is either for Candidiasis or Trichomoniasis.
There is currently no evidence that treating partners for Bacterial
Vaginosis makes any difference. If the index patient is treated for
vaginitis and cervicitis, the partner must be treated for Gonorrhea
and Chlamydia.
Cervical infection is often associated with a number of demographic
and behavioural risk factors. These need adapting to the local
situation. In a number of studies, these are some of the associated
factors for cervical infection:
• Age below 21 years (or in some situations 25).
• Unmarried.
• More than one partner in the last 3 months.
• A new partner in the last 3 months.
• Current partner has an STI or has recently started to use
condoms.

26
STIs Reporting Pathway
Introduction
Case reporting is the process of reporting cases of notifiable
diseases from health care providers or laboratories to public
health authorities.
Surveillance data on STIs can be used for a variety of purposes
related to the monitoring, prevention, control and allocation of
resources for STIs and HIV. Data obtained from case reporting
can be used in:
• Monitoring/evaluating implementation of health programs.
• Assessing magnitude of health problem.
• Understanding local epidemiology of health problem.
• Assessing changes in STIs trend and its distribution.
• Assessing the impact of the program intervention for control
of diseases.
• Enable predictions about pattern of occurrence of diseases.

Planning your Data Collection

I. Initial consideration (Roles of National Level)
The role of the National Level includes:
• Developing forms that all sites will use
• Conducting training.
• Developing a data management system.
• Specifying clear lines of reporting.
• Defining the roles of different workers, from health facilities or sentinel
sites through to the national level, clearly.
• Making the data management system explain clearly, how
surveillance
officers at both the district and national levels:

27
 - Receive data.
- Record data.
- Check the data for completeness and consistency.
• Designing a method for the submission of the monthly reports
(by mail,
regular direct pick-up from the sites and districts, or hand delivery).

II. Confidentiality and security

• All STIs surveillance data must be handled to ensure patient
confidentiality (the protection of a patient’s personally identifying
information) and privacy.
• Train staff who record, store and report data for the importance
of privacy and confidentiality of each patient’s data;
• Develop a written confidentiality policy for the STIs data.
• Restrict access to the STIs data to ensure that it cannot be modified.
• Remove all personal identifying information before reporting
data from one level to another;
• Keep patients’ personal identifying information only at the
health facility where it was collected and do not allow unauth
rized disclosure of the personal identifying information.
• Secure the data to protect it from harm or loss. Keep a backup
on CDROM every time data are added or edited.

III. Collecting data

A. At peripheral level (Primary Health Care facilities)
• STIs data collection should be an integral part of STI case management.
Everyone involved must have clearly defined duties.
• STIs data collection process should interfere as little as poss
ble with patient’s care and case management.
• The doctor who diagnoses and provides care for the patient:

28
- Is responsible for identifying cases and recording medical
and demographic data onto case reporting form (form S-1);
- Must record the diagnosis according to standard case def nitions
- Records STIs data on case reporting form (form S-1)
- Makes separate entries for each syndrome (some patients
will have more than one syndrome).
- Makes a zero entry if there were no cases of a specific syndrome
during that month (do not leave the space blank) so the district
level will know the report is complete.
• Every case of STIs must have rapid test for HIV screening,
with consent (verbal consent).
• Every case reporting form must be signed by Primary Health
Care physician.
• In some cases, the health facility will include several clinics or sites.
In that case, a supervising doctor or technician is responsible for:
- Collecting the case reporting form (S-1) from all clinics.
- Reviewing monthly reports from the health facility;
- Making their comments and investigating any problems
before the reports are submitted to district authorities.
• The final reporting forms (S-1) should be completed in triplicate.
Submit two copies to the health sector, and file one at the primary
health care center.
• One individual needs to take responsibility for keeping the
forms and filling out the STIs report forms (S-2) from the different
primary health care clinics, so that filling process could be
completed on time.
• A supervisor needs to ensure that STIs data (form S-2) is
ready before sending it the health sector.
• At the end of every Gregorian month data from every primary
health care facilities must be collected in collective form (S-2)
and sent to health sectors then to regional health affairs.

29
B. At district level (Regional Health Affairs)
When the district level (STIs coordinator) carefully reviews (S-2)
forms from the different health sectors, the quality of data received
at the national level is high. District level data checking and
editing should focus on:
• Checking for completeness of data.
• Ensuring that all the variables indicated on the data collection
forms (S-2) are appropriately filled.
• A copy of the health facility case reports should be kept at
the district level.
• STIs coordinator in the regional health affairs revise and combines
the total STIs case reporting forms (S-2) from different health
sectors in one collective form (S-2) to be sent to national level
(National AIDS Program) by fax, correspondence or by email
within 10 days of the next Gregorian month.

30
 STI Reporting Pathway

(Peripheral level)
Primary Health
Centers

Health sectors

(Intermediate level)
Feedback Reporting
Regional Health
process process
Affairs

(Central level)
MOH
General Directorate of Infectious Diseases Control
National AIDS Program

31
 STI Forms

32
STI Forms

National Aids Program 31

33
 ‫ﺇﻓﺮﺍﺯ ﻣﻬﺒﻠﻲ ﻣﺘﻜﺮﺭ‬
Recurrent Vaginal Discharge

32 National Aids Program

34
35