Evaluation of syndromic patient management algorithm for urethral discharge

Area of Science:

• Infectious Diseases
• Public Health
• Clinical Medicine

Background:

• Urethral discharge in men is a common symptom requiring effective diagnostic and treatment strategies.
• Microscopy is often unavailable in primary healthcare settings, necessitating alternative approaches.
• The syndromic management approach offers a potential solution for resource-limited areas.

Purpose of the Study:

• To evaluate the feasibility, validity, and cost-effectiveness of the syndromic management algorithm for male urethral discharge in Bandung, Indonesia.
• To assess the clinical and microbiological cure rates using the WHO-recommended algorithm.
• To compare the cost of the syndromic approach with traditional microbiological diagnosis.

Main Methods:

• The World Health Organization (WHO) algorithm for urethral discharge, without microscopy, was applied to male patients presenting with the symptom.
• Treatment included ciprofloxacin and doxycycline for gonococcal and chlamydial infections.
• Gonococcal culture and chlamydia antigen detection served as the gold standard for validation.

Main Results:

• The study enrolled 140 male patients; 119 had confirmed discharge and were managed by the algorithm.
• Clinical cure rates were 97% (104/107), with 99% (106/107) microbiologically cured.
• The syndromic algorithm was highly cost-effective (Rp5,894 per patient) compared to microbiological diagnosis (Rp43,024 per patient).

Conclusions:

• The syndromic management algorithm is well-suited for primary healthcare settings, demonstrating high feasibility, acceptability, and cost-effectiveness.
• With 100% sensitivity and high positive predictive value (75%-97%), it is an effective tool for managing urethral discharge and impacts STD/HIV prevention.
• The algorithm facilitates timely treatment and partner notification, crucial for controlling sexually transmitted infections.