Surveillance of STD syndromes: contributing to the STD programme in Côte d'Ivoire

In Côte d'Ivoire, management of sexually transmitted diseases (STDs) is based on a syndromic approach. The National Health Information System (NHIS), set up in 1995, supervises data drawn monthly on three STD syndromes: genital ulcers, discharges and warts. Information is collected in each community-based public clinic, collated in the 29 districts, then in the 10 regions, and finally centralized. We assessed the relevance of this information and its usefulness for the STD programme. The number of cases notified in adults of 15 years and above was compared in men and women for the years 1995 and 1996. The absolute number of cases was related to the number of consultations to evaluate the relative share of STDs in health care services, and to the population size to estimate STD annual incidence. Between 1995 and 1996, the number of reported STD cases remained steady in men, 32 410 and 31 470 cases, respectively, but increased by 35% in women, from 64 794 to 87 622 cases. As a result, STD annual incidence was unchanging in men (8%), but increased in women from 17 to 23%. However, between these two years, the relative contribution of STDs to all consultations decreased from 4.7 to 3.5% in men, while remaining steady in women, at around 7.0%. In this 2-year period, the ratio of the numbers of ulcers in men and women was about 1:1, and did not vary by district. In contrast, discharges were reported 2.7 times more by women, with a differing sex ratio from district to district. We suggest that vaginal discharges are often physiological, and are poorly instructive for STD surveillance. In contrast, ulcers in both genders, and male discharges, provide relevant information for the STD programme, for example to estimate the volume of STD drugs needed for public health services and to assess the epidemiological trends of STDs.