Introduction Besides a range of effective diagnostic tests and treatments, the extent of Sexually transmitted diseases (STDs) epidemic remains challenging. STDs are associated with enormous physical, psychological and economical consequences on the population of developing countries. World Health Organization emphasises on the syndromic approach, especially in areas having inadequate laboratory and transport facilities. Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and Neisseria gonorrhoeae (NG) are the most common STIs worldwide. They present similar clinical spectra in both women and men and are the leading cause of acquired infertility in women.

Methods In this prospective study (from June 2012 to Feb 2015), the accuracy and performance of syndromic treatment given at Safdarjung hospital, as per NACO-NACP III Syndromic diagnosis of STI/RTI and treatment guidelines (Provision of directly observed therapy for single-dose regimes) were validated by comparing the diagnosis carried out by PCR based assay.

Results Out of 6000 visited patients, 820 female patients (14%) had vaginal discharge syndrome and given treatment as per NACO guidelines; using Kit-I, Grey Kit (UD, ARD, Cervivitis), Kit-II, Green Kit (Vaginitis) and Kit-VI, Yellow Kit (LAP). Out of 824, 634 (77%) patients were enrolled in this study. Based on syndromic management 20%, 0.5%, 46%, pateints were infected with CT, NG, TV respectively. Co-infections were common: 7%, 11%, 1%, 12%, with CT+TV, CT+NG, NG+TV, CT+NG+TV respectively. However, with Specific PCR assays, out of 634, 110 (17%) were positive and 524 (83%) patient were negative and/or positive for other STDs. Out of 110 patients, 7%, 5%, 2%, were CT, NG, TV infected while 1%, 2%, 1%, were co-infected with CT+TV, CT+NG, CT+NG+TV respectively.

Conclusion Our results provide evidence that, symptom based disease management leads to inaccurate diagnosis and over treatment of patients resulting in huge economic wastage and may also contribute towards the development of drug-resistance.