Table 2

Recommended diagnoses and treatments

N=57Case 1: Gonorrhoea/chlamydiaCase 2: HSVCase 3: Trichomoniasis/BV
*eg “genital infection” or “vaginal infection.”
WHO guidelines for treatment of STI associated syndromes20“ . . .[T]he major pathogens causing urethral discharge are N gonorrhoeae and C trachomatis. . . . [T]reatment of a patient with urethral discharge should adequately cover these two organisms.” Flow chart for urethral disease leads to gonorrhoea and chlamydia.“Treatment [for genital ulceration] appropriate to local aetiologies . . . should be given . . . In many parts of the world, genital herpes is the most frequent cause of genital ulcer disease.” Flow chart for genital ulcers leads to HSV.“A spontaneous complaint of “abnormal” vaginal discharge (referring to quantity, colour or odour) is most commonly due to a vaginal infection . . . Thus, all women presenting with vaginal discharge should receive treatment for trichomoniasis and BV.” Flow chart for vaginal discharge leads to bacterial vaginosis and trichomoniasis (coupled with other risk factors, chlamydia and gonorrhoea are possible diagnoses).
Diagnosis (any)16(28%)12(21%)23(40%)
    General diagnosis*9223
    Specific diagnosis7100
    Correct diagnoses5; all for gonorrhoea(9%)7; all for HSV(12%)0(0%)
Treatments (any)24(42%)19(33%)47(83%)
    Appropriate treatment9; all effective against gonorrhoea only(16%)7; all effective against HSV(12%)9; all effective against both trichomoniasis and BV(16%)
Physician follow up recommended38(67%)37(65%)15(26%)