Syndromatic Treatment and STD Symptoms

Syndromatic treatment refers to the practice of selecting treatment for sexually transmitted diseases (STDs) based on symptoms, rather than based on a diagnosis of the infectious organism. This treatment approach is usually done in low-resource settings where the cost of testing is prohibitive or where it is difficult to get people to come back for test results.

While it can be efficient sometimes, there are two main problems with syndromatic treatment.

  1. Many sexually transmitted diseases are asymptomatic. Many people with HIV, chlamydia, gonorrhea, herpes, and other STDs won't have symptoms for years. In fact, they may never have them at all.
  2. The symptoms of STDs can be non-specific. A liquid discharge, in particular, can be caused by many different types of pathogens (infectious viruses, bacteria, or fungi).

Without a test that identifies the infectious pathogen, it can be very hard to figure out what the best treatment is. For that matter, it can be very hard to figure out what any effective treatment is.

Woman sitting in doctor's office
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In the United States, STD testing is pretty widely available. That means syndromatic treatment is less common in this country. That's a good thing. If your infection is treated with the wrong antibiotic, it won't be effective. The wrong antibiotic may also increase your risk of developing antibiotic-resistant strains of the disease.

The fact that it is so difficult to diagnose most STDs based on their symptoms is one of the reasons why some doctors refuse to diagnose individuals over the Internet. In these cases, it would be difficult to make such diagnoses accurately.

Syndromic Treatment Is Better Than Nothing

There are circumstances where syndromic treatment can be useful. In short, syndromic treatment is better than nothing. But it's not better than a reliable testing program. 

In general, in areas where testing isn't available, syndromic treatment is better than no treatment.

Syndromic treatment may also be cost-effective in countries that only provide screening for individuals who have symptoms. For example, a study in Taiwan found that it was far cheaper than standard testing. However, they only looked at the costs for people who had symptoms. They didn't investigate how many asymptomatic cases were being missed. 

There's also evidence that syndromic treatment can be harmful, even in areas with low resources. In Kenya, for example, researchers found that it missed many cases of STDs in high-risk women. It also led to many cases of overtreatment for STDs that didn't actually exist. In other words, it was problematic in both directions. It failed to treat important infections while also giving drugs to women who didn't need them.

STD screening is important. The only way to know whether you have an STD is to get tested for one. 

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