⚕️ Clinical Reminder: The syndromic approach treats for the most likely pathogens without waiting for lab results. Always combine treatment with partner notification, counselling, and condom promotion. Follow current NACO / state STI programme guidelines.
Candida · G. vaginalis · T. vaginalis · N. gonorrhoeae
🔴
Genital Ulcer Disease
Painful or painless genital ulcers/sores
T. pallidum · H. ducreyi · HSV-2 · C. trachomatis (LGV)
🟡
Lower Abdominal Pain / PID
Pelvic pain, adnexal tenderness in females
N. gonorrhoeae · C. trachomatis · Anaerobes
🟤
Inguinal Bubo
Enlarged, tender inguinal lymph nodes
C. trachomatis (LGV) · H. ducreyi
🔷
Scrotal Swelling
Scrotal pain, swelling; epididymo-orchitis
N. gonorrhoeae · C. trachomatis · E. coli
🟢
Neonatal Conjunctivitis
Purulent eye discharge in newborn <28 days
N. gonorrhoeae · C. trachomatis
🩺 Counselling & Prevention Essentials
🤝
Partner Notification
Trace & treat all sexual contacts from the last 3 months. Reinfection is the most common cause of treatment failure.
🛡️
Condom Promotion
Promote consistent condom use. Provide free condoms at ICTC/STI clinic. Dual protection against STI and pregnancy.
🔬
HIV Counselling
All STI patients should be offered HIV counselling & testing. GUD increases HIV transmission risk 10-fold.
🚫
Abstinence During Rx
Advise abstinence or condom use until patient and partner both complete treatment and are symptom-free.
💉
HBV Vaccination
Offer Hepatitis B vaccination to all non-immune STI patients. Check HBsAg status if available.
📋
ICTC Referral
Refer to ICTC for HIV testing. Positive patients enrolled in ART centre. Link to PPTCT for pregnant women.
👥 Partner Management Protocol
Trace all sexual partners from the last 3 months (or most recent sexual contact if <3 months)
Invite partners to the clinic for evaluation and treatment — refer to as EPT (Expedited Partner Therapy) where possible
Treat partners presumptively using the same syndrome-specific regimen
Instruct both patient and partner to avoid sex until 7 days after single-dose treatment (or until course is complete)
Document partner notification in case records; maintain confidentiality
Common Questions
FAQ
What is the syndromic approach for STI/RTI management?
The syndromic approach groups STIs by clinical syndrome (presenting complaint + signs) and prescribes standardised treatment for the most likely causative organisms without waiting for lab results. NACO recommends this for Indian primary care settings where lab facilities are limited. It is cost-effective, ensures same-day treatment, and reduces transmission.
What is the difference between STI and RTI?
RTI (Reproductive Tract Infection) is a broader umbrella term covering: (1) Sexually Transmitted Infections (STI) — e.g., gonorrhoea, chlamydia, syphilis; (2) Endogenous infections — caused by overgrowth of normal flora, e.g., bacterial vaginosis, candidiasis; and (3) Iatrogenic infections — occurring after procedures like IUD insertion or abortion. All STIs are RTIs, but not all RTIs are sexually transmitted.
Why is partner treatment mandatory even if asymptomatic?
Most STI pathogens (especially chlamydia, gonorrhoea) cause asymptomatic infection in up to 50–80% of women. Untreated partners continuously re-infect the index patient (ping-pong effect). Treating partners simultaneously breaks the transmission chain and reduces reinfection rates by over 80%.
When should I refer an STI patient to higher centre?
Refer when: (1) PID with fever >38°C, vomiting, or signs of peritonitis; (2) Genital ulcer that fails to heal after 1 week of treatment; (3) Suspected surgical emergency (ectopic, appendicitis); (4) Neonatal conjunctivitis with corneal involvement; (5) Fluctuant bubo requiring aspiration by trained provider; (6) Recurrent or treatment-refractory symptoms; (7) HIV-positive patient needing specialist care.
Is the syndromic approach valid during pregnancy?
Yes, but drug selection changes. Avoid Doxycycline, Metronidazole (1st trimester), and Fluoroquinolones in pregnancy. For urethral/cervical discharge in pregnancy: Cefixime 400 mg stat + Azithromycin 1 g stat is safe. For BV/trichomoniasis: Metronidazole is safe from 2nd trimester. Always check gestational age before prescribing. Untreated STIs in pregnancy cause preterm labour, PROM, neonatal infections, and congenital syphilis.
What is risk assessment for cervicitis in vaginal discharge syndrome?
A positive risk assessment identifies women at higher risk for cervical infection (gonorrhoea/chlamydia) requiring additional antibiotics. Risk factors include: (1) New sexual partner in last 3 months; (2) More than one current sexual partner; (3) Partner has urethral discharge; (4) No condom use. 2 or more risk factors = high risk → add Cefixime 400 mg + Azithromycin 1 g to standard vaginal discharge treatment.
⚕️ Medical Disclaimer: This tool is intended for use by trained healthcare professionals only. Drug regimens are based on NACO National STI/RTI Management Guidelines. Always correlate with clinical findings, local antimicrobial resistance patterns, drug allergies, pregnancy status, and comorbidities. Treatment protocols may be updated periodically — refer to current NACO/WHO guidelines for the latest recommendations. This tool does not replace clinical judgment.