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🦠 INFECTIOUS DISEASE · DERMATOLOGY · NACO INDIA

STI / RTI Syndromic Management Guide

Evidence-based syndromic management protocols for Sexually Transmitted Infections (STIs) and Reproductive Tract Infections (RTIs) based on India's National AIDS Control Organisation (NACO) guidelines.

NACO India Guidelines7 Clinical SyndromesPartner Notification
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Syndromic Treatment Selector

Select presenting clinical syndrome below

NACO India
⚕️ 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.
Clinical Syndromes
🔵

Urethral Discharge

Male urethral discharge or dysuria

🟣

Vaginal Discharge

Abnormal discharge, vulval itching

🔴

Genital Ulcer Disease

Painful or painless genital sores

🟡

Lower Abdominal Pain

Pelvic pain, adnexal tenderness (PID)

🟤

Inguinal Bubo

Enlarged, tender inguinal lymph nodes

🔷

Scrotal Swelling

Epididymo-orchitis, scrotal pain

🟢

Neonatal Conjunctivitis (Ophthalmia Neonatorum)

Purulent eye discharge in newborns under 28 days

📋 Contents — tap to expand
1. The Syndromic Approach in India2. Partner Notification & EPT3. STI vs. RTI Distinctions4. Management During Pregnancy5. Frequently Asked Questions
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Reviewed by Dr. Sharma, MBBS AFIH

Medical Officer, AAC Clinic · Updated 2026-06-09

1The Syndromic Approach in Indian Primary Care

In resource-constrained settings across India where rapid diagnostic assays (NAAT, dark-field microscopy, or viral cultures) are unavailable at primary health centers (PHCs) and community health centers (CHCs), the National AIDS Control Organisation (NACO) mandates the syndromic management approach.

Patients are grouped by clinical presentations (syndromes) and treated immediately on day one for the most prevalent and pathogenic organisms responsible for that presentation. This eliminates diagnostic delay, prevents patient loss to follow-up, and interrupts community transmission chains.

2Partner Notification & Expedited Partner Therapy (EPT)

Core Principles of Partner Management
  • Trace and treat all sexual contacts from the preceding 3 months (or most recent partner if <3 months).
  • Provide presumptive treatment for the same syndrome without waiting for symptoms to manifest in partners.
  • Instruct both patient and partner to maintain sexual abstinence until complete resolution of symptoms and finishing all multi-day or single-dose therapies (≥7 days post-treatment).

3Distinguishing RTIs from STIs

Reproductive Tract Infections (RTIs) encompass a broader clinical spectrum than Sexually Transmitted Infections (STIs):

  • Sexually Transmitted Infections (STIs): Exclusively or predominantly transmitted via sexual intercourse (e.g., HIV, Syphilis, Gonorrhoea, Chlamydia, Chancroid, HSV-2).
  • Endogenous RTIs: Result from overgrowth of normal vaginal flora due to altered local microenvironments (e.g., Bacterial Vaginosis, Vulvovaginal Candidiasis).
  • Iatrogenic RTIs: Associated with poorly aseptic medical procedures, unsanitary abortion practices, or unsterile intrauterine contraceptive device (IUCD) insertions.

4Management Considerations During Pregnancy

Untreated maternal STIs carry catastrophic risks including congenital syphilis, spontaneous abortion, intrauterine growth restriction (IUGR), preterm premature rupture of membranes (PPROM), and neonatal sepsis.

  • Safe Regimens: Benzathine Penicillin G remains the absolute drug of choice for syphilis in pregnancy. Cefixime and Azithromycin are safe for gonococcal and chlamydial cervicitis.
  • Contraindicated Drugs: Doxycycline and Quinolones are strictly contraindicated during pregnancy due to fetal bone growth inhibition and arthropathy risks. Metronidazole should be avoided during the first trimester.

5Frequently Asked Questions

What is the syndromic approach for STI management?+
The syndromic approach groups STIs by clinical presentation and prescribes standardized treatment covering the most common causative organisms without waiting for laboratory results, ensuring same-day treatment in primary care.
What is the treatment for urethral discharge in males?+
Per NACO guidelines: Cefixime 400 mg single oral dose (for gonorrhoea) plus Azithromycin 1 g single oral dose (for chlamydia and NGU), administered simultaneously.
How to manage genital ulcer disease (GUD) without vesicles?+
Treat empirically for syphilis and chancroid using Benzathine Penicillin G 2.4 MU IM single dose plus Azithromycin 1 g PO stat. If vesicles are present, add Acyclovir 400 mg TDS for 7 days to cover herpes simplex virus.
Clinical Summary: Syndromic management provides immediate, effective treatment in primary care. Always prioritize partner notification and HIV testing integration.
Medical Disclaimer: This clinical reference guide is for qualified healthcare professionals. Drug regimens are based on NACO national STI/RTI guidelines. Always corroborate therapy with local resistance patterns, patient allergies, and pregnancy status.