Treatment and care

Correct and effective treatment of sexually transmitted infections (STIs) – ideally given and taken on the same day, at the first contact between patients and health-care providers – is an important public health measure in the control of STIs, since it endeavours to break the chain of transmission of the infection without delay.

Countries should establish and use national standardized treatment protocols for STIs. Standardization ensures that all patients receive appropriate and adequate treatment at all levels of the health-care service. The protocols can also facilitate the training and supervision of health-care providers and help reduce the risk of development of resistance to antimicrobials. Finally, having a standardized list of antimicrobial agents can also facilitate procurement of the medicines.

STI case management

The purpose of comprehensive STI case management is to provide treatment, obtain cure, reduce the risk of developing complications from STIs, and reduce or prevent future infections. STI case management includes bio-behavioural interventions such as HIV pre-exposure prophylaxis (PrEP), voluntary medical male circumcision and ensuring that sex partners are appropriately treated. This requires that the patient receives the following services: 

• medical and sexual history taken;
• correct diagnosis (whether syndromic or based on diagnostic tests);
• effective treatment;
• health education and counselling about the infection and risks;
• advice on compliance with treatment;
• promotion and/or provision of condoms (male or female);
• promotion and/or provision of HIV PrEP;
• promotion and/or provision of other preventive interventions, such as vaccines against hepatitis A and B and human papillomavirus, and voluntary medical male circumcision, where appropriate;
• partner services; and
• clinical follow-up, where appropriate.

Thus, effective case management consists not only of antimicrobial therapy to obtain cure and reduce infectiousness, but also the comprehensive assessment and care of a patient’s sexual and reproductive health and that of their sex partners.