SEXUALLY TRANSMITTED DISEASES (STD)

1. Every clinic has a review of quality of care once a year by a supervisor preferably using the validated DISCA (District STD Quality of Care Assessment) instrument.

2. Every clinic has at least one member of staff but preferably all professional staff trained in the management of STD using the "Training Manual for the Management of a person with a Sexually Transmitted Disease".

3. Every clinic has at least one member of staff (but preferably all who have been trained for STD) trained as a counsellor for HIV/AIDS/STD.

1.1 Standard Treatment Guidelines and Essential Drug List, latest edition.
1.2 Syndromic Case Management of Sexually Transmitted Diseases - guide for decision-makers, health care workers and communicators.
1.3 The Diagnosis and Management of Sexually Transmitted Diseases in Southern Africa, latest edition.
1.4 Supplies of patient information pamphlets on STD in the local languages.
1.5 Posters on STD and condoms in all the local languages.
1.6 Wall charts of the 6 protocols of STD management in consultation rooms.

2.1 A condom dispenser placed in a prominent place where condoms (with pamphlets on how to use) can be obtained without having to request them.
2.2 Examination light (or torch if no electricity) for every room with a screened examination couch.
2.3 Sterile specula (specula plus steriliser).

3.1 List of drugs in accordance with the Essential Drugs List and latest management protocols.
3.2 A supply of male condoms with no period where condoms are out of stock.
3.3 Gloves.
3.4 Dildos – at least one per clinic but preferably one per consulting room.

4.1 Clinic staff provide STD management daily and have extended hours, or on call weekend time, if in an urban or peri-urban area.
4.2 The staff are adolescent friendly with friendly communication so as to be accessible and acceptable to shy patients whether male or female.
4.3 Patients have friendly, non-judgemental, confidential private consultations.
4.4 Staff are able to take a history and examine patients correctly with dignity respected when all patients have skin, mouth, genital and peri-anal areas examined.
4.5 The history is taken correctly and partner change inquired about (the gender of partners is not presumed).
4.6 Syphilis serology is done on all patients with STD - and twice in pregnancy (if PR available at clinic this is done there), some do VDRL.
4.7 Pap smears are done on women over 35 or with a history of vulval warts.
4.8 Patients are counselled on safe sex and HIV/AIDS is explained to them.
4.9 Treatment is according to the protocol for each syndrome.
4.10 Condom use is demonstrated and condoms provided.
4.11 Contact cards in the correct language are given and reasons explained so that at least 60% result in the contact coming for treatment.

5.1 All patients are referred to the next level of care when their needs fall beyond the scope of competence.
5.2 Conjunctivitis in the newborn is referred after initial treatment.
5.3 The patient is referred if pregnant and has herpes in the last trimester.
5.4 Pelvic inflammatory disease is referred if patient is sick, has pyrexia and tachycardia, or severe tenderness, or is pregnant.
5.5 A painful unilateral scrotal swelling age under 18 is referred immediately for a surgical opinion regarding a possible torsion.

6.1 All patients receive health education on asymptomatic STD, misconceptions, rationale of treatment, compliance and return visit.
6.2 Time is given during counselling and discussion after treatment about the need for contacts to be treated.
6.3 If the patient’s syndrome is vaginal discharge the possibility of it not being sexually transmitted is discussed.
6.4 If pregnant then implications for the baby are discussed (congenital syphilis, ophthalmia, HIV, chlamydia).
6.5 The importance of condom use is stressed.

7.1 Patient’s records are kept according to protocol with confidentiality stressed.
7.2 Laboratory registers with return time for laboratory specimens not greater than 3 days.
7.3 A register is kept of contact cards issued and returned.
7.4 Partner notification cards are in local languages.

8.1 Staff Liaise with traditional healers about the care of STDs.

9.1 Staff collaborate with different departments such as schools, churches, traditional healers and community organisations implementing health promotion activities leading to the prevention of STD.