This algorithm shows how the clients risk factors for
STDs can be incorporated into the decision process. This approach
would be appropriate for most populations served by FP/MCH providers.
When a woman presents with vaginal discharge, the provider
assesses her risk of infection by asking a series of questions
on demographic variables and behavioral factors. The answers
to the questions guide the providers treatment approach.
Sample questions are:
- Does your partner have any STD symptoms?
- Have you had sex with more than one person or with a new
partner in the preceding three months?
- Are you younger than 21 years of age?
- Are you single?
If a woman answers yes to some of these questions and hence
appears at higher risk of STDs, the provider treats her for
both vaginitis and cervicitis.
If a woman appears at low risk for STD infection, the provider
treats only for vaginitis. The woman is advised to return if
the discharge persists, when she will be treated for cervicitis.
If a woman does not clearly belong in either the high- or low-risk
group, the provider does further assessment, if possible, and
considers local STD prevalence data. The assessment could be
a pelvic exam or inexpensive laboratory test such as a Gram
stain, which can help distinguish between vaginitis and cervicitis.
Prevalence rates of gonorrhea and chlamydia within the population
being served can also help the provider determine appropriate
treatment, since these infections cause cervicitis.