12.1. Dissemination
The syndromic guidelines will be made available as a printed publication and as downloadable documents on the WHO website under sexually transmitted infections – guidelines. There will be links to other supporting documentation at https://www.who.int/health-topics/sexually-transmitted-infections#tab=tab_1.
WHO headquarters will work with WHO regional offices and country offices to ensure that countries receive support in adapting, implementing and monitoring these guidelines. All levels of WHO (headquarters, regional offices and country offices) will work with regional and national partners – including the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the Joint United Nations Programme on HIV/AIDS (UNAIDS), NGOs and other agencies implementing HIV, STI and sexual and reproductive health services to ensure an integrated approach to preventing and controlling STIs. WHO will ensure that these external partners are fully engaged in supporting the dissemination and implementation of these guidelines.
These guidelines will also be disseminated at conferences related to STIs and HIV and conferences linked with HIV and STIs and sexual and reproductive health. Efforts will be made to disseminate the information recommended in these guidelines through electronic media, especially during restrictions on meetings because of the COVID-19 pandemic.
The approved guidelines will be officially launched and followed by regional webinars to disseminate the guidelines. WHO will also work with Project ECHO (Extension for Community Healthcare Outcomes), which has been previously partnered with in the WHO African Region in disseminating WHO HIV guidelines using the amplified Internet connectivity and wide network of health-care providers. WHO will also work with the Integrated Best Practice Platform to disseminate the guidelines to health-care providers providing sexual and reproductive health services.
12.2. Updating the STI guidelines and user feedback
A system of monitoring relevant new evidence and updating the recommendations in these guidelines will be established and mechanisms for disseminating the new information put into operation. Some of the mechanisms will be by electronic communication. An electronic follow-up survey of key end-users of these guidelines will be conducted after one year of their dissemination. The results of the survey will be used to identify challenges and barriers to the uptake of the guidelines, to evaluate their usefulness in improving service delivery for STIs and to identify topics or gaps in managing people with STIs that need to be addressed in future editions.
12.3. Implementation considerations
12.3.1. Adaptation, implementation and monitoring
These guidelines provide recommendations for providing STI services, mainly using the syndromic approach to enable countries and settings with limited resources to provide evidence-informed interventions for managing people with symptomatic STIs. These guidelines address the syndromes of urethral discharge among men, vaginal discharge and pelvic inflammatory disease among women, genital ulcers among men and women and anorectal infections among men and women.
However, the epidemiology of the specific pathogens causing the syndromes needs to be established in each setting since there is wide geographical variation. Further, the patterns of antimicrobial resistance need to be monitored and may necessitate adapting the choice of medicines used in each syndrome. In areas lacking local data as a basis for adaptation, the recommendations in these guidelines can be adopted as presented since there has been global assessment before inclusion in these guidelines.
12.3.1.1. Opportunities for integrated approaches
Testing opportunities using rapid point-of-care tests
Existing services should be used for making the etiological diagnosis of STIs. Many countries have facilities for implementing point-of-care testing for diagnosing HIV infection. Already, many countries have adopted the dual or triple elimination projects to test for HIV, syphilis and/or viral hepatitis at the same time. This should be scaled up for people seeking care for STIs, people receiving PrEP for HIV infection, young people undergoing voluntary medical male circumcision and others.
Testing opportunities using molecular testing technologies
The molecular platform (such as for tuberculosis antimicrobial resistance diagnosis or viral load detection) is available in many countries. Molecular testing can be expanded at specific sentinel sites or designated laboratories to include detecting STIs, determining the causes of STI syndromes and possibly incorporating the detection of antimicrobial resistance genetic markers in pathogens such as N. gonorrhoeae and M. genitalium as technologies advance and become affordable and more accessible.
Integrated training of health-care providers
Health-care providers should be trained jointly in implementing the guidelines to enhance services for HIV and the other STIs, antenatal care and family planning care.
12.3.1.2. Establishing referral centres and sentinel site laboratories
Countries should establish or strengthen sentinel sites that can provide support to primary health-care services that need specialist services, such as an STI expert or physician or gynaecologist or genitourinary referral centres for or places to refer people with persistent or recurrent STIs. At the same time, these centres or nearby laboratories can be equipped and strengthened to provide support for STI programmes in areas such as etiological studies and antimicrobial resistance monitoring.
