Results.

 Participants were aged 18-56 years, almost 86% of them were married and 5.5% were newly married. The prevalence of STD's among patients attending family planning centers was 25% compared to 18% in the antenatal university  clinics.50% were at high risk in family planning compared to 45% in antenatal university clinics . The cure rate of syndromic approach exceeded 90% in the two study centers .Sensitivity (TP%) varied between 88.5%, 32.7%,3.8% and for syndromic, risk approach and clinical approaches respectively. Specificity (TN%) varied between 14.4%, 87.5%,and 91.5% and respectively. Over treatment rate (FP % ) reported for syndromic was as high as 85.4% compared to 12.5% for risk approach and 8.4% for  clinical approach. Performance parameters were reported for combined syndromic with clinical (AUC was 0.82 and LR+ was 4.12 ) followed by the combined Risk , clinical and syndromic approach (AUC was 0.80 and LR+ was 4) In addition to the validation of different approaches , the study explored that 27.3% of the study subjects have reported high risk :new marriage , symptomatic partner, before 21 years age and risky partner's occupation.

The cost varied from 5$ per case in syndromic to 30 $ if laboratory diagnosis was further adopted  with therapeutic cost.

Conclusions

The WHO approach is considerably valid for management of STD's in developing countries and reduction of  its limitation of over treatment can be achieved by combination with either clinical and or risk approach. The elements of risk approach score should be adjusted in different geographical settings.,

Keywords: Syndromic approach , WHO Algorithm ,Risk score ,Over treatment , Validity and predictive values

The subject of the study was a project funded by EMR/TDR-WHO SGS04/424.