An evaluation of sexually transmitted infection case - Management in health facilities in 4 border provinces of Cambodia

Background: Cambodia has reported the highest prevalence of HIV in the general population in Asia. Sex work and high sexually transmitted infection (STI) prevalences are thought to be major contributory factors. Goal: The goal of this study was to assess standards of STI care through a survey of public sector health facilities in 4 border provinces of Cambodia. Methods: Healthcare facilities providing STI care were identified. Interviews were held with healthcare providers and STI patients and a manual check made of the STI register and standard medical history forms for female sex workers (SWs) registered with the 100% condom use program. Clinical management was assessed for SWs, women with vaginal discharge, and men with urethral discharge. Advice about condom use, partner notification, STI and HIV education, and availability of STI drugs were reviewed. Results: Seven percent of all patients seeking health care at health centers (HCs) had STI-related problems. Coverage of sex workers was high in 3 provinces. Drug stock outs, particularly cefixime, occurred at all levels of assessment. In STI clinics, almost all (99-100%) cervicitis and urethritis cases were diagnosed and treated correctly. In HCs with integrated STI services, according to national guidelines, cervicitis was diagnosed in 65% of women with vaginal discharge of whom 47% were diagnosed correctly, and in these, 88% were treated correctly. Sixty-six percent of SWs seen at STI clinics were diagnosed with cervicitis and 54% at follow up. Conclusions: STI services should be expanded further to health centers not currently offering STI care. Overtreatment for cervicitis in both SWs at reattendance and low-risk women with vaginal discharge are continuing problems. The WHO/UNAIDS STI service indicator criteria had limited application for the assessment of SW services but were adapted for local needs. Attendance of SWs in designated STI clinics appears to be a useful indicator for the acceptability and efficiency of the current national STI program.