Correct Answer: A. Grey
The clinical presentation of a 22-year-old female with minimal vaginal discharge and cervical erosions is pathognomonic for herpes simplex virus (HSV) infection. Cervical erosions (not ulcers, but shallow defects with erythematous base) are the hallmark finding in genital herpes. The grey kit is the syndromic management kit for genital ulcer disease (GUD) as per Indian STI guidelines and the National AIDS Control Organization (NACO) protocol. Although HSV presents with vesicles that progress to erosions rather than true ulcers, the grey kit contains acyclovir (400 mg TDS for 7–10 days) and counselling materials for HSV management. The grey kit is specifically designated for GUD syndrome in India's syndromic approach to STI management, which includes HSV, syphilis, haemophilus ducreyi, and Klebsiella granulomatis. The minimal discharge and absence of purulent exudate rules out urethritis/cervicitis syndromes (which would use the red kit). This syndromic approach, endorsed by NACO and the Ministry of Health & Family Welfare, India, is the standard of care in Indian STI clinics where laboratory confirmation may not be immediately available.
Why the other options are wrong
B. Red — The red kit is used for urethritis/cervicitis syndrome, characterized by purulent urethral or cervical discharge. This patient has minimal discharge and erosions (not mucopurulent exudate), making the red kit inappropriate. Red kit contains antibiotics for Neisseria gonorrhoeae and Chlamydia trachomatis, which do not cause cervical erosions. C. Green — The green kit is designated for lower abdominal pain syndrome (pelvic inflammatory disease, endometritis). This patient presents with localized cervical findings without abdominal pain or systemic symptoms. Green kit is not indicated for isolated cervical pathology. D. Yellow — The yellow kit is used for vaginal discharge syndrome (non-gonococcal, non-chlamydial cervicitis, candidiasis, trichomoniasis). This patient has minimal discharge and erosions, not the copious or frothy discharge typical of yellow kit indications. Erosions point to HSV, not candida or trichomonas.
High-Yield Facts
- Grey kit = genital ulcer disease (GUD) syndrome; contains acyclovir, counselling, and condoms per NACO guidelines.
- Cervical erosions (shallow, erythematous defects) are pathognomonic for HSV, not true ulcers.
- Red kit = urethritis/cervicitis syndrome (gonorrhoea, chlamydia); requires purulent discharge, not erosions.
- Green kit = lower abdominal pain syndrome (PID); requires abdominal tenderness and systemic signs.
- Yellow kit = vaginal discharge syndrome (candida, trichomonas, non-specific); requires copious or frothy discharge, not erosions.
- Indian syndromic STI management uses colour-coded kits to enable treatment without laboratory confirmation in resource-limited settings.
Mnemonics
GREY = GUD (Genital Ulcer Disease) Genital Ulcer Disease → GREY kit. Remember: erosions (HSV) and ulcers (syphilis, chancroid) = GUD = GREY. Use when you see cervical or genital erosions/ulcers without purulent discharge. Colour-Coded STI Kits (RGYG) Red = urethritis/cervicitis (pus), Green = lower abdominal pain (PID), Yellow = vaginal discharge (frothy/copious), Grey = genital ulcer (erosions/ulcers). Discriminator: presence of discharge type and anatomical location.
NBE Trap
NBE may lure students who confuse HSV erosions with candida or trichomonas discharge (yellow kit) by focusing on "discharge" in the stem. The key discriminator is erosions (HSV) versus discharge type (candida = white curdy, trichomonas = frothy). Erosions = GUD = Grey kit.
Clinical Pearl
In Indian STI clinics, the syndromic approach using colour-coded kits enables same-day treatment without waiting for culture or PCR results—critical in high-burden settings. A patient with cervical erosions and minimal discharge should receive the grey kit immediately; HSV serology or PCR confirmation can follow, but treatment must not be delayed.
_Reference: Park's Textbook of Preventive and Social Medicine (Communicable Diseases section on STI syndromic management); NACO Guidelines on STI Management in India_