Objectives To validate our revised syndromic algorithms of the management of sexually trans mitted diseases and determine their sensitivity, specificity, positive predictiv e value and cost-effectiveness.Methods Patients with either urethral discharge, vaginal discharge or genital ulcer, wer e selected during their first visits to three urban sexually transmitted disease clinics in Fujian Province, China. They were managed syndromically according t o our revised flowcharts. The etiology of the syndromes was detected by laborat ory testing. The data were analyzed using EPI INFO V6.0 software. Results A total of 736 patients were enrolled into the study. In male patients with ur ethral discharge, the sensitivities for gonococcal and chlamydial infections wer e 96.7% and 100%, respectively, using the syndromic approach. The total positi ve predictive value was 73%. In female patients with vaginal discharge, the sen sitivity was 90.8%, specificity 46.9%, positive predictive value 50.9%, and n egative predictive value 89.3% for the diagnosis of gonorrhea and/or chlamydial infection by syndromic approach. In patients with genital ulcer, the sensitivi ties were 78.3% and 75.8%, specificities of 83.6% and 42.9%, and positive pr edictive values of 60.0% and 41.0% for the diagnosis of syphilis and genital h erpes, respectively, using the syndromic approach. Cost-effectiveness analysi s indicated that the average cost of treatment for a patient with urethral disch arge was RMB 46.03 yuan using syndromic management, in comparison with RMB 149 .19 yuan by etiological management. Conclusions The syndromic management of urethral discharge was relatively effective and suit ed clinical application. The specificity and positive predictive value for sy ndromic management of vaginal discharge are not satisfactory. The revised flowc hart of genital ulcer syndrome could be suitable for use in clinical settings. Further validation and revision are needed for syndromic approaches of vaginal d ischarge and genital ulcer.