Sexually Transmitted Infections (STIs) – General

Notes
  • The syndromic approach of control of STIs and their sequelae is based on the identification of a syndrome (a group of symptoms and easily recognised signs associated with a number of well defined aetiologies).
  • Though this approach is occasionally inaccurate and incomplete it is more prefffered, especially in developing countries, as the alternative of the Laboratory diagnosis approach tends to be complicated, overly expensive and often leads to delayed treatment.
Symptoms
  • with time.
Diagnosis
  • Take history that includes the following: current symptoms, sexual history, sexual orientation, type of sexual activity (oral, vaginal, anal sex), pregnancy and use of contraceptives among others.
  • Ano-genital examination.
Management
  • Treatment of the STIs must encompass the following 4Cs:
  • Compliance with the full drug course & follow-up
  • Counselling on the safer sexual behavior.
  • Condoms (proper use)
  • Contact tracing, partner treatment and notification
  • Vaginal Discharge Syndrome (VDS):

………………………………………………………………………..………….

Sx

Abnormal vaginal discharge/ dysuria or vulval itching/ burning

Dx

Vaginal candidiasis /

or bacterial vaginosis ??

Rx

*If no male urethreitis syndrome (MUS), patient is above 35 yrs and discharge is not confirmed

 

1.Tabs Metronidazole 2gm STAT

  1. Clotrimazole pessary 200mg inserted intravaginally NOCTE x 3/7

or

Clotrimazole pessary 500mg inserted intravaginally NOCTE

Or

Clotrimazole pessary 100mg inserted intravaginally NOCTE 6/7

 

*If no satisfactory response

Rx

 

  1. Tabs Metronidazole 400mg BD x 1/52

 

*If no male urethreitis syndrome (MUS), patient is above 35 yrs, discharge is confirmed, NO lower abdominal pain (LAP) or NO pain on moving the cervix.

 

Rx

  1. Tabs Norfloxacin 800mg STAT
  2. Caps Doxycycline 100mg BD x1/52

 

*Alternative treatment A

 

  1. Inj Spectinomycin 2gm STAT
  2. Caps Doxycycline 100mg BD x1/52 

 

*Alternative treatment B

  1. Inj. Ceftriaxone 250mg STAT
  2. Tabs Azithromycin 1gm STAT
  3. Tabs Metronidazole 2gm STAT

 

*In case of vulval oedema, curd-like discharge, erythema and excoriations treat for candidiasia:

 

1.Clotrimazole pessary 200mg inserted intravaginally NOCTE x 3/7

  1. Clotrimazole cream applied thinly on the vulva BD and continue for 3 days after the symptoms disappear (maximum of 2 wk)

 

Or

1.Caps Fluconazole 200mg STAT

 

* For the partner;

 

1.Caps Fluconazole 200mg STAT plus

2.Clotrimazole cream BD

 

*If no improvement add;

1.Tabs Metronidazole 400mg BDx 1/52

………………………………………………………………………..………….

  • Lower Abdominal Pain (LAP)

 

Sx

Lower abdominal pain/ with or without vaginal discharge in a sexually active patient

Ix

Investigate whether the abdominal tenderness is due to the following:

- Surgical causes

- Gynaecological causes such as pregnancy, missed periods, abdominal vaginal bleeding, recent delivery and abdominal mass.

*If the investigation above is positive refer for gynaecological or surgical care. If negative proceed as follows; otherwise,

 

Dx

Pelvic Inflammatory Disease (PID)

Rx

Implementation of 4Cs

  1. Tabs Norfloxacin 800mg STAT
  2. Caps Doxycycline 100mg BDx 1/52
  3. Tabs Metronidazole 400mg BD x 10/7 

 

(Refer if pregnant).

……………………………………………………………………………………..

  • Male Urethritis Syndrome (MUS)

[Mainly caused by gonorrhea and/or chlamydia]

 

Sx

Urethral discharge or dysuria

Ix

Medical history; sexual orientation; patient to milk urethra if no clear discharge.

If discharge present treat as follows;

Rx

Implementation of 4Cs

  1. Tabs Norfloxacin 800mg STAT
  2. Caps Doxycycline 100mg BD x1/52
  3. If the partner has VDS add:

 Tabs Metronidazole 400mg BD x 10/7

 

*Alternative treatment A

 

  1. Inj Spectinomycin 2gm STAT
  2. Caps Doxycycline 100mg BD x1/52
  3. If the partner has VDS add:

Tabs Metronidazole 400mg BD x 10/7

  1. Implementation of 4Cs

 

*Alternative treatment B

  1. Inj. Ceftriaxone 250mg STAT
  2. Tabs Azithromycin 1gm STAT
  3. Tabs Metronidazole 2gm STAT

………………………………………………………………………..………….

  • Scrotal swelling/pain

 

Sx

Scrotal swelling/pain

Ix

History & physical examination.

Check whether the testes are elevated and/or rotated, history of trauma or any other cause that may not be associated with STDs.

If none of the above;

Dx

STDs

Rx

.Implementation of 4Cs

Tabs Norfloxacin 800mg STAT

  1. Caps Doxycycline 100mg BD x1/52

 

*Alternative treatment A

 

  1. Inj Spectinomycin 2gm STAT
  2. Caps Doxycycline 100mg BD x1/52 

 

*Alternative treatment B

  1. Inj. Ceftriaxone 250mg STAT
  2. Tabs Azithromycin 1gm STAT

………………………………………………………………………..………….

  • Genital Ulcer Syndrome (GUS)

[Mainly caused by chancroid, syphilis and herpes genitalis]

 

Sx

Genital ulcers with/without pain

Ix

History & physical examination especially of ulcers & buboes

 

*If buboes are absent and not sexually active in the last 3 months

 

Dx

Herpes genitalis ??

Rx

  1. Tabs acyclovir 400mg TID x 1/52

    Advise HIV testing.

 

*If buboes are present and sexually active in the last 3 months;

 

Rx

  1. Inj. Benzathine benzyl penicillin 2.4 IM 2.4MU STAT

2.Tabs Erythromycin 500mg TID x 1/52

 

*If allergic to penicillins, give only

1.Tabs Erythromycin 500mg TID x 14/7

 

*Alternative treatment B;

  1. Inj. Ceftriaxone 250mg OD x 10-14 days

 

* Other options;

 

  1. Inj. Benzathine benzyl penicillin 2.4 IM 2.4MU STAT
  2. Tabs acyclovir 400mg TID x 1/52 if HIV positive or the status is unknown

 

 *If ulcers have not improved after a week add,

  1. Tabs Azithromycin 1gm STAT
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