Sexually Transmitted Infections (STIS)

Clinical Description

Refer to the Management of Sexually Transmitted Infections using Syndromic Management

Approach, Guidelines for Service Providers

All patients who present with STI symptoms should be offered HIV Testing andCounselling.

NB: Women with abnormal vaginal discharge or symptoms of an STI MUST HAVE A

VAGINAL SPECULUM EXAMINATION AS PART OF THEIR EVALUATION TO EXCLUDE

CERVICAL CANCER!!

Note: Prompt and effective treatment of STIs helps prevent spread of HIV infection

Treatment

• Ensure adequate privacy in patient management.
• Establish a correct diagnosis whenever possible. This involves doing blood tests and obtaining tissue samples for laboratory analysis to identify the specific causative agent and institute specific treatment (in the hospital setting).
• Make efforts to trace, treat and counsel all sexual contacts.
• Provide health education and counselling on each return visit.
• Advice on 'safer sex' practices to prevent re- infection, i.e., abstinence, correct use and storage of condoms, mutual faithfulness of uninfected partners, decrease in number of sexual partners, use of non-penetrative sexual techniques and the importance of partner notification and treatment.
• Offer a supply of condoms at each patient's visit.

Note: Periodically check the patient's understanding of the above issues by asking him/her to repeat the information give

Syndromic management of STIs

The syndromic approach is based on the fact that most common causes of an STI generally present with certain groups of signs and symptoms (syndrome) and treatment given is supposed to target the commonest possible causes of that syndrome. It should be noted, however, that these signs and symptoms only point to certain diagnoses. The caregiver should ALWAYS seek to establish the definitive diagnosis whenever possible as stated above. This may necessitate a speculum examination.

Common STI syndromes:

• Genital ulcer disease (GUD)
• Urethral discharge (UD)
• Genito-urinary symptoms in women (GUS)
• Lower abdominal pain (women) (LAP)
• Enlarged inguinal lymph nodes (bubo)
• Balanitis/balanoposthitis