SS — Key Facts & Diagnosis

Clinical description

• Main symptoms: acute, one-sided pain and swelling of the scrotum. ± tenderness of epididymis/testis/vas deferens, reddening/oedema of scrotal skin, urethral discharge, fever.
• Sexually transmitted causes: Neisseria gonorrhoea, Chlamydia trachomatis (most common in men under 35).
• Non-STI causes: E. coli, S. haematobium, mumps orchitis, M. tuberculosis.
• Testicular torsion, trauma and inguinal hernia are surgical emergencies — refer immediately if these cannot be ruled out.

Treatment

After ruling out surgical emergency, always prescribe complete syndromic treatment. For severe pain/swelling: bed rest, elevate scrotum, cold compresses, analgesics. Review after 3–7 days. Investigate for TB if no improvement (Xpert on urine/semen).

Standard syndromic treatment for SS

• Ceftriaxone 500 mg IM stat.
• Azithromycin 1000 mg oral stat.
• Ciprofloxacin 500 mg oral BD for 10 days.

Partner treatment

Partner treatment (asymptomatic)

• Ceftriaxone 500 mg IM stat + azithromycin 1000 mg oral stat + doxycycline 100 mg oral BD for 7 days.

At every visit

HIV & ART status

• Ascertain HIV + ART status from health passport or self-report.
• Offer new HIV test for all unless previously diagnosed. Do not use coercion.
• New positive: active referral for ART initiation.
• New negative: refer/offer PrEP, VMMC, consistent condom use.
• Known positive: reinforce ART adherence or refer for re-initiation.

Hepatitis B

• Offer HBV rapid test for all patients born before 2002.
• HBsAg negative: refer for HBV vaccination unless previously completed 3 doses.
• HBsAg positive: refer for clinical and treatment assessment.

Syphilis screening

• Offer syphilis rapid test for concurrent asymptomatic syphilis (except in GUD/ARI where it does not influence treatment decisions).

Risk reduction & condoms

• Risk reduction counselling. Promote and dispense condoms.
• Promote VMMC for all non-circumcised men. Schedule appointment in 2 weeks.