Chapter 17: Sexually Transmitted Infections (STIs)

Overview

• Refer to the Management of Sexually Transmitted Infection using Syndromic Management Approach, Guidelines for Service Providers.
• All patients who present with STI symptoms should be offered HIV Testing and Counselling.
• Women with abnormal vaginal discharge or symptoms of an STI MUST have a vaginal speculum examination as part of their evaluation

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

General Management

• 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; if client is HIV negative, offer r HIV Pre-exposure Prophylaxis and Voluntary Medical male Circmcision

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

SYNDROMIC MANAGEMENT OF STIS

OVERVIEW

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: