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SEXUALLY TRANSMITTED
INFECTIONS
DR. NAZRILA HAIRIZAN NASIR
PAKAR PERUBATAN KELUARGA
KLINIK KESIHATAN PANDAMARAN
INTRODUCTION
 Sexually transmitted disease (STD),
is also known as sexually transmitted
infection (STI) or venereal disea...
 A person may be infected, and may
potentially infect others, without
showing signs of disease.
 STIs can be transmitted via human
sexual behaviour including vaginal
intercourse, oral sex and anal sex.
 It may also b...
 STI incidence rates remain high in most of the
world
 In 1999, the WHO estimates that 340 million
new cases of STIs hav...
 The highest rate of new cases per 1000
population has occurred in sub Saharan Africa
 About 60% of these infections occ...
CAUSATIVE ORGANISM
STD BACTERIAL
Gonorrhoea Neisseria gonorrhoea
Syphillis Treponema pallidum
Chancroid Haemophillus ducre...
CAUSATIVE ORGANISM
STD VIRAL
AIDS HIV 1 and HIV 2
Genital Herpes Herpes simplex virus
Genital warts Human Papilloma virus
...
CAUSATIVE ORGANISM
STD CAUSATIVE ORGANISM
Vaginal thrush
Balanoposthitis
FUNGAL
Candida albicans
Vaginitis, urethritis
Bal...
GONORRHOEA
 CAUSATIVE ORGANISM
 Neisseria gonorrhoea
 INCUBATION PERIOD
 2-5 Days
 SIGNS AND SYMPTOMS
 Urethral (>80%) / Vaginal discharge – often
purulent
 Dysuria(50% Men)+ frequency
 Aymptomatic in...
GONORRHOEA DISCHARGE
 DIAGNOSIS
 Urethral smear ( cervical/rectal exudates)– gram
negative intracellular diplococci, pus cells +++
 Urethral...
DISCHARGE OF GC
 Recommended Treatment
 IM Ceftriaxone 500 mg stat
 AND
 Azithromycin 1g orally
 NB : Dose of Cefftriazone has been i...
 Alternative treatment
 Cefixime (ZINECEF) 400mg stat dose orally
 IM Spectinomycin 2 gm stat or
 IM Cefotaxime 500mg ...
 Advice
 No unprotected sex, no alcohol till they n their
partners complete treatment
 Contact tracing
 Examine and in...
 Follow up
 1 week – 2GT, urethral smear and culture to detect
PGU
 2 weeks – 2GT, urethral smear
POST GONOCOCCAL URETHRITIS
 Diagnosis
If 7 days or more after treatment of gonorrhea
 2GT : 1st glass threads
: 2nd glas...
NON SPECIFIC URETHRITIS(NSU) /
CHLAMYDIA
 Causative organism
 Chlamydia sp
 Incubation period
 1-3 weeks
 Clinical pr...
NON SPECIFIC URETHRITIS(NSU) /
CHLAMYDIA
 Clinical presentation : in men
 Asymptomatic (50-60%)
 Mucopurulent urethral ...
 Diagnosis
 Specimens for testing :
 urethral/endocervical swab And or first void urine
 Lab Tests
 Gram stain : incr...
 TREATMENT
 Oral Doxycycline 100mg bd for 7 days or
 Oral Azithromycin 1 gm stat
 ALTERNATIVE
 Ofloxacin for 500 mg b...
 TREATMENT in Pregnancy
 Oral Erythromycin stearate 500 mg qid for 7days or
 Oral Erythromycin ES 800mg QID for 7 days
...
 Contact tracing
 Examine and investigate sex partner, treat if positive
 If testing not available or partners are unwi...
VAGINAL CANDIDIASIS
 Causative organism
 Candida albicans (80-92%)and other yeasts
 Clinical presentation
 Vaginal/vul...
VAGINAL DISCHARGE
(CANDIDA ALBICANS)
 Predisposing factors
 Endogenous
 DM, AIDS, pregnancy, debilitating
diseases
 Exogenous
 OCP,antibiotics,immunosuppr...
 Diagnosis
 Lateral wall of vagina /subpreputial smear :
 Gram stain (sensitivity 65-68%)
 10% KOH microscopy ( sensit...
 Treatment
 Oral therapy
 Fluconazole 150mg stat dose
 Itraconazole 200mg bd for 1 day : contraindicated in
pregnancy
...
TRICHOMONAS VAGINITIS
 Causative organism
 Trichomonas vaginalis
 Incubation period
 4 days-4 weeks
 Clinical presentation Female
 Profuse, malodorous, frothy, thin dc (grey to yellow
green in colour)
 Pruritis
 Dyspar...
 Clinical presentation: male
 Usually contacts of infected women
 Scanty- moderate urethral discharge
 Rarely prostati...
T.VAGINALIS DISCHARGE
TRICHOMONAS VAGINALIS
 Diagnosis
 Saline wet mount – oval or pear shape
organism ( positive in 30%) : Must be
performed ASAP as motility dimin...
 Pregnancy :
 Published data suggest no increased risk
of tetratogenicity in Normal doses
 High dose metronidazole ( 2g...
 Advice
 No sex, alcohol until 1 week treatment
completed
 Contact tracing
 Examine and investigate sex partners, trea...
BACTERIAL / ANAEROBIC VAGINOSIS
 Causative organism
 Mixed flora consisting of Gardnerella
vaginalis and other anerobes ...
 Diagnosis:
 Amsel’s criteria, diagnosis is made by the
presence of any 3 out of the 4 features given
below :-
 Charact...
 Recommended Treatment
 Oral Metronidazole 400 mg bd for 5days or
 Oral Metronidazole 2 gm stat dose or
 Alternative t...
GENITAL HERPES
 Commonest genital ulcer
 50% recur but milder in form
 Causative organism
 Herpes simplex type 1 or 2
...
 Genital ulcer/sore
 Single/multiple
 Superficially ulcerated, scabbed, red edged
 PAINFUL
 Symptoms
 burning sensat...
GENITAL ULCER-HERPES
COMMON AREA
CORONAL SULCUS
GLANS
SHAFT
MAY HAVE VAG DC
25% IN CERVIX ONLY
 Diagnosis
 Direct IF for HSV Ag
 Serology- paired sera taken 2 weeks apart
 Tzank test for multinucleated giant cells...
Syphillis
 CLASSIFICATION
 ACQUIRED
 EARLY SYPHILIS (<2 YEARS)
 PRIMARY SYPHILIS
 SECONDARY SYPHILIS
 EARLY LATENT S...
Syphillis
 LATE SYPHILIS (>2 YEARS)
 LATE LATENT SYPHILIS
 TERTIARY SYPHILIS (GUMMA)
 CARDIOVASCULAR SYPHILIS
 NEUROS...
SYPHILIS
 Primary Syphilis
 Clinical presentation
- Usually single, NON TENDER sharply
demarcated ulcer with indurated e...
GENITAL ULCER IN SYPHILIS
GENITAL ULCER
GENITAL ULCER
 Treatment
 IM Benzathine Penicilline 2.4 mega single dose
 Procaine penicillin G, 600,000 units I.M. daily
for 10 days
If allergic to Penicillin
 Oral Doxycycline 100mg bd for 14 days or
 Oral Erythromycin 500 mg qid for 14 days
 Erythrom...
 Contact tracing
 Examine and investigate sex partner
and treat when indicated
 Follow up
 VDRL titre at 1,3,6,12,18,2...
 Secondary syphilis
 Incubation period
- 6-8 weeks after chancre appear
 Clinical presentation
- Rashes: macular/macula...
- Condylomata lata in moist areas
- Generalised lymphadenopathy, non
tender
 Diagnosis/Treatment/contact tracing/follow u...
 Early Latent Syphilis
 Syphilis infection of less than 2 years duration
 Positive serology without sn and sx
 Usually...
 Late latent syphilis
 Syphilis infection of more than 2 years duration
 Positive serology without sn and sx
 Usually ...
 Treatment
- IM Benzathine Penicillin 2.4 mega units
weekly for 3 weeks
If allergic to Penicillin
- Oral Doxycycline 100 ...
MODIFIED SYNDROMIC APPROACH
 introduced in 1999 in all health centres in
Malaysia
 sexually transmitted diseases that ha...
ADVANTAGES OF MSA
 treating more than one infection at a time (estimated
60% of patients had > 1 infection at one time)
...
 reduce complications and risk of transmitting
the disease to others.
 minimum lab investigations needed
 enable the pa...
SYNDROMES
 genital ulcer syndrome
 urethral discharges syndromes in men
 vaginal discharges syndrome (cervicitis &
vagi...
CLIENT
REGISTRATION OF CLIENT
HISTORY TAKING AND PHYSICAL EXAMINATION
COMPLICATIONS??
NIL
TREAT ACCORDING TO MSA
DO SIMPLE...
GENITAL ULCER SYNDROME
 GENITAL HERPES
 herpes simplex
 CHANCROID
 haemophilus ducreyi
 CHANCRE
 syphilis
Patient complains of genital ulcer or sore
HISTORY AND PHYSICAL EXAMINATION
ULCER PRESENT?
TREATMENT FOR SYPHILIS & CHANCR...
URETHRAL DISCHARGE
SYNDROME
 GONORRHOEA
 Neiserria gonorrhoea
 CHLAMYDIA TRACHOMATIS
 NON SPECIFIC URETHRITIS
Patient complains of urethral discharges/Dysuria in males
(1st time/ recurrences)
History and Physical Examination
INVESTI...
VAGINAL DISCHARGE SYNDROME
 TRICHOMONIASIS
 Trichomonas vaginalis
 CANDIDIASIS
 Candida albicans
 GONORHHOEA
 NEISSE...
Patient complains of vaginal discharges
HISTORY AND PHYSICAL EXAMINATION
INVESTIGATIONS NEEDED
1. VAGINAL SWAB
@WET MOUNT ...
THANK YOU
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Sexually Transmitted Infection (Malaysian STI Guidelines 2015)

GARISPANDUAN PENYAKIT KELAMIN 2015

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Sexually Transmitted Infection (Malaysian STI Guidelines 2015)

  1. 1. SEXUALLY TRANSMITTED INFECTIONS DR. NAZRILA HAIRIZAN NASIR PAKAR PERUBATAN KELUARGA KLINIK KESIHATAN PANDAMARAN
  2. 2. INTRODUCTION  Sexually transmitted disease (STD), is also known as sexually transmitted infection (STI) or venereal disease (VD).  In recent years the term sexually transmitted infection (STI) has been preferred
  3. 3.  A person may be infected, and may potentially infect others, without showing signs of disease.
  4. 4.  STIs can be transmitted via human sexual behaviour including vaginal intercourse, oral sex and anal sex.  It may also be transmitted via the use of IV drug needles after its use by an infected person, as well as through childbirth or breastfeeding.
  5. 5.  STI incidence rates remain high in most of the world  In 1999, the WHO estimates that 340 million new cases of STIs have occurred worldwide.  The largest number of new infections occurred in the region of  South and Southeast Asia,  sub-Saharan Africa  Latin America and the Caribbean.
  6. 6.  The highest rate of new cases per 1000 population has occurred in sub Saharan Africa  About 60% of these infections occur in young people <25 years of age
  7. 7. CAUSATIVE ORGANISM STD BACTERIAL Gonorrhoea Neisseria gonorrhoea Syphillis Treponema pallidum Chancroid Haemophillus ducreyi Non specific urethritis Chlamydia trachomatis Lymphogranuloma venerium Chlamydia trachomatis
  8. 8. CAUSATIVE ORGANISM STD VIRAL AIDS HIV 1 and HIV 2 Genital Herpes Herpes simplex virus Genital warts Human Papilloma virus Hepatitis HBV, HCV
  9. 9. CAUSATIVE ORGANISM STD CAUSATIVE ORGANISM Vaginal thrush Balanoposthitis FUNGAL Candida albicans Vaginitis, urethritis Balanoposthitis PROTOZOAL Trichomonas vaginalis Genital scabies ARTHROPODS Sarcoptes scabei
  10. 10. GONORRHOEA  CAUSATIVE ORGANISM  Neisseria gonorrhoea  INCUBATION PERIOD  2-5 Days
  11. 11.  SIGNS AND SYMPTOMS  Urethral (>80%) / Vaginal discharge – often purulent  Dysuria(50% Men)+ frequency  Aymptomatic infection is common in females  Endocx: >50%  Rectum >85% ( also in Men)  Pharynx :>90% ( also in Men)
  12. 12. GONORRHOEA DISCHARGE
  13. 13.  DIAGNOSIS  Urethral smear ( cervical/rectal exudates)– gram negative intracellular diplococci, pus cells +++  Urethral culture – Thayer Martin or Stuarts/Amine
  14. 14. DISCHARGE OF GC
  15. 15.  Recommended Treatment  IM Ceftriaxone 500 mg stat  AND  Azithromycin 1g orally  NB : Dose of Cefftriazone has been increased from 250mg as development of resistance in other parts of the world  Addition of azithromycin is for synergestic therapeutic effect, reduce resistance and treatment of co-infection with C. trachomatis
  16. 16.  Alternative treatment  Cefixime (ZINECEF) 400mg stat dose orally  IM Spectinomycin 2 gm stat or  IM Cefotaxime 500mg stat  NB : Penicillins, tetracyclines, quinolones no longer recommended for Rx of Gonorrhoea: high resistant rates  Azithromycin alone not recommended RX for gomnorrhoea
  17. 17.  Advice  No unprotected sex, no alcohol till they n their partners complete treatment  Contact tracing  Examine and investigate sex partner( within 3 preceding months) ,  treat for gonorrhoea preferably after evaluation for sexual acquired infection
  18. 18.  Follow up  1 week – 2GT, urethral smear and culture to detect PGU  2 weeks – 2GT, urethral smear
  19. 19. POST GONOCOCCAL URETHRITIS  Diagnosis If 7 days or more after treatment of gonorrhea  2GT : 1st glass threads : 2nd glass clear ( not done anymore as not very useful)  Urethral smear negative, PC > 5 phf  Treatment  As for NSU
  20. 20. NON SPECIFIC URETHRITIS(NSU) / CHLAMYDIA  Causative organism  Chlamydia sp  Incubation period  1-3 weeks  Clinical presentation : in women  Asymptomatic (60-70%)  Mucopurulent vaginal discharge (30-40%)  Intermenstrual/post coital bleed  Lower abd pain  Acute and chronic symptoms and signs of PID
  21. 21. NON SPECIFIC URETHRITIS(NSU) / CHLAMYDIA  Clinical presentation : in men  Asymptomatic (50-60%)  Mucopurulent urethral discharge (30-40%)  Signs of epididymo-orchitis and prostatitis  Both Men and Women  Dysuria  Ano-rectal discomfort + discharge  Arthralgia  Pharyngeal infections  conjunctivitis
  22. 22.  Diagnosis  Specimens for testing :  urethral/endocervical swab And or first void urine  Lab Tests  Gram stain : increase PMN> to 5 per high power in urethral smear and >20 in endocervical smear/ /> 10 in first void urine  Cell culture : considered gold std but not recommended for routine use  Direct Fluorescent antibody test (DFAT)  Enzyme immunoassays(EIA)  Necleic acid amplification test (NAAT)
  23. 23.  TREATMENT  Oral Doxycycline 100mg bd for 7 days or  Oral Azithromycin 1 gm stat  ALTERNATIVE  Ofloxacin for 500 mg bd for 7 days or  Oral Erythromycin stearate 500 mg qid for 7days or  Oral Erythromycin ES 800mg QID for 7 days  Advice  To avoid sex and alcohol until cured
  24. 24.  TREATMENT in Pregnancy  Oral Erythromycin stearate 500 mg qid for 7days or  Oral Erythromycin ES 800mg QID for 7 days  Amoxycilling 500mg tds for 7 days  Oral Azithromycin 1 gm stat  Advice  To avoid sex for 7 days until they and their partners have completed treatment
  25. 25.  Contact tracing  Examine and investigate sex partner, treat if positive  If testing not available or partners are unwilling for examination : treat emperically  Follow up  After 2-3 weeks  If remain symptomatic/do not complete their Rx/have unprotected sex with untreated partner: retreated with appropriate contact tracing  Test of cure in asymptomatic individual not recommended
  26. 26. VAGINAL CANDIDIASIS  Causative organism  Candida albicans (80-92%)and other yeasts  Clinical presentation  Vaginal/vulva - Intense pruritis and erythema  Vulva soreness  Vaginal excoriation and edema  Thick, white ‘ cheesy’ curdlike discharge  Discomfort in coitus  Dysuria  In Men : rash on glans penis /fissures over prepuce/oedema of prepuce
  27. 27. VAGINAL DISCHARGE (CANDIDA ALBICANS)
  28. 28.  Predisposing factors  Endogenous  DM, AIDS, pregnancy, debilitating diseases  Exogenous  OCP,antibiotics,immunosuppressant, IUCD, tight fitting jeans, wet suit.
  29. 29.  Diagnosis  Lateral wall of vagina /subpreputial smear :  Gram stain (sensitivity 65-68%)  10% KOH microscopy ( sensitivity 70%)  Culture on Sabouraud’s agar  Treatment (topical/oral)  Clotrimazole vaginal pessary 200mg ON for 3 nights or  Clotrimazole vaginal pessary 500mg ON stat  alternative  Nystatin pessary100,000 units ON for 2 weeks  Tioconazole pessaries 200mg daily for 3 days
  30. 30.  Treatment  Oral therapy  Fluconazole 150mg stat dose  Itraconazole 200mg bd for 1 day : contraindicated in pregnancy  Advice  Avoid local irritants ; perume, soap, etc  Avoid tight fitting synthetic clothings  Follow up  Repeat vaginal smear and culture after 7-14 days
  31. 31. TRICHOMONAS VAGINITIS  Causative organism  Trichomonas vaginalis  Incubation period  4 days-4 weeks
  32. 32.  Clinical presentation Female  Profuse, malodorous, frothy, thin dc (grey to yellow green in colour)  Pruritis  Dyspareunia  Dysuria  Diffuse erythema of cervix and vaginal walls  Characteristic punctate appearances on cervix – ‘strawberry cervix’  Lower abd discomfort  Asymptomatic 10-50%
  33. 33.  Clinical presentation: male  Usually contacts of infected women  Scanty- moderate urethral discharge  Rarely prostatis/balanoposthitis  Asymptomatic 15-50%  Complications :  PROM  Low birth weight  Preterm delivery
  34. 34. T.VAGINALIS DISCHARGE
  35. 35. TRICHOMONAS VAGINALIS
  36. 36.  Diagnosis  Saline wet mount – oval or pear shape organism ( positive in 30%) : Must be performed ASAP as motility diminishes with time  PCR  Treatment  Oral Metronodazole 400 mg bd for 5 days or  Oral Metronidazole 2 gm stat dose or  Tinidazole 2 g stat
  37. 37.  Pregnancy :  Published data suggest no increased risk of tetratogenicity in Normal doses  High dose metronidazole ( 2g) not recommended in pregnancy and breast feeding ( metallic taste in breast milk)
  38. 38.  Advice  No sex, alcohol until 1 week treatment completed  Contact tracing  Examine and investigate sex partners, treat sex partners epidemiologically  Follow up  7-10 days- repeat wet mount film
  39. 39. BACTERIAL / ANAEROBIC VAGINOSIS  Causative organism  Mixed flora consisting of Gardnerella vaginalis and other anerobes such as Mycoplasma hominis.  Clinical presentation  Characteristic – copious whitish grey dc, malodorous  No obvious vulvitis/vaginitis  + Dysuria/dyspareunia  + Pruritis  50% asymptomatic
  40. 40.  Diagnosis:  Amsel’s criteria, diagnosis is made by the presence of any 3 out of the 4 features given below :-  Characteristic vaginal dc ie Homogeneous, thin, white discharge that smoothly coats the vaginal walls  Wet prep or gram stain- clue cells  Amine Sniff test (Fishy odor of vaginal discharge before or after addition of 10% KOH )  Vaginal fluid PH > 4.5
  41. 41.  Recommended Treatment  Oral Metronidazole 400 mg bd for 5days or  Oral Metronidazole 2 gm stat dose or  Alternative treatment  Intravaginal metronidazole 0.75% gel once daily for 5 days or  Intravaginal clindamycin 2% cream once daily for 7 days or  Clindamycin 300 mg b.d. P.O. for 7 days
  42. 42. GENITAL HERPES  Commonest genital ulcer  50% recur but milder in form  Causative organism  Herpes simplex type 1 or 2  Incubation period  2-5 days
  43. 43.  Genital ulcer/sore  Single/multiple  Superficially ulcerated, scabbed, red edged  PAINFUL  Symptoms  burning sensation at genital area – crops of vesicles appears – burst after 24 hrs – painful ulcers – scabs – heals + (may affect buttock and thigh)  enlarged glands in groin
  44. 44. GENITAL ULCER-HERPES COMMON AREA CORONAL SULCUS GLANS SHAFT MAY HAVE VAG DC 25% IN CERVIX ONLY
  45. 45.  Diagnosis  Direct IF for HSV Ag  Serology- paired sera taken 2 weeks apart  Tzank test for multinucleated giant cells  Treatment  Oral Acyclovir 200 mg 5x/daily for 5 days  Start within first 3 days of onset of lesion  Saline Sitz bath  Analgesics
  46. 46. Syphillis  CLASSIFICATION  ACQUIRED  EARLY SYPHILIS (<2 YEARS)  PRIMARY SYPHILIS  SECONDARY SYPHILIS  EARLY LATENT SYPHILIS
  47. 47. Syphillis  LATE SYPHILIS (>2 YEARS)  LATE LATENT SYPHILIS  TERTIARY SYPHILIS (GUMMA)  CARDIOVASCULAR SYPHILIS  NEUROSYPHILIS  CONGENITAL  EARLY (<2 YEARS OLD)  LATE (> 2 YEARS OLD)
  48. 48. SYPHILIS  Primary Syphilis  Clinical presentation - Usually single, NON TENDER sharply demarcated ulcer with indurated edges and clean base - Local lymph nodes enlarged  Diagnosis - Dark ground microscopy - VDRL/TPHA
  49. 49. GENITAL ULCER IN SYPHILIS
  50. 50. GENITAL ULCER
  51. 51. GENITAL ULCER
  52. 52.  Treatment  IM Benzathine Penicilline 2.4 mega single dose  Procaine penicillin G, 600,000 units I.M. daily for 10 days
  53. 53. If allergic to Penicillin  Oral Doxycycline 100mg bd for 14 days or  Oral Erythromycin 500 mg qid for 14 days  Erythromycin ethyl succinate 800 mg q.i.d. P.O. x 14 days or  Ceftriaxone 500 mg I.M. daily for 10 days (if no anaphylaxis to penicillin  Azithromycin 2 g single dose P.O (concerns regarding intrinsic macrolide resistance)
  54. 54.  Contact tracing  Examine and investigate sex partner and treat when indicated  Follow up  VDRL titre at 1,3,6,12,18,24 months
  55. 55.  Secondary syphilis  Incubation period - 6-8 weeks after chancre appear  Clinical presentation - Rashes: macular/macular papular usually symmetrical over palms and soles
  56. 56. - Condylomata lata in moist areas - Generalised lymphadenopathy, non tender  Diagnosis/Treatment/contact tracing/follow up - As for primary syphilis
  57. 57.  Early Latent Syphilis  Syphilis infection of less than 2 years duration  Positive serology without sn and sx  Usually detected by screening (STD, ANC, blood donors, contact tracing)  Treatment/Contact tracing/Follow up - As for primary syphilis
  58. 58.  Late latent syphilis  Syphilis infection of more than 2 years duration  Positive serology without sn and sx  Usually detected by screening or contact tracing  Investigation - LP, CXR
  59. 59.  Treatment - IM Benzathine Penicillin 2.4 mega units weekly for 3 weeks If allergic to Penicillin - Oral Doxycycline 100 mg bd for 30 days or - Oral Erythromycin 500 mg qid for 30 days  Follow up - VDRL titre 6 monthly for first 2 years, there after anually until sero negative or stable at low titres
  60. 60. MODIFIED SYNDROMIC APPROACH  introduced in 1999 in all health centres in Malaysia  sexually transmitted diseases that have the same symptoms are grouped into a syndrome to ensure early treatment can be given to sti patients.
  61. 61. ADVANTAGES OF MSA  treating more than one infection at a time (estimated 60% of patients had > 1 infection at one time)  treating patients at first visit  client friendly services  counseling and advise given to patients  prevent self treatment  reduced possibilities of drug resistance
  62. 62.  reduce complications and risk of transmitting the disease to others.  minimum lab investigations needed  enable the paramedic to treat the disease*
  63. 63. SYNDROMES  genital ulcer syndrome  urethral discharges syndromes in men  vaginal discharges syndrome (cervicitis & vaginitis)  neonatal conjunctivitis
  64. 64. CLIENT REGISTRATION OF CLIENT HISTORY TAKING AND PHYSICAL EXAMINATION COMPLICATIONS?? NIL TREAT ACCORDING TO MSA DO SIMPLE LAB TEST FILL IN MSA TREATMENT FORM NOTIFICATION GIVE 2 WEEKS APPOINTMENT REFERYES
  65. 65. GENITAL ULCER SYNDROME  GENITAL HERPES  herpes simplex  CHANCROID  haemophilus ducreyi  CHANCRE  syphilis
  66. 66. Patient complains of genital ulcer or sore HISTORY AND PHYSICAL EXAMINATION ULCER PRESENT? TREATMENT FOR SYPHILIS & CHANCROID **IST CHOICE: I/M B. PENICILLIN 2.4 MILL U/ WEEKLY FOR 2 WEEK , PLUS AZITHROMYCIN 1 GM STAT ** 2ND CHOICE: I/m B. PENICILLIN 2.4 MILL U/ WEEK FOR 2 WEEK PLUS 1/M CEFTRIAXONE 250 MG STAT If allergy to 1ST dose Benzathine penicillin, -avoid 2nd dose. -give Oral Doxycycline100 mg bd x 14days Or Oral Erythromycin ES 800mg BDX14days NB: Doxycline – NO in pregnancy and lactation Erythromycin in pregnancy, Rx baby as Congenital Syphilis NO MULTIPLE SUPERCIAL EROSIONS OR VESICLES PRESENT? GENITAL HERPES MANAGEMENT EDUCATE FOR BEHAVIORAL CHANGE TCA 2 WEEKS FOR REVIEW YES
  67. 67. URETHRAL DISCHARGE SYNDROME  GONORRHOEA  Neiserria gonorrhoea  CHLAMYDIA TRACHOMATIS  NON SPECIFIC URETHRITIS
  68. 68. Patient complains of urethral discharges/Dysuria in males (1st time/ recurrences) History and Physical Examination INVESTIGATIONS NEEDED * Urethral smear for GC *Culture for GC/CHLAMYDIA *VDRL<TPHA & HIV (after counseling) DISCHARGE PRESENT? YES NO DO 2 GLASS TEST RESULT POSITIVE? YES TREATMENT OF GONORRHEA AND CHLAMYDIA 1ST CHOICE: AZITHROMYCIN 1 GM STAT 2ND CHOICE: I/M CEFTRIAXONE 250 MG STAT If Azithromycin and plus Ceftriaxone NA DOXYCLINE 100 MG BD x10-14 days use IM Spectinomycin 2 gm/dose 3RD CHOICE: 1/M CEFTRIAXONE 250 MG STAT plus ERYTHROMYCIN ES 800 MG BD X 10-14 DAYS GC – STUARTS TRANSPORT MEDIA CHLAMYDIA – CHLAMYDIA TRANSPORT MEDIA
  69. 69. VAGINAL DISCHARGE SYNDROME  TRICHOMONIASIS  Trichomonas vaginalis  CANDIDIASIS  Candida albicans  GONORHHOEA  NEISSERIA GONORRHOEA  CHLAMYDIA  BACTERIAL VAGINOSIS  Gardnerella vaginalis
  70. 70. Patient complains of vaginal discharges HISTORY AND PHYSICAL EXAMINATION INVESTIGATIONS NEEDED 1. VAGINAL SWAB @WET MOUNT FOR TRICHOMONAS VAGINALIS AND CLUE CELLS FOR BACT VAGINOSIS @GRAM STAIN FOR CANDIDA ALBICANS 2. CERVICAL SWAB @ GRAM STAIN FOR GC AND PUS CELLS @ CULTURE FOR GC 3.VDRL,TPHA & HIV TEST TREATMENT FOR : CERVICITIS VAGINITIS 1ST CHOICE: AZITHROMYCIN 1 GM STAT METRONIDAZOLE 2 GM STAT plus 2ND CHOICE: I/M CEFTRIAXONE 250 MG STAT Nystatin pessary 100,00 u daily x 14 days plus or DOXYCLINE 100 MG BDX 10-14 DAYS Clotrimazole pessary 200mg daily x 3 hari 3RD CHOICE: IM CEFTRIAXONE 250MG S Plus ERYTHROMYCIN 800MG BD X 10-14 DAYS TREAT CONTACT/PARTNER
  71. 71. THANK YOU

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