Sexually Transmitted Infections
Sexually Transmitted Infections
- The syndromic approach to Sexually Transmitted Infections (STI) diagnosis and management is to treat the signs or symptoms (syndrome) of a group of diseases rather than treating a specific disease
- This allows for the treatment of one or more conditions that often occur at the same time and has been accepted as the management of choice
Causative organisms and medicine management for STI syndromes:
Organism | Syndrome/s | Medicine management |
Neisseria gonorrhoeae | VDS, MUS, LAP | Ceftriaxone + azithromycin |
Chlamydia trachomatis | VDS, MUS, LAP, GUS, Bubo | Azithromycin |
Trichomonas vaginalis | VDS, LAP | Metronidazole |
Bacterial vaginosis (overgrowth of Gardnerella vaginalis, lactobacillus, anaerobes etc.) | VDS | Metronidazole |
Candida albicans | VDS | Clotrimazole |
Treponema pallidum | GUS | Doxycycline/ benzathine benzylpenicillin |
Herpes simplex | GUS | Aciclovir |
Haemophilus ducreyi | GUS, Bubo | Azithromycin |
- It is important to take a good sexual history and undertake a thorough ano-genital examination in order to perform a proper clinical assessment
- The history should include questions concerning symptoms, recent sexual history, sexual orientation, type of sexual activity (oral, vaginal, anal sex), the possibility of pregnancy (females), use of contraceptives including condoms, recent antibiotic history, antibiotic allergy, recent overseas travel and domestic violence
- Refer to a social worker, as required
Note:
Standard referral letter for treatment failure must include the following:
- Reason for referral: presumptive diagnosis (e.g. persistent cervicitis with suspected resistant gonorrhoea)
- Clinical findings including speculum examination for vaginal discharge
- Treatment history (including all medicines with dose and duration)
- Details of notification and treatment history of partner(s)
Suspected STI in children should be referred to hospital for further investigation and management. |
GENERAL MEASURES
- Counselling and education, including HIV testing
- Condom promotion, provision and demonstration to reduce the risk of STIs
- Compliance/ adherence with treatment
- Contact treatment/ partner management
- Circumcision promotion (counselling to continue condom use)
- Cervical cancer screening
Promote HIV counselling and testing |
Benzathine benzylpenicillin
- Benzathine benzylpenicillin remains the recommended treatment for syphilis
- However, due to global shortage of benzathine benzylpenicillin (limited global supply of the active pharmaceutical ingredient), the algorithms now recommend doxycycline, oral except in pregnant women and children
- Azithromycin is not recommended for the treatment of syphilis in pregnancy as azithromycin does not effectively treat syphilis in the fetus, and resistance develops rapidly to macrolides
- Therefore, the limited stock of benzathine benzylpenicillin must be reserved for use in pregnant women and children
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2020 Edition