Sexually Transmitted Infections

Accurate laboratory-proven diagnosis of sexually transmitted infections (STI) is desirable but not always possible. Management guidelines recommended in this section are based on the diagnosis of STl-associated syndromes. This involves the provision of the complete management package including provision of antibiotics for the STI syndrome, provision of health education, promoting risk reduction behaviour and treatment compliance, provision of condoms, providing information on partner referral an

The commonest causes are Neisseria gonorrhoeae and Chlamydia trachomatis, and the two often co-exist. Trichomonas vaginalis also causes a urethral discharge in men. All males with urethral discharge and all women with cervicitis should be treated for both gonorrhoea and chlamydia in view of the fact that the two coexist and present with similar signs and symptoms. Any sex partners in the preceding three months should be treated presumptively for the same infections as in the index patient, and a

All women with a vaginal discharge must have a vaginal examination. Some vaginal discharges are normal. However, any woman concerned about a vaginal discharge should be examined and the patient managed appropriately.

Anorectal symptoms and sexually transmitted anorectal infections are prevalent in men who have sex with men (MSM), in female sex workers, transgendered and heterosexual individuals who practise anal sexual intercourse.

Infections of the ano-rectal region can be divided into the following anatomical

The commonest cause of genital ulcers in both men and women is genital herpes simplex virus type 2 (HSV2) infection. Syphilis and chancroid also cause genital ulcers but the prevalence of chancroid is low in Zimbabwe. Clinical differentiation between the causes of genital ulcers is inaccurate except if the patient gives a clear history of recurrent attacks of vesicular lesions that may crust and heal spontaneously or if the clinical appearance of the lesions are those of superficial ulcers, when

These are most likely to be lesions of granuloma inguinale, a condition also known as Donovanosis and caused by Calymmatobacterium granulomatis. It should be remembered that persons who are immunosuppressed may not develop a bubo and occasionally persistent genital ulcers without bubo formation may occur as a result of chancroid in persons with immunosuppression and HIV infection.

This usually occurs in persons with lymphogranuloma venereum (LGV) which is caused by the L-types of Chlamydia trachomatis. The main effect of the infection is on the lymphatics and patients may present with penile and vulval lymphoedema together with inguinal buboes. Rectal LGV infection can also present with anal discharge and may be confused with inflammatory bowel disease. A small transient genital ulcer, which may heal on its own, may precede the swelling and buboes. The bubo is typically m

Acute scrotal swelling may occur in persons with acute epididymo-orchitis, testicular torsion and scrotal trauma, and in those with irreducible or strangulated inguinal hernia. Patients should be examined carefully in order to exclude these conditions. If patients do not respond to first line therapy, they should be referred for further investigations.

CAUTIONS: For external use only. Do NOT use podophyllin in pregnancy. Do not apply to the cervix, urethra or anal mucosa. Do not use imiquimod cream for genital warts on children under 12 years

The lesions of molluscum contagiosum may resolve spontaneously. In most instances, they do not have to be treated unless cosmetically unacceptable. If not acceptable, each lesion should be pricked with a sharpened “orange-stick” or needle and the contents of the lesion expressed. This alone may be sufficient, or each lesion can then be touched carefully with liquefied phenol. Referral for cryotherapy is also an option.

Patients with pediculosis pubis and their sexual partners should be treated as follows

This is defined as conjunctivitis with discharge occurring in a neonate within the first month of life. The condition is commonly caused by gonococcal, chlamydial and bacterial infection. The condition is preventable by detecting and treating maternal gonococcal and chlamydial infection during pregnancy and by instilling 1% tetracycline eye ointment carefully into the conjunctival sacs of every baby as soon as possible after birth.