S

e
x
u
a
l
l
c
•

o
.
n
D
E
tF
e
I
n
N
t
A
T
I
O
N
•

.
R
I
S
K
D
•

E
-
F
A
I
N
n
A
T
Ii
O
n
N
f
O
e
F
c
tS
RISK FACTORS
• Can be divided into
§ Biological factors

§ Social factors

§ Behavioural factors.

• Biological factors.

§ Age –young people are more at risk.

§ Sex- female are more affected than men.

§ Immune status of the host.-some sti’s increase risk of HIV

§ Virulence of the organism.

• SOCIAL FACTORS/CULTURAL FACTORS.
• Having multiple sexual partners
• Occupation eg sex workers
• BEHAVIOURAL FACTORS
• Participation in unprotected vaginal, oral or anal sex..
• Misuse of alcohol or use of recreational drugs. Substance misuse can inhibit your

judgment, making you more willing to participate in risky behavior

• [Link]
v chlamydia
v [Link]
v Syphilis
v CHANCROIDS
• [Link]
v HIV/AIDS
v human papillomavirus (HPV)
v herpes (HSV or herpes simplex virus)
v VIRAL HEPATITIS B
• [Link]
v PUBIC LICES
v SCABIES
•

4
.
P
r
o
t
o
z
o
a
•

T
r
i
c
h
o
S
i
g
Sores or bumps on the genitals or in the oral or rectal area
n •
• Painful or burning urination
s • Discharge from the penis
• Unusual or odd-smelling vaginal discharge
• Unusual vaginal bleeding

a • Pain during sex

• Sore, swollen lymph nodes, particularly in the groin but sometimes more
n widespread
d • Lower abdominal pain
• Fever
• Rash over the trunk, hands or feet
s
y
m
p
t
SYNDROME POSSIBLE CAUSE

vaginal discharge Vaginitis(trichomniasis, candidisis)

Cervicitis(gonorrhea, chlamydia

Urethral discharge Gonorrhea, chlamydia

Genital ulcer
Syphilis, chancroid, herpes
Lower abdominal pain Gonorrhea, chlamydia, mixed
anaerobes

Scrotal swelling gonorrhea, chlamydia

Neonatal conjunctivitis Gonorrhea,chlamydia

U
r
e
t
h • Urethral discharge is the presence of abnormal secretions
r from the opening of the urethra.
a • Clinical manifestation.

l - burning sensation when passing urine (dysuria)

- increased frequency of passing urine

d - itching sensation

• common causative agent are Neisseria gonorrhoea and

i
s Chlamydia trachomatis.
• Less common causative agent are Trichomonas vaginalis and
c
• Mycoplasma genitalium
h
a
D
I
AHistory taking is key.
•

GDuration,
•
•
amount of discharge, colour of discharge, pain on
micturition, history of multiple sexual partners, history of last unprotected casual sex.
NSystemic physical examination
•
- general inspection of the skin for rash, sores or warts.
O-palpation for presence of enlarged lymph nodes,
v
v

S-examination
v
v
of the oral cavity, and the inguinal region.
-the penis should be examined for ulcers, discharge or warts;.
I -the scrotum and testicles for swelling and tenderness
v
Lab investigation
S-culture of urethral discharge
•
•
• -urine/urethral swabs tests for gonorrhea and Chlamydia
• -Polymerase chain reaction[PCR]
 4C’s OF GOOD STI’S MANAGEMENT
• Counselling.
• -Emphasize on the risks of STIs including HIV
• -Offer HIV testing and counseling services
• Compliance.
• -Your patient should:
• • Avoid self medication
• • Take the full course of medication and not to share or keep it
• • Follow your other instructions
• Condoms.
• • Proper use of condom is the only other alternative to abstinence to protect from STIs
• • Give condoms to your patients
• • Explain and demonstrate the correct use of condoms
• Contact treatment.
• -Your patient should
• • Tell all his/her sexual partners to seek medication
 Vaginal Discharge Syndrome
• Women physiologically produce normal vaginal discharge, which is white, mucoid,
odourless , nonirritating, either thin or thick depending on the stage of the menstrual
cycle.
• Abnormal vaginal discharge which is most often associated with an STI is described in

terms of quantity, colour or odour. commonly indicates one or more of the following:
• • Vaginal infection
• • Vaginitis
• • STIs such as Chlamydia (Chlamydia trachomatis), Trichomoniasis (Trichomonas

vaginalis),
• Mucopurulent cervicitis due to gonorrhoea (Neisseria gonorrhoea)
• • Non-STIs such as Bacterial vaginitis (multiple organisms) or yeast infection (Candida

albicans)
• .
continuation
• Clinical Manifestation of yeast infection
• -White, cottage cheese-like discharge.
• -Swelling and pain around the vulva.
• -Intense itching.
• -Painful sexual intercourse
• Symptoms of bacterial vaginosis.
• -A white, gray, or yellowish vaginal discharge
• -A fishy odor that is strongest after sex or after washing with soap
• -Itching or burning
• -Slight redness and swelling of the vagina or vulva
• Signs of trichomoniasis
• -A watery, yellowish, or greenish bubbly discharge
• -An unpleasant odor
• -Pain and itching when urinating
• -Most apparent after your period
• DIAGNOSIS
• -history taking. Onset of symptoms, duration, number of sexual patners, history of

previous sti , color of the discharge, smell

• -pelvic examination- examination of the external genital area and the insertion of

a speculum to examine the vaginal walls and cervix.

• -Lab investigation –culture of the vaginal discharge
L
o
w
e
r • All sexually active women presenting with lower abdominal pain should be carefully evaluated for
signs of pelvic inflammatory disease (PID).
• Common causes include gonorrhea, chlamydia, and trichomoniasis.

A • Clinical Manifestations
• • Lower abdominal pain
b • • Pain on intercourse (dyspareunia)

d • • Bleeding after sex or between periods

• • Pain associated with periods (if this is a new symptom)
o • • Vaginal discharge
• • Pain on urination (dysuria)
m • • Fever, nausea and vomiting may also be present
i
n
a
l
diagnosis
• medical history. ask about sexual habits, history of sexually transmitted infections
and method of birth [Link] of pain,location,severity of the pain
• pelvic exam-palpation of tenderness,pelvic mass.
• transvaginal ultrasound
• Lab tests
• -pregnancy test
• -urine test to test for gonorrhea, chlamydia, and Trichomoniasis
• -urinalysis to rule out UTI
 Genital Ulcer Syndrome
• Genital ulcers in both men and women resulting from STIs are a result of
either syphilis or chancroid if solitary, or of viral herpes if multiple and
vesicular.
• Syphilis.

• Treponema pallidum is the causative organism for syphilis. Syphilis has 4

stages of clinical presentation:

• Primary Stage

• -This is characterized by a local lesion at the site of entry, which ulcerates

to form an ulcer
• -The classical ulcer known as a chancre, is usually single, painless and

relatively clean
 continuation
• Left untreated the chancre persists for about 3-6 weeks and then heals
spontaneously. In most
• cases regional lymphadenopathy develops within a week of appearance of

the chancre.
• The lymph nodes are non-tender, painless and often bilateral.

• Secondary Stage.

• -In this stage, Treponema pallidum disseminates widely throughout the body

about 3-6 weeks after the appearance of the chancre.

- It is at this stage that the disease is seen to be systemic.

- Common symptoms of secondary syphilis include skin rashes, itch mainly at

the palms and soles, generalized lymphadenopathy and mucosal ulceration,

among others.
- All manifestations of secondary syphilis resolve with or without treatment
• Latent Stage
• This stage of syphilis is asymptomatic after resolution

of the clinical manifestations seen in secondary syphilis.

• However, during this stage the patients have a positive

syphilis serology tests.

• Tertiary Stage
• This stage syphilis affect many different organs in the body,

including the heart, blood vessels, brain (neurosyphilis) and the eyes
(ocular syphilis).
• Neurosyphilis may present with severe headaches,difficulty in

coordinating muscular movements, paralysis, numbness and mental

disorders.
• Symptoms of ocular syphilis include changes in vision and even

blindness
• DIAGNOSIS-VDRL
• Chancroid
• This is caused by Haemophilus ducreyi, a gram-negative bacillus. It manifests

clinically as ulcerative lesions or inguinal tenderness.

• The ulcer is usually quite painful with ragged undermined edges, is sharply outlined

without indurations, and sometimes bleeds on scrapping.

• Painful inguinal bubo may be present and disfiguring of genitalia is a possible

complication.
• Diagnosis-swab culture of ulcer.
Neonatal Conjunctivitis (Ophthalmia Neonatorum)

§ This is an eye infection that occurs within the first 30 days of life.
§ It is caught during vaginal delivery from exposure to bacteria from the birth canal
§ most common cause is Neisseria gonorrhoea, with the cause been Chlamydia

trachomatis
§ All new-born babies, regardless of maternal signs or symptoms of infection, should

receive prophylaxis against ophthalmia neonatorum due to gonorrhoea or

chlamydial infection.
§ The incubation period is usually as follows:
§ C. trachomatis: 5-14 days
§ N. gonorrhoea: 3-5 days
Clinical symptoms
• redness,
• swelling of the lids,
• Pain and tenderness in the eyeball
• Conjunctival discharge: purulent, mucoid or mucopurulent (depending on the

cause)
• Corneal involvement (rare) may occur in herpes simplex ophthalmia neonatorum.

• DIAGNOSIS
C
o
m
p • Pelvic inflammatory disease
• Infertility
l • Eye inflammation/blindness

i • Liver cancer and cirrhosis by Hepatitis B

• Meningitis and bladder issues by Genital herpes
c • Pregnancy complication

a • Arthritis
• Ectopic pregnancies due to tubal damage
t • Erectile dysfuction.

i
o
n

o
f
A
n
o
r • In men, anorectal discharge typically occurs among MSMs and who engage in anal
e receptive intercourse.
c • In women, anal discharge caused by N. gonorrhoea and C. trachomatis is more likely

to be seen in female sex workers. It can be transmitted to the anal canal via a genital
t infection due to the proximity of the vagina, even in the absence of receptive anal
a intercourse.
• Clinical Presentation.
l • STI presenting with anorectal discharge may manifest with pain, pruritus, tenesmus,

mucopurulent or purulent discharge with or without rectal bleeding

D
i
s
c
• Clinical Examination
• -physical examination
- history of risk behaviour, duration of the discharge, and examine the anal opening of

the patient.
• Syndromic Treatment of Anorectal Discharge
A
•

n
S
T
o
I
rs
e
t
c
h
t
a
t
a
lc
a
u
U
s
l
e
c
a
e
n
rr
o
Syndromic Treatment of Anorectal Ulcers

• Non-vesicular Ulcer
• -First Line Preferred Treatment:
• Benzathine penicillin 2.4 MU IM weekly for 3 weeks AND Azithromycin 2 gm PO stat:

4Cs
• OR
• Second Line Preferred Treatment: Ceftriaxone 1 gm stat IM AND Doxycycline 100 mg

PO BD for 14 day if allergic to penicillin: 4Cs.

• Note: Doxycycline is contraindicated in pregnancy
•

F
i Vesicular Ulcers
r
s
t

L
i
n
e

P
r
e
f
e
r
r
•

S
T Painful Scrotal Swelling
I
s

m
a
y

p
r
e
s
e
n
t

w
C
•

lS
i
c
r
n
o
it
c
a
la

ls
w
M
e
a
l
l
n
i
i
n
f
g
e
c