SEXUALLY TRANSMITTED

INFECTIONS

BY:
Friday, October 24, 2025
Abrahaley W. 1
 contents

• Introduction
• Definitions
• Diagnosis of STI/STD
• Clinical diagnosis & management
• Syndromic management
• STD Clinical Syndromes

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 Introduction

 The most common infectious disease in the world.

 Sexually transmitted infections, also called venereal
diseases.
 Five key points about all STIs today:
1. STIs affect men and women of all backgrounds and
economic levels.
 They are most prevalent among teenagers & young adults.
2. The incidence of STIs is rising: Reason??
• Sexually active earlier but marrying later.
• In addition, divorce is more common.
• Sexually active people today are more likely to have multiple
sex partners during their lives & at risk for STIs.
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 Intro…
3. Most of the time, STIs cause no symptoms, particularly in
women but may be able to pass the disease on to a sex
partner.
• That is why periodic testing or screening for risky people.

4. More severe & more frequent for women than for men b/c
asymptomatic infection.
 Many women do not seek care until serious problems
infertility & ectopic (tubal) Pregnancy.
 STIs in women also may be associated with Cx Ca (HPV).

5 . STIs can be passed from a mother to her baby before,

during, or immediately after birth.
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 think-pair-share!!
• What is the difference b/n STD and STI?
• Why the term STI is commonly used?

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 Definitions
 STI – Infections acquired through sexual intercourse (may be
symptomatic or asymptomatic)

 STD – Symptomatic illness acquired through sexual intercourse

 WHO recommends that the term STD be replaced by STI.
 STI has been adopted since 1999 as it better incorporates
asymptomatic infections.
 to emphasize the infectious nature of asymptomatic diseases.
 the need for screening.
 early recognition, & treatment.

10/24/2025 6
 STI…

• Sexually transmitted infections are among the most common

causes of illness in the world
• STIs have health, social, economical & psychological
consequences
• Are caused by more than 30 different pathogens including
bacteria ,viruses ,protozoa ,fungus & parasites
• Despite there are more than 30 kinds of organisms that cause
STIs, most causes similar signs & symptoms

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 STI…
Organisms Diseases
Bacteria
[Link] Gonorrhea
Chlamydia trachomatis Chlamydia
Haemophilus ducrey Chancroid
Treponema pallidum Syphilis

viruses
Herpes simplex virus Genital herpes
Hepatitis B virus Hepatitis B
HPV Cx ca
HIV AIDS

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 STI…
Organisms Diseases

Protozoa

Tricomanas vaginalis Vaginitis

Fungi

Candida albicans Vaginitis

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 STI…

• The common classical STIs are gonorrhea,

syphilis, chancroid, lymph granuloma

venarem(LGV), chlamydia infections &

trichomoniasis.

• Can also be classified as: curable & non-curable

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 cont.…

Curable Non-curable
• Gonorrhea • HIV/AIDS
• Syphilis • human papilloma
• Chlamydia infection virus(HPV)
• chancroid • hepatitis B virus
• Trichomoniasis • herpes simplex virus
• Lymphoglandular venerium

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 The main modes of transmission of STI

• Unprotected penetrating sexual intercourse

• Mother to child

• Blood transfusion

• Other products of blood

 One means of reducing STI is through effective case

management and identification

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 STI…

• Epidmiology of STIs
– STIs are major public health problems in all
countries, but are especially in developing
countries due to very limited or absence of

adequate diagnostic & treatment facilities.

– Mostly young age groups are affected( especially
adolesents & adults)

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 STI…
• Public health impact of STIs: examples
– 1)women
• Cervical ca.
• PID with resulting infertility
• Chronic abdominal pain
• Ectopic pregnancy
• Related maternal mortality
– 2)If it occurs during pregnancy
• IUGR
• PROM
• Still birth
• Low birth weight
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2025 14
 Approach methodology to STIs

• There are 3 diagnostic approaches:

A. Etiologic
B. Clinical &
C. Syndromic
• What is the difference b/n the 3:

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 Approach…
Diagnostic approaches Advantages Disadvantages

1)Etiologic
This is done by identifying • Avoids over Rx • Requires skilled personnel
the causative agent using • Satisfies Patient who feel & sophisticated equipment
laboratory tests & giving not Properly attend to • Not easily accessible
treatment targeting to the • Can be used to screen • Costly & time consuming
pathogen identified asymptomatic Patient. • Delay in treatment
• Mixed infection overlook

2)clinical
Using clinical experience to • Save time for Patients • Requires high clinical skill
identify symptoms which • Reduce lab expenses • Mixed infections often
are typical for specific STI, overlooked
then giving treatment to the • Doesn’t identify
suspected pathogen(s) asymptomatic Patients

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 Approach…
3) Syndromic Advantage Disadvantage

Identification of clinical • complete STI care given -risk of over-treatment

syndrome & giving at first visit -requires prior research to
treatment targeting all the • simple, rapid & determine the common
locally known pathogens inexpensive cause of particular
which can cause the • Patient treated for syndrome
syndrome. possible mixed -asymptomatic infections
infections are missed
• accessible to broad
range of health workers
• curtails unnecessary
referrals

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 Approach…
• Syndromic approach is called “Comprehensive approach”
because in addition to the provision of treatment it includes:
 Education of the patient,
 Condom supply
 Counseling
 Partner notification and management
 HIV testing and counseling (HTC)

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 Approach…
• Therefore, to countries like Ethiopia the best way of
approach is Syndromic approach.
• Syndrome: is simply a group of the symptoms of which a
patient complains & the signs observed during
examination.
• So, we have to follow & treat them using a clinical
algorithm called flow chart.

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 Flow chart
• Is decision and action tree, and it is like a map that guides
the health worker to go through a serious of decision and
actions.
• Components Flow chart: it has 3 components that
we have to follow them in series
– Clinical problem: deals about the Patient’s presenting
complaints or symptoms.
– decision: deals with history and physical examination
– Action or Do box: deals on what action to be taken
• Benefits of flow-chart:
– Can be used any time in all types of health facilities
– Suggest clear decision
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 Major STD clinical syndromes

• Genital ulcer

• Urethral discharge

• Abnormal vaginal discharge

• Lower abdominal pain

• Inguinal bubo

• Scrotal swelling

• Neonatal conjunctivitis
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10/24/2025 22
 [Link] ulcer

Causative agent:

•Treponema pallidum(syphilis)

•Herpes simplex virus(herpes)

•Haemophilus ducreyi(chancroid)

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 [Link] ulcer

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 Genital Ulcers Syndrome

Patient complains
Of genital ulcer

Take history and

examine

Educate on risk
Reduction, offer HIV
Is ulcer vesicle or Solitary non-recurrent Counseling and
Recurrent or more No And non vesicular ulcer No
Testing(HCT)
Than 3 ulcer present present? Promote condom
Use and provide
Yes Condoms.
Yes
Treat only for
HSV Treat for SYPHILIS
CHANCROID and
HSV
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 Educate on risk reduction
Promote condom use and provide condoms
Offer HIV counseling and testing (HCT)
Ask the patient to return in 7 days
Notify and manage partner(s)

No No
Ulcer(s) healed? Ulcers Improving? Refer

yes Yes
Educate on risk reduction
Promote condom use and Continue treatment
Provide condom Complete 10days course
Offer HIV counseling and Consider follow up
testing(HCT)
Notify and manage partners
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 TREATMENT OF GENITAL ULCER SYNDROME

Recommended treatment for non vesicular genital ulcer

Benzathine Penicillin 2.4 miu IM stat / (in Penicillin allergy

Doxycyclin 100mg BID for 14 days Plus

• Ciprofloxacin 500mg BID orally for 3days /Erythromycin

tablets 500mg QID for 7days plus

• Acyclovir 400mg TID orally for 10 days (or 200mg five times

per day of 10 day)

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 TREATMENT OF GENITAL ULCER SYNDROME

• Recommended treatment for vesicular multiple first

episode genital ulcer

Acyclovir 200mg 5 times per day for 10days/Acyclovir

400mg TID for 10days

• Treatment for recurrent infection: Acyclovir 400 mg TID for

7 day

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 2. Urethral discharge

• Neisseria gonorrhea The most common

• Chlamydia trachomatis
• Trichomonas vaginalis

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 [Link] discharge

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 Clinical features
 Purulent/muco-purulent and profuse urethral discharge with or
without dysuria
 Small to large amount of mucus or pus at end of penis (urethral
discharge)
 Staining of underwear

 Frequency of urine (Other bacterial urinary tract infections should be

excluded)
 Occasionally urethral discharge is absent, or may be clear and
apparently non purulent

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Urethral discharge syndrome flow chart in men

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 Recommended treatment
• Ceftriaxone 250mg IM stat/Spectinomycin 2 gm IM stat plus

• Azithromycin 1gm PO stat/Doxycycline 100 mg PO BID for 7

days/Tetracycline 500 mg PO QID for 7 days/ Erythromycin

500 mg PO QID for 7 days in cases of contraindications for

Tetracycline (children and pregnancy)

• Note: The preferred regimen is Ceftriaxone 250mg IM stat

plus Azithromycin 1gm PO stat

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 Treatment….
• In addition to treatment, the healthcare provider should
educate the patient on
 Risk reduction

 Treatment compliance

 Proper and consistent use of condom

 Partner notification and management

 Importance of HIV testing

 Abstinence from sex till all symptoms resolve

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 [Link] discharge syndrome

1. Neisseria gonorrhoea cervicitis

2. chlamydia trachomatis
3. Trichomonas vaginalis
4. Gardnerella vaginalis vaginitis
5. Candida albicanis
Bacterial vaginosis (Gardnerella vaginalis) is the leading cause of
vaginal discharge in Ethiopia followed by candidiasis,
trichomoniasis, gonococcal and chlamydia cervicitis in that order.

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 [Link] discharge syndrome

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 CLINICAL MANIFESTATIONS
• The classical manifestation of vaginal discharge is

discharge from the vagina.

 Thin, homogenous whitish discharge with fishy odor

 Thick, profuse, malodorous, yellow-green, frothy, itchy

 Purulent exudate from the cervical Os ,White , thick

and curd like discharge coating the walls of the vagina

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 Vaginitis

• Bacterial vaginosis-homogeneous with typical fishy

odor.
• Vulvo vaginal candidasis –pruritis

-typical cheese-like discharge without odour.

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 Cervicitis
-Frequently asymptomatic.

clinical future
 Redness

 Contact bleeding

 Spotting

 Endocervical discharge

 Purulent exudates from cervical os.

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Risk factors for STI related cervicitis

• Risk factors for development of vaginal discharge

syndrome secondary to cervicitis:
 Multiple sexual partner in the last 3 months
 New sexual partner in the last 3 months
 Age below 25 years
 Ever traded sex

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 Complications of cervicitis & vaginalis

• PID
• PROM
• Preterm labor
• Infertility
• Chronic pelvic pain

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Vaginal Discharge (SPECULUM& BIMANUAL)

Patient complains of vaginal discharge

or vulval itching/burning

Take Hx, examine patient

(External speculum & bimanual)
Educate
no Offer HCVT
Review if symptom
Abnormal Any other
persist
discharge genital disease
Promote & provide
yespresent? present?
condom
yes
Lower abdominal
Use flow chart for
tenderness or
lower abdominal
cervical motion
pain
tenderness
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 Vaginal Discharge
• No
yes
Was risk
assessment Treat for CHLAMYDIA, GONORRHEA,
positive? BACTERIAL VAGINOSIS &
no TRICHOMONIASIS
yes

Vulvar edema/curd
Treat for BACTERIAL like discharge. Treat for candida
VAGINOSIS no
Erythema, albicans
excoriation present

Educate
Offer HCVT
Promote & provide condom
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 Recommended Rx for vaginal discharge for risk
assessment positive
• Ceftriaxone 250mg IM stat/ Spectinomycin 2 gm IM stat plus

• Azithromycin 1gm PO stat/Doxycycline 100mg PO BID for 7 day

Plus Metronidazole 500mg BID for 7 days

• If discharge is white or curd-like add Clotrimazole vaginal pessary

200 mg at bed time for 3 day

Note: The preferred regimen is Ceftriaxone 250mg IM stat plus

Azithromycin 1gm PO stat plus Metronidazole 500 mg BID for 7 day

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 Recommended Rx for vaginal discharge for risk
assessment negative

• Metronidazole 500mg BID for 7 days

• If discharge is white or curd-like add Clotrimazole
vaginal pessary 200 mg at bed time for 3 days

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 Recommended regimens for pregnant
women
• Metronidazole 250mg orally, 3 times per day for 7days ,
after first trimester
• Metronidazole 2gm orally, as a single dose, if treatment is
imperative during the first trimester of pregnancy.

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 Education on risk reduction
• Cure your infection

• Do not spread infection

• Help your sexual partner

• Come back to make sure you are cured

• Stay safe with condoms

• Keep safe by staying with one sexual partner

• Protect yourself against AIDS

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 [Link] abdominal pain/PID syndromes

CAUSATIVE AGENTS

• [Link] Common

• [Link]

• Mycoplasma genitalium

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 LAP/PID….

 Antecedent events
 Abortion
 Delivery
 Menstruation
 Gynecologic surgical procedures

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 Clinical features
 Bilateral lower abdominal or pelvic pain(dull
abdominal pain)
 lower abdominal and adnexal tenderness together
with cervical excitation
 Vaginal discharge
 pain during intercourse or urination

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Friday, October 24, 2025 51
 Recommended treatment for PID
Out patient
• Ceftriaxone 250mg IM stat/Spectinomycin 2 gm IM stat plus

• Azithromycin 1gm PO stat/Doxycycline 100mg PO BID for 14

days plus

• Metronidazole 500mg BID for 14 days

• Admit if there is no improvement within 72 hours

• Note : The preferred regimen is Ceftriaxone 250mg IM stat

plus Azithromycin 1gm PO stat plus Metronidazole 500 mg BID
for 14 days
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 Recommended treatment for PID
Inpatient
• Ceftriaxone 250mg IV/IM daily /Spectinomycin 2gm IM BID plus
• Azithromycin 1gm PO daily / Doxycycline tablet 100 mg BID for 14
days Plus Metronidazole 500mg BID for 14 days.
 Ceftriaxone or Spectinomycin or azithromycin should continue for
24hrs after the patient remain clinically improved.
• After which doxycycline and metronidazole should continue for a
total of 14 days

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 [Link] swelling syndrome

Cause depends on age:

 <35 -[Link]

-C. trachomatis
 >35 -Gram negative organisms or TB

Other causes :
 Brucellosis

 Mumps

 Onchocerciasis…
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 Scrotal Swelling
Patient complains of
Scrotal swelling/pain

Take history and

examine Reassure patient and educate
Provide analgesic if necessary
Promote condom use and provide
Condoms
Swelling/pain
Offer HIV counseling and testing (HCT)
confirmed? No
Yes Treat for GONORRHOEA and CHLAMYDIA
Testis rotated INFECTIONS
Or elevated, Educate on risk reduction
Or history of Promote condom use and provide condoms
No Offer HIV counseling and testing(HCT)
trauma
Notify and manage partner(s)
Yes Review within 7days if necessary
Refer immediately If worse refer
For surgical opinion
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 Recommend treatment for Scrotal Swelling
• Ceftriaxone 250mg IM stat/ Spectinomycin 2gm IM stat
plus
• Azithromycin 1gm PO stat/Doxycycline 100mg BID PO for
7 days
• Note :The preferred regimen is Ceftriaxone 250mg IM
stat plus Azithromycin 1gm PO stat
• In addition analgesia and scrotal support may be
indicated as required

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 [Link] bubo syndrome/Swollen gland
• Localised enlargement of lymphnodes in the groin area which
are painful and fluctuant.
• Causative agent:
 [Link]
 [Link]
 [Link]
 T. pallidum
 LGV

Friday, October 24, 2025 57

 [Link] bubo syndrome

Friday, October 24, 2025 58

 Patient complains of Inguinal bubo
inguinal swelling

Any other STI

Take history and
present ? No
examine
yes *Educate on risk
No reduction
Inguinal / Use *Offer HCT
femoral bubo(s) appropriate * Promote and
present? flowchart provide condoms
yes
Treat for LGV , Claymedia and CHANCROID
• If fluctuant , aspirate through healthy skin
• Educate on treatment compliance
• Counsel on risk reduction
• Promote and provide condom ands
• Notify and manage partner
• Offer HCT
• advise to return in 7 days for review and
continue treatment if improving
• Refer if no improvement
Friday, October 24, 2025 59
 Recommended Rx for Inguinal Bubo
• Ciprofloxacin 500mg BID for 3 days plus
• Doxycycline 100mg BID orally for 7 days/ Erythromycin
500mg QID orally for 14 days.
• If patient have genital ulcer add Acyclovir 400mg TID PO
for 10 days (or 200mg five times per day of 10 day)

Friday, October 24, 2025 60

 [Link] conjunctivitis
• Neonate may develop infection of the eye during
birth as a result of genital infection of the mother.
• Causative agents :
 [Link]
 [Link]

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 Neonatal conjunctivitis

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 Neonatal conjunctivitis

Clinical features:
• Red and edematous conjunctiva
• Edematous eye lead
• Discharge which may be purulent
• Orbital cellulitis in more serious cases

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 Prevention of Neonatal Conjunctivitis

• Prompt eye prophylaxis at delivery should prevent

gonococcal conjunctivitis.
• As soon as the baby is born, carefully wipe both eyes
with dry, clean cotton wool
• 1% tetracycline eye ointment into the infant’s eyes

Friday, October 24, 2025 64

 Neonate with eye discharge
Neonatal conjunctivitis
Take history and
examine

Bilateral or unilateral
swollen eyelids with
No o Reassure
mother
purulent discharge o Advise to
return if
yes
necessary

Treat for Gonorrhea and Chlamydia

Treat the mother and partner
Educate ,council the mother
Advice to return in three days
refer
No

improved Continue
Friday, October 24, 2025 yes treatment 65
 Recommended Treatment for Neonatal
Conjunctivitis
• Ceftriaxone 50mg/kg IM stat maximum dose 125/

Spectinomycin 25 mg/kg IM stat maximum dose 75mg plus

• Erythromycin 50mg/kg orally in four divided doses for 14

days

• Note: TTC is used as prophylaxis for neonatal conjunctivitis

but note for treatment

Friday, October 24, 2025 66

 Reference

• National guideline for the management of STI using

the syndromic approach
• WHO Guideline for the management of STI using the
syndromic approach

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 Thank you

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