STI Syndromic Management^2021^4EDI^^811

STI
) Syndromic Mangement (
: Adopted from
W.H.O GUIDELINES
CDC &
Prepared by Dr. Alok Acharya

The syndromic approach bases treatment on
groups of symptoms (client complaints) and signs
(client and provider observations) which can be
explained by more than one possible infection.
.These groups are called syndromes
This approach requires that providers of health

care know the most common causative organisms
for each syndrome and the appropriate anti-
.microbial treatment
Syndromic management enables providers of the
health care to offer treatment when services sites
lack laboratory facilities or skills that would allow
the specific causative organism to be identified
Providers of primary health care can start

treatment immediately, instead of referring the
client to a more complex service facility which may
.not be easily accessible
In the syndromic case management approach people
with STD are provided with the total care "package"
.and not simply antibiotics for the infection
The total management package should be given in

order to make sure that the patient understands
his/her illness and can take steps to avoid acquiring
.the infection again in future
In providing care for persons with STD all health care

providers should make sure that the patient is
.managed comprehensively
The various components of comprehensive
syndromic case management include the
.following steps
Make a syndromic diagnosis through history -1

.taking and examination
Give the patient the appropriate antibiotics for the-2

.STD syndrome
.Assess the patient's personal risk status for STD -3

:Provide health education on-4
.The nature of the infection and possible complications -
.The relationship between HIV infection and other STDs -
.The importance of treatment compliance -.
.Risk reduction through safer sexual behavior and safer sex acts -
. Arrange for partner (s) to receive treatment -
.
. Arrange for afollow –up examination -
The most relevent STD syndrome are
Urethral discharge-
Genital ulcer-
Vaginal discharge-
Lower abdominal pain-
Urethral Discharge
IN MEN:
 INFLAMMATION OF THE PERIURETHRAL TISSUE CAUSES
ABCESS
 MULTIPLE DISCHARGING SINUSES (multiple fistula
[WATERCAN PERINIUM].
 INFECTION EXTENDS ALONG THE URETHRA TO
PROSTATE, SEMINAL VESICLE AND EPIDIDYMIS.
IN WOMEN:
 VULVOVAGINITIS - MUCOPURULENT DISCHARGE.
 SALPINGITIS - INFECTION OF THE FALLOPIAN TUBES.
 CERVICITIS.
 PELVIC INFLAMMATORY DISEASE.
: Suggested treatment
Ceftriaxone 500 mg intramuscularly (IM) in a single dose ,
or
Spectinomycin 2g IM in a single does, or
Ciprofloxacin 500 mg orally in a single dose, or
Cefixime 400 mg orally in a single dose ,or
Kanamycin 2g IM in single dose , or
Thiamphenicol 2.5g orally daily for 2 daily for 2 days, or

;Plus : Doxycycline , 100 mg by mouth 2 times daily for 7 days
:OR Azithromycin , 1 gm by mouth single does
OR TETRACYCLINE , 500 mg by mouth 4 times daily for 7 days for

chlamydia
Syphilis Chancroid (soft Chancre)
STI caused by the spirochete -Treponema Pallidum Chancroid is STI that
incubation period - 9-90 days. causes painful open sores,
Modes of transmission• or chancroids, to develop
Vertical transmission through mother to child during in the genital area. It can
intrauterine life (transplacental). also often cause the lymph
Direct contact with infected discharges nodes in the groin to
Sexually (unprotected sex) with infected person swell and become painful.
Agent: Hemophilus Ducreyi
Primary stage: Incubation Period 2-5 days

Identified by the presence of painless sores or lesions, Risk Factors•
known as chancre, which disappears at the site of contact primarily occurs through
from the 10th to 90th day after initial exposure. direct contact with the
The sore/chancre is firm, painless, superficial, ulcerated, open sores of an infected
and may persist for 4-6 weeks, healing spontaneously. individual.
Painless regional Lymphadenopathy develop within 1-2
weeks after the appearance of the chancre.
This stage may be missed since the sore is usually painless.
Syphilis Chancroid
Secondary Stage: Additional risk factors

Occurs about 1-6 months after primary Infection include:
Characterized by flu-like syndrome : Mild pyrexia, Unprotected sexual contact
headache, anorexia, and sometimes weight loss . Multiple sexual partners
Lymphadenopathy and the appearance of systemic Sexual engagement with sex
reddish-pink rashes on the trunk, extremities, palms, workers
soles of the feet, anus, and vagina. Substance abuse
Flat-broad whitish lesions develop from the rash, Anal intercourse
known as Condylomata Lata. General sexual activity
Grey-white patches on the tongue, soft palate, and Residence in specific
throat, known as Snail Tracks. developing nations
Loss of hair (alopecia) may occur. Rough intercourse
Serological tests are positive.
This stage may last up to 9 months and is followed by a
latent period where no clinical signs are present.
Syphilis
Syphilis Chancroid
Tertiary stage: Signs and symptoms:
Affects the cardiovascular and nervous systems A small, painful ulcer appears on
1-10 years after initial infection. the genital parts, known as a
Without treatment, complications may include: soft chancre.
• Swelling (gumma) on the skin, mucous Enlargement and inflammation of
membrane, and bones. the inguinal area with pus.
• Ulceration of skin swellings resulting in chronic Headache.
ulcers. Generalized malaise.
• Spread to the cardiovascular system may lead to
aortic aneurysm, aortic insufficiency, or coronary
arteriosclerosis.
• Spread to the nervous system may result in
memory loss, confusion, mental disability.
• Joint degeneration, failing sight, and deafness
may occur.
Syphilis Chancroid
Diagnosis:
• VDRL (venereal disease research
laboratory) test.
RPR (rapid plasma reagent) test, which
confirms the presence of
the disease.
• Rahm test and Wasserman are some
of the tests for syphilis.
Suggested treatment :
For syphilis : Benzathine penicillin G, 2.4 million IU in 2

intramuscular
. injections during 1 clinic visit ; give 1 injection into each buttock
;Plus : Ciprofloxacin , 500 mg by mouth 2 times daily for three days
;OR azithromycin , 1g by mouth as a single dose
OR erythromycin , 500 mg by mouth 4 times daily for 7 days
Chancroid
Azithromycin 1 gm orally in a single dose
OR Ceftriaxone 250 mg IM in a single dose
OR Ciprofloxacin 500 mg orally 2 times/day for 3 DAYS
OR Erythromycin base 500 mg orally 3 times/day for 7 days
There is no cure for genital herpes but symptoms
should be treated as follows : advise clients to wash
genital area regularly with soap and water . Prescribe
,paracetamol ( acetaminophen )
. If available you may provide acyclovir treatment

Use any of the single – dose therapies recommended for

, uncomplicated gonorrhea
. OR ceftriaxone , 500 mg single dose intramuscular injection

if single – does therapy for gonorrhoea is not available give
trimethoprim 80 mg / sulfamethoxazole 400 mg ( co –
trimoxazole) , 10 tabltes orally once daily for 3 days and then 2
. tablets orally twice daily for 10 days
Plus : doxycyline , 100 mg by mouth 2 times daily for 14 days; OR

; tetracycline , 500 mg 4 times daily for 14 days
Plus : metronidazole , 400-500mg by mouth 2 times daily for 14

. days
Follow-up care
When clients return for follow-up, ask the

:following
?Do they have any symptoms of an STD
?Have they completed their course of treatment
?Have their partner(s) been treated

Treatment failure
STD management and treatment may fail for the following

:reasons
.The client may have failed to take the full course of medication -
The client may have been re-infected because the partner was -
.not treated
.The causative organism is resistant to the treatment regimen -
. The treatment was not appropriate -
Syndromes management does not address all Causative (

arganisms as in the case of common infections
(e.g,tymphogranuloma venereum and donovanosis that canse
ulceration )

STI Syndromic Management^2021^4EDI^^811

Uploaded by

Copyright:

Available Formats

STI Syndromic Management^2021^4EDI^^811

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

STI Syndromic Management^2021^4EDI^^811

Uploaded by

Copyright:

Available Formats

STI

Prepared by Dr. Alok Acharya

This approach requires that providers of health

Providers of primary health care can start

The total management package should be given in

In providing care for persons with STD all health care

Make a syndromic diagnosis through history -1

Give the patient the appropriate antibiotics for the-2

.Assess the patient's personal risk status for STD -3

.The nature of the infection and possible complications -

.The relationship between HIV infection and other STDs -

.The importance of treatment compliance -.

. Arrange for partner (s) to receive treatment -

Spectinomycin 2g IM in a single does, or

Ciprofloxacin 500 mg orally in a single dose, or

Cefixime 400 mg orally in a single dose ,or

Kanamycin 2g IM in single dose , or

Thiamphenicol 2.5g orally daily for 2 daily for 2 days, or

:OR Azithromycin , 1 gm by mouth single does

OR TETRACYCLINE , 500 mg by mouth 4 times daily for 7 days for

Primary stage: Incubation Period 2-5 days

Secondary Stage: Additional risk factors

For syphilis : Benzathine penicillin G, 2.4 million IU in 2

;Plus : Ciprofloxacin , 500 mg by mouth 2 times daily for three days

;OR azithromycin , 1g by mouth as a single dose

OR erythromycin , 500 mg by mouth 4 times daily for 7 days

There is no cure for genital herpes but symptoms

should be treated as follows : advise clients to wash

genital area regularly with soap and water . Prescribe

. If available you may provide acyclovir treatment

Use any of the single – dose therapies recommended for

. OR ceftriaxone , 500 mg single dose intramuscular injection

Plus : doxycyline , 100 mg by mouth 2 times daily for 14 days; OR

Plus : metronidazole , 400-500mg by mouth 2 times daily for 14

When clients return for follow-up, ask the

?Do they have any symptoms of an STD

?Have they completed their course of treatment

?Have their partner(s) been treated

STD management and treatment may fail for the following

.The causative organism is resistant to the treatment regimen -

. The treatment was not appropriate -

Syndromes management does not address all Causative (

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.