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    11 views22 pages

    Controlling Sexually Transmitted Diseases

    Uploaded by

    Taire Paul Capitulo

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 22
    CONTROLLING SEXUALLY TRANSMITTED DISEASES SYNDROMIC DIAGNOSIS Many health care providers lack time or equipment to diagnose STDs with laboratory tests, and many patients may not return for test results. Therefore, providers often diagnose based on clinical judgment and often they are wrong. The syndromic approach to STD patient management, which bases diagnosis on @ group of symptoms and treats for all diseases that could possibly cause that syndrome, could make diagnosis more accurate without extensive laboratory tests and allow treatment with a single visit. Combined with better drug supply, the approach could make STD services more widely acceptable through primary care clinics. The World Health Organization, working with STD experts, has developed step-by-step procedures, leading from presenting symptoms through diagnosis to treatment, to help providers use the syndromic approach. In the syndromic approach, providers diagnose and treat patients on the basis of _ groups of symptoms, or syndromes, rather than for specific STDs. Thus, for example, they treat for vaginal discharge or genital ulcer rather than for gonorrhea or sy! Since several STDs can cause a particular syndrome, providers may need to. at the same time. For example, genital ulcer is a symptom of both chan syphilis. Therefore, providers using syndromic approach in an area MAIN DISADVANTAGE OF SYNDROMIC APPROACH a) Failure to care adequately for people with STDs who have no symptoms. Women with STDS are often asymptomatic b) Wasting drugs which are scarce in many developing countries, on treatment for STDs that patients do not actually have THE PHYICAL EXAMINATION The physical examination allows providers to confirm the symptoms described by patients and, if possible, to check for signs of STDs. The physical examination can be conducted at several levels, each providing more information for a diagnosis. Syndromes only — Providers without gloves simply observe patients. Providers with gloves can examine patients more thoroughly. Many primary care providers using the syndromic approach are limited to this level of examination. Syndromes plus signs from physical examination — For women, the examination comprises an abdominal examination, pelvic examination with speculum and bimanual examination; for males, examining the penis and groin and feeling the testicles and epididymis. Syndromes and signs plus simple tests — for example, microscopy and testing the acidity (pH) of vaginal discharges — providers take specimens during _ the examination: samples of fluid from genital ulcers, a uretheal swabs GENITAL ULCERS PATIENT COMPLAINS OF GENITAL ULCER EXAMINE PATIENT L | Genital Ulcer Multiple Small, Blister-like Open Source (Painful or Painless) Painful Lesions May have Swollen Lymph Nodes In Groin I | Treat for Syphilis and , Chancroid Treat to Relieve Symptoms of Herpes GENITAL ULCERS TREATMENTS Syphilis 2) Benzathine penicillin G, 2.4 million 1U vo intramuscular injections during linic visit; give one injection in each buttock or b) Aqueous penicillin G, 1.2 million \U intramuscular injection daily for 10 days For men and non-pregnant women allergic to Penicillin ** Doxycyline, 100 mg by mouth 2 times daily for 15 days or ** Tetracycline, 500 mg by mouth 4 times daily for 15 days For pregnant women allergic to penicillin ** Erythromycin, 500 mg by mouth 4 times daily for 15 days. (Tell these women to bring their babies for screening for congenital syphilis within the first seven days after birth). URETHRAL DISCHARGE Man Complains of Urethral Discharge, Painful Urination | Examine Patients For Discharee Discharge Seen No Discharge Seen Treat for Gonorrhea & Chlamydia Re-evaluate if Symptoms Persist i ; Follow-up 7 Days After Clinic Visit URETHRAL DISCHARGE TREATMENTS Gonorrhea: a) Cefixime, 400 mg by mouth as single dose or b) Ceftriaxone, 250 mg intramuscular injection as a single dose or ¢) Ciprofloxacin, 500 mg by mouth as a single dose (Do not give to pregnant women) or d) Spectinomycin, 2 Gms intramuscular injection as a single dose Alternative Treatment: * Kanamycin, 2 Gms intramuscular injection as a single dose or * Trimethroprim 80 mg/ Sulfamethoxazole, 400 mg, 10 tablets once daily for 3 days, (Use only in areas where it has been proved effective against soa ji and where its effectiveness can be regularly monitored). VAGINAL DISCHARGE Woman Complains of Vaginal Discharge ee Risk Assessment: Ask These Questions Risk Assessment is Positive Only If Patient Answers “YES” To: Does your sexual partner have a discharge from his penis or open sores anywhere in his genital organ? Or if she answers “YES” to two or more of the following: a) Are you younger than 21 years? b) Are you unmarried, or not in union? ¢) Have you been with your husband or sex partner for less than three (3) months? d) Have you had more than one sexual partner in the last four (4) weeks? RISK ASSESSMENT POSITIVE SPECULUM AVAILABLE RISK ASSESSMENT POSITIVE, SPECULUM Profuse Discharge Clumped Discharge Oo — ~ VAGINAL DISCHARGE RISK ASSESSMENT NEGATIVE SPECULUM AVAILABLE RISK ASSESSMENT NEGATIVE Muco-Pus Profuse Clumped SPECULUM NOT From Cervix Discharge Discharge AVAILABLE 5 ee areal & Treat for: ie Treat for: Treat for: Trichomoniasis Treat for: 3 Candidiasis Gonorrhea and Candidiasis | © and and Bacterial Vagi- 2 | Trichomoniasis & eyes nosis Bacterial Vagi- Follow Up 7 Days After Clinic Visit TREATMENT Gonorrhea and Use same drugs for treatment (See treatment for Urethral Discharge) Chlamydia Candidiasis a) Clotrimazole, 200 mg vaginal tablet; insert one vaginal tablet daily for 3 days or b) Clotrimazole, 500 mg vaginal tablet; one vaginal tablet in the evening for one day ¢) Nystatin 100,000 1U; 1-2 tablets intravaginally daily for 14 days or d) Miconozole nitrate, 400 mg ovule; one vaginal ovule every evening for 3 days. (Should not be used in the first trimester of pregnancy) ‘Trichomonas and Bacterial Vaginosis jidazole, 400-500 mg by mouth 2 times daily for 7 days. ( Do not jin the first 3 months of pregnancy; delay any tr 1 month of pregnancy). Tell patients not to | LOWER ABDOMINAL PAIN WOMAN COMPLAINS OF LOWER ABDOMINAL PAIN Take History and Do Abdominal and Vaginal Examination Missed/Overdue Period? Pregnant? Or Recent Childbirth or Abortion Or Rebound Tenderness or Muscle Guarding? Or Vaginal Bleeding? Or Pelvic Mass? NO to all questions at left, But YES to Temperature 38°C or higher? Or pain during examination (on moving the cervix)? Or vaginal Discharge? Refer immediately to Hospital Treat for PID (For patients with IUD, remove IUD 2-4 days after starting treatment) NO TO ALL QUESTIONS LOWER ABDOMINAL PAIN TREATMENTS Pelvic Inflamatory Disease (PID) — Use this regimen only if the patient is well enough to take food and liquids, walk unassisted, take her medication, and return for follow-up. Otherwise, refer to higher level care. Single dose treatment for Gonorrhea a) Cefixime, 400 mg by mouth as a single dose b) Ceftrixone, 250 mg iy He Rpaitay injection as a single dose ¢) Ciprofloxacin, 500 nay mouth as a single dose d) Spectinomycin, 2 on by intramuscular injection as a single dose e) Kanamycin, 2 Gms ‘iy theanavenae injection as single dose a treatment — If single dose is not available ‘only in areas where it has been proved effective against effectiveness can be regularly monitored) a2 STEPS FOR STD PREVENTION AND MANAGEMENT (iohn Hopkins Schoo of Hygiene and Public Health) Give All Patients: 1. Treatment 2. Instruction for medication and follow-up 3. Education and counseling: (Make sure every STD patient leaves the clinic understanding and remembering these messages): a) Cure Your Infection: Take all your medications as instructed even if symptoms disappear or you feel better. b) Do not Spread STDs: Do not have sex again until you take all your medications as directed and you have no more symptoms. If you must have sex, use condoms with partners. c) Help Your Sexual Partner Get Treatment: Tell them to come for treatment or else bring them in. d) Come Back to Make Sure You Are Cured: If you still have symptoms, you can get more medicine to cure your infection. e) Stay Cured With Condom: Always use condom with any occasion al sexual partners and, if possible with your steady partners. f) Keep Safe by Staying With Just One Sexual Partner. g) Protect Yourself Against AIDS: Sexually transmitted diseases increase your risk of getting AIDS. h) Protect Your Baby: Go (or send your wife) to an antenatal clinic within the first three (3) months of pregnancy for a physical exam and screening for ‘STD. 3 Training suited to each practitioner's role in STD services. Condoms, readily cheap and available and heavily promoted to the public. In addition, women urgently need more effective barrier methods that they can control. Counseling to help STO patients understand their illnesses, take medications correctly, and prevent future infections. Women need special help to protect themselves. Mass-media communication to alert people to STDs, encourage them to to seek treatment, promote condoms, and support mutual monogamy. Methods of notit can be treated. ing the sexual partners of STD patients so that they, too, ACs of STD Management: e215. 5 Counseling Compliance to treatment Condom use Contact treatment 14 SYNDROMIC AND LABORATORY DIAGNOSIS, TREAMENT & FOLLOWU-UP GENITAL ULCERS EXAMINE PATIENT \ Genital Ulcer Multiple Small, Blister-like Open Source (Painful or Painless) Painful Lesions May have Swollen Lymph Nodes In Groin [ Treat to Relieve Symptoms of Herpes Treat for Syphilis & Chancroid TT —— _] Use Rapid Plasma Reagin (RPR) Test or Venereal Disease Research Laboratory Reassure Patient That Lesions (VORL) ‘Will Improve Within 7 Days | Discharge Seen Use Gram Stain Test of Discharge Examine Patients For Discharee_ Look for Gram Negative Intracellular 15 No Discharge Seen a! Re-evaluate if Symptoms Persist sl Diploccoci | Intracellular Intracellular | Diplococci Diplococci Present Not Present Treat for GC & Treat for Chlamydia Chlamydia Follow-up 7 Days After Clinic Visit CURE DISCHARGE PERSIST Treatment Regimen | VAGINAL DISCHARGE RISK ASSESSMENT POSITIVE SPECULUM AVAILABLE Use Wet Mount Smear (Saline + KOH) Test Trichomoniasis & Bacterial Candidiasis \Vaginosis Wet Mount Positive Wet Mount Negative Trichomonas Present Yeast Cell Negative Treat for GC & Chlamydia Treat for GC & Chlamydia Treat for GC and and and Chlamydia Follow-up 7 days After Clinic Visit VAGINAL RISK ASSESSMENT DISCHARGE NEGATIVE SPECULUM AVAILABLE Use Wet Mount (Saline + KOH) TEST Wet Mount Negative No Mucopus Discharge from Seen Cervix Treat for Gonorrhea and Chlamydia Wet Mount Positive Trichomonads Present Treat for Trichomoniasis and Bacterlal Vagl- nosis Yeast Cell >20% Clue Present Present Treat for Candidiasis [ Sb

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