MINISTRY OF HEALTH
NATIONAL AIDS AND STI CONTROL PROGRAMME
Algorithm to manage common STIs Syndromes: Urethral discharge in Male
History of urethral discharge or symptoms
Take history and examine
Discharge present
Urethritis treatment and 4Cs
Cefixime 400mg stat and Tabs
Azithromycin 1.5gm stat
If discharge persists after 7 days
treatment
Give Alternative urethritis
treatment and 4 Cs
IM Ceftriaxone 500mg Stat and Tabs
Azithromycin 1.5 gm stat or IM
Gentamicin 240mg Stat and Tabs
Azithromycin 1.5 gm stat
If discharge persists after 7
days treatment
Refer for investigations
Counselling
• Emphasize on the risks of STIs including HIV
• Discuss other 3 Cs
• Offer HIV testing and counseling services
REPUBLIC OF KENYA, NATIONAL AIDS/STD CONTROL PROGRAMME (NASCOP), P. O. BOX 19361 - 00200 NAIROBI, TEL: +254 2729502/ 02630867
Algorithms for Managing Common STI Syndromes
Discharge absent
Symptomatic treatment and 4Cs
Compliance
WEBSITE: www.nascop.or.ke
Algorithm to manage common STIs Syndromes: Vaginal discharge or pruritus Algorithm to manage common STIs Syndromes: Opthalmia
Algorithm to manage common STIs Syndromes: Lower abdominal Algorithm to manage common STIs Syndromes: Male and female
History of vaginal discharge pain in women Genital ulcer disease Neonatorum
Enquire about lower abdominal pain and examine
Patient or client complaints of lower abdominal pain Patient or client complains of a genital sore or ulcer Neonate with eye
No lower abdominal pain or tenderness Lower abdominal pain discharge
Abdominal mass or Abdominal tenderness No tenderness
or tenderness present Take history and examine for ulcer
tenderness due to or tenderness on moving on abdominal
Vaginitis treatment and 4Cs surgical or the cervix examination Take history and
Ulcer present?
Clotrimazole 100 mg pessary intra-vaginally daily Follow the flow chart gynaecological examine
for 6 days and Tabs Metronidazole 2 gm STAT for lower abdominal causes they are Symptomatic Yes No
or pain determined if there treatment or
Flucanozole 150 mg and 2 gm Metronidazole stat Treat for Pelvic Inflammatory Treat for HSV2*, syphilis and Chancroid and 4Cs Offer or refer for HIV Discharge present
is rebound vaginitis
disease and 4Cs testing and
tenderness and/ or treatment if
Cefixime 400mg stat and oral Benzathine Penicillin 2.4 MU stat and counseling and 4 Cs
For Pregnant women guarding, last there is vaginal
doxycycline 100 mg twice a day Azithromycin 1.5 gm stat and follow up for Opthalmia neonatorum treatment
Only Clotrimazole 200 mg pessary intra-vaginally menstrual period is discharge
for 14 days and Metronidazole or soreness
daily for 3 days. overdue, recent 400 mg thrice daily for 14 days. IM Ceftriaxone 500 mg Stat and Azithromycin 1.5 1% Tetracycline eye ointment TDS X
abortion or Or Start flowchart gm stat (in case of allergy to penicillin) 10 days
delivery, IM Ceftriaxone 500mg Stat and again after
If no improvement after7 days
* Treat HSV2 with Acyclovir 400 TID X 7 days if
Treat mother for cervicitis and her
menorrhagia &/ or oral doxycycline 100 mg twice a repeating
day for 14 days and client presents with an ulcer with multiple painful partner for urethritis
Treat for Cervicitis and 4 Cs metrorhhagia) abdominal
Metronidazole 400 mg thrice vesicles grouped together with history of
Tab Cefixime 400 mg and Tabs Azithromycin 1.5 gm stat examination
daily for 14 days. recurrence.
Or Or Follow up within 24 hours
IM Ceftriaxone 500 mg Stat and Tabs Azithromycin 1.5 IM Gentamicin 240mg Stat and NB: IndividualsReview in 7 daysHIV disease, repeat
with advanced
Refer for
oral doxycycline 100 mg twice a
gm stat inj Benzathine Penicillin weekly for three weeks Ulcer is not healing
surgical or day for 14 days and Ulcer is healing
Or gynecological Metronidazole 400 mg thrice Improving Not Improving
(GUD heals slowly; improvement is
IM Gentamicin 240mg Stat and Tabs Azithromycin 1.5 gm assessment daily for 14 days. Continue HSV2** treatment
defined as sign of healing and reduction
stat of pain. HIV-infected people respond
for a further 7 days and
For Pregnant women review Continue with 1% Offer alternative treatment as
(Do not use Gentamicin if pregnant) slowly to GUD treatment
Refer for obstetric evaluation Tetracycline ointment Ceftriaxone 62.5 mg IM stat
Ulcer still not responding TDS for 10 days and 4 Cs and 1% Tetracycline ointment
If discharge persists after 7 days Offer or refer for HIV testing and
If no improvement after 7 days REFER for investigations TDS for 10 days and 4 Cs
counseling and 4 Cs
Refer for investigations Refer for investigations
FIGHT AIDS! REMEMBER THE 4Cs OF GOOD STI MANAGEMENT
Condoms Contact treatment
Your patient should: • Proper use of condom is the only other alternative to abstinence Your patient should
• Avoid self medication to protect from STIs • Tell all his/her sexual partners to seek medication
• Take the full course of medication and not to share or keep it • Give condoms to your patients
• Follow your other instructions • Explain and demonstrate the correct use of condoms