Sexually Transmitted Infections

Nursing Students’ Lecture Notes

Richard Karing’uri
Lecturer, KMTC-Kilifi
Learning Outcomes

• By the end of this lesson, nursing students shall be

able to:-

1. Describe the cause and mode of transmission of

STIs

2. Describe the pathophysiology and the signs and

symptoms and diagnosis of STIs

3. State the treatment, prevention and control of

STIs

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Introduction

• Transmitted primarily through sexual contact.

Bacterial STIs
1. Chlamydia & Lymphogranuloma venerum
2. Gonorrhea
3. Syphilis
4. Chancroid
Viral STIs
5. HIV/AIDS
6. Herpes
7. Condylomata acuminata (Genital warts)
8. Hepatitis (B & C)
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 5. Molluscum contagiosum
Parasitic STIs
6. Trichomoniasis
7. Pediculosis pubis (Pubic lice)
8. Scabies
Fungal
9. Candidiasis

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Karing'uri
Risk factors

Individual risk behavior

1. Age of first sexual intercourse
2. Multiple sexual partners
3. Frequency of partner change
4. Frequency of exposure
5. Sexual practices
6. Health seeking behavior

Demographic risk behavior

7. Age
8. Marital status
9. Occupation
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Socioeconomic factors

1. Literacy levels.

2. Urbanization and industrialization-Emergence of

slums, prostitution , promiscuity.

3. Work related separation of spouses.

4. Drugs and alcohol use

5. Poverty

6. Ethnic cultural practices- Wife inheritance,

cleansing, disco matanga, FGM
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 No Many
Happy stable marriage sexual
Living in a stable community with partners
extended family
Fear of God
Fear of parents STI
Fear of public opinion
Fear of law
Fear of pregnancy
Knowledge of STIs
Fear of sterility No STI
Fear of HIV/AIDs
Absorbing interest: work, leisure, sports
Avoidance of sex for material gain Faithfulness or
Yes Abstinence
Figure 1: Social factors influencing absence or presence of STIs.
Source: Communicable Diseases (Norberg & Kigondu, 2007
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Environmental factors
1. Political instability
2. Availability and accessibility of health and
support services

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General Approaches to prevention of STIs
1. A
2. B
3. C
4. Contact tracing

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Gonorrhea

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Causation, Transmission and Characteristics
• Caused by Neisseria gonorrhoeae a Gram- negative
kidney shaped diplococci.
• Transmitted through:-
1. Unprotected sexual intercourse.
2. Vertical transmission – Ophthalmia neonatorum
• Risk of infection after a single exposure
−Male-20-30%
−Female 60-90%
• Can be acute or chronic.
• Can cause sterility in both males and females.

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Figure 1: Neisseria gonorrheae seen under a microscope.
Note the pink color (Gram-negative ) and formation of a pairs
of spherical cocci, the diplococci
• Up to 80% of women are asymptomatic and
therefore may not be aware they are infected.
• Most of men with have symptom
• A common STI globally.

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Physiology
1. The bacteria adhere to mucosal surfaces,
particularly in the urethra, cervix, rectum,
pharynx, and conjunctiva.
2. The bacteria then induce an inflammatory
response, leading to the characteristic symptoms
and potential complications if untreated.

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Forms of Gonorrhea
1. Urogenital – Affects the genitourinary system.
2. Extragenital –Outside the urogenital system.
Pharynx, rectum.

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Signs and Symptoms
Urogenital gonorrhea
• Men-Urethral discharge (purulent), dysuria,
testicular pain in cases with epididymitis.
• Women-Often asymptomatic; when present,
symptoms include vaginal discharge, dysuria,
intermenstrual bleeding, and pelvic pain.
Extragenital infections
• Pharyngeal: Often asymptomatic; mild sore throat
possible.
• Rectal: Symptoms include discharge, anal itching,
soreness, and sometimes bleeding.

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Complications
1. Pelvic Inflammatory Disease (PID) in Women
• An infection of the uterus, fallopian tubes,
ovaries due to untreated gonorrhea.
• Manifests with chronic pelvic pain, can cause
ectopic pregnancy, and infertility due to
scarring and blockage of fallopian tubes.
2. Disseminated Gonococcal Infection (DGI)
• Systemic spread of gonorrhea through the
bloodstream, affecting joints, skin, and other
organs.

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• Manifests with septic arthritis, tenosynovitis,
skin lesions, fever.
• Can result in permanent joint damage and,
rarely, life-threatening conditions such as
endocarditis or meningitis.

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Diagnosis
• Clinical evaluation
• Lab diagnosis
1. Specimen – Urethral smear (men), endocervical
smear (women).
2. Culture and microscopy

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Treatment
1. PO norfloxacin 800 mg single dose or
2. PO ciprofloxacin 500 mg single dose or
3. PO olfloxacin 400 mg single dose or
4. PO levofloxacin 250 mg single dose
5. PO enoxacin 400 mg singe dose

• Avoid quinolones in pregnant women.

1. PO cefixime 400 mg single dose or
2. IM cefotaxime 2g single dose or
3. PO azithromycin 1g in a single dose
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Ophthalmia neonatorum
• Severe eye infection in newborns, typically occurring
within the first month of life caused by exposure to
Neisseria gonorrhoeae in the cervix and the vagina.
• Manifests with:-
1. Conjunctivitis
2. Purulent discharge -Thick, yellow-green pus
from the eyes, often causing the eyelids to stick
together.
3. Irritation and discomfort
4. Vision-If untreated, can lead to corneal
ulceration and blindness.

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Figure 2: Cervicitis due to gonorrhea Figure 3: Urethral discharge due to
gonorrhea

Figure 4: Ophthalmia neonatorum

Treatment
• IV gentamycin 1mg/kg tds 3/7
• PO cefuroxime 125 mg 5/7

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Prevention
• TEO.

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Trichomoniasis

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Causation, Transmission and Characteristics
• Caused by a protozoa called Trichomonas vaginalis.
• Infects the genital tract of both males and
females.
• Transmitted
−Sexually (primarily).
−Contaminated clothes and other items.
• Affects 10% of all women at anytime.
• Mostly asymptomatic in men but symptomatic in
women.
• No immunity after infection.

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Figure 5: An illustration of Trichomonas vaginalis

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Pathophysiology
1. T. vaginalis infects the urogenital tract, attaching
to the epithelial cells, causing inflammation and
epithelial damage.
2. Leads to discharge and irritation, increasing
susceptibility to other infections like HIV.

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Signs and Symptoms
Women
1. Vaginal discharge: Often frothy, yellow-green,
and fishy smelling.
2. Vaginal Irritation: Itching, burning, or discomfort.
3. Dysuria: Pain during urination.
Men
• Often asymptomatic. If symptomatic presents with:-
−Urethral discharge
−Dysuria or mild irritation in the urethra.

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Laboratory Diagnosis
Microscopy: Wet mount to visualize motile T. vaginalis.
Specimen – Fresh drops of vagina or urethral
discharge or HVS.

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Treatment
1. PO metronidazole or tinidazole 400 mg tds 5/7
2. Clotrimazole vaginal pessaries for 6 nights
3. Treat both partners

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Prevention and Control
1. Abstinence
2. Being faithful to one sexual partner
3. Use of condoms
4. Contact tracing and treatment
5. General hygiene
6. Avoid sharing undergarments and sex toys.

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Syphilis

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Causation, Transmission and Characteristics
• Caused by Treponema pallidum a Gram-negative
spirochete.
• A chronic multisystem disease.
• Transmitted
−Sexually (primarily).
−Vertically - Transplacental
• Slowly progressing disease, can be disabling and
may be fatal 10-20 years.

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Figure 6: Treponema pallidum

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Pathophysiology and Clinical Picture
• Stages, 4 each characterized by unique symptoms
and mechanisms of tissue damage
Primary Syphilis
1. The bacteria enters the body through small
abrasions in the skin or mucous membranes.
2. After an incubation period of around 3 weeks, it
multiplies locally, causing a painless ulcer or
chancre at the site of entry.
3. The chancre in women my be in the vagina or the
cervix
4. The bacteria then invade nearby lymphatic
channels and spread throughout the body.
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Figure 7: Chancre in primary syphilis

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Secondary Syphilis
• 4 to 6 weeks the bacteria goes to the blood, leading
to systemic symptoms:
1. Generalized eruption of non itchy
maculopapular skin rash – May also appear
on the soles of the feet and the palms.
2. Condylomata lata –Highly infectious warty
round lesions in the moist parts of the body-
vulva, perineum, mouth, axilla, between the
buttocks and underneath the breast.
3. Generalized lymphadenopathy.
4. Partial loss of scalp hair.
5. Snail track ulcers of the tongue and oral cavity.

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Figure 7: Syphilis maculopapular rash

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Figure 8: Condylomata lata of the anus.

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Figure 8: Snail track ulcer on the inside lip.

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Latent Syphilis
• If untreated, the infection enters a latent phase
• No visible symptoms, but the bacteria remain in the
body.
• Last for years.
• The bacteria may continue to replicate at low levels
in lymphoid tissues.

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Tertiary Syphilis
• Untreated syphilis progresses after years to decades,
affecting multiple organs.
• The bacteria trigger a chronic inflammatory
response, causing severe damage in various organs
and tissues.
• This manifests with granulomatous lesions in the
organs called syphilitic gummas.
• Other manifestations include:-
−CVS (Aortic incompetence, aneurysms).
−Neurosyphilis –Personality changes, memory loss,
gait and walking problems, paralysis.

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Diagnosis
• Specimen: Blood
• Serological tests – VDRL or RPR

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Treatment
1. IM procaine penicillin 0.8 MU od 10/7
or
2. IM benzathine penicillin 2.4 MU (1.2 each buttock)
as a single dose
• Incase of penicillin allergy
1. PO doxycline 100 mg bd 10/7
or
2. PO tetracycline 500 mg qid 10/7
• Use erythromycin incase of penicillin allergy in
pregnancy

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• Syphilis longer than 1 year
−IM benzathine penicillin 2.4 MU (1.2 each
buttock) 3/52
• If there is evidence of neuro involvement
−IM procaine penicillin 0.8 MU od 3/52
• For congenital syphilis
−IV benzylpenicillin 50 MU/kg qid 1/7 then
−IV benzylpenicillin 50 MU/kg tds 3/7 then

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Prevention and Control
1. Abstinence
2. Being faithful to one sexual partner
3. Use of condoms –Offer 50-70% protection
4. Contact tracing and treatment

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Chancroid

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Causation, Transmission and Characteristics
• Caused by Haemophilus ducreyi a Gram-negative
bacilli.
• Transmitted via sexual intercourse.
• H. ducreyi penetrate genital skin and mucous
membranes easily.
• Women by harbor the bacteria in the vagina without
symptoms and become infection reservoir.
• Infected males usually show symptoms.
• Direct self inoculation can result to extra-genital
lesion.

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Figure 6: Microscopic appearance of Haemophilus ducreyi

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Pathophysiology

1. The bacteria adhere to the epithelial cells and invade

the tissues, in the genital area, produce toxins that
disrupt the epithelial cells and facilitate tissue
necrosis.
2. Immune responses results in local inflammation,
forming painful ulcers at the site of infection.
3. The bacteria leads to swollen, tender regional lymph
nodes.
4. Without treatment, ulcers cause significant scarring
and complications like secondary bacterial
infections.
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Signs and Symptoms
• The incubation period in 4-7 days in men and up to
10 days in women.
Painful ulcers
• One or more painful, soft, and irregularly shaped
ulcers at the genital, anus or thighs.
Lymphadenopathy
• In the perineal area. Lymph nodes my be painful and
may become abscessed and rupture if untreated.
Pus Discharge
• The ulcers may exude a purulent (pus-like)
discharge, which may be foul-smelling.

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Figure 7: Ulcers of chancroid

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Diagnosis
• Clinical diagnosis is unreliable.
Laboratory
• Specimen – Smears from the ulcer for culture and and
microscopy

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Table 1: Differentiating chancroid from syphilis

Clinical feature Chancroid Syphilis

Single or multiple, Single, painless, hard,

Ulcer painful, soft, well defined edge, clear
irregular pus, edema discharge.
Lymph glands Unilateral or
bilateral, painful, Bilateral, painless, no
often suppurative suppuration.
Incubation 3 to 5 days 10 – 17 days

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Treatment

• Treat chancroid with any of the following:-

 Azithromycin 1 g orally, single dose.

 Ceftriaxone 250 mg IM, single dose.

 Ciprofloxacin 500 mg orally, twice daily for 3 days.

 Erythromycin 500 mg orally, three times daily for 7

days.

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Prevention and Control
1. Abstinence
2. Being faithful to one sexual partner
3. Use of condoms –Offer 50-60% protection
4. Contact tracing and treatment

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Herpes Genitalis (Genital
Herpes)

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Causation, Transmission and Characteristics
• Caused by Herpes simplex virus (HSV) 2 of
Herpesviridae family.
• Transmitted:-
1. Sexually transmitted –Primarily
2. Vertically – During birth
• It is a chronic condition characterized by periods of
active symptoms (outbreaks) and asymptomatic
phases.
• Affects both men and women.
• Transmission rates are higher from male to female.
• Highly prevalent worldwide.

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Pathophysiology
• HSV enters the body through mucous membranes or
breaks in the skin.
• It travels to sensory neurons and establishes latency
in the dorsal root ganglia.
• During reactivation, the virus travels back down
the nerve to the skin or mucous membrane, causing
recurrent outbreaks.
• Reactivations are triggered by events such as:-
1. Anxiety, depression
2. Menstruation, pregnancy
3. Fever
4. Trauma
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Signs and Symptoms
• Incubation period is 3 to 7 days after exposure.
Primary Infection
1. Painful, grouped vesicles on an erythematous
base in the genital area, anal region and upper
inner thighs
2. Lesions may progress to ulcers, which crust over
and heal within 2-4 weeks.
3. Systemic symptoms may occur including:-
• Fever Headache
• Myalgia
• Inguinal lymphadenopathy.
• Dysuria and vaginal/urethral discharge may also
occur in women.
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Recurrent outbreak
• Milder symptoms compared to the primary outbreak.
• Fewer lesions, less pain, and shorter duration (3-7
days).

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Figure 8: An illustration of female genital herpes. Find a
group of vesicles on an erythematous base

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Figure 9: A female patient with genital herpes.

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Figure 10: A male patient with genital herpes of the penile
shaft

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Diagnosis
• Mostly done by evaluation of the clinical signs and
symptoms.
Laboratory
• No always done
1. PCR (Polymerase Chain Reaction): Confirmatory
diagnosis.
2. Serological tests: Detect HSV antibodies, helpful for
determining type (HSV-1 or HSV-2).

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Treatment
• The goal for treatment is.
1. Relieve symptoms
2. Shorten the duration of outbreaks
3. Minimize the frequency and severity of future
outbreaks.
4. Reduce Transmission
5. Improve quality of life
• Antiviral drugs are used
1. Primary episode: Acyclovir 400 mg orally, 3
times a day for 7-10 days.
2. Recurrent episodes: A shorter course (e.g., 5
days

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Neonatal Herpes
• A rare potentially severe infection that occurs in
newborns who acquire the herpes simplex virus (HSV)
during birth.
• Can lead to significant morbidity and even mortality if
not treated.
Forms of Neonatal Herpes
1. Localized skin, eye, and mouth disease
• Clusters of vesicles on the skin, eyes, or mouth.
• It is the least severe, but if untreated, it can
progress to more severe forms.

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2. Central Nervous System (CNS) disease
• Involves the brain and spinal cord.
• Symptoms include seizures, lethargy, irritability,
and poor feeding.
• Can result in permanent neurological damage or
developmental delays.
3. Disseminated disease
• The most severe form.
• The virus spreads to multiple organs (e.g., liver,
lungs, heart).
• Symptoms include respiratory distress, jaundice,
bleeding disorders, and shock.
• High mortality rate if not treated promptly.
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Diagnosis of neonatal herpes
• Hx taking and examination of the mother.
• PCR on the neonate
• Imaging techniques on the newborn.
Treatment of neonatal herpes
• IV acyclovir promptly.
• Supporting treatment e.g. for seizures.

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Prevention and Control
1. Abstinence
2. Being faithful to one sexual partner
3. Use of condoms –Offer 30-50% protection
4. Avoid sexual intercourse during outbreaks.
5. Contact tracing for counselling and treatment.
6. Pregnant women with herpes should be delivered
in a hospital via CS to avoid neonatal herpes.

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Genital Warts (Venereal Warts/
Condylomata acuminata)

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Causation, Transmission and Characteristics
• Caused by Human Papilloma Virus (HPV) with belong
to Papillomaviridae family.
• Primarily caused by low-risk HPV types, especially
HPV types 6 and 11, which are responsible for
about 90% of cases.
• High-risk HPV types 16 and 16 that cause cancer do
not typically cause warts.
• Transmission occurs through skin-to-skin contact,
primarily during sexual activity.
• Very common STI worldwide among sexually active
young adults.
• Both males and females can be affected.
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Pathophysiology
• The virus infects the epithelial cells of the skin and
mucous membranes, causing benign growths.
• HPV can remain latent in the body, and warts can
recur even after treatment.

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Signs and Symptoms
Appearance of warts
• Soft, flesh-colored or grayish growths that may be
flat, raised, or cauliflower.
• Vary in size from a few millimeters to large clusters.
• Typically painless but may cause itching,
irritation, or bleeding, especially if traumatized.

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Common locations of warts
• Men: Penile shaft, glans, urethral meatus, scrotum,
and perianal area.
• Women: Vulva, vagina, cervix, perineum, and
perianal area.
• Both sexes: Inner thighs and groin area. Can also
appear in the oral cavity or throat after oral-genital
contact

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Diagnosis
• Primarily a clinical diagnosis based on the
appearance of lesions.
• Differentiate it from Condylomata lata by doing
VDRL

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Figure 11: Genital warts in female. Some have a cauliflower
appearance

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Figure 12: Genital warts

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Treatment
• No cure for HPV – Treat to remove visible warts and
alleviate symptoms.
1. Podofilox solution -A topical antimitotic agent
applied directly to the warts.
2. Cryotherapy-Freezing warts with liquid nitrogen.
3. Surgical removal -Excision, laser therapy, or
electrosurgery for large or resistant lesions.

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Prevention and Control
1. HPV Vaccination-Gardasil-9 vaccine covers HPV
types 6, 11, 16, 18, and others.
2. Abstinence
3. Being faithful to one sexual partner
4. Use of condoms –Offer 50 to 70% protection
5. Avoid sexual intercourse during outbreaks

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Hepatitis B

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Causation, Transmission and Characteristics
• An infection of the liver caused by the Hepatitis B
virus (HBV) of Hepadnaviridae family.
• Transmitted via contact with infected bodily
fluids:
1. Blood (e.g., via shared needles, blood
transfusions, or needlestick injuries)
2. Sexual contact
3. Vertical transmission
• Primarily affects the liver.
• It can lead to both acute and chronic liver disease.

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Pathophysiology
1. HBV enters hepatocytes and begins replicating.
2. The immune response to infected liver cells leads
to inflammation and potential liver damage.
3. Most recover fully, but about 5-10% of cases
become chronic.
4. Chronic HBV infection can progress to cirrhosis,
liver failure, or hepatocellular carcinoma
(HCC) over time.

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Signs and Symptoms
• Incubation period is 1-4 months after exposure.
• Asymptomatic in many cases.
• When symptomatic in acute cases:-
1. Fatigue
2. Jaundice
3. Dark urine
4. Fever, nausea, vomiting
5. Paid in discomfort on the abdominal right upper
quadrant

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• In chronic Hepatitis B (lasting more than 6
months) it will be asymptomatic for years.
• Can lead to liver complications such as cirrhosis
and liver cancer.

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Diagnosis
• Serology – Specimen is blood
• HBsAg (Hepatitis B surface antigen)- Indicates
current infection.

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Treatment
Acute HBV
• Mostly supportive care as it often resolves on its
own.
Chronic HBV
• Antiviral medications can help control the virus but
cannot cure it.
• Common medications include Tenofovir and
Entecavir.

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Prevention and Control
Vaccination
• The Hepatitis B vaccine -healthcare workers, and
high-risk individuals.
Safe practices:
1. Use of condoms during sexual activity.
2. Avoid sharing needles or personal items that may
be contaminated with blood.
3. Screening blood products
PMTCT of HBV
4. HBV screening in the 1st trimester.

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2. HBsAg-positive -Further testing for HBV viral
load to assess the risk of transmission.
3. Tenofovir in the 3rd trimester – Reduces the viral
load and reduces the risk of transmission.
4. HBV vaccine in 3 doses (birth, 1-2 months, and 6
months) + HBV immunoglobulin
5. HBsAg testing at 9-12 months to confirm
immunization and to check for infection.
6. If the infant does not develop enough antibodies,
more doses of the vaccine may be needed.

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Hepatitis C

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Causation, Transmission and Characteristics

• An infection of the liver caused by the Hepatitis C

virus (HCV) of Flaviviridae family.
• Transmitted via contact with infected bodily
fluids:
1. Blood (e.g., via shared needles, blood
transfusions, or needlestick injuries)
2. Sexual contact
3. Vertical transmission - Uncommon
• Primarily affects the liver.

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Pathophysiology
1. HCV replicates in hepatocytes, leading to liver
inflammation and damage.
2. infection leads to chronic hepatitis in about 75-
85% of cases.
3. Chronic hepatitis causes progressive liver damage,
potentially resulting in cirrhosis, liver failure, or
hepatocellular carcinoma (HCC).

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Signs and Symptoms
• Incubation period is 15 to 160 days after exposure.
• Asymptomatic in many cases.
• When symptomatic in acute cases:-
1. Fatigue
2. Jaundice
3. Dark urine
4. Fever, nausea, vomiting
5. Abdominal pain on the right upper quadrant
• Chronic infection: May remain asymptomatic for
decades. Symptoms, if present, fatigue is the most
common, jaundice is rare.

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Complications
• Cirrhosis (20-30% risk after 20-30 years).
• Hepatocellular carcinoma (1-4% annual risk in
cirrhotic patients).

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Diagnosis
• Serology – Specimen is blood
1. Anti-HCV antibodies: Indicate exposure to the
virus (detected 4-10 weeks post-infection).
2. HCV RNA PCR: Confirms active infection
(detectable 1-2 weeks post-exposure).

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Treatment
1. Acute Hepatitis- Monitor for spontaneous clearance
(occurs in about 15-25% of cases).
2. Early antiviral therapy can be considered.
3. Chronic Hepatitis- Direct-Acting Antivirals
(DAAs): Highly effective (>95% cure rates).
 Examples include sofosbuvir, ledipasvir,
velpatasvir.
 Treatment duration 8-12 weeks, depending on
genotype and cirrhosis status.
4. Liver transplant -For end-stage liver disease or HCC
in eligible patients.

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Prevention and Control
• No vaccine available.
• Prevention strategies:-
1. Safe injection practices.
2. Screening of blood products.
3. Harm reduction programs for intravenous drug
users (e.g., needle exchange, opioid
substitution therapy).
4. HCV screening in high-risk populations (e.g.,
prisoners, those with HIV).

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Table 2: Differences between Hepatitis B and Hepatitis C

Clinical Hepatitis B Hepatitis C

feature
Vertical Common (risk: 70-90% Possible, but less
transmission without prophylaxis) common (risk: 5-7%)
Chronic Approx. 5-10% in Approx. 75-85% of
Infection adults, higher in acute cases progress
infants to chronic
Treatment Suppresses the virus The treatment cures
but not cure it the virus
Vaccine Available Not available

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Chlamydia trachomatis

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Infections Caused by Chlamydia trachomatis

Trachoma
• Chronic infectious disease of the eye caused by
Chlamydia trachomatis, serotypes A, B, Ba, and C.
• Transmitted by contact with contaminated fingers,
fomites and flies.
Chlamydia
• An infection of the genital tract cause by
Chlamydia trachomatis serotypes D-K.
• Sexually transmitted.

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Lymphogranuloma venereum
• An invasive infection of they genitals and lympatic
system and caused by Chlamydia trachomatis,
serotypes L1, L2 and L3
• Sexually transmitted.

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Chlamydia

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Causation, Transmission and Characteristics

• Bacterial infection caused by Chlamydia trachomatis

serotypes D-K
• Transmitted sexually.
• Primarily affects the genital tract, but can also infect
the rectum, throat, and eyes.
• The infection is often asymptomatic.
• Can result to complications if left untreated.

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Pathophysiology

1. The bacterium infects the epithelial cells of the

mucous membranes.
2. Causes inflammation and tissue damage, which
can lead to scarring in the genital tract.
3. If untreated, can progress to serious
complications e.g. PID in women

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Signs and Symptoms

• Asymptomatic in up to 70-90% of women and 50%

of men -Complicates early diagnosis.
In Women
1. Mucopurulent vaginal discharge.
2. Dysuria.
3. Intermenstrual bleeding or post-coital bleeding.
4. Pelvic pain if PID has developed.

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In men
1. Urethritis-Clear or purulent penile discharge.
2. Dysuria.
3. Epididymitis-Pain and swelling in the scrotum.
4. Proctitis -Rectal pain, discharge, bleeding (common
in MSM).
Other manifestations
• Conjunctivitis-Can occur if infected fluids contact the
eyes.

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Diagnosis

• Nucleic Acid Amplification Tests (NAATs)

• Specimen -Urine (men). Endocervical swabs
(women), as well as from rectal or throat swabs.

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Treatment

1. PO doxycycline 100 mg bd 1/52 or

2. PO tetracycline 500 mg qid 1/52
• For pregnancy women
1. PO erythromycin 500 mg qid 7 days

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Prevention and Control

• As for other STIs

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Lymphogranuloma Venereum

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Causation, Transmission and Characteristics

• Bacterial infection caused by Chlamydia trachomatis

serotypes L1, L2, L3.
• Sexually transmitted and common among MSM.
• Found in other all parts of the world.

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Pathophysiology

• The bacteria infect the lymphatic tissue, leading to

inflammation and potential tissue damage.

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Signs and Symptoms

Incubation period: 3-30 days post-exposure.

Primary Stage
• Appearance of a painless ulcer (papule or
pustule) at the site of infection
• Often unnoticed because it heals quickly.
Secondary Stage
• Occurs 2-6 weeks after the primary lesion.
• Painful inguinal or femoral lymphadenopathy
(commonly unilateral).
• Groove sign: Swelling above and below the inguinal
ligament.
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• Proctocolitis (in MSM): Symptoms include rectal
pain, discharge, bleeding, tenesmus, and constipation.
• Systemic symptoms: Fever, malaise, and arthralgia.
Tertiary Stage (Late Stage)
• If untreated, can progress to chronic inflammation
leading to complications:
1. Genital elephantiasis (lymphatic obstruction) –
more common in men
2. Anal strictures, fistulas, and rectal fibrosis.
3. Esthiomene (destructive ulceration of the
genital area, more common in women)

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Figure 13: Groove sign. Bilateral swelling below and above
the inguinal ligament

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Figure 14: A female patient with esthiomene. There is a
destructive ulceration of the vulva.

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Figure 15: A male patient with genital elephantiasis as result
of chronic Lymphogranuloma venereum

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Diagnosis

• Clinical suspicion in patients with risk factors (e.g.,

MSM with proctocolitis or lymphadenopathy).
Laboratory tests
• Nucleic acid amplification tests (NAATs) on
swabs from ulcers, lymph nodes, or rectal
specimens.

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Treatment

1. PO doxycycline 100 mg bd 2/52

For pregnant women
2. PO erythromycin 500 mg qid 2/52

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Prevention and Control

• As for other STIs

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Syndromic Management of STIs

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What is Syndromic Management of STIs?

• Involves diagnosing and treating infections

based on a patient's reported symptoms and
clinical signs, rather than waiting for laboratory
confirmation.
• Useful in settings with limited diagnostic
resources, like many parts of Kenya, and helps
reduce the spread of infections by providing
immediate treatment.

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• Patients are grouped into 5 syndromes based on
their symptoms:-
1. Urethral discharge
2. Vaginal discharge or pruritus
3. Genital ulcers
4. Lower abdominal pain
5. Ophthalmia neonatorum

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End

Richard Karing'uri