SEXUALLY TRANSMITTED

INFECTIONS
BY:
Dr OLASINDE ABDULAZEEZ AYODEJI
Department of Community Medicine, ABUTH Zaria.
OUTLINE
• INTRODUCTION
• SYNDROMIC MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS
• ADVANTAGES AND DISADVANTAGES OF SYNDROMIC MANAGEMENT
OF STIs
• COMMON STI SYNDROMES
• FLOW CHART (PROTOCOLS) FOR STIs SYNDROMIC MANAGEMENT
INTRODUCTION
• Sexually transmitted infections (STIs) are infections spread predominantly by sexual
contact, including vaginal, anal and oral sex.
• Some STIs can also be spread through non-sexual means such as via blood or blood
products. Many STIs including syphilis, hepatitis B, HIV, chlamydia, gonorrhoea, herpes,
and HPV can also be transmitted from mother to child during pregnancy and
childbirth.
• More than 30 different bacteria, viruses and parasites are known to be transmitted
through sexual contact.
• Eight of these pathogens are linked to the greatest incidence of sexually transmitted
disease. Of these 8 infections, 4 are currently curable: syphilis, gonorrhoea, chlamydia
and trichomoniasis. The other 4 are viral infections which are incurable: hepatitis B,
herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV).
INTRODUCTION (contd.)
• STIs are spread predominantly by sexual contact, including vaginal, anal
and oral sex. Some STIs can also be spread through non-sexual means
such as via blood or blood products. Many STIs—including syphilis,
hepatitis B, HIV, chlamydia, gonorrhoea, herpes, and HPV—can also be
transmitted from mother to child during pregnancy and childbirth.

• A person can have an STI without having obvious symptoms of disease.

Common symptoms of STIs include vaginal discharge, urethral discharge
or burning in men, genital ulcers, and abdominal pain.
SYNDROMIC MANAGEMENT OF
SEXUALLY TRANSMITTED
INFECTIONS (STIs)
• Many healthcare facilities in developing countries lack the equipment and trained
personnel required for etiological diagnosis of STIs (using laboratory tests to
identify the causative agent).
• Where no laboratories or point-of-care diagnostic tests are available, a syndrome-
based approach to the management of STI patients should be promoted.
• With the syndromic management approach, accessible, affordable, and effective
management of individuals with STIs relies on utilization of flowcharts (algorithms)
for each STI syndrome. The flowcharts enable diagnoses of common STI syndromes,
provision of current country-specific appropriate treatment, and advice on the
management of sexual partners.
• Preferably, the flowcharts should be based on local etiological and antimicrobial
susceptibility data. Otherwise, WHO treatment recommendations should be used.
SYNDROMIC MANAGEMENT OF STIs
(contd.)
• Syndromic management refers to the approach of treating STI symptoms
and signs based on the organisms most commonly responsible for each
signs and symptoms (syndrome).
• Syndromic management is simple, assures rapid, same-day treatment, and
avoids expensive or unavailable diagnostic tests for patients that present
with symptoms.
• This approach results to overtreatment and missed treatment as majority of
STIs are asymptomatic. Thus, in addition to syndromic management,
screening strategies are essential.
• To interrupt transmission of infection and prevent re-infection, treating
sexual partners is an important component of STI case management.
ADVANTAGES AND DISADVANTAGES
OF SYNDROMIC MANAGEMENT OF
STIs
ADVANTAGES
• Highly sensitive when used to detect infection among symptomatic patients,
does not miss mixed infections, which are common
• Treatment is given at first visit so delays in treatment are avoided and the
patient is not lost to follow-up before treatment is initiated — this increases client
satisfaction, and reduces further transmission and complications from untreated
infections
• Provides opportunity and time for education and counselling
• Avoids expensive laboratory tests
• Can be implemented at primary care level because it is easy to use, does not
require highly trained STI specialists
ADVANTAGES AND DISADVANTAGES
OF SYNDROMIC MANAGEMENT OF
STIs (contd.)
ADVANTAGES (contd.)
• Limits referral to specialist centres
• Problem-orientated (based on patient’s symptoms)
• High rates of cure, provided that the effectiveness of the drugs
selected is adequate and properly monitored
• The use of flow charts standardises diagnosis, treatment, referral and
reporting, allowing for improved surveillance and programme
management
ADVANTAGES AND DISADVANTAGES
OF SYNDROMIC MANAGEMENT OF
STIs (contd.)
DISADVANTAGES
• Over-diagnosis and over-treatment that may result in increased drug costs, possible side-
effects of multiple drugs, alterations in vaginal flora and potential for increased drug
resistance
• Cannot be used to detect infections among asymptomatic individuals
• The syndromic approach for vaginal discharge is poorly predictive of the presence of cervical
chlamydial and/or gonococcal infection
• Over-treatment of partners of women with vaginal discharge, most of whom do not have an
STI, may lead to potentially serious social and physical consequences for the female index case
• Not easily accepted by doctors as thought of as inferior quality
• Does not address the issue of poor treatment-seeking behaviour by symptomatic individuals
COMMON STI SYNDROMES
Most common
Syndrome Symptoms Signs
causes

Chancroid
Genital ulcer
Genital sore Genital ulcers Genital herpes
disease (GUD)
Syphilis

Dysuria (pain during urination) Urethral discharge (if

Chlamydia
Urethral discharge Frequent urination necessary, ask the patient to
Gonorrhea
Urethral discharge milk the urethra)

Dyspareunia (pain during sexual

Candidiasis
intercorse)
Abnormal vaginal Chlamydia
Vaginal discharge Dysuria (pain during urination)
discharge Gonorrhea
Unusual vaginal discharge
Trichomoniasis
Vaginal itching