Sexually transmitted infections refers to the mode of transmission of infection and the the reproductive tract infection refers to the site where the infection occurs. All Reproductive tract infections cannot be sexually transmitted infections.
- Gonorrhoea
- Chylamydia
- Syphilis
- Trichomoniasis
- Chancroid
- Genital herpes
- Genital warts caused by HPV
Incidence: The incidence of STD's is increasing by 10% every year where safe sex practices are being ignored. 448 million new cases of curable STD's occur annually through out the world in persons aged 15 to 49 years.
- Age less than 25 years
- Young age at first sex
- Non barrier contraception method
- New, multiple or symptomatic sexual partners
Discussion on Some Common STDS:
1. Chlamydia: is one of the most common STI and is easily passed on during sex. Most people don't experience any symptoms, so they are unaware they're infected.
Clinical Features:
In women, chlamydia can cause pain or a burning sensation when urinating, a vaginal discharge, pain in the lower abdomen during or after sex, and bleeding during or after sex or between periods. It can also cause heavy periods.
In men, chlamydia can cause pain or a burning sensation when urinating, a white, cloudy or watery discharge from the tip of the penis, and pain or tenderness in the testicles.
With changing sexual practices it's also possible to have a chlamydia infection in the rectum, throat or eyes.
2. Genital warts are small fleshy growths, bumps or skin changes that appear on or around the genital or anal area. They're caused by the human papilloma virus (HPV) and are also common STI.
Clinical Features: The warts are usually painless, but some patients may notice some itching or redness. Occasionally, they can cause bleeding.
Clinical Features: The warts are usually painless, but some patients may notice some itching or redness. Occasionally, they can cause bleeding.
HPV is spread by skin-to-skin contact and can even spread without penetrative sex.
3. Genital herpes: is a common infection caused by the herpes simplex virus (HSV), which is the same virus that causes cold sores.
Clinical Features; Some people develop symptoms of HSV a few days after coming into contact with the virus. Small, painful blisters or sores usually develop, which may cause itching or tingling, or make it painful to urinate.
After been infected, the virus may remains dormant (inactive) most of the time. However, certain triggers can reactivate the virus, causing the blisters to develop again, although they're usually smaller and less painful.
4. Gonorrhoea: is a bacterial STD easily passed on during sex. About 50% of women and 10% of men don't experience any symptoms and are unaware they're infected.
Clinical features:
3. Genital herpes: is a common infection caused by the herpes simplex virus (HSV), which is the same virus that causes cold sores.
Clinical Features; Some people develop symptoms of HSV a few days after coming into contact with the virus. Small, painful blisters or sores usually develop, which may cause itching or tingling, or make it painful to urinate.
After been infected, the virus may remains dormant (inactive) most of the time. However, certain triggers can reactivate the virus, causing the blisters to develop again, although they're usually smaller and less painful.
4. Gonorrhoea: is a bacterial STD easily passed on during sex. About 50% of women and 10% of men don't experience any symptoms and are unaware they're infected.
Clinical features:
In women, gonorrhoea can cause pain or a burning sensation when urinating, a vaginal discharge (often watery, yellow or green), pain in the lower abdomen during or after sex, and bleeding during or after sex or between periods, sometimes causing heavy periods.
In men, gonorrhoea can cause pain or a burning sensation when urinating, a white, yellow or green discharge from the tip of the penis, and pain or tenderness in the testicles.
Approach To A Patient With STD: During the history and physical examination it is important to ask about the timing of last intercourse, contraceptive method used, number of sexual partners, duration of relationship, past STD"S, menstrual and medical history as well as any antimicrobial treatment taken by the patient.
On examination always confirm if the discharge is present or not, look for genital ulcers, enlarged inguinal lymph nodes, do a per vaginal and a speculum examination.
Diagnosis: Different diagnostic tests are available for different STD's and a brief summary is given here:
1. Do a urine dipstick and a mid stream urine for culture and sensitivity.
2 If an ulcer is present take swabs for HSV culture and dark field microscopy for syphilis.
3. For chlamydia a PCR rapid test is available that is only done in high risk population as it is an expensive test.
4. For gonorrhoeae in men urethral smear for gram stain and culture are helpful but not much useful in women.
5. For syphilis, rapid test, VDRL and RPR are available.
Management: The treatment plan and options are different for different presentations.
1. Urethral Discharge: If a patient presenting with urethral discharge and the discharge is confirmed on examination treat it as a case of gonorrhea or chlamydia with Azithromycin 1 gm oral and Cefixime 400 mg oral once in a stat dose. If there is no discharge on examination then symptoms should be reviewed again and if persist then it is treated with Metronidazole 2 gm oral in a single stat dose.
2. Vaginal Discharge: A patient presenting with vaginal discharge should receive treatment for trichomoniasis and bacterial vaginosis with metronidazole 2 gm and cotrimazole vaginal tablet 500 mg once in a stat dose. If cervicitis is also suspected on examination as with cervical motion tenderness then also give Azithromycin 1 gm oral and Cefixime 400 mg oral once in a stat dose.
3. Genital ulcers: A patient with a painless genital ulcer usually have syphilis and needs treatment with benzathine benzyl penicillin 2.4 gm IM in a single stat dose. For penicillin allergic patients give doxycyline 200 mg/day for 14 days or erythromycin 2gm/day for 14 days.
Prevention: All patients should be advised to practice safe sex and to treat the partner at the same time.
In men, gonorrhoea can cause pain or a burning sensation when urinating, a white, yellow or green discharge from the tip of the penis, and pain or tenderness in the testicles.
Approach To A Patient With STD: During the history and physical examination it is important to ask about the timing of last intercourse, contraceptive method used, number of sexual partners, duration of relationship, past STD"S, menstrual and medical history as well as any antimicrobial treatment taken by the patient.
On examination always confirm if the discharge is present or not, look for genital ulcers, enlarged inguinal lymph nodes, do a per vaginal and a speculum examination.
Diagnosis: Different diagnostic tests are available for different STD's and a brief summary is given here:
1. Do a urine dipstick and a mid stream urine for culture and sensitivity.
2 If an ulcer is present take swabs for HSV culture and dark field microscopy for syphilis.
3. For chlamydia a PCR rapid test is available that is only done in high risk population as it is an expensive test.
4. For gonorrhoeae in men urethral smear for gram stain and culture are helpful but not much useful in women.
5. For syphilis, rapid test, VDRL and RPR are available.
Management: The treatment plan and options are different for different presentations.
1. Urethral Discharge: If a patient presenting with urethral discharge and the discharge is confirmed on examination treat it as a case of gonorrhea or chlamydia with Azithromycin 1 gm oral and Cefixime 400 mg oral once in a stat dose. If there is no discharge on examination then symptoms should be reviewed again and if persist then it is treated with Metronidazole 2 gm oral in a single stat dose.
2. Vaginal Discharge: A patient presenting with vaginal discharge should receive treatment for trichomoniasis and bacterial vaginosis with metronidazole 2 gm and cotrimazole vaginal tablet 500 mg once in a stat dose. If cervicitis is also suspected on examination as with cervical motion tenderness then also give Azithromycin 1 gm oral and Cefixime 400 mg oral once in a stat dose.
3. Genital ulcers: A patient with a painless genital ulcer usually have syphilis and needs treatment with benzathine benzyl penicillin 2.4 gm IM in a single stat dose. For penicillin allergic patients give doxycyline 200 mg/day for 14 days or erythromycin 2gm/day for 14 days.
Prevention: All patients should be advised to practice safe sex and to treat the partner at the same time.
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