Algorithms for Managing Common STI Syndromes

  VAGINAL DISCHARGE OR PRURITUS  LOWER ABDOMINAL PAIN IN WOMEN 

GENITAL ULCER DISEASE (GUD) OPHTHALMIA NEONATORUM
URETHRAL DISCHARGE

Patient or Client complains

History of urethral discharge or of lower abdominal pain
symptoms Patient or client complains of a genital Neonate with eye discharge
sore or ulcer
History of vaginal discharge
Enquire about lower abdomen pain and examine DO ABDOMINAL AND BIMANUAL
Take history and examine
EXAMINATION
Milk urethra if necessary TAKE HISTORY AND EXAMINE TAKE HISTORY AND EXAMINE
FOR ULCER

NO LOWER ABDOMINAL PAIN LOWER ABDOMINAL PAIN

OR TENDERNESS Offer or refer for
OR TENDERNESS No
ULCER PRESENT? HIV testing and
counseling and
DISCHARGE ABSENT Yes
ABDOMINAL MASS ABDOMINAL NO TENDERNESS ON 4Cs
TENDERNESS OR DISCHARGE PRESENT
OR ABDOMINAL ABDOMINAL Treat for HSV2*, syphilis and
DISCHARGE PRESENT FOLLOW THE TENDERNESS DUE TO TENDERNESS ON EXAMINATION
VAGINITIS Rx and 4Cs Chancroid, and 4Cs. Review in 7
FLOW CHART FOR SURGICAL OR GYNAE MOVING THE days.
LOWER CAUSES CERVIX
SYMPTOMATIC Rx AND 4Cs ABDOMINAL PAIN OPHTHALMIA NEONATORUM R X
IF NO IMPROVEMENT AFTER 7 DAYS SYMPTOMATIC
R OR VAGINITIS Continue HSV2* treatment
X
REFER FOR SURGICAL PID Rx AND 4Cs R X IF THERE IS No for a further 7 days,
OR ULCER HEALING**?
VAGINAL Alternative GUD R x
CERVICITIS Rx AND 4Cs GYNAECOLOGICAL
DISCHARGE Yes Review in 7 days. FOLLOW UP IN 24 HOURS
ASSESSMENT
URETHIRITIS Rx AND 4Cs
IF DISCHARGE/SYMPTOMS PERSIST
AFTER 7 DAYS Offer or refer for
IF NO IMPROVEMNT AFTER 7 Yes
HIV counseling and
DAYS ULCER HEALING**?
testing and 4Cs NOT BETTER
BETTER
REFER FOR START FLOWCHART
REFER FOR No
INVESTIGATION AGAIN AFTER REPEATING
INVESTIGATION ABDOMINAL
IF DISCHARGE PERSISTS AFTER EXAMNATION
7 DAYS REFER FOR
o
VAGINITIS Rx X *Surgical or gynaecological causes are determined by rebound tenderness INVESTIGATION CONTINUE WITH
Clotrimazole 1 pessary intravaginally daily for 6 days and/or guarding, last menstrual period overdue, recent abortion or delivery; 1% TETRACYCLINE
(Or Clotrimazole 200mgs pessaries intravaginally daily for 3 Menorrhagia and/or metrorrhagia EYE OINTMENT TDS
days) AND Metronidazole 400mg 10 DAYS AND 4Cs
ALTERNATIVE URETHIRITIS RX GENITAL ULCER DISEASE (GUD) R X
AND 4Cs If pregnant PELVIC INFLAMMATORY Erythromcyin 500mg TID x 7 days
AND
DISEASE (PID) RX Benzathine Penicillin 2.4 MU IM stat
Alternative Rx AND 4Cs
Clotrimazole 1 pessary intravaginally daily x 6 days (Or Norfloxacin 800mg stat (or Ciprofloxacin 500mg single dose) If Penicillin allergy:
Clotrimazole 200mgs pessaries intravaginally daily for 3 days) AND Use Erythromcin 500mg QID x 14 days
IF DISCHARGE PERSISTS AFTER
7 DAYS
Doxycycline 100mg BD x 7 days OPHTHALMIA NEONATORUM TREATMENT
*Treat HSV2 with Acyclovir 400mg TID for 7 days if
AND
client presents with an ulcer with multiple vesicles
Metronidazole 400mg BD x 10 days
(painful) grouped together with history of recurrence. 1% TETRACYCLINE eye ointment TDS x 10 days
REFER FOR INVESTIGATIONS Treat mother for cervicitis and
Alternative GUD Rx:
CERVICITIS R X Ciprofloxacin 500mg single dose partner for urethritis
Norfloxacin 800mg stat (or Ciprofloxacin 500mg stat)
If pregnant:
URETHRITIS Rx AND Doxycycline 100mg BD x 7 days
Refer for obstetric evaluation if PID is suspected **GUD heals slowly; improvement is defined as sign of ALTERNATIVE Rx:
healing and reduction of pain. People with HIV
Norfloxacin 800mg stat (or Ciprofloxacin 500mg single dose) infection will be slower in responding to GUD treatment
AND If pregnant ALTERNATIVE TREATMENT Ceftriaxone 62.5mg IM stat and 1%
Doxycycline 100mg BD x 7 days
IM Spectinomycin 2gm stat (or IM Ceftriaxone 250mg Azithromycin 1gm PO single dose or Tetracycline eye ointment TDS x
10 days and 4Cs
Alternative Rx single dose) Cefixime 400mg PO single dose
AND
IM Spectinomycin 2gm stat (or IM Ceftriaxone 125 – 250 mg
single dose) Erythromycin 500mg QID x 7 days
AND
Doxycycline 100mg BD x 7 days

FIGHT AIDS! REMEMBER THE 4Cs OF GOOD STI MANAGEMENT

Counseling Compliance Condoms Contact treatment
Emphasize with your patient (put yourself in your Your patient should: Proper condom use is the only other alternative to abstinence Your patient should
patient’s place) Avoid self-medication Give condoms to your patient Tell all his/her sexual partners to seek medication
Dialogue with your patient Take the full course of medication and not share or Explain and demonstrate the proper use of the condoms
Discuss the other 3cs keep it
’
Offer testing and counseling services Follow your other instructions

REPUBLIC OF KENYA, NATIONAL AIDS/STD CONTROL PROGRAMME (NASCOP), P. O. BOX 19361, 00200 NAIROBI TEL 729502/27/49, FAX 720514