TM: Syndromic Approach to STIs (i) (STIs/Infectious diseases/GU clinics…
TM: Syndromic Approach to STIs (i)
potential serious health risks
early + effective tx integral component for control
prevention of HIV transmission NB
often present as a defined set of similar signs + symptoms (syndromes)
inaccessibility of appropriate health services
drug accessibility, resistance patterns, cost of tx
single dose same day DOT = best
stigma - partner notification
identify + tx a high prop of the core transmitting group
achieve high success rate to reduce the average no of secondary cases from 1 primary infectious case to 1 or less
find ways to identify assymptomatic individuals - screening
STIs/Infectious diseases/GU clinics
Drs referral not necessary
patient's personal data kept strictly confidential
routine serological blood test for syphilis + HIV for all patients on a voluntary basis
full hx about risky behaviours + exposures
remind defaulters for follow-up
behavioural risk assessment
proper + consistent condom use
prompt + routine medical consult after unsafe exposure
free condom distribution
same day Tx - often empirically (before you have definitive +ve result)
medical social work
Hx, exam, collect specimens, investigations
local resistance patterns
clinic can do it via post
"you have been exposed to an STI please book an appointment"
ensures patient anonymity
do you have sex with men, women, or both?
in past 2 months how many sexual partners?
in past 12 months how many sexual partners?
is it possible any of your partners in past 12 months has sex with someone else while they were still in a sexual relationship with you?
what do you do to protect yourself from STIs + HIV?
to understand your risks I need to understand the kind of sex you've had recently...
condoms: never, sometimes, always?
why don't you use condoms
in what situations/with whom do you not use condoms
anal sex (penis-in-rectum/anus)
oral sex (mouth-on-penis/vagina)
have you/any of your partners had an STI?
have you/any of your partners injected drugs? (hep/HIV)
have you/any of your partners exchanged money/drugs for sex?
is there anything else about your sexual practices I need to know about?
diseases associated with discharge
urethral (men): N gonorrhoeae, C trachomatis
cervical: N gonorrhoeae, C trachomatis
vaginal: bacterial vaginosis (Gardnerella vaginalis), trichomonas vaginalis, candida albicans
easily transmitted by oral sex
T pallidum: hard ulcerate solitary chancre
LGV: chlamydia serovers L1-3 - multiple soft chancres + local lymphadenopathy
granuloma inguinale: multiple Klebsiella granulomata
fixed drug eruption (allergy, always in same site)
Behcet's disease (rare disorder causing blood vessel inflamm, common in Mediterranean pop)
malignant lesions (vulval/penile cancers)
increases risk of HIV infection + transmission (HIV can't penetrate intact skin, ulcer = break in skin)
no of lesions, presence/absence of lymphadenopathy + constitutional symptoms useful clues to cause