National AIDS Control Organisation Ministry of Health & Family Welfare

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Title
National AIDS Control Organisation
Ministry of Health & Family Welfare
extracted text
it

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50

NATIONAL AIDS CONTROL PROGRAMME
INDIA
Simplified STI & RTI Treatment Guidelines
(Flow Charts)
0

Prepared by
National AIDS Control Organisation
Ministry of Health & Family Welfare
GOVERNMENT OF INDIA

-

•

1

>
4

Syndromic Approach
(Flow Charts)

INDEX
1.

Urethral Discharge Syndrome

2,3 & 4

2.

Vaginal Discharge Syndrome

5,6,7 & 8

3.

Genital Ulcer Syndrome

9,10& 11

4.

Inguinal Swelling Syndrome

12&13

5.

Lower Abdominal Pain

14 & 15

6.

Scrotal Swelling

16 & 17

7.

Ophthalmia Neonatorum

18 & 19

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC DIAGNOSIS,TREATMENT & FOLLOW UP
URETHRAL DISCHARGE
Man complains of urethral discharge and painful urination

Examine patient for urethral discharge

♦
No discharge seen

Discharge seen

*
Reevaluate if symptoms persist

Treat for Gonorrhoea and Chlamydia

FOLLOW UP 7 DAYS AFTER CLINIC VISIT

*
Discharge persists

Cured

♦
Complete any remaining treatment

TREATMENT
GONORRHOEA
Ciprofloxacin 500 mg orally in a single
dose (contraindicated in pregnancy)
OR
Norfloxacin 800 mg orally in a single
dose
OR
Kanamycin 2 g IM as a single dose

Treatment regimen
followed
♦

Treatment regimen not
followed
♦

Refer to higher care

Repeat treatment

STEPS FOR STD PREVENTION AND MANAGEMENT
Give all patients
1 Treatment
2 Instructions for medication and
follow up
3 Education and counseling
4 Condoms

CHLAMYDIA
Doxycycline 100 mg orally 2 times
daily for 7 days
OR
Tetracycline 500 mg orally 4 times
daily for 7 days
OR
Erythromycin 500 mg orally 4 times
daily for 7 days (pregnant women)

Education and Counseling for patients
1 Cure your infection
2 Do not spread STD

N.B.iletracycline and Doxycycline should not be used during pregnancy and lactation.

2

3 Help your sexual partners to get
treatment
4. Come back to make sure you are
cured
5 Stay cured with condoms
6 Keep safety by staying with just
one sexual partner
7 Protect yourself against AIDS
8 Protect your baby - ask your wife
to attend ANC during pregnancy

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC DIAGNOSIS,TREATMENT & FOLLOW UP
URETHRAL DISCHARGE

URETHRAL DISCHARGE
gonorrhoeae

Gonococeal organism

URETHRAL DISCHARGE
- Neisseria gonorrhoea

URETHRAL DISCHARGE
— Chlamydia trachomatis

URETHRAL DISCHARGE
- Chlamydia trachomatis

URETHRAL DISCHARGE

3

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC & LABORATORY DIAGNOSISJREATMENT & FOLLOW UP
URETHRAL DISCHARGE
Man complains of urethral discharge and painful urination

Examine patient for urethral discharge
No discharge seen

Discharge seen

- Use gram staining of discharge
- Look for gram-ve intracellular diplococci
4<

Intracellular diplococci present

Reevaluate if symptoms persist

Intracellular diplococci not seen

♦
Treat for Gonorrhoea and
Chlamydia

Treat for Chlamydia

FOLLOW UP 7 DAYS AFTER CLINIC VISIT
Discharge persists

Cured

Complete any remaining treatment

Treatment regimen not
followed

Refer to higher care

Repeat treatment

STEPS FOR STD PREVENTION AND MANAGEMENT

TREATMENT
GONORRHOEA
Ciprofloxacin 500 mg orally in a
single dose (contraindicated in
pregnancy)
OR
Norfloxacin 800 mg orally in a single dose
OR
Kanamycin 2 g IM as a single dose

Treatment regimen
followed
♦

CHLAMYDIA
Doxycycline 100 mg orally 2 times
daily for 7 days
OR
Tetracycline 500 mg orally 4 times
daily for 7 days
OR
Erythromycin 500 mg orally 4 times
daily for 7 days (pregnant women)

Give all patients
1 Treatment
2 Instructions for medication and
follow up
3 Education and counseling
4 Condoms
Education and Counseling for patients
1 Cure your infection
2 Do not spread STD

N.B.Tetracycline and Doxycycline should not be used during pregnancy and lactation.

4

3 Help your sexual partners to get
treatment
4. Come back to make sure you are
cured
5 Stay cured with condoms
6 Keep safety by staying with just
one sexual partner
7 Protect yourself against AIDS
8 Protect your baby - ask your wife
to attend ANC during pregnancy

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC DIAGNOSIS,TREATMENT & FOLLOW UP
VAGINAL DISCHARGE
Woman complains ofVaginal
Discharge

RISK
-> ASSESSMENT

Ask if patient answers ‘yes’to : Does your sexual partner have a discharge from
his penis or open sore anywhere in his genital area?

*

4,

Yes

No

4*

Risk Assessment -ve

Risk Assessment +ve

4
Profuse
Discharge

Clumped
Discharge

4

4*

Treat for
Gonorrhoea,
Chlamydia,
Trichomoniasis
& Bacterial
Vaginosis

♦

4*

4Speculum
Available

Treat for
Gonorrhoea,
Chlamydia &
Candidiasis

Speculum Not
Available

Speculum Not
Available

4*
Treat for
Gonorrhoea,
Chlamydia,
Candidiasis &
Trichomoniasis
& Bacterial
Vaginosis

Speculum Available

I

4

*

T

Treat for
Candidiasis &
Trichomoniasis
& Bacterial
Vaginosis

Mucopus
from cervix

Profuse
Discharge

iClumped
CDischarge

4-

41

4*

Treat for
Gonorrhoea &
Chlamydia

Treat for
Trichomoniasis
& Bacterial
Vaginosis

Treat for
Candidiasis

and
TREATMENT
E.,::..,...,.'
Erythromycin stearate 500 mg orally four times
■ * for •7 days
J
Cervical discharge on speculum examination: a day
"Trf.-xr r'nn/ir<ilir i rnr-d i i rlno
Treatment for Cervicitis includes treatment for Vaginal discharge on speculum examination
both Gonorrhoea and Chlamydial infection.
Recommended regimen:
Recommended regimen (non-pregnant women): Metronidazole 400 mgm thrice daily for 7 days
Ciprofloxacin 500 mg in a single dose orally
and
and
Miconazole or Clotrimazole 200 mg
Doxycyc’ine 100 mg orally twice daily for 7
intravaginally once daily for 3 days
days.
or
Alternative regimen:
Clotrimazole 500 mg intravaginally once only,
Azithromycin
1 g single oral dose under
.
or
supervision (effective both for Gonorrhoea and Fluconazole 150 mg orally as a single dose
Chlamydial infection)
During the first trimester of pregnancy no
In case of pregnancy:
Metronidazole must be given, and treatment is
Inj. Ceftriaxone 250 mg single IM dose
by Miconazole only.
N.B.Tetracycline and Doxycycline should not be used during pregnancy and lactation.

5

4*
No Discharge
Seen

STEPS FOR STD PREVENTION AND MANAGEMENT
Give all patients
1 Treatment
2 Instructions for medication and
follow up
3 Education and counseling
4 Condoms

Education and Counseling for patients
1 Cure your infection
2 Do not spread STD

3 Help your sexual partners to get
treatment
4. Come back to make sure you are
cured
5 Stay cured with condoms
6 Keep safety by staying with just
one sexual partner
7 Protect yourself against AIDS
8 Protect your baby - ask your wife
to attend ANC during pregnancy

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC DIAGNOSIS,TREATMENT & FOLLOW UP
VAGINAL DISCHARGE
|R
•

i 53

Bartholin Absces

Candidiasis

I

1
Moniliasis

Trichomonas Vaginitis
6

"

■

•

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC & LABORATORY DIAGNOSIS,TREATMENT & FOLLOW UP
VAGINAL DISCHARGE
RISK
ASSESSMENT

Woman complains ofVaginal
Discharge

Ask if patient answers ‘yes’ to : Does your sexual partner have a discharge from
his penis or open sore anywhere in his genital area?

4*
No

Yes
Candidiasis

|

_____

♦

I

I

Speculum Available
Use wet mount (saline + KOH)Test

Speculum Available
Use wet mount (saline + KOH)Test

4*

4*
Wet mount +ve

4
Trichomonas Vaginalis
present (Trichomonads)
Treat for Gonorrhoea,
Chlamydia,Trichomoniasis
& Bacterial Vaginosis

TrichomonasVaginitis

Risk Assessment -ve

Risk Assessment +ve

4/ Jr

4
Yeast cells
present
4
Treat for
Gonorrhoea and
Candidiasis

Wet mount+ve

... .
.
Wet mount -ve

Wet mount -ve

Treat for
Gonorrhoea
&
Candidiasis

4*

4

Trichomonads
**
‘
Present

Yeast
cells
present*

Treat for
Trichomonaisis

Treat for
Candidiasis

Mucopus
from
r'lariziv
cervix

No
discharge
seen

20 % clue
Cells
Present

..
Treat for
Gonorrhoea,
& Chlamydia
VIUIIUII liuca,

and
TREATMENT
E
::
Erythromycin
stearate 500 mg orally
Cervical discharge on speculum examination: four times a day for 7 days
Treatment for Cervicitis includes treatment for Vaginal discharge on speculum examination
u
gj.1 infection.
r.
:
both Gonorrhoea
and r'U!
Chlamydial
Recommenoed
regimen:
Recommended regimen (non-pregnant women): Metronidazole 400 mgm thrice daily for 7 days
Ciprofloxacin 500 mg in a single dose orally
and
and
Miconazole or Clotrimazole 200 mg
Doxycycline 100 mg orally twice daily for 7
intravaginally once daily for 3 days
or
days.
Clotrimazole 500 mg intravaginally once only,
Alternative regimen:
Azithromycin
1
g
single
oral
dose
under
,
or
supervision (effective both for Gonorrhoea and Fluconazole 150 mg orally as a single dose
-- i:_i
—
*:—\
- t*" 7 the first
—
------ 1 -of
— pregnancy
--------- y
Chlamydial
infection)
During
trimester
no
Metronidazole
In case of pregnancy:
f.L.
L must
- ' ‘ be given, and treatment is
Inj. Ceftriaxone 250 mg single IM dose
by Miconazole only.
N.B.Tetracycline and Doxycycline should not be used during pregnancy and lactation.

7

Bacterial
Vaginosis

STEPS FOR STD PREVENTION AND MANAGEMENT
Give all patients
-|1 -j-reatment

Instructions for medication and
follow up
3 Education and counseling
4 Condoms

2

Education and Counseiing for patients
1 Cure your infection
2 Do not spread STD

Help your sexual partners to get
treatment
4. Come back to make sure you are
cured
5 Stay cured with condoms
6 Keep safety by staying with just
one sexual partner
7 Protect yourself against AIDS
8 Protect your baby - ask your wife
to attend ANC during pregnancy

3

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC & LABORATORY DIAGNOSIS,TREATMENT & FOLLOW UP
VAGINAL DISCHARGE

Clinical Features of Trichomoniasis: History

Clinmical Features of Candidiai Vulvovaginitis
Examination

Sexually active woman:
Discharge
: 50%
cream colored, frothy, offensive sudden
onset, during or after menstruation or ex­
acerbation with menstruation
Pruritus
: 75% severe
Dysparunia : feeling of fullness in genitalia
Dysuria
: 20%

Vulva ranges from pallid to erythematous
Vulvar edema ± excoriations
Discharge
: thick, white, cheesy, adherent
Atypically
: thin, watery, white sheen to vagina and
labia
few organism

Clinical Features of Trichomoniasis :
Examination

Edema and excoriation of external genitalia
Frothy, purulent, foul smelling discharge
Granular Vaginitis of fomices and cervix
Strawberry cervix
Bartholinitis
Urethritis
Abdominal or rectal tenderness rare
Trichomonas Vaginalis

8

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC DIAGNOSIS,TREATMENT & FOLLOW UP
GENITAL ULCER
Patient complains of genital ulcer(s)

*
Examine patient

Primary Syphilis

4- Genital ulcer (open sore may be painful or painless)
- May have swollen lymph nodes in groin

Multiple small blister like painful lesions

-Treat to relieve symptoms of Herpes
- Reassure patient that lesions will improve within 7 days

Treat for Syphilis and Chancroid

FOLLOW UP 7 DAYS AFTER CLINIC VISIT

4

4*

Improvement or cured

No improvement

4*

*

Complete any remaining treatment

Refer to higher care

TREATMENT
SYPHILIS
Benzathine Penicillin G 2.4 million units in 2 injections
(give one injection in each buttock)
OR
Aqueous Procaine Penicillin G1.2 million units IM injection
daily for 10 days
For men and non-pregnant women sensitive to Penicillin
Doxycycline 100 mg orally 2 times daily for 15 days
OR
Tetracycline 500 mg orally 4 times daily for 15 days
For pregnant women sensitive to Pencillin
Erythromycin 500 mg orally 4 times daily for 15 days
(advise those women to bring the child within 7 days of
birth for screening)

CHANCROID
Erythromycin 500 mg orally 4 times daily for 7 days
Alternative Treatment
Ciprofloxacin 500 mg orally as a single dose (do not give
to pregnant women)
OR
Trimethoprim 80 mg/Sulphamethoxazole 400 mg 2 tablets
2 times daily for 7 days
OR
Ceftriaxone 250 mg in a single IM dose
HERPES SYMPTOMATIC THERAPY
- Apply topical antibiotic ointments. Advise patient to
wash genital area regularly with soap and water.
- First episode - Acyclovir 200 mg orally 5 times daily
for 7 days
- Recurrent episodes - Acyclovir 200 mg orally 5 times
daily for 5 days

N.B.:Tetracycline and Doxycycline should not be used during pregnancy and lactation.

9

STEPS FOR STD PREVENTION
AND MANAGEMENT
Give all patients
1 Treatment
2 Instructions for medication
and follow up
3 Education and counseling
4 Condoms

Education and Counseling
for patients
1 Cure your infection
2 Do not spread STD
3 Help your sexual partners
to get treatment

4. Come back to make
sure you are cured
5 Stay cured with
condoms
6 Keep safety by
staying with just
one sexual partner
7 Protect yourself
against AIDS
8 Protect your baby ask your wife to
attend ANC during
pregnancy

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC DIAGNOSIS,TREATMENT & FOLLOW UP
GENITAL ULCER

CHANCROID IN MALE
— Haemophilus Ducreyi

CHANCROID IN MALE
- Haemophilus Ducreyi

Primary Syphilis

HARD CHANCRE IN MALE
— Treponema Pallidum

HARD CHANCRE IN MALE
-Treponema Pallidum

CHANCROID IN FEMALE
- Haemophikus Ducreyi

10

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC & LABORATORY DIAGNOSIS,TREATMENT & FOLLOW UP

GENITAL ULCER
Patient complains of genital ulcer(s)

4
Examine patient

T"

I*
- Genital ulcer (open sore may be painful or painless)
- May have swollen lymph nodes in groin

Multiple small blister like painful lesions

I

-Treat to relieve symptoms of Herpes
- Reassure patient that lesions will impove within 7 days

Treat for Syphilis and Chancroid
-Test blood for VDRL or RPR

*
FOLLOW UP 7 DAYS AFTER CLINIC VISIT

•f

4-

Improvement or cured
4-

Complete any remaining treatment

No imporvement

Positive for VDRL or RPR

l

Tell pregnant women to bring their
babies for treatment after birth. It is
especially important to treat sexual
partner for Syphilis

Refer to higher level care

CHANCROID
TREATMENT
Erythromycin 500 mg orally 4 times daily for 7 days
SYPHILIS
Alternative Treatment
Benzathine Penicillin G 2.4 million units in 2 injections Ciprofloxacin 500 mg orally as a single dose (do not
(give one injection in each buttock)
' give to pregnant women)
OR
OR
Aqueous Procaine Penicillin G 1.2 million units IM Trimethoprim 80 mg/Sulphamethoxazole 400 mg 2
injection daily for 10 days
tablets 2 times daily for 7 days
For men and non-pregnant women sensitive to Penicillin
OR
Doxycycline 100 mg orally 2 times daily for 15 days
Ceftriaxone 250 mg in a single IM dose
OR
HERPES SYMPTOMATIC THERAPY
Tetracycline 500 mg orally 4 times daily for 15 days
- Apply topical antibiotic ointments. Advise patient to
For pregnant women sensitive to Pencillin
wash genital area regularly with soap and water.
Erythromycin 500 mg orally 4 times daily for 15 days
- First episode - Acyclovir 200 mg orally 5 times daily
(advise those women to bring the child within 7 days of
for 7 days
birth for screening)
- Recurrent episodes - Acyclovir 200 mg orally 5 times
daily for 5 days
N.B.:Tetracycline and Doxycycline should not be used during pregnancy and lactation.

11

4<

STEPS FOR STD PREVENTION
AND MANAGEMENT

Give all patients
1 T reatment
2 Instructions for medica­
tion and follow up
3 Education and counseling
4 Condoms
Education and
Counseling for patients
1 Cure your infection
2 Do not spread STD
3 Help your sexual partners
to get treatment

4. Come back to make
sure you are cured
5 Stay cured with
condoms
6 Keep safety by
staying with just
one sexual partner
7 Protect yourself
against AIDS
8 Protect your baby ask your wife to
attend ANC during
pregnancy

SEXUALLY TRANSMITTED DISEASE
INGUINAL BUBO
Patient complains of enlarged and painful
inguinal lymph nodes

Take history and examine

4*
Ulcer(s) present?

♦

* YES

Use genital ulcers flow chart

-Treat for lymphogranuloma venereum
- Educate
- Counsel
- Promote and provide condoms
- Partner management
- Advise to return in 14 days
♦

14 DAYS
4*
Responding to treatment

L.G.V. Bubo

*NO

Refer to higher level facility

4*

YfS
Presume cured

TREATMENT
Doxycycline 100 mg orally twice
daily for 14 days or
Tetracycline 500 mg orally four times
a day for I4 days

Alternate regimen:

Erythromycin stearate 500 mg orally
four times daily for 14 days.

STEPS FOR STD PREVENTION AND MANAGEMENT
If a bubo becomes fluctuant, pus should
be aspirated with a wide-bore needle
and syringe every second or third day,
until there is no aspirate. The entry into
the bubo should be made through
normal healthy skin. Under no
circumstances should a bubo be
incised.

Give all patients
1 Treatment
2 Instructions for medication and
follow up
3 Education and counseling
4 Condoms

Education and Counseling for patients
1 Cure your infection
2 Do not spread STD

N.B.:Tetracycline and Doxycycline should not be used during pregnancy and lactation.

12

3 Help your sexual partners to get
treatment
4. Come back to make sure you are
cured
5 Stay cured with condoms
6 Keep safety by staying with just
one sexual partner
7 Protect yourself against AIDS
8 Protect your baby - ask your wife
to attend ANC during pregnancy

SEXUALLY TRANSMITTED DISEASE

INGUINAL BUBO

BUBO IN MALE
— Chlamydia trachomatis
serovars L1-L3

UBO IN FEMALE
— Chlamydia trachomatis
serovars L1-L3

BUBO IN MALE
- Chiamydia trachomatis serovars L1-L3

BUBO IN FEMALE
- Chiamydia trachomatis serovars L1-L3

Inguinal Bubo (Grove)

13

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC DIAGNOSIS,TREATMENT & FOLLOW UP
LOWER ABDOMINAL PAIN
(Speculum and bimanual examination possible with or without microscopy)

Woman complains of lower abdominal pain
Take history and do abdominal examination

- Abdominal rebound tenderness ?
-and/or guarding?

_

^YES

—

■►yes

- Mucopus exuding from cervix?
- and / or tenderness on cervical movements?
- and / or adnexal tenderness?
- Is temperature 38°C or higher?

YES

Surgical referral

ijo
- Last menstrual period overdue?
- Recent abortion or delivery?
- Menorrhagia or metrorrhagia?

*

NO

*

Gynaecological referral
-Treatment for RID*
- Examine and treat partner(s) [A]
- Health education and counselling
Review after 3-7 days

4'

NO
4-

Improvement

Adnexal mass present?

NJ)

___________ fjp_______

YES

Refer

TREATMENT for P.I.D.

Cefixime 400 mg orally as a single dose
OR
Kanamycin 2 g IM as a single dose
Alternative treatment if single dose treatment
is not available
Trimethoprim 80 mg/ Sulphamethoxazole 400
mg 10 tablets once daily for 3 days.
PlusTreatment for Chlamydia
Doxycycline 100 mg orally 2 times daily for 14
days
OR
Tetracycline 500 mg orally 4 times daily for 14
days
Plus Treatment for Anaerobic infection
Metronidazole 400 mg twice daily for 14 days

(Gonorrhoea +Chlamydia+Anaerobic infection)
Use this regimen only if patient is well enough
to take food and liquids, walk unassisted,
take her medication, and return for follow up.
Otherwise, refer to higher level care.
Single dose treatment for Gonorrhoea
Ciprofloxacin 500 mg orally as a single dose
OR
Norfloxacin 800 mg orally as a single dose
OR
Ceftriaxone 250 mg IM as a single dose
OR

Continue treatment

Refer to higher level care

|eve| care

Advise patient to return for
reevaluation if pain persists

•For patients with IUD, remove IUD 2-4 days after starting treatment

STEPS FOR STD PREVENTION AND MANAGEMENT
Give all patients
1 Treatment
2 Instructions for medication and
follow up
3 Education and counseling
4 Condoms
Education and Counseling for patients
1 Cure your infection
2 Do not spread STD

N.B.:Tetracydine and Doxycycline should not be used during pregnancy and lactation.

14

Help your sexual partners to get
treatment
4. Come back to make sure you are
cured
5 Stay cured with condoms
6 Keep safety by staying with just
one sexual partner
7 Protect yourself against AIDS
8 Protect your baby - ask your wife
to attend ANC during pregnancy

3

SEXUALLYTRANSMITTED DISEASE
SYNDROMIC DIAGNOSIS,TREATMENT & FOLLOW UP
LOWER ABDOMINAL PAIN
(Speculum and bimanual examination possible with or without microscopy)

r

NORMAL
FALLOPIAN TUBE

INFECTED
FALLOPIAN TUBE

'iJ

OVARY

ACUTE SALPINGITIS (PID)

15

SEXUALLYTRANSMITTED DISEASE

SCROTAL SWELLING
Patient complains of painful swelling

♦
Injury to scrotum
*
NO

^YES

Swelling of scrotum

^NO'

Refer to higher level facility

*

• - Reassure patient and educate
- Promote and provide condoms

YES

Testis rotated or retracted

*

^NO'

4*
YES

41

Refer immedialtely to higher level care

-Treat for gonorrhoea and chlamydia
- Educate
-Counsel
- Promote and provide condoms
- Partner management and treatment
- Return in 14 days

14 jiays

TREATMENT
Ciprofloxacin 500 mg as a single oral
dose (make sure that the patient
swallows
the
tablets
under
supervision).
Alternative regimen
Ceftriaxone 250 mg IM as a single dose
OR
Cefixime 400 mg in a single oral dose
OR
Kanamycin 2g IM as a single dose
Recommended regimen for chlamydial
urethritis:
Doxycycline 100 mg orally twice daily
for 10 days (make sure that the patient
receives 20 tablets or capsules with
instructions to take one tablet in the
morning and one in the evening).
Alternative regimen

Tetracycline 500 mg orally 4 times a
day for 10 daysor
Erythromycin 500 mg orally 4 times a
day for 10 days or
Sulfisoxazole 500 mg orally 4 times a
day for 10 days (equivalent doses of
other sulfonamides may also be used).
Supportive therapy
This is a painful condition and
supportive therapy with
- Bed rest
- Scrotal elevation with a scrotal
support and analgesic is essential
part of management
- Advise the patient to take all his
tablets and inform him about the
mode of transmission of STD and
the possible complications of
infection and, in particular,
epididymo-orchitis.

Tenderness and swelling confirmed

4

NO

YES

4

*
Refer to higher level facility

Cured

STEPS FOR STD PREVENTION AND MANAGEMENT
Give all patients
1 Treatment
2 Instructions for medication and
follow up
3 Education and counseling
4 Condoms

Education and Counseling for patients
1 Cure your infection
2 Do not spread STD

N.B.Tetracycline and Doxycycline should not be used during pregnancy and lactation.

16

Help your sexual partners to get
treatment
4. Come back to make sure you are
cured
5 Stay cured with condoms
6 Keep safety by staying with just
one sexual partner
7 Protect yourself against AIDS
8 Protect your baby - ask your wife
to attend ANC during pregnancy

3

SEXUALLYTRANSMITTED DISEASE
SCROTAL SWELLING

SCROTAL SWELLING
— Neisseria gonorrhoeae
— Chlamydia trachomatis
SCROTAL SWELLING
- Neisseria Gonorrhoea
- Chlamydia Trachomatis

17

SEXUALLYTRANSMITTED DISEASE
OPHTHALMIA NEONATORUM
(NEONATAL CONJUNCTIVITIS)
Mother presents neonate with discharging eyes
4

Take history and examine baby

*
Conjunctivitis present?

^NO

- Reassure mother
- Review if symptoms persist

*

*
YES

4-

- Treat baby for gonorrhoea and chlamydia
- Treat mother and father for gonorrhoea
and chlamydia
- Educate parents
- Review baby in 2 days

4*
Examine in 2 days
Improved?

NO

*

Refer to higher level facility

*
YES
4*
- Reinforce education
- Complete treatment
- Presume cured

TREATMENT
Ceftriaxone 50 mg/kg body weight by
intramuscular injection as a single dose
to a maximum of 125 mg.
Alternative regimens where Ceftriaxone
is not available:
Kanamycin 25 mg/kg body weight by
intramuscular injection as a single dose
to a maximum of 75 mg
OR

STEPS FOR STD PREVENTION AND MANAGEMENT

Spectinomycin 25 mg/kg body weight
by intramuscular injection as a single
dose to a maximum of 75 mg PLUS
Erythromycin syrup 50 mg/kg body
weight per day orally in 4 divided doses
for 14 days.
Single dose Ceftriaxone, Kanamycin
and Spectinomycin are of proven
efficacy. The addition of Tetracycline
eye ointment to these regimens is of
no documented benefit.

Give all patients
1 Treatment
2 Instructions for medication and
follow up
3 Education and counseling
4 Condoms
Education and Counseling for parents
1 Cure your infection
2 Do not spread STD

N.B.:Tetracycline and Doxycycline should not be used during pregnancy and lactation.

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3 Help your sexual partners to get
treatment
4. Come back to make sure you are
cured
5 Stay cured with condoms
6 Keep safety by staying with just
one sexual partner
7 Protect yourself against AIDS
8 Protect your baby - ask your wife
to attend ANC during pregnancy

SEXUALLYTRANSMITTED DISEASE
OPHTHALMIA NEONATORUM

£ -

OPHTHALMIA NEONATORUM
- Neisseria Gonorrhoea
- Chlamydia Trachomatis

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