Sexually Transmitted and

Reproductive Tract Infections

¨
(Gonorrhea syphilis
chlamydia herpes
warts HIV

Candida bacterial
vaginosis
Vacuum
Sores

&

Drips
STI/RTI ?


 HIV/AIDS
 STI/RTI ?


 ANC Blood Donation VCT
2004 2005 2006 2004 2005 2006 2004 2005 2006

HIV+ 1.5% 2.3% 1.6% .85% 1.6% .85% 14.9% 19.9% 18.5%

Hep B
7.0% 9.4% 6.7% 7.3% 8.9% 8.3% 4.0% 14.4%
+

VDRL
1.6% 1.9% 1.4% 1.0% 2.4% 1.8% 2.4% 8.8%
+
 ukd,f0efaqmifrdcifrsm;wGifHIV

2.5

1.5

0.5

0
1999 2000 2001 2002 2003 2004 2005 2006
 STI HIV
 HIV STI

 STI HIV

– HIV STI

– HIV

– STI HIV

 STI HIV
 STI ?
STI

– STI

STI/HIV
 ?






 STI ?

 STI

chlamydia







STI
?
STI
?

STI
… ?
STI



Challenge of STI/RTI Services
 Syndrome Approach

 Syndrome Approach
(WHO)

 Syndrome Approach
 Syndrome Approach


 STI









 Effective(
– WHO
Syndrome Approach
STIs
 Efficient(
 Standardized Approach
(
 Overdiagnosis and over-treatment
(
– Antibiotics





Syndrome #1
Vaginal Discharge(

In non-pregnant women
Vaginal Discharge – no SPA
pain
Treatment for Vaginal Discharge
Syndrome #2
Lower Abdominal Pain

In women
Lower Abdominal Pain in
Women
 Lower Abdominal Pain
(
 Speculum

– CMT = cervical motion tenderness

Female Anatomy
Fallopian Tube Scarring and
Blockage as a Consequence
of PID
 Treatment for Lower
Abdominal Pain in Women
Inpatient Treatment
Outpatient Treatment
 Genital Ulcer Syndrome
(

Men and Women

Genital Ulcer Syndrome
Men and Women
Treatment for Genital Ulcers
Additional Treatments for
Genital Ulcers
Treatment for Herpes Virus
(not generally available at Mae Tao
Clinic)
Syndrome #5
Inguinal Swelling (buboes)

Men and Women (

Inguinal Swelling (buboes)
Men and Women
Inguinal Swelling due to Granuloma
Inguinale
Treatment for Inguinal Swelling
Aspirate fluctuant lymph nodes


Syndrome #4
Urethral Discharge from Penis
(
Urethral Discharge in Men
(
Treatment for Urethral
Discharge
 Genital Warts(

Men and Women (

 Refer to the
Burma Border Guidelines for Treatment
Pages 104 – 107.
Genital ulcers Syphilis Benzathine penicillin 2.4 MU IM STAT
(open sores) Chancroid - (give 1.2 MU IM each buttock)
also covers And Ciprofloxacin 500 mg BID x 3D
Donovanosis

Genital ulcers Herpes Wash with soap and water TID

(small, painful Paracetamol 2 tabs PO TID x 5D
blisters) Acyclovir if available or for delivery

Genital warts Condylomata Wash with soap and water TID

(in clusters, like accuminata Paracetamol 2 tabs PO TID x 5D
cauliflower) Consider podophyllin paint 10-25% weekly
if available
May require surgical removal

Vaginal Gonorrhea Ciprofloxacin 500 mg PO STAT

discharge, pus, and Or Ceftriaxone 250mg IMI STAT
cervicitis Chlamydia And Doxycycline 100 mg PO 2xD x 14D
Vaginitis
a. white frothy discharge
b. grey, smelly discharge
c. lumpy white itchy
discharge
Lower abdominal pain,
pain during sexual
intercourse, pain on
palpation, vaginal
discharge/pus, cervicitis
Penile or urethral
discharge, pus, urethral
irritation, urinary burning
Metronidazole 2g PO STAT
Trichomonas Metronidazole 2g PO STAT
BV Nystatin 100,000u PV x 7 nights
Candida
PID Ceftriaxone 250mg IMI Or
Ciprofloxacin 500 mg PO STAT
& Metronidazole 400mg TID 14d
& Doxycycline 100mg BID 14d
Gonorrhea Ciprofloxacin 500 mg PO STAT
Chlamydia & Doxycycline 100 mg BID14d
 Keys to Reducing STI’s

 HIV





 Gaining Clinical
Experience


 STI team
Thank You