By ULY CLINIC

Management of other common sti conditions

The following common STI conditions have been grouped together because of their different presentations and can easily be diagnosed through laboratory investigations and clinical observation.

However, others are not related to sexual transmission but they affect genital parts, e.g. Balanoposthitis, while other some conditions which are transmitted through close sexual intimacy may not affect genital parts only e.g. Pediculosis and Scabies.

Early Syphilis:

This refers to primary, secondary or latent syphilis of not more than two years duration.

Give:

Benzathine Penicillin 2.4 MU, I.M single dose given as two injections at each buttock.

Azithromycin (PO) 1gm start

Alternative regimen for penicillin allergic non-pregnant patients

Doxycycline 100 mg PO 12 hourly for 15 days

Late Syphilis

This refers to Syphilis infection of more than 2 years.

Benzathine Benzyl Penicillin 2.4 M.U once weekly for 3 consecutive weeks.

Azithromycin 2gm stat.

Syphilis in Pregnancy

Pregnant women should be regarded as a separate group requiring close surveillance, in particular, to detect possible re-infection after treatment has been given. It is also important to treat the sexual partner(s).

Benzathine Benzyl Penicillin 2.4 M.U, IM as a single dose In case of late syphilis 3 doses of

Benzathine Benzyl Penicillin should be provided.

Congenital Syphilis

All infants born to sero-positive mothers should be treated with a single intramuscular dose of benzathine penicillin, 50 000 IU/kg whether or not the mothers were treated during pregnancy (with or without penicillin).

Treatment regimens for early congenital syphilis (up to 2 years of age), and Infants with abnormal cerebrospinal fluid:

Aqueous benzyl penicillin 100,000–150,000 IU/kg/day administered as 50,000 IU/kg/dose IV 12 hourly, for the first 7 days and every 8 hourly thereafter for a total of 10 days For congenital syphilis in children 2 or more years

Aqueous benzyl penicillin, 200,000–300, 000 IU/kg/day by intravenous or intramuscular injection, administered as 50,000 IU/kg every 4–6 hours for 10– 14 days

The alternative regimen for penicillin allergic patients, after the first month of life

Erythromycin, 7.5–12.5 mg/kg (PO) 4 times daily for 30 days.

Syphilis and HIV Infection

All patients with syphilis should be encouraged to undergo testing for HIV because of the high frequency of dual infection and its implications for clinical assessment and management.

Genital Warts (Venereal Warts)

Human papilloma virus (HPV) is a common sexually transmitted pathogen. Genital warts are painless but may lead to serious complications.

The removal of the lesion does not mean cure of the infection.

No treatment is completely satisfactory. Recommended regimens for venereal warts are as follows:

Chemical Treatment (High level Health Facility Management)

Self patient Administered

Podophllotoxin 10–25% solution or gel twice daily for 3 days, followed by 4 days of no treatment, and the cycle repeated up to 4 times. (total volume of podophyllotoxin should not exceed 0.5ml per day)

Imiquimod 5% cream applied with a finger at bedtime, left on overnight, 3 times a week for as long as 16 weeks. The treatment area should be washed with soap and water 6–10 hours after application and hands must be washed with soap and water immediately after application.

Note: The safety of both podophyllotoxin and imiquimod during pregnancy has not been established.

Provider Administered

Podophyllin 10–25% in compound tincture of benzoin, applied carefully to the warts, avoiding normal tissue.

External genital and perianal warts should be washed thoroughly 4–6 hours after the application of podophyllin.

Podophyllin applied to warts on vaginal or anal epithelial surfaces should be allowed to dry before removing the speculum or anoscope.

Treatment should be repeated at weekly intervals.

Trichloroacetic acid (TCA) (80–90%) applied carefully to the warts avoiding normal tissue, followed by powdering of the treated area with talc or sodium bicarbonate (baking soda) to remove unreacted acid.

Repeat application at weekly intervals.

Physical Treatment (Available at higher centres)

Cryotherapy with liquid nitrogen, solid carbon dioxide, or a cryoprobe.

Repeat applications every 1-2 weeks

Electrosurgery

Surgical removal

Treatment for Vaginal Warts

Recommended regimens for treatment of vaginal warts are:

Cryotherapy (with liquid nitrogen)

Podophyllin 10–25% (allow to dry before removing speculum)

Trichloroacetic acid (TCA) (80–90%)

Treatment for Cervical Warts

Treatment of cervical warts should not be started until the results from a cervical smear test are known

Management of Meatal and Urethral Wart

Cryotherapy

Podophyllin 10–25%

Note: Urethroscopy is necessary to diagnose intra-urethral warts, but they should be suspected in men with recurrent meatal warts. Some experts prefer electrosurgical removal.

Updated on, 5.11.2020

References

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