Sexually Transmitted Infections

STI Overview & Syndromic Approach - Setting the Stage

• STIs: Significant public health problem in India; ↑HIV transmission.
• Complications: PID, infertility, ectopic pregnancy, adverse pregnancy outcomes (neonatal infections), anogenital cancers.
• Syndromic Case Management (SCM): NACO's cornerstone for STI control.
  • Approach: Identifies symptom groups (syndromes) for treatment decisions.
  • Action: Treats commonest pathogens without initial lab confirmation using specific drug regimens.
  • Tools: Pre-packaged, color-coded kits for different syndromes. 📌 (e.g., Kit 1 Grey for Urethral Discharge/Cervicitis).
  • Benefit: Ensures prompt, effective treatment, vital in resource-limited settings.

⭐ Syndromic management is crucial for timely STI control in resource-limited settings, especially at primary healthcare levels, reducing onward transmission.

Ulcerative STIs - Sores & Stories

• Syphilis (Primary): T. pallidum. Painless, indurated single chancre. Dx: Darkfield, Serology. Rx: Benzathine Penicillin G 2.4 MU IM.

• Chancroid: H. ducreyi. Painful, soft, multiple ulcers; painful bubo. Dx: Gram stain ("school of fish"). Rx: Azithromycin 1g PO.

• Genital Herpes: HSV-2. Multiple painful vesicles → ulcers. Recurrent. Dx: Tzanck smear (giant cells). Rx: Acyclovir.

• LGV: C. trachomatis (L1-L3). Transient painless ulcer; painful adenopathy ("groove sign"). Rx: Doxycycline 100mg BD x 21d.

• Donovanosis: K. granulomatis. Painless, progressive, beefy-red ulcer; no adenopathy. Dx: Donovan bodies. Rx: Azithromycin 1g weekly x 3w.

⭐ The "groove sign" in LGV, a depression between enlarged inguinal node groups, is highly suggestive.

Discharge & Dysuria STIs - Drips & Discomfort

• Gonorrhea (N. gonorrhoeae)

  • Symptoms: Purulent discharge (urethral/cervical), dysuria. Complications: epididymitis (men), PID (women), DGI (arthritis, dermatitis).
  • Dx: Gram stain (diplococci), NAAT.
  • Rx: Ceftriaxone 500mg IM + Azithromycin 1g PO.

• Chlamydia (C. trachomatis D-K)

  • Symptoms: Often asymptomatic. Mucoid/watery discharge, dysuria. Complications: PID, infertility.
  • 📌 Reiter's Syndrome: Urethritis, conjunctivitis, arthritis ("Can't see, pee, climb a tree").
  • Dx: NAAT (gold standard).
  • Rx: Azithromycin 1g PO (single) OR Doxycycline 100mg BD x 7d.

• Trichomoniasis (T. vaginalis)

  • Symptoms (Women): Frothy, yellow-green, malodorous discharge; itching; dysuria.
  • Dx: Wet mount (motile trichomonads), NAAT.
  • Rx: Metronidazole 2g PO (single). Treat partners.

  ⭐ Strawberry cervix (colpitis macularis) is characteristic.

• Non-Gonococcal Urethritis (NGU)

  • Causes: C. trachomatis (commonest), M. genitalium.
  • Symptoms: Dysuria, mucoid discharge.
  • Rx: Azithromycin 1g PO or Doxycycline 100mg BD x 7d. Persistent: Moxifloxacin (M. genitalium).

Viral STIs, Complications & Prevention - Viral Villains & Vigilance

• Key Viruses & Clinical Impact:
  • HPV: Genital warts (types 6, 11); Oncogenic: cervical, anogenital, oropharyngeal cancers (types 16, 18). ⭐ > HPV types 16 & 18 cause ~70% of cervical cancers & many related malignancies.
  • HBV/HCV: Sexual route. Chronic liver disease, cirrhosis, HCC.
  • Molluscum Contagiosum: Poxvirus; umbilicated skin papules.
  • (HIV, HSV: Critical viral STIs, detailed elsewhere).
• Significant Complications:
  • Malignancy: HPV (cervical, anal), HBV/HCV (liver).
  • MTCT: HSV (neonatal), HBV, HIV.
  • ↑ HIV acquisition/transmission with co-STIs.
• Prevention Strategies: 📌 VACCINES pivotal!
  • Vaccination: HPV (Gardasil 9: 9 types incl. 6,11,16,18); HBV (universal, 3 doses).
  • Condoms: Consistent use reduces transmission.
  • Screening: Pap smears; HBV, HCV, HIV tests.
  • Early Dx/Tx, partner notification/Tx.
  • Antenatal screening (HIV, HBV, Syphilis). oka

High‑Yield Points - ⚡ Biggest Takeaways

• Syphilis: Painless chancre (1°), condylomata lata (2°); treat with Benzathine Penicillin G.
• Gonorrhea: Purulent discharge, gram-negative diplococci; treat with Ceftriaxone + Azithromycin.
• Chlamydia: Often asymptomatic, most common bacterial STI; NAAT diagnosis, treat with Azithromycin.
• Genital Herpes (HSV-2): Painful vesicles; Acyclovir manages outbreaks.
• HPV: Genital warts (6, 11), cervical cancer link (16, 18); vaccination prevents.
• Trichomoniasis: Frothy discharge, strawberry cervix; Metronidazole for patient and partner.
• Chancroid: Painful ulcer and painful adenopathy (H. ducreyi); treat with Azithromycin.