Sexually Transmitted Infections

Sexually Transmitted Infections (STIs) result in several clinical syndromes caused by organisms that can be acquired and transmitted through sexual activity.

      They cause acute morbidity in adults and may result in long-term complications such as urethral stricture, infertility, ectopic pregnancy, anal fistula, cervical cancer, foetal wastage, prematurity, low birth weight, ophthalmia neonatorum and congenital syphilis. Their control is the cornerstone in improving reproductive health and reducing Human Immunodeficiency Virus (HIV) infections.
      Comprehensive management of STI is important and comprises prompt and effective case detection and treatment. However, owing to the lack of laboratory equipment and manpower in primary care facilities where most patients first present, an accurate diagnosis is often not possible. Also with most STIs, one cannot usually tell which organism is causing the infection from the history and physical examination alone. Multiple infections also occur, with each needing to be treated. Failure to treat one infection adequately may result in the development of serious complications.
     It is therefore more practical in managing STIs to base treatment on a ‘syndromic diagnosis’, which identifies all STIs that could cause a particular symptom or sign and provide treatment for each of them simultaneously.
    The common clinical syndromes associated with STIs include urethral discharge in males, persistent/recurrent urethral discharge, vaginal discharge, lower abdominal pain, genital ulcer, scrotal swellings, inguinal lymphadenopathy (buboes), ano-rectal syndromes (ano-rectal discharge, ulcers and vesicles), and genital warts. Scabies and pediculosis pubis may also be transmitted by sexual contact.
     In dealing with patients with STI, privacy and confidentiality, especially with the history taking and examination, are paramount.
     Education and counselling of STI patients and concurrent management of their partners provide additional opportunities to reduce the risk of STI in the community.