STI-related Ano-rectal Related Syndromes

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Cause

  • C. Trachomatis
  • Herpes Simplex Virus-2 (HSV-2)
  • N. Gonorrhoea 
  • Treponema pallidum 

Symptoms

  • Anal discharge 
  • Rectal Bleeding 
  • Pruritus 
  • Rectal pain, 
  • Tenesmus
  • Constipation 

Signs

  • Anal ulcers or blisters
  • Anal growth 
  • Tenderness on rectal examination 
  • Anal discharge or bleeding 

TreatmentTreatment Objectives

  • To relive pain
  • To treat for the major causes simultaneously 

Non-pharmacological treatment 

  • Keep lesions dry and clean 

Pharmacological treatment 

A. For anorectal discharge, treat for gonorrhea and chlamydia

(See sections on STI related Urethral discharge in Males, or STI related Vaginal Discharge) 

B. For anorectal ulcers or vesicles

For 1st episode of vesicular lesions treat for herpes simplex virus 

  • Aciclovir, 200 mg, 4-6 hourly for 7 days (5 doses per day)

Or 

  • Aciclovir, 400 mg, 8 hourly for 7 days 

Episodic treatment for recurrent HSV vesicular lesions to be started on first day of appearance of lesions           

  • Aciclovir, 400 mg, 8 hourly for 5 days 

Or

  • Aciclovir, 800 mg, 12 hourly for 5 days

Or

  • Aciclovir, 800 mg, 8 hourly for 2 days

And 

C. For Syphilis

  • Benzathine Penicillin G, IM, 1.2 MU in each buttock (total dose 2.4 MU) stat

Or 

  • Procaine Penicillin Aqueous, IM (by deep injection), 1.2 MU daily for 10 days

Or

D. For persons allergic to penicillins 

  • Doxycycline, oral, 100 mg 12 hourly for 14 days

Or

  • Tetracycline, oral, 500 mg 6 hourly for 14 days

Or

  • Erythromycin, oral, 500 mg 6 hourly for 14 days

And

E. For Chlamydia 

  • Doxycycline, oral, 100 mg 12 hourly for 7 days

Or

  • Tetracycline, oral, 500 mg 6 hourly for 7 days

Or

  • Erythromycin, oral, 500 mg 6 hourly for 7 days

And

F. For Chanchroid

  • Ceftriaxone, IM, 250 mg stat.

Or

  • Azithromycin, oral, 1g stat.

Or

  • Ciprofloxacin, oral, 500 mg 12 hourly for 3 days

Or

  • Erythromycin, oral, 500 mg 6 hourly for 7 days

Referral Criteria

  • If the symptoms or lesions do not improve after treatment refer to a health facility with microbiology support for appropriate treatment and exclusion of other causes to exclude other causes.