General Info - STIs and RTIs

Sexually transmitted infections (STIs) — are generally acquired by sexual contact with a person who has an STI. The organisms (bacteria, viruses or parasites) that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids. Reproductive tract infections (RTIs) occur in the genital tract and affect both women and men. Some RTIs, such as syphilis and gonorrhea, are sexually transmitted, but many are not. In women, overgrowth of endogenous microorganisms normally found in the vagina may cause RTIs (yeast infection, bacterial vaginosis).

Clinical Presentation

Sores or bumps on the genitals or in the oral or rectal area
Painful or burning urination
Discharge from the penis
Vaginal discharge that is abnormal in colour, odour, amount or consistency
Itching or irritation of the vulva or vagina
Unusual vaginal bleeding
Pain during sex
Lower abdominal pain
Genital ulcers, sores or blisters
Swelling, lumps or ulcer in the groin area

STIs/RTIs Management Approaches

Management of STIs/RTIs can be done in either of the following approaches:

Aetiological laboratory approach: By identification of causative agents through laboratory methods and sensitivity pattern to the medicine to be used, followed by disease-specific treatment.
Aetiological clinical approach: By targeting disease treatment based on suspected causative agents diagnosed clinically. This is not appropriate at any health facility because of its demands on the clinical acumen of the service provider and the danger of incorrect diagnosis and hence, insufficient treatment.
Syndromic approach: This identifies clinical syndromes (symptoms and signs) followed by syndrome-specific treatment that targets causative agents which cause the syndrome.

Management of STIs/RTIs using Aetiological Laboratory Approach

It identifies causative agents through laboratory methods, followed by disease-specific treatment. This is the best approach to be used at a Health Facility (HF) which has a laboratory capable of doing the laboratory investigation and producing timely result(s) so as to enable the clinician to prescribe medicine (s) according to the causative agent(s) and sensitivity pattern.

Management of STIs/RTIs using Syndromic Approach

This approach is recommended if the HF is not able to conduct appropriate laboratory investigation(s) and producing timely result(s) to enable the clinician to prescribe the medicine in accordance with causative agent(s).

Syndromic management of STIs is based on the diagnosis of defined symptoms and easily recognizable clinical signs. Each syndrome can be caused by several different causative agents. For each syndrome, a well-defined standard treatment which has been proven to be effective against most endemic causative agents for the syndrome are used.

Syndromic approach of managing STIs/RTIs entails the service provider to follow laid down steps in a flow chart which guides him/her in making rational management decisions for treating the client. These are therefore known as treatment flow-charts. They may also be known as treatment algorithms, treatment protocols or treatment decision trees. They guide the provider through a series of decisions and actions that need to be made. Each decision or action is enclosed in a box, with one or two routes leading out of it to another box, with another decision or action. Upon learning a patient’s symptoms and signs, the service provider turns to the flow chart for the relevant syndrome and works through the decisions and suggestions it guides to manage the client accordingly. Each flow chart is made up of a series of three steps. These are:

The clinical problem (the patients presenting symptoms and signs)
The decision that needs to be taken
The action that needs to be carried out