Management of Other Common STI Conditions
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Late Syphilis
This refers to Syphilis infection of more than 2years.
A: benzathine benzylpenicillin (IM) 2.4MU once weekly for 3 consecutive weeks
AND
A: azithromycin (PO) 2g stat
Syphilis in Pregnancy
Pregnant women should be regarded as a separate group requiring close surveillance to detect possible re-infection after treatment has been given. It is also important to treat the sexual partner(s).
A: benzathine benzylpenicillin (IM) 2.4MU, as a single dose
In case of late syphilis 3 doses of benzathine benzylpenicillin should be provided.
Congenital Syphilis
All infants born to sero-positive mothers should be treated with a single intramuscular dose of benzathine benzylpenicillin, 50000IU/kg whether 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:
A: benzyl penicillin (IV) 100000–150000IU/kg/day administered as 50000IU/kg/dose 12hourly, for the first 7days and every 8hourly thereafter for a total of 10days
For congenital syphilis in children 2 or more years
A: benzyl penicillin (IV or IM) 200000 – 300000IU/kg/day administered as 50000IU/kg every 4–6hourly for 10–14days
The alternative regimen for penicillin allergic patients, after the first month of life
A: erythromycin (PO) 7.5–12.5 mg/kg 6hourly for 30days
Syphilis and HIV InfectionAll 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)
D: 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 hourly 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.
Other treatment approaches (Available at higher centres)
Cryotherapy with liquid nitrogen, solid carbon dioxide, or a cryoprobe. Repeat applications every 1-2 weeks
OR
Electrosurgery
OR
Surgical removal
Treatment for Vaginal Warts
Recommended regimens for treatment of vaginal warts are:
D: cryotherapy (with liquid nitrogen)
OR
D: podophyllin 10–25% (allow to dry before removing speculum)
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
D: Cryotherapy
OR
D: podophyllin 10–25%
Note: Urethroscopy is necessary to diagnose intra-urethral warts, but they should be suspected in men with recurrent meatal warts.