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.