OG27.1 | Sexually Transmitted Infections — Summary & Reflection

KEY TAKEAWAYS

Sexually Transmitted Infections — Summary

Syndromic management (NACO): treat at first visit without waiting for lab results, using syndromes (GUD, vaginal/urethral discharge, inguinal bubo) + epidemiological history. Partner notification and treatment are mandatory.

Genital ulcer disease differential:
- Syphilis: painless, indurated, clean-based chancre → VDRL/TPHA
- Herpes: very painful, multiple vesicles/ulcers, recurrent → Tzanck/PCR
- Chancroid: painful, soft, purulent base → gram stain 'school of fish'
- LGV: small ulcer + prominent bubo → C. trachomatis PCR
- Donovanosis: painless, beefy-red, progressive → Donovan bodies

Key regimens:
- Syphilis (primary/secondary/early latent): benzathine penicillin 2.4 MU IM single dose
- Gonorrhoea: ceftriaxone 500 mg IM + azithromycin 1 g oral (dual therapy — ciprofloxacin AVOIDED)
- Chlamydia: azithromycin 1 g single dose (OR doxycycline 100 mg BD × 7 days — NOT in pregnancy)
- Trichomoniasis: metronidazole 2 g single dose (treat partner)
- Herpes first episode: acyclovir 400 mg TDS × 7–10 days
- Chancroid: azithromycin 1 g single dose OR ceftriaxone 250 mg IM

Pregnancy contraindications: doxycycline/tetracyclines contraindicated; syphilis in pregnancy = benzathine penicillin ONLY (desensitise if allergic)

Long-term implications: PID → infertility + ectopic; congenital syphilis; neonatal conjunctivitis; neonatal herpes; HIV transmission facilitation

REFLECT

The 22-year-old woman with the painful genital ulcer and bubo and the 28-year-old asymptomatic pregnant woman at the start of this module both have STIs, but their risks are fundamentally different. The pregnant woman's asymptomatic syphilis poses a risk not just to herself but to her unborn baby — a case of congenital syphilis that a simple blood test and a single injection could have prevented entirely. Consider: what are the barriers in your clinical setting to universal antenatal syphilis screening? What communication skills are required to discuss STI diagnosis sensitively — preserving confidentiality, informing the partner, and avoiding stigma? How would you approach partner notification in a conservative social context? Record your reflections on the intersection of clinical medicine, public health, ethics, and communication in managing STIs.