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Patient complains of urethral Discharge or dysuria - PowerPoint PPT Presentation


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TREATMENT OF GONORRHOEA Uncomplicated Anal/ Genital Infection Ciprofloxacin 500 mg orally once only (Ciprofloxacin is contraindicated in pregnancy and for children or adolescents) OR Cefixime 400 mg orally once only OR Ceftriaxone 125 mg IM once only OR Spectinomycin 2 gm IM once only

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Presentation Transcript
slide1

TREATMENT OF GONORRHOEA

Uncomplicated Anal/ Genital Infection

Ciprofloxacin 500 mg orally once only (Ciprofloxacin is contraindicated in pregnancy and for children or adolescents)

OR

Cefixime 400 mg orally once only

OR

Ceftriaxone 125 mg IM once only

OR

Spectinomycin 2 gm IM once only

Disseminated Gonococcal infection

Ceftriaxone 1 gm IM or intravenous once daily for 7 days

OR

Spectinomycin 2 gm IM twice daily for 7 days

URETHRAL DISCHARGE

Use appropriate flow chart

Yes

Patient complains of urethral Discharge or dysuria

Any other genital disease

No

  • 4 Cs
  • Ask patient to return in 7 days if symptoms persist

No

Take history and examine. Milk urethra if necessary

Discharge confirmed?

TREATMENT OF CHLAMYDIA

Uncomplicated Anal/ Genital Infection

Doxycycline 100 mg orally twice daily for 7 days

(Not to be used for pregnant women, children or adolescents)

OR

Azithromycin 1 gm orally once only

Alternative Regimens

Amoxycillin 500 mg orally 3 times a day for 7 days

OR

Erythromycin 500 mg 4 times a day for 7 days

OR

Ofloxacin 400 mg orally twice a day for 7 days

OR

Tetracycline 500 mg orally 4 times a day for 7 days

4 Cs:

Compliance Counseling

Promote & provideCondoms

Counseling for STI prevention, HIV testing; Educate and Reassure patient

Partner (Contact) treatment

Yes

slide2

TREATMENT OF GONORRHOEA

Uncomplicated Anal/ Genital Infection

Ciprofloxacin 500 mg orally once only (Ciprofloxacin is contraindicated in pregnancy and for children or adolescents)

OR

Cefixime 400 mg orally once only

OR

Ceftriaxone 125 mg IM once only

OR

Spectinomycin 2 gm IM once only

PERSISTENT URETHRAL DISCHARGE

Use appropriate flow chart

Patient complains of urethral Discharge or dysuria

Yes

Any other genital disease

  • 4 Cs
  • Ask patient to return in 7 days if symptoms persist

No

No

Take history and examine. Milk urethra if necessary

TREATMENT OF CHLAMYDIA

Uncomplicated Anal/ Genital Infection

Doxycycline 100 mg orally twice daily for 7 days

(Not to be used for pregnant women, children or adolescents)

OR

Azithromycin 1 gm orally once only

Alternative Regimens

Amoxycillin 500 mg orally 3 times a day for 7 days

OR

Erythromycin 500 mg 4 times a day for 7 days

OR

Ofloxacin 400 mg orally twice a day for 7 days

OR

Tetracycline 500 mg orally 4 times a day for 7 days

No

Discharge confirmed?

Yes

Refer for laboratory tests and Specialist Care

4 Cs:

Compliance Counseling

Promote & provide Condoms

Counseling for STI prevention, HIV testing; Educate and Reassure patient

Partner (Contact) treatment

Not better

Does History confirm re-infection or poor compliance

Repeat Urethral Discharge Treatment

Yes

TREATMENT OF TRICHOMONAS

Metronidazole 400 or 500 mg orally twice daily for 7 days

OR

Tinidazole 500 mg orally twice daily for 7 days

slide3

GENITAL ULCERS

TREATMENT OF HSV-2

Treatment of First Episode:

Acyclovir 400 mg 3 times a day for 7 days

Treatment of Recurrent Episodes:

Acyclovir 400 mg 3 times a day for 5 days

Suppressive therapy:

Acyclovir 400 mg twice a day continuously

Refer for laboratory testing and Specialist treatment

Patient complains of genital ulcer

Take history and examine

  • Treat for HSV
  • Test and Treat for syphilis
  • 4 Cs
  • Ask patient to return in 7 days if symptoms persist

No

TREATMENT OF SYPHILIS

Early Syphilis (Primary, Secondary or Latent of less than 2 years duration)

Benzathine Penicillin 2.4 million IU intramuscularly once

(Due to large volume it is recommended that this dose be divided and given as 2 injections sites)

For more detailed treatment of syphilis please see the attached sheet

Ulcer(s) improving

Only vesicles present

Yes

Yes

No

Ulcer(s) healed

No

Continue treatment for another 7 days

  • Treat for syphilis AND HSV
  • 4 Cs
  • Ask patient to return in 7 days if symptoms persist

Sore or ulcer present

Yes

4 Cs:

Compliance Counseling

Promote & provide Condoms

Counseling for STI prevention, HIV testing; Educate and Reassure patient

Partner (Contact) treatment

Yes

No

  • 4 Cs
  • Reassure
slide4

TREATMENT OF GONORRHOEA

Uncomplicated Anal/ Genital Infection

Ciprofloxacin 500 mg orally once only (Ciprofloxacin is contraindicated in pregnancy and for children or adolescents)

OR

Cefixime 400 mg orally once only

OR

Ceftriaxone 125 mg IM once only

OR

Spectinomycin 2 gm IM once only

Disseminated Gonococcal infection

Ceftriaxone 1 gm IM or intravenous once daily for 7 days

OR

Spectinomycin 2 gm IM twice daily for 7 days

SCROTAL SWELLING

  • Reassure patient
  • Provide analgesics if needed
  • 4 Cs

Patient complains of Scrotal Swelling

No

No

Swelling/ Pain Confirmed

History and examination

Testes rotated or elevated or history of trauma

Yes

TREATMENT OF CHLAMYDIA

Uncomplicated Anal/ Genital Infection

Doxycycline 100 mg orally twice daily for 7 days

(Not to be used for pregnant women, children or adolescents)

OR

Azithromycin 1 gm orally once only

Alternative Regimens

Amoxycillin 500 mg orally 3 times a day for 7 days

OR

Erythromycin 500 mg 4 times a day for 7 days

OR

Ofloxacin 400 mg orally twice a day for 7 days

OR

Tetracycline 500 mg orally 4 times a day for 7 days

Refer for surgical evaluation

4 Cs:

Compliance Counseling

Promote & provide Condoms

Counseling for STI prevention, HIV testing; Educate and Reassure patient

Partner (Contact) treatment

Yes

anal symptoms

TREATMENT OF GONORRHOEA

Uncomplicated Anal/ Genital Infection

Ciprofloxacin 500 mg orally once only

OR

Cefixime 400 mg orally once only

OR

Ceftriaxone 125 mg IM once only

OR

Spectinomycin 2 gm IM once only

Disseminated Gonococcal infection

Ceftriaxone 1 gm IM or intravenous once daily for 7 days

OR

Spectinomycin 2 gm IM twice daily for 7 days

TREATMENT OF CHLAMYDIA

Uncomplicated Anal/ Genital Infection

Doxycycline 100 mg orally twice daily for 7 days

OR

Azithromycin 1 gm orally once only

Alternative Regimens

Amoxycillin 500 mg orally 3 times a day for 7 days

OR

Erythromycin 500 mg 4 times a day for 7 days

OR

Ofloxacin 400 mg orally twice a day for 7 days

OR

Tetracycline 500 mg orally 4 times a day for 7 days

ANAL SYMPTOMS

Treat for Gonorrhoea and Chlamydia

Yes

Discharge Confirmed

Confirm on exam

Discharge

No

No abnormality

Supportive/ symptomatic care

No

Anal symptoms

Ulcers or blisters seen

Treat for HSV-2Test and treat for Syphilis

Examination (use proctoscope if cause not seen on inspection)

Yes

TREATMENT OF HSV-2

Treatment of First Episode:

Acyclovir 400 mg 3 times a day for 7 days

Treatment of Recurrent Episodes:

Acyclovir 400 mg 3 times a day for 5 days

Suppressive therapy:

Acyclovir 400 mg twice a day continuously

Pain

Wart removal/ needs observation for cancer

Warts

4 Cs:

Compliance Counseling

Promote & provide Condoms

Counseling for STI prevention, HIV testing; Educate and Reassure patient

Partner (Contact) treatment

Treat for Hemorrhoids (piles)

TREATMENT FOR WARTS

Treatment is meant for external genitalia and vaginal. Please refer to gynaecologic specialist for cervical warts

Provider administered: Podophyllin 10-25% in compound of tincture or benzoin. Apply carefully avoiding normal tissue. External genital genitalia should be washed thoroughly in 1-4 hours. Allow the applied medicine to dry before removing speculum. Repeat application weekly as needed.

OR

Cryotherapy (when available). Repeat after 1-2 weeks as needed

Hemorrhoids (piles) seen

Refer for Surgical evaluation

Ano-Rectal Fissures

slide6

TREATMENT OF GONORRHOEA

Uncomplicated Anal/ Genital Infection

Ciprofloxacin 500 mg orally once only

OR

Cefixime 400 mg orally once only

OR

Ceftriaxone 125 mg IM once only

OR

Spectinomycin 2 gm IM once only

Disseminated Gonococcal infection

Ceftriaxone 1 gm IM or intravenous once daily for 7 days

OR

Spectinomycin 2 gm IM twice daily for 7 days

TREATMENT OF CHLAMYDIA

Uncomplicated Anal/ Genital Infection

Doxycycline 100 mg orally twice daily for 7 days

OR

Azithromycin 1 gm orally once only

Alternative Regimens

Amoxycillin 500 mg orally 3 times a day for 7 days

OR

Erythromycin 500 mg 4 times a day for 7 days

OR

Ofloxacin 400 mg orally twice a day for 7 days

OR

Tetracycline 500 mg orally 4 times a day for 7 days

Treat for Gonorrhoea and Chlamydia

VAGINAL DISCHARGE

High NG/CT prevalence in community or high individual risk profile

Patient complains of vaginal discharge, vulval itching or burning

Yes

No

Lower abdominal pain

No

Yes

Yes

History, examination and

Risk assessment*

Use Lower Abdominal pain flowchart

Treat for BV/ Trichomonas

Abnormal discharge or vulval erythema

  • *Risk factors assessed should include:
  • Personal sexual history (including extramarital sex)
  • High risk group membership
  • Community factors such as STI prevalence in community.

No

Vulval edema/curd-like discharge, erythema, excoriations present

Use Appropriate flowchart

Yes

No

Yes

Any other genital disease

  • Reassure patient
  • Provide analgesics if needed
  • 4 Cs

Treat for Candida

No

4 Cs:

Compliance Counseling

Promote & provide Condoms

Counseling for STI prevention, HIV testing; Educate and Reassure patient

Partner (Contact) treatment

TREATMENT OF CANDIDA

Miconazole or clotrimazole 200 mg intarvaginally daily for 3 days

OR

Clotrimazole 500 mg intravaginallly once

OR

Fluconazole 150 mg orally once

Alternate Regimen

Nystatin 100,000 IU intarvaginally daily for 14 days

slide7

OUTPATIENT TREATMENT OF LOWER ABDOMINAL PAIN

Ceftriaxone 125 mg IM once only

OR

Spectinomycin 2 gm IM once only

PLUS

Doxycycline 100 mg orally twice daily for 7 days

OR

Tetracycline 500 mg orally 4 times a day for 7 days

(both Doxycylcine and Tetracycline are contraindicated for pregnant women)

PLUS

Metronidazole 400 mg orally twice daily for 14 days

LOWER ABDOMINAL PAIN

Patient complains of lower abdominal pain

Appropriate surgical or gynecological referral

History and examination (including gynecological exam)

Yes

Any other illness found

Cervical motion tenderness or lower abdominal tenderness and vaginal discharge

Appropriate management

No

  • Any of the following present:
  • Missed or overdue period
  • Recent delivery/ abortion/ miscarriage
  • Adnominal guarding and/or rebound tenderness
  • Abnormal vaginal bleeding
  • Abdominal mass
  • intrauterine device
  • Manage for PID
  • 4 Cs
  • Review in 5 days

Refer or Specialist care

No

Yes

ALL PATIENTS NOT IMPROVING WITH OUTPATIENT THERAPY MUST BE ADMITTED FOR FURTHER TREATMENT

No

Patient improved

Yes

4 Cs:

Compliance Counseling

Promote & provide Condoms

Counseling for STI prevention, HIV testing; Educate and Reassure patient

Partner (Contact) treatment

  • Continue until treatment completed
  • Reassure patient
  • Provide analgesics if needed
  • 4 Cs
  • Ask patient to return as needed
slide8

Treatment of Syphilis

All patients being considered for STI management must be considered for syphilis testing: All those who test positive must be treated

Late Latent Syphilis (Infection of more than 2 years duration)

Benzathine Penicillin 2.4 million IU intramuscularly once a week for 2 consecutive weeks

(Due to large volume it is recommended that this dose be divided and given as 2 injections sites)

Alternative Regimen

Procaine Benzyl Penicillin 1.2 million IU intramuscularly once daily for 20 days

Alternative Regimen (for Penicillin allergic patients and non-pregnant patients)

Doxycycline 100 mg orally twice a day for 30 days

OR

Tetracycline 500 mg orally 4 times a day for 30 days

Alternative Regimen (for Penicillin allergic patients and pregnant patients)

Erythromycin 500 mg orally 4 times a day for 30 days

Early Syphilis (Primary, Secondary or Latent of less than 2 years duration)

Benzathine Penicillin 2.4 million IU intramuscularly once

(Due to large volume it is recommended that this dose be divided and given as 2 injections sites)

Alternative Regimen

Procaine Benzyl Penicillin 1.2 million IU intramuscularly once daily for 10 days

Alternative Regimen (for Penicillin allergic patients and non-pregnant patients)

Doxycycline 100 mg orally twice a day for 14 days

OR

Tetracycline 500 mg orally twice a day for 14 days

Alternative Regimen (for Penicillin allergic patients and pregnant patients)

Erythromycin 500 mg orally 4 times a day for 14 days