STIs

15.5.06

• Major public health problem on its own, and linking with HIV.
• 75% of curable STIs - developing countries.
• Major causes of morbidity, mortality and health costs - sequelae eg. infertility, CA, AIDS.
• Social and economic upheaval in societies.

What is happening?
• Chlamydia did not exist as bacterial STI until 1960s.
• Improved diagnostic methods.
• Active screening problems.
• People mobility.
• Enhanced surveillance of infectious syphilis was introduced in London in 2001.

Sexual history
• Important competent sexual history and assess risks.
• Non-genitourinary signs.
• Social history.
• Sexual history.
• Contraception.

Common symptoms
• Discharge.
• Rash.
• Lumps.
• Pain.

CHLAMYDIA
• Obligate intracellular small gram negative bacteria.
• Two forms:
-Elementary - infectious.
-Reticulate.

Risk factors
• Age <25 years.
• New sexual partner/more than one sexual partner in recent years.
• Lack of barrier contraception.
• Use of oral contraceptive pill.
• Women undergoing termination of pregnancy.

Asymptomatic in 80% of women and 50% of men.

Treatment of uncomplicated infection
Recommended regimens
• Doxycycline 100mg qd for 7 days.
• Azithromycin 1g orally in single dose.

Alternate regimens
• Erythromycin 500mg qd for 7 days
or Erythromycin 500mg bd for 14 days.
• Or, Ofloxacin 200mg bd or 400mg od for 7 days.
• Or, Tetracycline 500mg qd for 7 days.

Pregnancy and breastfeeding
• Doxycycline and Ofloxacin contraindicated in pregnancy.
• Safety of Azithromycin not fully assessed.
• Erythromycin has significant side-effect profile and <95% effective.
• Amoxycillin 500mg td for 7 days.

GONORRHOEA
• Clinical disease resulting from gram negative diplococcus Neisseria gonorrhoeae.

Recommended treatments - uncomplicated infection
• Ceftriaxone 250mg im.
• Ciproflloxacin 500mg orally as single dose.
• Or, Ofloxacin 400mg orally as single dose.
• Or, Amipicillin 2g/3g plus Probenecid 1g orally as single dose, where regional prevalence of Penicillin-resistant N. gonorrhoeae <5%.
• Or, Cefotaxine 500mg im as single dose.
• Or, Spectromycin 2g im as single dose.

SYPHILIS
Congenital or acquired.

Acquired syphilis:
• Early syphilis:
-Primary.
-Secondary.
-Early latent, <2 years.
• Late syphilis:
-Late latent, >2 years.
-Tertiary gummatous cardiovascular neurosyphilis.

Treatable and curable.