1.1. Background 1
1.2. Rationale for standardized treatment recommendations 1
1.3. Case management 2
1.4. Syndromic management 3
1.5. Risk factors for STI-related cervicitis 4
1.6. Selection of drugs 5
2. TREATMENT OF STI-ASSOCIATED SYNDROMES 6
2.1. Urethral discharge 6
Persistent or recurrent urethral discharge 9
2.2. Genital ulcers 11
Genital ulcers and HIV infection 12
Inguinal bubo 16
2.3. Scrotal swelling 18
2.4. Vaginal discharge 21
Cervical infection 22
Vaginal infection 23
2.5. Lower abdominal pain 27
2.6. Neonatal conjunctivitis 31
3. TREATMENT OF SPECIFIC INFECTIONS 33
3.1 Gonococcal infections 33
Uncomplicated anogenital infection 33
Disseminated gonococcal infection 34
Gonococcal ophthalmia 34
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GUIDELINES FOR THE MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS
CONTENTS
3.2 Chlamydia trachomatis infections (other than lymphogranuloma venereum) 36
Uncomplicated anogenital infection 36
Chlamydial infection during pregnancy 37
Neonatal chlamydial conjunctivitis 37
Infantile pneumonia 38
3.3 Lymphogranuloma venereum 38
3.4 Syphilis 39
Clinical presentation summary 39
Syphilis and HIV infection 41
Syphilis in pregnancy 41
Congenital syphilis 42
Early syphilis 43
Late latent syphilis 43
Neurosyphilis 44
Congenital syphilis 45
3.5 Chancroid 46
3.6 Granuloma inguinale (Donovanosis) 47
3.7 Genital herpes infections 48
Herpes in pregnancy 48
Herpes and HIV coinfection 49
Suppressive therapy 49
3.8 Venereal (genital) warts 51
Vaginal warts 53
Cervical warts 53
Meatal and urethral warts 53
3.9 Trichomonas vaginalis infections 54
Trichomoniasis in pregnancy 54
3.10 Bacterial vaginosis 56
BV in pregnancy 57
BV and surgical procedures 57
3.11 Candidiasis 58
Vulvo-vaginal candidiasis 58
Vulvo-vaginal candidiasis in pregnancy 59
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Vulvo-vaginal candidiasis and HIV infection 59
Balanoposthitis 59
3.12 Scabies 60
3.13 Pubic lice 62
4 KEY CONSIDERATIONS UNDERLYING TREATMENTS 63
4.1 The choice of antimicrobial regimen 63
Effi cacy 63
Safety 64
Cost 64
Compliance and acceptability 65
Availability 65
Coexistent infections 65
Risk of reducing drug effi cacy for other indications 66
4.2 Comments on individual drugs 66
Cephalosporins 66
Macrolides 67
Suphonamides 68
Quinolones 69
Tetracyclines 70
4.3 Antimicrobial resistance in N. gonorrhoeae 70
4.4 Antimicrobial resistance in H. ducreyi 71
5 PRACTICAL CONSIDERATIONS IN STI CASE MANAGEMENT 72
5.1 The public health package for STI prevention and control 72
5.2 Comprehensive case management of STI 72
Identifi cation of the syndrome 73
Antimicrobial treatment for the syndrome 74
Education of the patient 74
Condom supply 74
Counselling 75
Notifi cation and management of sexual partners 76
5.3 Access to services 78
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CONTENTS
6 CHILDREN, ADOLESCENTS AND SEXUALLY TRANSMITTED INFECTIONS 80
6.1 Evaluation for sexually transmitted infections 81
Initial examination 82
Examination at 12 weeks following assault 83
Presumptive treatment 83
Susceptibility and clinical presentation of STI in children and adolescents 83
Cervical infections 84
Genital ulcer disease 84
Anogenital warts 85
Vaginal infection 85
ANNEXES
ANNEX 1. LIST OF PARTICIPANTS, MAY 1999 87
ANNEX 2. LIST OF PARTICIPANTS, NOVEMBER 2001 89
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