Signs and Symptoms:

In Men:

• Dysuria: Painful or burning sensation during urination.

• Genital Sores: Open lesions or ulcers on the genitals (less common than discharge).

• Urethral Discharge: Discharge from the urethra, typically white, yellow, or green in color. This usually appears within 1 to 4 days after infection.

• Testicular/Scrotal Pain: Pain or tenderness in the testicles or scrotum.

• Sore Throat: Burning sensation or soreness in the throat (pharyngeal gonorrhoea).

In Women:

• Dysuria: Painful or burning sensation during urination.

• Vaginal Discharge: Yellowish-white, pus-like discharge from the vagina.

• Rectal Discharge: Discharge from the rectum (rectal gonorrhoea).

• Genital Sores: Open lesions or ulcers on the genitals (less common than discharge).

• Anal Symptoms: Anal itching, soreness, or pain, especially during oral-anal sexual contact.

• Painful Bowel Movements: Discomfort or pain during defecation.

• Pharyngeal Infection: May cause a sore throat, but often asymptomatic (without symptoms).

Complications:

Untreated gonorrhoea can lead to serious and permanent health issues. It also increases the risk of acquiring other infections, including HIV, Hepatitis B, and Hepatitis C.

In Women:

• Pelvic Inflammatory Disease (PID): Infection of the reproductive organs.

• Internal Abscesses and Chronic Pain: Development of pus-filled pockets and persistent pain.

• Fallopian Tube Blockage: Scarring and obstruction of the fallopian tubes.

• Increased Ectopic Pregnancy Risk: Higher chance of pregnancy outside the uterus.

• Infertility: Difficulty or inability to conceive.

• Urinary Tract Infections (UTIs): Infections of the urinary system.

• Bartholin’s Abscess: Infection and abscess formation in the Bartholin’s glands near the vaginal opening.

• Puerperal Sepsis: Infection of the reproductive tract after childbirth.

• Ophthalmia Neonatorum: Eye infection in newborns acquired during birth.

In Men:

• Infertility: Difficulty or inability to father a child.

• Orchitis: Inflammation of the testicles.

• Disseminated Gonococcal Infection (DGI): In rare cases, the infection spreads to the bloodstream, leading to systemic infection. DGI is often characterized by arthritis and skin rash (dermatitis).

In Neonates:

• Ophthalmia Neonatorum: Serious eye infection in newborns that can cause blindness if untreated.

Note: In approximately 2% of cases, gonorrhoea bacteria can enter the bloodstream in both sexes. This can lead to:

• Systemic Symptoms: Fever, loss of appetite, and joint pain (arthritic pain).

• Organ Invasion: Potential infection of vital organs such as the heart, liver, and central nervous system (CNS).

Treatment:

• Primary Regimen:

  • Ceftriaxone: 250 mg administered as a single intramuscular injection.

  • Azithromycin: 1 g taken orally as a single dose.

  • Doxycycline: 100 mg taken orally twice daily for a specified duration.

  • Erythromycin: (500mg four times a day) is used in pregnancy.

• Alternative Treatment Options:

  • Cefixime: 400 mg taken orally as a single dose.

  • Doxycycline: 100 mg taken orally twice daily for a specified duration.

CHLAMYDIA

Chlamydia is a prevalent sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis, which is gram-negative. It is the most commonly reported STI globally. A significant characteristic of chlamydia is that many infected individuals are asymptomatic, meaning they experience no noticeable symptoms.

Mode of Transmission:

Chlamydia is primarily transmitted through unprotected sexual contact with an infected person, including:

• Vaginal Intercourse

• Anal Intercourse

• Oral Sex

Signs and Symptoms:

Often, chlamydia infection is asymptomatic, particularly in women. When symptoms do appear, they can be mild and easily overlooked.

In Women:

• Increased Vaginal Discharge: A change in the amount or consistency of vaginal discharge.

• Vaginal Bleeding: Bleeding after sexual intercourse or between menstrual periods.

• Intermenstrual Bleeding: Bleeding between regular menstrual cycles.

• Postcoital Bleeding: Bleeding during or immediately after sexual intercourse.

• Lower Abdominal Pain (LAP): Pain in the lower abdomen or pelvic area.

• Burning Pain During Urination: Dysuria, or painful urination.

In Men:

• Watery Penile Discharge: Thin, clear, or cloudy discharge from the penis.

• Penile Burning/Itching: Burning sensation or itching around the tip of the penis.

• Frequent Urination: Increased urge to urinate.

• Testicular Pain: Pain or discomfort in the testicles.

Investigations:

Diagnostic tests for chlamydia include:

• Vaginal Swabs: Samples taken from the vagina for laboratory analysis.

• Urethral Swabs: Samples collected from the urethra for testing.

• Urinalysis: Urine test to detect the presence of chlamydia bacteria.

Treatment:

Chlamydia is effectively treated with antibiotics. Common treatment regimens include:

1. Azithromycin (Azithromax): 1 gram taken orally as a single dose.

2. Erythromycin: 500 mg taken orally every 6 hours for 7 days.

3. Levofloxacin (Levaquin): 500 mg taken orally once daily for 7 days.

Complications:

Untreated chlamydia can lead to serious long-term health problems, especially in women:

• Pelvic Inflammatory Disease (PID): Infection of the female reproductive organs, a major cause of infertility.

• Infertility: Difficulty conceiving or inability to have children.

• Ectopic Pregnancy: Pregnancy occurring outside the uterus, which is life-threatening.

• Cervicitis: Inflammation of the cervix.

• Arthritis: Reactive arthritis, a joint inflammation triggered by chlamydia infection.

• Bartholin’s Abscess: Abscess in the Bartholin’s glands near the vagina.

• Ophthalmia Neonatorum: Eye infection in newborns if the mother has chlamydia during delivery.

PROTOZOA-TRICHOMONIASIS

Trichomoniasis, often called “trich,” is a sexually transmitted infection caused by the protozoan parasite Trichomonas vaginalis.

Incubation Period: Can range from months to years, with many individuals being long-term carriers without symptoms.

Symptoms:

Symptoms can vary, and some people may not experience any symptoms. When present, symptoms can include:

• Vaginal Discharge: Characteristically yellowish, frothy, and with an offensive odor.

• Dyspareunia: Painful sexual intercourse.

• Erythematous Mucosa: Reddened and inflamed vaginal mucosa (lining).

Diagnosis:

Diagnosis is typically based on clinical findings and laboratory tests:

• Discharge Characteristics: Profuse, purulent (pus-filled), and malodorous vaginal discharge.

• Vulvar Pruritus: May be accompanied by itching of the vulva.

• Vaginal Exudate: Secretions may visibly exude from the vagina.

• Strawberry Cervix: In severe cases, patchy vaginal edema and a “strawberry cervix” (cervix with punctate hemorrhages) may be observed.

• Vaginal pH: pH of vaginal secretions is typically greater than 5 (elevated).

• Microscopy: Microscopic examination of vaginal discharge reveals motile trichomonads and an increased number of leukocytes (white blood cells).

• Clue Cells: May be present if bacterial vaginosis (BV) co-exists.

• Whiff Test: May be positive, particularly if BV is also present.

Treatment:

Treatment aims to eradicate the Trichomonas vaginalis parasite. Both the infected individual and their sexual partner(s) must be treated to prevent reinfection.

• Metronidazole: 500mg taken orally three times a day (TDS) for 5-7 days is a common and effective treatment.

• Alternative Medications: Tinidazole, secnidazole, or ornidazole pessaries (vaginal suppositories) can be used.

• Symptomatic Relief: Nystatin and clotrimazole cream may be used to alleviate symptoms like itching and yeast infections, but these do not treat trichomoniasis itself.

• Drez V gel: Another topical treatment option.

• Ineffective Treatments: Flagyl gel (metronidazole gel) alone is generally not effective for trichomoniasis.

• Partner Treatment: Crucially, the sexual partner(s) must also be treated concurrently to prevent recurrence.

Bacterial Vaginosis (BV)

Bacterial vaginosis (BV), also called vaginal bacteriosis, is the most frequent cause of vaginal infection in women of childbearing age. It’s characterized by an imbalance in the vaginal flora, where normal lactobacilli are replaced by an overgrowth of other bacteria.

• Risk Factor: Frequently develops after sexual intercourse with a new partner.

• Rarity in Virgins: It is uncommon in women who have never been sexually active.

• STI Risk Increase: BV increases the risk of acquiring sexually transmitted infections (STIs).

• Not an STI: Despite its association with sexual activity and increased STI risk, BV itself is not classified as a sexually transmitted infection.

Diagnosis:

Diagnosis of BV is based on clinical criteria and laboratory findings, often referred to as Amsel criteria:

• Fishy Odor: A distinct fishy vaginal odor, often more noticeable after sexual intercourse.

• Vaginal Discharge: Thin, grayish-white vaginal secretions.

• Clue Cells: Presence of clue cells on microscopic examination of vaginal discharge. Clue cells are epithelial cells covered in bacteria.

• Elevated Vaginal pH: Vaginal pH greater than 4.5 (normal vaginal pH is acidic, usually 3.8-4.5).

• Positive Whiff Test: A positive “whiff test” occurs when adding 10% potassium hydroxide (KOH) to vaginal secretions produces a fishy odor.

Treatment:

Treatment aims to restore the balance of vaginal bacteria and relieve symptoms.

• Metronidazole (Flagyl):

  • 500 mg orally twice a day (BID) for one week is highly effective (approximately 95% cure rate).

  • A single 2-gram oral dose of Flagyl is also used (approximately 84% cure rate).

  • Flagyl gel (metronidazole vaginal gel) applied intravaginally is another treatment option.

• Clindamycin:

  • Clindamycin cream applied intravaginally.

  • Oral clindamycin capsules.

• Partner Treatment: Treatment of the male partner is generally not recommended for BV, as it is not considered an STI.

Transmission of Viral STIs:

Viral STIs are typically transmitted through:

• Penile-Vaginal Contact

• Oral-Genital Contact

• Oral-Anal Contact

• Genital-Anal Contact

• Condom Protection: Condoms offer some protection against transmission, but they do not fully prevent transmission of viral infections that can be present on areas not covered by the condom, such as the vulva, base of the penis, scrotum, and surrounding genital regions.

• Asymptomatic Transmission: Human Papillomavirus (HPV), which causes genital warts, is frequently transmitted by individuals who are asymptomatic and unaware of their infection.

Genital Warts (Condylomata Acuminata):

Genital warts are caused by the human papillomavirus (HPV) and are a common viral sexually transmitted infection. They manifest as growths in the genital, perineal, and anal areas.

• Location: Genital warts typically develop on the genitals, perineum (area between genitals and anus), and anus. In women, they are less common inside the vagina.

• Pregnancy Impact: Genital warts may grow more rapidly during pregnancy and often regress (shrink or disappear) after childbirth (in the puerperium).

• Offensive Odor: The infection can sometimes result in an unpleasant odor.

Diagnosis:

Diagnosis is primarily based on clinical examination:

• Clinical Findings: Genital warts are typically diagnosed based on their characteristic appearance as soft, fleshy growths.

• Chancre Appearance: Described as a soft chancre, which is a small, painful ulcer with an irregular shape (though technically a chancre is associated with syphilis, this description likely refers to the wart’s appearance).

Treatment:

Treatment aims to remove visible warts and manage symptoms, but there is no cure to eliminate the HPV virus itself.

• Topical Podophyllin: Application of 10% podophyllin resin directly to the wart, 2-3 times per week.

  • Caution: Podophyllin is a caustic agent that can burn healthy skin. Therefore, it is crucial to protect the surrounding skin by applying Vaseline (petroleum jelly) before application.

  • Wash-off: The medication should be washed off after 4 hours of application.

• Cauterization: Surgical removal or destruction of warts using cautery (burning) may be used for severe or extensive genital warts.

• Syphilis Rule-out: Patients with genital warts should be tested for syphilis to rule out condylomata lata, which are wart-like lesions associated with secondary syphilis.

• Pregnancy Contraindication: Podophyllin is contraindicated (should not be used) during pregnancy. Treatment is usually delayed until after delivery in pregnant women.

Genital Herpes (Herpes Simplex):

Genital herpes is a sexually transmitted infection caused by the herpes simplex virus (HSV), typically HSV-2, but sometimes HSV-1. It is characterized by recurring outbreaks of painful blisters in the genital area.

Incubation Period: 2 to 21 days from initial exposure to the virus.

Signs and Symptoms:

Outbreaks of genital herpes are characterized by:

• Painful Blisters: Small, painful blisters that appear on the vulva, perineum, vagina (in women), and/or penis or perineum (in men).

• Ulcer Formation: The blisters typically rupture, leaving small, red, and painful open sores (wounds).

• Dysuria: Painful urination due to irritation of the urethra by herpes lesions.

• Systemic Symptoms (Primary Infection):

  • Pyrexia: Fever.

  • Purulent Vaginal Discharge: Pus-like vaginal discharge.

  • Muscle Pain (Myalgia).

  • Headache.

  • Enlarged Inguinal Lymph Nodes: Swollen lymph nodes in the groin area, which may be tender to the touch.

Treatment:

Treatment for genital herpes focuses on managing outbreaks, reducing symptoms, and preventing complications. Antiviral medications can help control outbreaks but cannot cure the infection.

• Topical Acyclovir Cream: 5% acyclovir cream applied directly to the lesions five times daily for 5 days.

• Oral Acyclovir: Acyclovir 200 mg taken orally five times daily for 5 days.

• Symptomatic Relief:

  • Warm Saline Baths: Sitz baths with warm saline solution can help relieve pain and promote healing, as well as prevent secondary bacterial infections.

• Partner Treatment: Treating the sexual partner is important to prevent reinfection and further transmission.

• Pregnancy Management: Pregnant women with active genital herpes at the time of delivery are typically advised to undergo an elective Cesarean section to minimize the risk of neonatal herpes infection to the baby during vaginal birth. Neonatal herpes can be severe and life-threatening for newborns.

Pelvic Inflammatory Disease (PID):

Pelvic Inflammatory Disease (PID) is an infection of the upper female reproductive tract. It affects organs including:

• Uterus (Endometritis)

• Fallopian Tubes (Salpingitis)

• Ovaries (Oophoritis)

• Peritoneum (Pelvic Peritonitis)

PID is most commonly caused by sexually transmitted infections (STIs), particularly:

• Gonorrhoea (Neisseria gonorrhoeae)

• Chlamydia (Chlamydia trachomatis)

Signs and Symptoms:

Symptoms of PID can vary from mild to severe. Common symptoms include:

• Fever

• Abdominal Pain: Lower abdominal pain and tenderness.

• Cervical Motion Tenderness (CMT): Extreme tenderness of the vaginal fornices upon movement of the cervix during pelvic examination. This is a key diagnostic sign.

Treatment:

Treatment for PID typically involves antibiotics to eradicate the infection.

• Antibiotic Regimen:

  • Metronidazole: 400 mg – 500 mg orally twice a day for 10-14 days.

  • Azithromycin: Typically given as a single dose or a course.

  • Alternative Antibiotics: In cases of sensitivity or allergy, erythromycin or cotrimoxazole may be used, guided by antibiotic sensitivity testing if available.

Complications:

Untreated PID can lead to serious and long-term complications:

• Salpingitis: Inflammation and potential scarring of the fallopian tubes, a major cause of infertility and ectopic pregnancy.

• Infertility: Difficulty or inability to conceive due to damage to the reproductive organs.

• Chronic Abdominal and Pelvic Pain: Persistent pain in the abdomen and pelvic region.

• Menstrual Disorders: Irregularities in menstrual cycles.

• Dyspareunia: Painful sexual intercourse.

Prevention:

Preventing STIs, which are the primary cause of PID, is crucial for PID prevention. Strategies include:

• Safer Sex Practices: Consistent and correct use of condoms during sexual activity.

• Fidelity in Marriage/Relationships: Maintaining monogamous relationships with uninfected partners.

• Avoiding Promiscuity: Reducing the number of sexual partners.

• Health Education on STIs: Public health campaigns to educate about STI transmission, prevention, and the importance of early detection and treatment.

• Adequate Detection and Treatment: Early diagnosis and prompt treatment of STIs in individuals and their partners to prevent progression to PID and further spread.

• Prenatal Screening: Investigations and serological testing of pregnant women for STIs to allow for timely treatment and prevention of perinatal transmission.

Basic Facts About STIs:

Sexually transmitted diseases (STDs), also known as sexually transmitted infections (STIs), are infectious conditions caused by various microorganisms. They are primarily transmitted from person to person through unprotected sexual intercourse.