Pregnant Partner Considerations:

When managing cases where the patient’s partner is pregnant, doxycycline should not be used. Instead, erythromycin is the recommended alternative.

Administer erythromycin 500 mg orally every six hours, continuing for a total of 14 days.

Managing Fluid-Filled Swellings:

Swellings that show signs of being filled with fluid (fluctuant) require daily aspiration to remove the accumulated fluid.

It is crucial not to cut into the bubo. Instead, utilize a large-gauge needle (smaller than 20 gauge) to withdraw fluid through the unbroken skin every other day (every 2 days) until the swelling completely subsides.

As another option to doxycycline, a single dose of azithromycin 1 gram can be considered for treatment.

Important Warning: Never perform incision on fluctuant swellings, as this action carries the risk of creating a persistent sinus tract.

Treating the Underlying Sexually Transmitted Infection:

If a diagnosis of Lymphogranuloma venereum (LGV) or chancroid is made, start the appropriate antibiotic therapy as outlined in established treatment guidelines for these specific infections.

Consider contact tracing and treatment of sexual partners to prevent further spread of the infection within the community.

Monitoring and Follow-up Care:

Regularly observe the swelling to track its progress and how well it is responding to the prescribed treatment.

Schedule return visits (follow-up examinations) to assess whether the swelling has resolved completely and to ensure that no complications have arisen.

Treatment for Persistent Buboes:

Should the inguinal bubo persist even after initial treatment, and if the patient’s partner has not received treatment, continue the initially prescribed treatment regimen for an additional 14 days.

Referral for Specialized Care:

If the condition does not improve despite treatment efforts, it is recommended to refer the patient to a specialist for more advanced management and evaluation.

Lower Abdominal Pain Syndrome

Lower abdominal pain syndrome is recognized as a highly prevalent and significant sexually transmitted infection syndrome affecting women, leading to considerable consequences for both reproductive health outcomes and socioeconomic well-being.

Its clinical presentation can range from sudden onset (acute) to long-lasting (chronic), which presents diagnostic complexities due to the broad spectrum of conditions that can mimic its symptoms.

Patients commonly present with symptoms including:

• Pain in the abdominal area

• Vaginal bleeding outside of menstruation

• Pain during sexual intercourse

• Menstrual irregularities characterized by heavy and prolonged bleeding

• Elevated body temperature (fever)

• In some cases, vomiting

A thorough clinical assessment involves evaluating:

• Tenderness upon abdominal palpation

• Pain elicited upon movement of the cervix during pelvic exam

• Tenderness in the regions of the ovaries and fallopian tubes

• Possible enlargement of the fallopian tubes

• Presence of masses in the pelvic area

An elevated body temperature can be a significant indicator. A detailed internal pelvic exam using both hands (bimanual vaginal examination) is essential for proper assessment.

Case Definition:

The syndrome is defined by the presence of lower abdominal pain and discomfort during sexual activity, alongside clinical findings such as vaginal discharge, tenderness in the lower abdomen upon examination, or a fever exceeding 38 degrees Celsius.

Causes (Aetiology):

This symptom complex strongly suggests pelvic inflammatory disease (PID), a condition encompassing inflammation of the fallopian tubes (salpingitis) and/or the uterine lining (endometritis).

The responsible infectious agents may include bacteria such as gonococcus, chlamydia, or anaerobic bacteria.

Management Strategies:

Referral for Urgent Surgical Evaluation:

Patients exhibiting symptoms that could indicate other surgical emergencies but are similar in presentation to lower abdominal pain syndrome should be immediately referred for hospital admission and inpatient care for further evaluation and management.

Syndromic Antibiotic Treatment Approach:

A combination of ciprofloxacin, metronidazole, and ceftriaxone is typically prescribed. This broad-spectrum antibiotic approach is employed to target the likely causative pathogens, acknowledging the difficulty in quickly establishing a specific microbial diagnosis.

Due to the potentially chronic nature of this condition, outpatient treatment is typically extended.

Management in Patients with Intrauterine Contraceptive Devices (IUCDs):

For patients who are using intrauterine contraceptive devices (IUCDs), which are known to be a predisposing factor for PID, the IUCD should be removed after initiating antibiotic treatment and continuing for at least 2 days.

Contraceptive counselling is crucial for these patients following IUCD removal.

Comprehensive Management of Sexually Transmitted Infections:

Management should also encompass other vital components of STI case management, including partner notification and treatment, patient education on treatment adherence, and promotion of preventive measures to reduce future risk.

Ongoing monitoring and evaluation are necessary to address any potential complications and to ensure the prescribed treatment is effective in resolving the infection and associated symptoms.