MoH GUIDELINES ON

MANAGEMENT OF SEXUALLY
TRANSMITTED INFECTIONS (STI)
PETER BWALYA COLOURED BWALYA
•Sexually Transmitted Infections (STIs) are
among the most common causes of all
Out Patient Department (OPD)
attendances in Zambia.
Three approaches to the management of
STIs
• There are three approaches to the management of STIs,
• i) Aetiological: - where one collects specimens for laboratory
identification of causative agent before treatment.
• ii) Clinical: - where one depends on experience and own knowledge,
and
• iii) Syndromic: - where one identifies based on symptoms and signs
and treats to cover the majority of organisms that may cause those
symptoms.
 Syndromic approach
• The syndromic approach to managing STIs has been adopted by
the Ministry of Health for the management of STIs in public
health institutions in Zambia.
• Syndromic case management is based on identifying consistent
groups of symptoms and easily recognized signs and providing
treatment which will deal with the majority of organisms
responsible for producing each syndrome.
• Using the syndromic approach, a diagnosis is made by taking a
client's history and examining them to verify their STI problem.
There are 8 common syndromes
namely
i. Urethral discharge
ii. Vaginal discharge
iii. Genital ulcer
iv. Genital growth
v. Lower abdominal pain
vi. Inguinal bubo
vii. Scrotal swelling and
viii. Neonatal conjunctivitis.
A. Urethral Discharge

•This is a condition in which there is dysuria

coupled with often copious, mucoid
discharge from the urethral meatus.
•Two common conditions presenting with
urethral discharge are Gonococcal and
Chlamydia urethritis.
 1 . Gonococcal urethritis
Description
• This is an acute inflammatory condition of the
columnar epithelial lining of the urethra.
• It is caused by a gram- negative intracellular
diplococcus, Neisseria gonorrhoea.
 Clinical Features
• The incubation period is 3 to 5 days and
• the patient will present with dysuria (difficulty in micturition),
followed by urethral discharge of copious, a mucoid fluid which
sometimes contains pus.
• Frequency and urgency may develop as the disease spreads to
the posterior urethra.
• Examination of the discharge shows a purulent, yellowish-
green urethral discharge.
• The lips of the meatus may be red and swollen.
 Complications These include:
• Acute epididymo-orchitis: This is an important complication, which
is usually unilateral swelling and tenderness of the testis and
epididymis. Bilateral epididymo-orchitis may result in sterility.
• Urethral strictures: This is a late complication occurring in cases
which are treated inadequately or not at all. This could occur 10 to
25 years after initial infection or in cases of recurrent infections.
• Disseminated Gonococcal Infection: This is an arthritis-dermatitis
syndrome in which the patient presents with a mild febrile illness,
malaise, migratory polyarthralgia or polyarthritis) and a few
pustular skin lesions.
2. Non-Gonococcal Urethritis
Description
• The term Non-gonococcal urethritis is used to
describe other causes of urethritis apart from
Neisseria gonorrhoeae.
• The organisms commonly responsible are
Chlamydia trachomatis and Ureaplasma
urealyticum among more than 20 known
organisms.
 Clinical Features
• Symptoms usually occur 7 to 28 days after intercourse;
• Usually mild dysuria and discomfort in the urethra and
• A clear to purulent mucoid discharge. Although the discharge may be
slight and the symptoms mild, they are frequently more marked in the
morning when the lips of the meatus are often stuck together with
dried secretions.
• On examination, the meatus may be red, with evidence of dried
secretion on underwear.
• Occasionally the onset is more acute, with dysuria, frequency and a
copious purulent discharge.
Diagnosis
• This is based on bacteriological examination of
the discharge to exclude gonorrhoea.
Complications
• These include epididymitis and urethral
stricture.
• Perihepatitis could also occur.
 Treatment

Syndrome Causal Recommended Recommended

Pathogens regime regime
for
children
Urethral Discharge Neisseria Ciprofloxaci n 500mg Spectinomycin
Gonorrhea stat Plus 40mg/kg IM stat
(maximum
Doxycycline
2g stat)
100 bd X 7/7
>8years old
Erythromycin
Chlamydia 50mg/kg/day in 4 doses
for 14 days
• Persistent urethral discharge one week after
treatment consider Trichomonas vaginalis, then
treatment with Metronidazole 2g PO single
dose for adults and 5mg/kg body weight for
children.
Prevention
• Avoiding multiple sexual partners and
unprotected casual sexual intercourse. Condom
use is advised.
 3. Gonorrhoea in Neonates
a. Ophthalmia Neonatorum
Description
• Ophthalmia Neonatorum is inflammation of the conjunctiva in the
neonatal period (day 1 to day 28) due to infection with Neisseria
gonorrhoeae.
• The gonococcus produces a toxin which dissolves the cornea and can lead
to blindness.
• The infection is acquired during birth when passing through the birth canal.
The incubation period is 3 to 5 days.
• Non-gonococcal conjunctivitis is due to Chlamydia trachomatis,
Staphylococcus aureus and Streptococcus pneumoniae.
Ophthalmia Neonatorum
Clinical features
• It commonly presents with purulent, copious eye
discharge usually in both eyes.
• Itching and redness are also present
• The neonate may also present with septicaemia with
fever, rash and joint swelling.
Diagnosis
• This is confirmed by taking an eye swab for culturing
for Gonorrhea.
Treatment
• Note: The use of antibiotic eye ointments in gonococcal
conjunctivitis is of no documented benefit.
• Systemic treatment is recommended for all symptomatic
cases
• NOTE: The baby's mother and partner(s) should receive
syndromic treatment for Gonorrhea and Chlamydia.
• Breastfeeding mothers should be given Gentamicin and
not Ciprofloxacin for gonorrhoea but for Chlamydia give
Erythromycin.
Neonatal Gonorrhoea Spectinomycin 50mg/kg
Conjunctivitis IM stat

Plus Chlamydia Plus

Erythromycin 50mg/kg
PO QID X 7 days

Normal Saline
lavage of the
affected eye
 Prevention
• Women with pelvic inflammatory disease or urinary tract infection
in pregnancy should be treated promptly before delivery.
• Every child’s eyes should be swabbed with cotton wool soaked
with Povidone-iodine or normal saline immediately after birth.
• Apply any of the following:
• Povidone-iodine
• Silver nitrate 1% aqueous solution stat
• Erythromycin 0.5% ophthalmic ointment stat
• Tetracycline ophthalmic ointment 1% stat
• Normal saline
Vaginal Discharge and Lower Abdominal Pain
in Women
• Various gynaecological conditions could present with
vaginal discharge and lower abdominal pain.
These include:
• Pelvic Inflammatory Disease (PID)
• Vulvovaginitis
• Urinary Tract Infection (UTI)
4. Pelvic Inflammatory Disease
Description
• Pelvic inflammatory disease is a condition
involving the pelvic organs i.e. cervix (cervicitis),
uterus (endometritis), salpinx (salpingitis) and
ovaries (oophoritis).
• Organisms that may be responsible for this disease are-
Neisseria gonorrhoea and Chlamydia trachomatis.
• Endogenous aerobic bacteria such as E. coli, Klebsiella,
Proteus and Streptococcus species and endogenous
anaerobes such as Bacteroides, Peptostreptococcus and
Peptococcus;
• Mycoplasma hominis and Actinomycetes isreali affect
predominantly the vagina presenting as vaginal discharge
but ascend through the cervical tract to cause Pelvic Infl am
mato ry Disease (PID). PID is a disease of the young
woman.
 Some of the predisposing factors
are:
• Sexual intercourse
• Induced abortion
• Dilatation and curettage or endometrial biopsy
• Intra-uterine device (IUD) insertion or use
• Hysterosalpingosramy
• Laparoscopy
• Radium insertion into the endometrial cavity.
Clinical Features
Symptoms
• Lower abdominal pain
• Copious purulent vaginal discharge may be
present or absent
• High -grade fever is an indicator for admission
• Nausea
Symptoms cont’
• Vomiting
• Painful sexual intercourse (dyspareunia)Signs
• Occasional diarrhoea
• Lower abdominal tenderness with rebound is an
indicator for admission
• Adnexia tenderness
• Cervical excitation
Complications
• Peritonitis
• Tuba-ovarian abscess
• Hydrosalpinx
• Ectopic Pregnancy
• Chronic Pelvic Pain
• Infertility
• Mortality
Indications for immediate referral to
gynaecology or surgery
•missed/overdue period
•recent delivery or abortion
•abdominal guarding or rebound tenderness
•abnormal vaginal bleeding
•abdominal mass
•temperature above 38 degrees Celsius
 5. Vulvovaginitis
Description
•Vulvovaginitis is an inflammatory condition
affecting the vulva and the vagina.
•The causative organisms include; Candida
albicans, Chlamydia trachomatis,
Trichomonas vaginalis. Bacterial vaginosis.
Clinical Features
Symptoms:
•Vaginal itching
•Burning sensation
Signs
•A watery, thick or mucoid, foul-smelling
and yellowish or brown vaginal discharge
is sometimes present.
Diagnosis
• Insert a speculum into the vagina and using a swab
take two specimens one from the cervical mucosa for
gram stain and culture on Gonococcal media for
gonorrhoea, the second for wet mount and
microscopy for Candida, Trichomonas.
Complications
• Secondary bacterial infection
• Skin excoriation
• Dermatitis
Vaginal Neisseria Adults: Children:
Discharge and gonorrhoeae Ciprofloxacin Spectinomcin
lower 500mg PO stat 40mg/kg IM
Abdominal Plus Doxycycline stat
Pain 100 bd (maximum 2g
PO X 7/7 stat)
 Plus
Chlamydia Metronid Metronidaz
azole 2g ole
Trichomoniasis PO stat 5mg/kg
body
weight

Plus
Bacterial
Vaginosis
 Vaginal Neisseria Adults: Children:
TREATMENT
Discharge gonorrhoeae Ciprofloxacin Spectino
and lower 500mg PO stat mycin
Abdomina Plus 40mg/kg
l Pain Doxycycline IM stat
100 bd (maximu
PO X 7/7 m 2g
stat)
Plus
Chlamydia Metronidazole
Metronidazole 2g 5mg/kg
PO stat body
Trichomoniasis weight
Plus
Bacterial
Vaginosis
Vaginal Candidiasis
Fluconazole 150mg PO stat
6. Urinary Tract Infection
Genital Ulceration
Description
• Genital Ulceration is the loss of continuity in the
epithelial surface covering the genital area.
• Ulcerative lesions of the genitalia are common
outpatient problems. Men are more commonly
affected than women.
•There are many causes including:
•Chancroid
•Granuloma inguinale (Donovanosis)
•Herpes genitalis
•Lymphogranuloma venereum
•Syphilis
7. Syphilis

•Description
•This is an infection caused by spirochaetes
called Treponema pallidum, a corkscrew-
shaped organism with an incubation period
of 9 to 90 days.
Clinical Features
• Primary syphilis presents with a painless papule at the site of
inoculation which then ulcerates.
• The ulcer called a chancre, is often solitary with a firm,
indurated base and is therefore often referred to as hard sore.
• Oral and vulva lesions may be subtle.
• In men, the chancre could be found on the glans penis, shaft,
anus and rectum whereas in women it is found on the vulva,
cervix and perineum.
• Chancres may also be found on the skin or
mucous membrane of the ano-genital area as
well as the lips, tongue, buccal mucosa, tonsils
or fingers.
• Rarely chancres can be found on other parts of
the body, often producing such minimal
symptoms that they are ignored.
• There may be bilateral inguinal
lymphadenopathy. Without treatment, the ulcer
heals in 3-6 weeks.
• Secondary syphilis presents 6 to 12 weeks after infection with
cutaneous rashes which may be generalized and also affect the soles
and palms.
• The rash can mimic any skin disease ranging from circular plaques
like psoriasis, or light copper coloured scaly macules like pityriasis
rosea Patchy hair loss is a common presentation.
• In the mouth are found snail track ulcers which are slimy superficial
erosions.
• Condylomata lata is flat warty papules and plaques found on the
genitalia and perineal skin. Generali sed enlarged lymph nodes may
occur.
• Other areas may be involved as well such as eyes (uveitis), bones
(periostitis), joint s, meninges, kidneys (glomerulitis), liver and
spleen.
• Tertiary syphilis: Presents 10 to 25 years after the initial infection.
• The patient may present with cardiovascular complications.
• These include dilated aneurysm of the ascending aorta, narrowing
of the coronary aorta or aortic valvular insufficiency.
• The central nervous system complications include dementia and
psychosis and meningovascular neurosyphilis.
• Congenital syphilis presents with clinical features as those of
secondary syphilis in adults.
• Mild constitutional symptoms of malaise, headache, anorexia,
nausea, bone pain s and fatigability are present as well as fever,
anaemia, jaundice, albuminuria and neck stiffness
Diagnosis
•Collect blood specimen and allow to clot,
send to the laboratory for identification of
antibodies to Treponema pallidum using
screening methods like VDRL (Venereal
Disease Research Laboratory), RPR (Rapid
Plasma Reagin)
Treatment Adult:
• Benzathine Penicillin 2.4 M. U IM weekly for a total 3 doses
Alternatively give
• Procaine Penicillin 1.2 M.U IM daily for 10 days
• OR
• Erythromycin 500mg 4 times a day for 14 days in penicillin allergy and
children (50mg/kg body weight )
• OR
• In non-pregnant adults; Doxycycline 100mg twice daily for 14 days.
• Child:
• Benzathine Penicillin 50 000units/kg IM weekly for a total of 3 doses.
Treatment of Genital Ulcers
• Most patients with primary or secondary syphilis
infection have jarisch - herxheimer reaction
within 6 hours to 12 hours of initial treatment.
• The reaction is manifested by generalized
malaise, fever, headache, sweating, rigours and a
temporary exacerbation of syphilitic lesions. This
usually subsides within 24 hours and poses no
danger other than the anxiety it produces.
8. Chancroid
•Description
•This is an acute, localized, contagious
disease characterised by painful genital
ulcers and suppurative inguinal lymph
nodes. The causative organism is
Haemophilus ducreyi a short, slender, gram-
negative bacillus with rounded ends and
usually found in chains or groups.
Clinical Features
• The incubation period is 3 to 7 days. Small, painful papules
rapidly break down to become shallow ulcers with ragged
undermined edges.
• The ulcers, which vary in size and often coalescing, are shallow,
non-indurated, painful and surrounded by a reddish border. The
inguinal lymph nodes become enlarged, tender and matted,
forming a fluctuant abscess (Bubo) in the groin.
• The skin over the abscess becomes red and shiny and may
break down to form a sinus. Chancroid may coexist with other
causes of genital ulcer.
Complications
• Phimosis
• Urethral stricture
• Urethral fistula
• Severe tissue destruction leading to a phagedenic
ulcer which may grow rapidly and cause auto
amputation of the penis. Biopsy the ulcer to
distinguish from squamous cell carcinoma.
Treatment
•Ciprofloxacin 500mg twice daily orally
for three days.
•OR
•Erythromycin 500mg orally 6 hourly for
7 days
 9. Lymphogranuloma Venereum
Description
• This is characterized by transitory primary ulcerative
lesion followed by suppurative lymphadenitis.
• It is caused by serotypes of Chlamydia trachomatis
L1, L2, L3 which are distinct from those causing
trachoma, urethritis, cervicitis and inclusion
conjunctivitis.
Clinical Features
• The incubation period is 3 to 12 days. A small, transient,
non-indurated vesicular lesion is formed that rapidly
ulcerates, heals quickly and may pass unnoticed.
• Usually, the first symptoms are unilateral, tender enlarged
inguinal lymph nodes, enlarging above and below the
inguinal ligament giving rise to the characteristic groove
sign.
• They progress to form a large, tender fluctuant mass that
adheres to the deep tissues and inflates the overlying skin.
• Multiple sinuses may develop and discharge purulent or
bloodstained material. Healing eventually occurs with scar
formation.
• The patient may have constitutional symptoms of fever,
malaise, joint pain, anorexia, and vomiting.
• Backache is common in women in whom the lesion may be
on the cervical or upper vagina resulting in the enlargement
and suppuration of perirectal and pelvic lymph nodes.
• This results in the formation of rectovesical and rectovaginal
fistulas. Aspirate suppurating glands with a wide bore needle
through intact skin. Avoid incision and drainage through a
fluctuant area which results in chronic sinus formation.
Treatment
Drugs
• Doxycycline 100mg orally twice daily for 14 days or
• Alternative and/or in pregnancy
• Inguinal Buboe Chancroid
• Ciprofloxaci n 500mg PO
• Erythromycin 500mg orally 6 hourly for 14 days.
• All sexual partners should be examined. The patient should be kept
under observation for 6 months after apparently successful
treatment.
 10. Herpes Genitalis
Description
• Herpes Genitalis is an infection of the genital or anogenital area by
herpes simplex virus (herpesvirus hominis type 2). Type 1 (HSV-1) is
the most common cause of genital ulceration in developed
countries.
• It is moderately contagious and usually spreads by sexual contact.
• Lesions usually develop 4 to 7 days after sexual contact. The
condition tends to recur because the virus establishes a latent
infection of the sacral sensory nerve from which it reactivates and
re-infects the skin.
Clinical Features
• The primary lesions are more painful, prolonged
and widespread than those of recurrent
infections. Itching and soreness usually precede
a small patch of erythema on the skin or mucous
membrane.
• A small group of painful vesicles develops, they
erode and form several superficial, circular
ulcers with a red areola, which coalesce.
• The ulcers become crusted after a few days and
generally heal with scarring in about 10 days.
• The inguinal lymph nodes are usually slightly enlarged.
• Tender lesions in men may occur on the prepuce,
glans penis, and penile shaft whereas in women may
occur on the labia, clitoris, perineum, vagina and
cervix.
• In addition to pain, in primary infection, the patient
may experience generalized malaise, fever, difficulty in
micturition or difficulties in walking.
Diagnosis
• This is mainly clinical but can be confirmed by tissue culture.
• Scrape the roof of the blister and make a smear. Stain with
Papanicolaou stain. Giant multinucleated cells are diagnostic
Complications
• Aseptic meningitis
• Transverse myelitis
• Autonomic nervous dysfunction involving the sacral region
leading to urinary retention.
Drugs
• Acyclovir 200mg orally 5 times daily for 7 days for initial infection.
• Acyclovir 200mg orally 5 times daily for 5 days for recurrent infection.
Genital Syphilis Benzathine Benzathine Penicillin
Ulcer Penicillin 2.4M.U IM 50 000units/ kg IM
Disease weekly x 3 weekly
doses x 3 doses

Ciprofloxacin
Chancroid 500mg PO BD x
days
Acyclovir 20mg/kg 8
Herpes Genitals Acyclovir 400mg hourly for CNS and
TDS x 7 days disseminated disease;
extend therapy to 21 days;
for disease limited to the
skin and mucous
membranes for 14 days
Lympho Doxycycline 100 BD x
granuloma 14days
Venerium
11. Granuloma lnguinale
(Donovanosis)
• Rare in Zambia
Description
• This is a chronic granulomatous condition usually
involving the genitalia and spreads by sexual contact.
• It is common in the tropical and subtropical climate
and is caused by gram-negative, Calymmato
bacterium granulomatis and intracellular bacillus
found in mononuclear cells.
Clinical Features
• The initial lesion is a painless, beefy-red nodule.
Multiple nodules appear and coalesce to form a large
elevated, velvety, granulomatous mass.
• The incubation period is 1 to 12 weeks.
• The sites of infection in men are penis, scrotum, groin
and thighs, whereas in women the vulva, vagina and
perineum are the common sites, with the face being
affected in both sexes.
• In homosexual men, the anus and buttocks are affected.
• There is no lymphadenopathy. The infection may involve
other parts of the body. Progress is slow but the eventual
lesion may cover the whole external genitalia, the deep-
seated ulcers causing lymphatic obstruction and
elephantiasis of the genitalia.
• Healing is also slow and often leads to scar tissue formation.
Secondary infection is common and can cause gross tissue
destruction.
Complications
• Anaemia
• Weight loss
Diagnosis
• Do a punch biopsy of the lesion and crush between two glass
slides. Stain with Wright's or Giemsa Stain to show gram-
negative rods within macrophages. Secondly, send the biopsy
for histopathology to rule out squamous cell carcinoma.
Thirdly, diagnosis can be based on clinical findings that are
often characteristic i.e. bright, beefy- red granulomatous
lesions.
Treatment
• Drugs
• Erythromycin 500mg orally 6 hourly for 14 to 21 days.
Prevention:
• Condom use is advisable
12. Genital Growth (Condylomata Acuminata)

Description
•This is a fleshy growth found around the
anogenital region caused by Human
papillomavirus infection HPV6 and 11
but HPV 16 and 18 are associated with
cancer of the cervix.
Clinical Features
• Lesions can be subclinical (not visible to the naked
eye) or overt ano-genital warts.
• Visual inspection of overt disease (fleshy growth of
the lower genital tract) detects obvious lesions,
which are often multifocal in distribution. However,
the appearance and size depending on their
location, the trauma to which they are subjected
and the degree of irritation.
Genital Genital Podophyllin 25% Cauterisation
growths warts topically by physician (i) 0 5 – fluorouracil cream
(Condylomata weekly till (ii)Trichloroacetic acid
Acuminata) resolved (iii)Cryosurgery
(iv) Electro
Benzathine Penicillin cauterisation
2.4 MU IM weekly (v) Laser
for 3 doses vapourisation
(vi) Surgical
removal

Benzathine
Condylomata lata
Penicillin 50
000iu/kg IM weekly
for 3 doses
For Cervical Warts DO NOT CAUTERISE
Diagnosis
• This is based on direct inspection. If uncertain, confirmation can be
done by biopsy. May predispose to cancer of the cervix.
Treatment
• Podophyllin paint compound (Podophyllin resin 15% in compound
Benzoin tincture) – applied every week until lesions disappear. The
application should not be left on for more than 4 hours. Where
possible, the application should be done in the clinic.
• OR
• Silver nitrate crystals 5% daily until lesions disappear. Recurrence is
common.
Prevention
•Avoid multiple sexual partners.
•Condom use is advised.
Special consideration pertaining to syndromic
management.
Pregnant women
• Vaginal discharge syndrome: for Neisseria gonorrhoeae give
Spectinomycin 2g IM stat; for Chlamydia give Erythromycin 500mg
QID for 5-7 days
• Genital Ulcer Disease: for Chancroid give Erythromycin 500mg QID X
7 days; for LGV give Erythromycin 500mg QID for 7 days; for Herpes
Genitalis give Acyclovir as in the non-pregnant. In the event of an
outbreak during labour, consult a gynaecologist to consider an
emergency Caesarian Section; for Donovanosis give Erythromycin
500mg QID for 3 weeks until all lesions have completely healed.
• Genital Growths: Genital warts, LEAVE ALONE, wait
until delivery, then decide on surgical management.
During labour, if the pelvic outlet is obstructed, or
vaginal delivery would result in excessive bleeding,
Caesarian Section is indicated.
• For cervical warts, refer to a gynaecologist for a pap
smear to rule out CIN, because cauterization can lead
to vaginal fistulas or perforation. For anal warts, refer
to a surgeon because cauterization could lead to
fistula formation. For urethral-meatal warts, refer to a
surgeon
HIV Infected
• Genital Ulcer Disease: in Chancroid, since the
ulcers heal slower, it is recommended that the
courses of treatment take longer, give
Erythromycin 500mg QID for 5 - 7 days. Children
For children treated with Erythromycin,
follow up for symptoms of pyloric stenosis
which present with vomiting and abdominal
discomfort/distention.
13. Hepatitis
Description:
• Acute inflammation of the liver caused by primarily human
viruses from A to E; B and C.
Mode of transmission
• Cutaneous, or
• Mucous membrane exposed to contaminated blood
• Unprotected sex by an infected partner, or through
contaminated needle by injection, and Perinatal
transmission.
The clinical features of acute hepatitis are common to
all of them and these are:
• Malaise
• Nausea
• Abdominal pain
• Anorexia
• Jaundice
• Dark urine
• Fever
• Rash
• Arthralgia
 Hepatitis B Hepatitis C

Incubation 60 – 180 days 15 – 180

days
Transmission Blood borne Sexual
Blood borne
Sexual
Progression to Occasionally varies by age Usually
chronicity

Etiologic agent Hepatitis B Virus Hepatitis C Virus

Comments Vaccine available Not available

Serologic diagnosis HBsAg, IgM anti-HBc HCV RNA; anti

HCV
Treatment
• Counsel patient for HIV AIDS and if negative give
Lamivudine 150mg twice a day.
• If positive refer to ART Clinic.
Prevention
• Hepatitis B vaccine is available for children, but no
vaccine for Hepatitis C
• Safe sex
• Avoid the use of contaminated needles.
14. Acute Epididymo-orchitis

Description
•This is an inflammation of the epididymis
and the testes.
•It is usually a complication of urethritis
which is not treated at all or which was
improperly treated.
Clinical Features
• Presentation is mucoid, puss-filled urethral
discharge, painful scrotal swelling usually
unilateral but could be bilateral, the pain is
gradual and dull.
• Milking of the urethra produces puss-filled
discharge. Diagnosis is confirmed by culture of
urethral discharge. Complications include
atrophy of the testes, infertility.
Supportive
• Bed rest,
• Scrotal support or elevation,
• Scrotal ice packs,
• Analgesia
• The causative organism in men less than 35
years of age is usually Neisseria gonorrhoeae or
Chlamydia trachomatis.
Treatment
• Drugs
• The best antibiotics are those that are sensitive to the above organisms.
• Ciprofloxacin 500mg stat oral + Doxycycline 100 mg OD for 7 days.
• OR
• Ceftriaxone 1g (I.M.) once + Doxycycline 100mg 12 hourly for 7 days.
• Erythromycin may be substituted for Tetracycline or Doxycycline at 500mg
every 6 hours for 7 days.
• In men older than 35 years of age, the cause is mostly due to coliform gram
negative bacilli. Gentamicin 80mg 8 hourly for 7 days or a 3rd generation
cephalosporine as above may be used until the sensitivity is determined.
Prevention
•Avoiding multiple sexual
partners
•Usage of condoms.
References

•Zambia National Formulary

Committee 2017 - 2020