This document provides information on sexually transmitted infections (STIs) in Sinazongwe District, Zambia. It defines STIs, discusses their prevalence and impact in Zambia, and outlines the syndromic approach used to manage common STIs according to their symptoms. Key points covered include defining common STIs, their relationship to HIV transmission, evaluating patients for STIs, and treating common infections and syndromes like urethral discharge, vaginal discharge, and genital ulcers.

1. Sinazongwe District. ©2019
medicshealthlog® Justin K. Ng’andwe.

2. Objectives.
At the end of the presentation the Audience will be able to:
i. Define STI’s
ii. Understand and Identify STI syndromes and Management (2017 STI Guidelines for
Zambia)
iii. Understand what to look for and ask during History taking on Clients with sings and
symptoms presumptive of an STI

3. • Sexually transmitted infections (formally known as STDs) are infections that
are ‘Commonly’ spread by sexual activities, especially Vaginal intercourse,
anal sex and Oral sex.
• They are Many types of STI
• In Zambia it’s one of the most common cause of all out patient department
(OPD) attendance.
• They are among the most common causes of illness in the world and have
far-reaching health, social and economic consequences for many countries.
In addition, socio-economic determinants such as unemployment, poverty,
polygamous relationships seem to play an important role in the spread of
STIs.
• It has continued to be one of the major causes of morbidity and remain
the major contributor to new HIV infections in Zambia in the reproductive
age group 14-49year old.

4. FACTS ABOUT STIs;
 Rank among the top 5 disease categories for which adults seek health care
 >1 million people acquires an STI every day
 500 million people become ill with one of the 4STIs (Chlamydia, Gonorrhea, Syphilis
and Trichomoniasis.
 >290 Million women have HPV
 HPV infections causes about 530 000 cases of CC and 275 000 CC deaths are
recorded every year.
 Majority of STI are asymptomatic
 STI can present in any of the opening, genital, Anal or oral
 STIs increase the risk of HIV transmission
 STI can be transmitted from mother-to-Child
 Are major causes of PID, adverse pregnant out come and infertility in women

5. • RELATIONSHIP WITH HIV:
• They are all STIs
• Similar risky behaviors are involved
• Prevention and treatment of STIs reduces the number
of new HIV infection
• STIs increases the risk of both acquiring and
transmitting HIV
• In people with HIV, having an STI increases VL in blood
and genital secretions

6. SIX KEY ELEMENTS IN A TYPICAL HEALTH CONSULTATION
1. Hx taking
2. Physical examination and specimen collection (where
possible)
3. Early Diagnosis and treatmen
4. STI prevention counseling
5. Prevention Methods
6. Sexual partners, Confidentiality and reporting (HMIS)
- Patient referral
- Provider referral
- Conditional referral

7. CONDITION THAT MASK THE DEFINATE DIAGNOSIS FOR STIs
• UTI
• GASTLITIS
• MUMPS
• ENT
• MSD
• ATHRITIS
• Non-blood Diarrhea
• dermatitis
• Urticaria/hives
• Conjunctivitis
• PUO
• Clinical Malaria
• Anemia
• Genitalia Elephantiasis
• Other STIs

8. Approaches in the management of STIs
There are three traditional approaches utilized in the diagnosis and treatment of STIs.
The following are the three main approaches of diagnosis and treatment of STIs:
1. The etiologic approach
This approach requires the use of laboratory tests to identify the causative agent. It is the ideal
approach in clinical medicine. It allows evidence-based diagnosis and management of STIs.
2. The clinical approach
This approach involves the use of clinical experience to identify symptoms typical for a specific
STI, then treatment is targeted to the suspected pathogen.
3. The syndromic approach
The syndromic management approach is based on the identification of consistent groups of
symptoms and easily recognized signs, and provision of treatment that covers the majority of
organisms responsible for producing that syndrome.
Flowcharts have been developed to guide health workers in the implementation of syndromic
management of STIs. It is especially useful at primary health-care level where resources are
limited. It allows treatment of the patient at the first visit and enables treatment of mixed
infections. However, it fails to identify asymptomatic infectio

9. - The Sydronic approach is adopted by the Ministry of health
in Zambia for management of STI in public health
institutions.
- There 8 common syndromes identified, namely
1. Urethral Discharge
2. Vaginal discharge
3. Genital Ulcer
4. Genital Growth
5. Lower Abdominal pain
6. Inguinal bubo
7. Scrotal swelling
8. Neonatal Conjuctivitis

10. URETHRAL DISCHARGE:
Common Causes.
1. Gonococcal Urethriti (Gra – Intracellular diplococcus, neisseria
gonorrhea).
CF. - icubation period 3-7 days
- Dysuria/difficulty in micturition
- Urethral discharge of copious mucoid/pussy fluid
The examination of the discharge shows a purulent, yellowish-green
discharg with a red swollen meatus sometimes
1. Non-Conococcal Urethrytis( other causes apart from
N.Gonorrhea, eg, Chlamydia trachomatis, among other 20
comong causes).
CF. – Symptoms usually occur 7-28 days after intercourse
- with mild dysuria and disconfort
- clear-purulent mucoid discharge (more marked in the morning
On examination the meatus may be red, with evidence of dried
secretion on underwear

11. Symptoms Causal
Pathogens
Recommended
Regime
Recommended
Regime for
Children
Urethral
Discharge
Neissera
Gonorrhea
Chlamydia
Ciprofloxacin 500mg
Start
+
Doxycycline 100mg bd
7/7
Spectinomycin
40mg/kg IM start
(maximum 2g
start)
>8years old
Erythmycin
50mg/kg/day in 4
Doses for 14 days
TREATMENT
NB: For persistent urethral discharge one week after treatment consider
trichomonas vaginilis, then treat with Metronidazole 2g PO start for adults
Metronidazole 5mg/kg body weight for children

12. VAGINAL DISCHARGE AND LOWER ABDOMINAL PAIN
IN WOMEN
- Various gynecological conditions present with Vaginal discharge and lower
abdominal pain. These includes; -
1. Pelvic inflammatory Disease (PID)#
the condition involving the pelvic organs ie, cervix (cervicitis), uterus
(endometritis), salpinx (salpingitis) and ovaries (oophoritis).
Responsible Organisms: *
Symptoms: L/abdominal pain, Vaginal discharge (sometimes absent)
High-grade fever, nausea, vomiting, painful coitus (dyspareunia)
2. Vulvoginitis
Condition affectin the Vulva and the Vagina
Causative organsms: *
Symptoms: Vaginal itching, Burning Sensation
3. Urinary tract infections (UTI)
Condition involving the urethra, bladder and sometimes the Kidneys
Symptoms: Painful urination, urge to urinate, back ache, blood in urine
* Refer to treatment table

13. Symptoms Causal
Pathogens
Recommended
Regime
Recommended
Regime for
Children
Vaginal
discharge
And lower
abdominal
pain
Neissera
Gonorrhea
Chlamydia
Ciprofloxacin 500mg
Start
+
Doxycycline 100mg bd
7/7
+
Spectinomycin
40mg/kg IM start
(maximum 2g
start)
>8years old
Erythmycin
50mg/kg/day in 4
Doses for 14 days
Trichomoniasis
Bacterial Vaginosis
Metronidazole
2g PO start
+
Metronindazole
5mg/kg BW
Vaginal
Candidiasis
Fluconazole
150mg PO start
TREATMENT

14. COMPLICATIONS (DISCHARGES AND LOWER ABDOMINAL
PAIN)
Male Female
• Epididymo-orchitis
• Uretral stricture
• Perihepatitis could also
occur
• Peritinitis
• Tubo-ovarian abscess
• Hydrosalpinx
• Ectopic Pregnancy
• Chronic Pelvic pain
• Infertility
• Mortality
• Abnormal vaginal bleeding
• Abdominal mass

15. GENITAL ULCERATION
DEFINITION:
- loss of continuity in the epithelial surface covering
the genital are
- Men are commonly affected than women
CAUSES:
• Granuloma anguinale (Donovanosis)
• Herpes genitalis
• Lymphogranuloma venereum
• Syphilis

16. SYPHILIS
• Caused by Treponema pallidum
• Incubation period of 9-90 days
Clinical features:
- painless papule…which later ulcerate to form a chancre
- Chancre is firm with indurated base; referred to as a hard sore
- Chancre can be found on; MEN; WOMEN;
- glans penis - vulva
- shaft - cervix
- anus - perineum
- rectum
- The chanre may also be found on the skin or mucous membrane of the
anogenital area as well as lips, toungue, buccal mucosa, tonsils or fingers
- there may be bilateral inguinal lymphadenopathy
NB: the ulcer heals 3-6 weeks

17. TYPES OF SYPHILIS
EARLY SYPHILIS (history of contact or Symptom
within a year)
LATE SYPHILIS ( no history of contact or symptom
in one year)
Primary Secondary Tertiary Syphilis
• identified by the
presence of an ulcer
or chancre at the
site of inoculation.
• A chancre is usually
indurated and
painless.
• Chancre forms
approximately 21
days after initial
exposure to T.
pallidum.
• Presents 6-12
weeks after
infection
• Generalized
Cutaneous rash
which may affect
the soles and
pulms
• The rash can mimic
any skin disease
• Snail track ulcer in
the mouth
• Condylomata lata
on the genitalia
perineal skin
• Lyphdenopathy
• May involve the
eyes, bones, joints,
meninges, kidneys,
liver and spleen
• Present 10 to 25 years after initial
infection
• Presents with cardiovascular complication
• Includes dilated aneurysm of the
ascending aorta
• Narrowing of the coronary aorta
NS complication
• Dementia
• Psychosis
• Meningovascular neurosyphilis
Note:
Congenital syphilis presents
with features like those of
secondary syphilis in adults

18. CHANCROID
• Characterized by a painful genital ulcer
• Suppurative inguinal lymph nodes
• Caused by Haemophilus ducreyi
Clinical features:
 IP 3 to 7days
 Small painful papules
 Papules break down to form shallow ulcers, non-indurated and surrounded with
reddish border
 Inguinal lymph nodes (tender and matted), forming a bubo in the groin (abscess)
 Red and shiny skin on the abscess and may break to form a sinus
NB: may co-exist with other causes of genital ulcer
LYMPHOGRANULOMA VENEREUM
• Characterized by tensitory primary ulcerative lesion followed by suppurative lypgadenitis
• Caused by serotypes of chlamydia trachomatis L1, L2,L3
C’features:
- Ip 3 to 12 days
- form an ulcer that heals quickly and may pass unnoticed
- Enlarged lymph nodes (tender)
- Developes multiple sinuses which may discharge purulent or blood staining material
- The client may have contitutional symptoms of fever malaise, joint pain,
anorexia/vomiting

19. LYMPHOGRANULOMA VENEREUM cont……
- The client may have contitutional symptoms of fever malaise, joint pain,
anorexia/vomiting
- In women, backache is common in whom the lesion may be on the cervix or upper
vagina resulting in the enlargement suppuration of perirectal and pelvic lymp nodes.
- This results into rectovaginal vistulas
- caused by herpes simplex virus
- Spread by sexual contact
- The condition tend to recure because the virus establish a latent infection
C’ features;
• Lesion develop 4 to 7 days after sexual contact
• Painful lesions, prolonged and widespread
• Genital itching and soreness
• Develops a small group of painful vesicles which later erode and form several
superficial, circular ulcer
• Ulcer become crusted after a few days and generally heal with scarring in 10 days
• Slightly enlarged inguinal lymph nodes
• The patient may experience generalized malaise, fever, difficulty uriting and walking
HERPES SIMPLEX

20. Name of syndrom Causative agent Reccomended
treatment
Genital
Ulcer
Treponema Benthathine. P
2.4 M.U
IM weekly for
three weeks
B.P 50
000units/kg IM
weekly X 3 doses
Trachomatis L1,2
and 3
Ciprofloxacin
500mg po BD X
3days
Acyclovir 20mg/kg
8houly for CNS
and disseminated
disease; treat for
21 days
- For disease
limited to skin and
mucous
membranes treat
for 14 days
• Haemophilus*
ducreyi
• Trachomatis
L1,2 and 3
Doxycycline
100mg BD X
14days
Herpes Simplex
Virus
Acyclovir 400mg
tds X 7days
TREATMENT OF GENITAL ULCERS
*alternative and or in pregnance; Erythromycin 500mg QID 14days
NB: Treat partner and observe client for 6months after apparently successful
treatment

21. STIs in NEONATES
• All neonatal and Congenital STIs are transmitted from mother-
to-child
• The most common are Ophthalmia Neonatum, Congenital
Syphilis and HIV infection
OPHTHALMIA NEONATUM:
• Inflammation of the conjuctiva in the neonatal period due to infection with Neisseria gonorrheae
• Infection is acquired during birth
• Has the incubation period of 3 to 5 days
• Chlamydia, trachomatis, staphylococcus aureus and streptococcus pneumoniae can also cause
neonatal conjustivitis
• CF: presents with purulent, copious eye discharge (birateral), itching and redness, fever, rash,
joint sweelling and septicaemia
CONGENITAL SYPHILIS
Cf;
• Malaise, headache, anorexia, nausea, bone pain and fatigibility
• Including fever, jaundice, albuminuria and neck stiffness

22. CONDITION LIKELY CAUSE TREATMENT
Neonatal Conjuctivitis Gonorrhea
Chlamydia
Spectinomycin 50mg/kg
IM start
Plus
Erythromycin 50mg/kg
PO QID for 7days
Normal Saline lavage of
the affected eye
Congenital Syphilis Syphilis 50 000units/kg IM
weekly for total of 3
doses
TREATMENT

23. Granuloma Inguinal (Donovanosis)
Chronic Granulomatous condition usually involving the genitalia and spread by sexual contact
Caused by Calymmatobacterium granulomatis
Clinical Features:
• Painless lession
• Beefy-red nodules
• Large nodules appear and form a large elevated, velvety, granulomatous mass
• Incubation period 1-12 weeks
• Sites: MEN: WOMEN:
Penis Vulva
Scrotum Vagina
Groin Perineum
Thighs Face
Face
Anus
Buttocks
• There is no lyphodenopathy
• Slow progress but eventually may cause lymphetic obstruction and Elephantiasis of the Genitalia
• May result into Anemia and Weight loss
• Treatment: Erythromycin 500mg QID for 14 to 21 days
• Note: Rare in Zambia

24. Genital Growth (Condylomata Acuminata)
• Freshy growth found around the anogenital region
• Caused by Human Papiloma Virus infection (HPV)
Clinical Features:
- May present with Subclinical lesions
- Or Overt anogenital Warts
- Appearance and size depends on their location
Condition Cause Treatent High level options
Genital Growth Genital warts
(Condylomata
Acuminata)
Podophylilline
25% topically by physician
Benzathine. P 2.4MU IM weekly
for 3doses
Cauterrisation
i. 05 fluorouracil
cream
ii. Trichoroacetic acid
iii. Cryosurgery
iv. Electro
Cauterisation
v. Laser vapourisation
vi. Surgical removal
Conndylomata
lata
Benzathine P. 50 000iu/kg
IM weekly for 3 doses

25. HEPATITIS
• An acute inflammation of the liver caused by primary human virus A to E; B and C
Mode of Transmission:
 Cutaneous
 Mucous membrane exposed to contaminated blood
 Unprotected sex by infected partner
 Contaminated needle by injection
 Perinatal transmission
Clinical Features:
• Malaise
• Nausea
• Abdominal pain
• Anorexia
• Jaundice
• Dark urine
• Fever
• Rash
• Athralgia

26. Hepatitis B Hepatitis C
Incubation 60-180 days 15-180ays
Transmission Blood born
Sexually
Blood born
Sexually
Progression to Chronicity Occasionally varies by age Usually
Etiologic Agent HBV HCV
Comment Vaccine Available Not Available
HEPATITIS B Vs C
TREATMENT:
• 3tc 150mg BD
Prevation :
• Safe sex
• HB vaccine
• Avoid use of Contaminated needles

27. ̿ ̿̿
STI FREE ZAMBIA IS PRODUCTIVE