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PCL 424 > STI Management > Flashcards

STI Management Flashcards

Dr. Joda

1
Q

What is syndromic management?

A

Refers to the diagnosis and treatment of an individual based on signs and symptoms, prior to laboratory confirmation of the specific disease.

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2
Q

Mention 5 key features of syndromic management.

A
  1. Problem-oriented
  2. Highly sensitive
  3. Does not miss mixed infections
  4. Uses flowcharts that guides the healthcare provider through logical steps
  5. Provides opportunity for education and counselling.
  6. Treats patients at first visit.
  7. Accessibility
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3
Q

Mention 5 advantages of syndromic management.

A
  1. Patients are treated at first contact with health services
  2. Treatment is very accessible
  3. Treatment comes with necessary education and counselling
  4. Does not require sophisticated equipment.
  5. Broad-based treatment modality
  6. Patients are treated promptly
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4
Q

What are the disadvantages of symptomatic treatment?

A
  1. Broad treatment is unnecessary if lab results are available
  2. Some patients still require specialised care
  3. Pharmacists are not involved at the training stage at the Ministry of Health.
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5
Q

What are the requirements for care providers in syndromic treatment?

A

Care providers must:
- Have a copy of the syndromic chart
- Be trained in the use of the chart
- Must have a minimal level of clinical skills e.g. History taking, Physical assessment ad examination skills, Good communication skills

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6
Q

Each flowchart is made up of a series of three sorts of steps:

A

-The clinical problem
- A decision to make
- An action to take

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7
Q

Mention 6 syndromes produced by STIs.

A
  1. Urethral discharge
  2. Vaginal discharge
  3. Lower abdominal pain
  4. Genital ulcer
  5. Neonatal conjunctivitis
  6. Scrotal swelling
  7. Inguinal bubo
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8
Q

What are the symptoms associated with Vaginal discharge?

A

i. Unusual vaginal discharge
ii. Vaginal itching
iii. Dysuria
iv. Dyspareunia (painful intercourse)

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9
Q

What are the symptoms associated with Urethral discharge?

A

i. Urethral discharge
ii. Dysuria
iii. Frequent urination

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10
Q

What are the STIs that cause Urethral discharge?

A
  • Gonorrhea
  • Chlamydia
  • Trichomoniasis
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11
Q

What are the STIs that cause Vaginal discharge?

A
  • Gonorrhea
  • Chlamydia
  • Trichomoniasis
  • Candidiasis
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12
Q

What are the STIs that cause Lower abdominal pain?

A
  • Gonorrhea
  • Chlamydia
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13
Q

What are the STIs that cause Genital ulcers?

A
  • Syphilis
  • Chancroid
  • Lymphogranuloma venerum (LGV)
  • Herpes
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14
Q

What are the STIs that cause Neonatal conjunctivitis?

A
  • Gonorrhea
  • Chlamydia
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15
Q

What is the treatment for Urethral discharge?

A

Ciprofloxacin 500mg single dose
+
Doxycycline 100mg b.d x7/7
+
Metronidazole 2g single dose

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16
Q

How is persistent urethral discharge handled?

A

If the patient returns with the same symptoms after seven days check for:
- poor compliance or
- reinfection
treat the patient as before, if either of these proves to be the case.

If compliance seems good, the persistent syndrome may be due to:
- drug resistance: in this case, offer an alternative drug therapy
- a different causal agent

If symptoms continue to persist, refer the patient.

17
Q

What is the treatment for Vaginal discharge?

A

Treatment for urethral treatment
+
Nystatin 100,000 U x14/7
OR
Tioconazole 300mg vaginal pessary single dose [For candidiasis]

18
Q

Distinguish between Vaginitis and Cervicitis.

A

i. Vaginitis is caused by trichomoniasis, candidiasis and bacterial vaginosis (CBT) while cervicitis is caused by gonorrhea and chlamydia.

ii. Vaginitis is the most common cause of vaginal discharge while cervicitis is a less common cause.

iii. Vaginitis is easy to diagnose while cervicitis is difficult to diagnose.

iv. Vaginitis causes no serious complications while cervicitis causes major complications.

v. Except for trichomoniasis, treatment of partner is unnecessary in vaginitis while in cervicitis requires treatment of the partner.

19
Q

What are the risk factors associated with cervical infection?

A
  • Age below 21 years (sometimes 25)
  • Unmarried;
  • More than one partner in the last 3 months
  • Current partner has an STI or has recently started to use condoms;
  • A new partner in the last 3 months.
20
Q

What is the treatment for Lower abdominal pain?

A

Ciprofloxacin 500mg single dose
+
Doxycycline 100mg b.d x7/7
+
Metronidazole 400mg tab po bdx14/7

21
Q

PID refers to infections of the female upper genital tract: the uterus, fallopian tubes, ovaries or pelvic cavity

True or False?

A

True.

22
Q

PID includes endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis

True or False?

A

True.

23
Q

Patients with lower abdominal pain must be referred immediately if any of the following is present:

A
  • Missed or overdue periods
  • Recent delivery, Abortion, Miscarriage
  • Abdominal guarding and/or rebound tenderness
  • Abdominal vaginal bleeding (Erratic bleeding)
  • Abdominal mass

These are also to be checked for in patient’s history.

24
Q

What is the treatment for Genital ulcer?

A

Benzathine Penicillin 2.4 MU IM single dose
+
Erythromycin 500mg q.i.d x7/7
+
Doxycycline 100mg bd pox14/7

25
Q

Highlight the steps involved in the management of Herpes.

A
  • Analgesics as required
  • Reassuring the patient that they will go away of their own accord, but might recur.
  • Explain importance of keeping the area clean and dry,
  • Advise patient not to have sexual contact until area is healed.
  • Specific treatment may be offered but this treatment only controls the ulcers. It does not cure herpes.
26
Q

What is the treatment for Neonatal conjunctivitis?

A

Ceftriaxone 50mg/kg (125mg maximum dose)
+
Erythromycin syrup 125mg q.i.d x10/7

27
Q

Define Neonatal conjunctivitis.

A

Neonatal conjunctivitis (ophthalmia neonatorum) is defined as purulent conjunctivitis occurring in a baby less than one month of age.

*For babies older than 1 month, the cause is unlikely to be an STI.

28
Q

Describe Neonatal conjunctivitis preventive therapy?

A

As soon as the baby is born, carefully wipe both eyes with dry, clean cotton wool.
Then apply 1% silver nitrate solution or 1% tetracycline eye ointment into the infant’s eyes (in the conjunctival sacs)

29
Q

What are the roles of the pharmacist in STI drug management?

A

i. Providing pharmaceutical care including documenting care
ii. Checking for ADRs
iii. Checking for drug interactions
iv. Checking that no other incompatibilities exist

30
Q

What do the 4 Cs represent?

A
  1. Counselling and Education
  2. Compliance
  3. Contact tracing
  4. Condoms
31
Q

What are the education and counselling points involved in STI management?

A

i. Advising patients on the importance of complying with treatment
ii. Explaining how STIs are transmitted and the possible complications of infection
iii. Advising the patient not to engage in sexual activity until completely cured
iv. Discussing the patient’s choices for safer sexual behaviour
v. Educating and counselling the patient on condom use
vi.Enlisting the patient’s help with partner referral.

PCL 424 (12 decks)

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