Sexually Transmitted Infections (STIs) are infections that are primarily passed from person to person through sexual contact. They are caused by bacteria, viruses, or parasites.
Causes
- Bacterial STIs: Include chlamydia, gonorrhea, and syphilis.
- Viral STIs: Include human immunodeficiency virus (HIV), herpes simplex virus (HSV), human papillomavirus (HPV), and hepatitis B.
- Parasitic STIs: Include trichomoniasis.
Diagnosis
- History:
- Sexual History: Number of partners, type of sexual activities (oral, anal, vaginal), condom use, history of previous STIs.
- Symptoms: Unusual discharge, genital ulcers or warts, pelvic pain in women, testicular pain in men, itching, and dysuria (painful urination).
- Physical Examination:
- Genital Exam: Look for discharge, ulcers, warts, or other lesions.
- Pelvic Exam in Women: To check for signs of infection or inflammation.
- Oral and Anal Exams: If appropriate, based on sexual history.
- Investigations:
- Laboratory Tests: Urine tests, swabs from the genitals, throat, or rectum, blood tests.
- Specific Tests:
- Anal and Oral swabs for PCR and MCS
- PCR for chlamydia and gonorrhea
- PCR for HPV – cervical or anal (MSM)
- PCR for herpes.
- Serological tests for syphilis, HIV, HBV, HCV
Differential Diagnosis
- Urinary Tract Infection (UTI): Especially in cases presenting with dysuria.
- Vaginal Infections: Such as bacterial vaginosis or yeast infections.
- Non-infectious Conditions: Like dermatological conditions (lichen planus, psoriasis) or allergic reactions.
Management
- Antibiotics: For bacterial STIs like chlamydia, gonorrhea, and syphilis.
- Antivirals: For viral STIs like HIV, HSV, and hepatitis B.
- Antiparasitic Treatment: For trichomoniasis.
- Symptomatic Treatment: For relief of symptoms like itching or pain.
- Partner Notification and Treatment: To prevent reinfection and spread to others.
- Education and Counseling: About safe sex practices and follow-up testing.
- Regular Screening: For sexually active individuals with risk factors ie every 3-6 months for MSM (Men who have Sex with Men)
Long-term Management and Monitoring
- Regular Follow-Up: Especially for chronic infections like HIV and hepatitis B.
- Cancer Screening: Regular Pap tests for women with HPV.
- Vaccination: Such as HPV vaccine and hepatitis B vaccine.
Prevention
- Safe Sex Practices: Including the use of condoms.
- Vaccination: For preventable STIs like HPV and hepatitis B.
- Regular Screening: Particularly for individuals with multiple sexual partners.
In summary, the diagnosis and management of STIs require a comprehensive approach, including a detailed sexual history, appropriate physical examination, specific investigations, and individualized treatment and counseling. Prevention strategies, including safe sex practices and vaccination, play a key role in controlling the spread of STIs.