The diagnosis and treatment of genital infections have several difficulties: lack of specificity of symptoms; frequency of asymptomatic infections; lack of performance of field laboratory tests; frequency of mixed infections; need to simultaneously treat (s) partner (s) if the infection is sexually transmitted 1; increased risk of relapse or treatment failure in cases of co-infection with HIV.
Therefore, WHO introduced the syndromic approach to IG developed and standardized care protocols: the patient with a syndrome is treated for different germs / 2 infections can cause this syndrome.
Search genital infection if / patient (e) complains:
Purulent urethral discharge Pain / irritation during urination (dysuria)
abnormal vaginal discharge
Itching / burning of the vulva
Pain during sexual intercourse (dyspareunia)
Pain / irritation during urination (dysuria)
Vesicle or ulcer (s) on the genitals
Burning of the vulva or perineum
Growths ano / genital
Lower abdominal pain (in women)
Principles of treatment of genital infections:
– The patient can receive effective treatment without the need for laboratory tests. Some tests may be useful in vaginal and urethral discharge, but pending the results should not delay initiation of treatment (results should be available within the hour).
– Treat the patient at the first consultation (no patient should leave the consultation without pay, pending laboratory results, for example).
– The single dose treatment should be preferred whenever it is shown.
– If urethral discharge, abnormal vaginal discharge (with the exception of candidiasis), genital ulcers (except herpes) and sexually transmitted genital infection high, the partner must be treaty. For candidiasis, herpes and warts, the partner is treated only if symptomatic.
– Patients with sexually transmitted infections should be informed about their disease and its treatment, be counseled to reduce risk and possible screening of HIV. Condoms must be supplied to them for the duration of treatment.
1* Genital infections can be sexually transmitted (p. Ex. Gonorrhea, chlamydia) or not (p. Ex. Most candidiasis).
2* Remember that in areas where schistosomiasis haematobium is endemic, the symptoms of genital infection can be caused by or associated with urogenital schistosomiasis.
Special situation: sexual violence:
Given the somatic, psychological, legal and social consequences of the assault, the medical care is not limited to the research and treatment of genital lesions or infections.
It is based on listening to the victim, a complete physical examination, laboratory tests, if available, the drafting of a medical certificate.
Following the consultation, a prophylactic or curative treatment should be initiated.
– Prophylactic treatment:
• Priority is given to the risk of HIV transmission (start as soon as possible antiretrovirals for patients seen within 48-72 hours after exposure, see HIV infection and AIDS) and the prevention of pregnancy resulting rape (give the earliest possible emergency contraception within 72 hours of rape: levonorgestrel PO, 1 tablet to 1,500 mcg or 2 tablets of 750 mcg single dose) 3;
• prevention of sexually transmitted infections based on the administration of a single dose of azithromycin 1 g + cefixime 400 mg; one can also treat trichomoniasis, if necessary distance from other treatments;
• tetanus prophylaxis (see Tetanus) in case of wounds;
• vaccination against hepatitis B (accelerated vaccination schedule, see viral hepatitis.
– Curative treatment:
• diseases / infections reported, if the event is not new.
Psychological support is necessary, regardless of the time elapsed since the event. It is based on immediate assistance (reception, listening) and if necessary monitoring in order to identify and treat psychological and / or psychiatric consequences (anxiety, depression, post-traumatic syndrome, etc.).
3* Between 72 and 120 hours (5 days) after the rape, emergency contraception remains effective enough to be offered.