Sexually Transmitted Infections

SYPHILIS

Usually presents either as a primary lesion or through chance finding on +ve serology testing (latent syphilis). May be associated with HIV.

It is important to be alert to the various manifestations of secondary syphilis (constitutional symptoms and non-pruritic generalised rash).

Diagnosis: reagin tests, treponemal antibody test, PCR, biopsy or CSF analysis.

Management The management of syphilis has become quite complex and referral of the patient to a specialist facility for diagnosis, treatment and follow-up is recommended.

Recommended anti-microbial therapy Early syphilis (primary, secondary or latent) of not more than 2 yrs duration:

• benzathine penicillin 1.8 g IM (2.4 million units) as a single dose or

• procaine penicillin 1 g IM daily for 10 d

For patients hypersensitive to penicillin:

• doxycycline 100 mg (o) bd for 14 d or

Late syphilis: more than 2 yrs or indeterminate duration:

• benzathine penicillin 1.8 g IM once wkly for 3 doses

URETHRITIS

Rules

• All people under 30 yrs who have ever had sex, even if asymptomatic, should be tested annually for chlamydia with a first-catch urine or genital swab.

• For a person of any age requesting an ‘STI check-up’, test for:

  • – urine PCR or genital swab for chlamydia and gonorrhoea

  • – serology for Hepatitis B (if not vaccinated or immune)

  • – syphilis and HIV