Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Condition | Causes | Clinical Tests | Treatment |
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Urethral Discharge |
Chlamydia trachomatis: The most common cause of non-gonococcal urethritis (NGU).
Neisseria gonorrhoeae: Bacterial STI leading to purulent urethral discharge. Mycoplasma genitalium: Less common, but important in persistent infections. Trichomonas vaginalis: Parasitic infection causing urethritis. Non-infectious causes: Trauma, chemical irritants, or inflammation from urinary catheters. |
Nucleic Acid Amplification Test (NAAT): For Chlamydia trachomatis and Neisseria gonorrhoeae (gold standard).
Microscopy and Culture: For gram-negative diplococci (gonorrhoea) or trichomonads. Urine Test: First-void urine sample for NAAT. Urethral Swab: If discharge is visible, particularly for gonorrhoea testing. Serological Tests: If HIV or syphilis is suspected. |
Chlamydia: Doxycycline 100 mg twice daily for 7 days (or azithromycin if pregnant).
Gonorrhoea: Ceftriaxone 500 mg IM once plus azithromycin 1 g orally. Mycoplasma genitalium: Azithromycin or moxifloxacin. Trichomoniasis: Oral metronidazole 400-500 mg twice daily for 5-7 days. Partner notification: and treatment are essential to prevent reinfection. Abstain from sexual activity:* until treatment is complete and symptoms resolve. |
Genital Ulcers |
Herpes Simplex Virus (HSV): Most common cause of painful genital ulcers.
Syphilis: Painless ulcers (chancres) caused by Treponema pallidum. Chancroid: Painful ulcers caused by Haemophilus ducreyi (rare in the UK). Lymphogranuloma venereum (LGV): Caused by certain serovars of Chlamydia trachomatis, presenting with painless ulcers and lymphadenopathy. Behçet’s Disease: A non-infectious autoimmune condition that can cause recurrent ulcers. |
- NAAT Testing: For herpes simplex virus and Chlamydia trachomatis (LGV) using swabs from ulcers.
- Serology: For syphilis (e.g., treponemal enzyme immunoassays, VDRL, RPR). - Dark-Field Microscopy: For Treponema pallidum (syphilis), if available. - Ulcer Culture: For Haemophilus ducreyi in suspected chancroid cases. - HIV Testing: Recommended for all patients with genital ulcers. |
- Herpes: Oral acyclovir (400 mg three times daily for 5-10 days) or valacyclovir.
- Syphilis: Benzathine penicillin G 2.4 million units IM once (early syphilis). - Chancroid: Azithromycin 1 g orally as a single dose or ceftriaxone 250 mg IM. - LGV: Doxycycline 100 mg twice daily for 21 days. - Behçet’s Disease: Immunosuppressive treatment (e.g., corticosteroids, colchicine) under specialist care. - Partner notification and testing for all cases of STI-related genital ulcers. |
Genital Warts |
Human Papillomavirus (HPV): Types 6 and 11 cause most genital warts. Warts are often painless but can be itchy or uncomfortable.
HPV transmission: Occurs through direct skin-to-skin contact during sexual activity. |
Visual Examination: Genital warts are typically diagnosed based on their appearance.
Biopsy: Rarely required but can be used to rule out malignancy in atypical lesions. HPV Testing: Considered as part of cervical screening in women for high-risk HPV types (16, 18). |
Topical Podophyllotoxin: Applied twice daily for 3 days, followed by 4-day breaks, for up to 4 cycles.
Cryotherapy: Freezing the warts with liquid nitrogen. Imiquimod Cream: 5% cream applied 3 times a week for up to 16 weeks. Surgical Excision or Laser Therapy: Reserved for large or resistant warts. HPV Vaccination: Recommended for prevention (e.g., Gardasil vaccine). Regular follow-up: for recurrence and patient education on transmission prevention. |