According to the World Health Organization (WHO) more than one million sexually transmitted infections (STIs) are acquired every day worldwide, the majority of which are asymptomatic. And each year there are an estimated 374 million new infections with one of four STIs: chlamydia, gonorrhoea, syphilis and trichomoniasis. 

What are Sexually Transmitted Infections (STIs)? 

Sexually transmitted infections (STIs) are predominantly spread from one person to the other during unprotected sexual intercourse which can either be vaginal, anal, or oral sex. Some STIs can also be transmitted from mother to child, during pregnancy, birth, and breastfeeding. 

STIs are a marker of unprotected sex and contribute to the transmission of HIV. A person can have an STI without having noticeable symptoms of the disease. The term sexually transmitted infection (STI) is, therefore, a broader term than the sexually transmitted disease (STD). 

What are the most common symptoms of STIs? 

A person with an STI can have one of these symptoms: 

• abnormal vaginal or penile discharge 
• burning urine 
• genital ulcer 
• painful intercourse 
• lower abdominal pain 
• scrotal swelling 

Risk Factors of getting infected with an STI: 

• inconsistent or lack of condom use 
• use of hormonal contraceptive without condom use 
• history of diagnosed and untreated STI 
• having a partner who has an STI or who had an STI in the last 8 weeks 
• periodic separation of partners (partner not always available e.g., travelling partner)
• uncircumcised males 

HOW TO MANAGE A PATIENT WITH AN STI 

SA adopted a syndromic approach for the control and management of STIs since 1996. 

What is syndromic management approach? 

The approach is based on the identification of consistent groups of symptoms, easily recognised signs or syndromes, and the provision of treatment that will deal with the most serious organisms responsible for producing such syndromes. 

Guided by the protocol for the management of a person with STI (Sexually Transmitted Infections Management Guidelines 2015) which is the first line of comprehensive management and control of STIs; healthcare workers are able to treat the STI patients using the syndromic management approach. 

STIs are preventable and many are treatable. STI screening at all healthcare visits can promote STI prevention and management; it further provides an opportunity for additional health promotion and education. 

This fact sheet highlights the STI syndromes and educational measures to consider when managing the STI patient. 

STI SYNDROMES ACCORDING TO THE SYNDROMIC MANAGEMENT APPROACH 

The syndromes are caused by different disease pathogens. It is possible that more than one pathogen can cause the same symptoms. It is therefore important for a pharmacist to know the signs and the appropriate management. 

Comprehensive management of a patient with STI 

• history taking 
• physical examination 
• correct diagnosis (identification of the syndrome) 
• treatment using the syndromic approach 
• health education 
• HIV counselling and testing 
• partner notification and treatment 

General measures on STI prevention and treatment adherence open to clinicians 

• counselling and education, including HIV testing 
• condom promotion, provision, and demonstration to reduce the risk of STIs 
• compliance/adherence to treatment 
• contact treatment/partner notification 
• circumcision 
• contraception and conception counselling 

PATIENT EDUCATION ON STI PREVENTION: 

How can I protect myself from STIs? 

• reporting early any STI symptoms at the clinic for management 
• visiting a healthcare facility regularly for STIs and HIV screening. 
• NB: a person with an STI is at greater risk of HIV acquisition and transmission 
• abstaining from penetrative sexual intercourse 
• delaying sexual debut 
• consistent and correct use of condoms 
• pregnant women to attend the antenatal care early and be screened for both HIV and STIs which includes syphilis 
• partner notification, tracing, and treatment to avoid re-infection 

 What to expect at the clinic? 

• private and confidential consultation 
• full history including sexual history will be taken 
• full examination and diagnosis of STI will be done 
• STI treatment will be provided 
• HIV test will be offered 
• condom provision and demonstration 
• partner notification slip(s) will be offered 
• Partner notification is the process of identifying the sexual partner(s) of a client with an STI and ensuring that they are aware of their exposure, and they should also be treated. 
• Relevant partner(s) include those with whom the client with an STI has had sexual intercourse in the last 8 weeks even if they have no symptoms. 

What are the benefits of condom use? 

Used correctly and consistently; condoms can be used as a dual protection method; for protection against STIs including HIV and prevention of unwanted pregnancy.