The daily educational pearl – suspected STDs

Management of suspected STDs

Investigations: depend on gender and clinical presentation

Male patients:
– 2 x urethral swabs
– one dry for Chlamydia / gonorrhoea PCR
– one to smear on glass slide, then place in charcoal transport medium for M/C/S
– first pass urine for chlamydia and gonorrhoea PCR
– clotted blood tube for serological tests (syphilis, hepatitis B, HIV serology) (after consent / counselling re: HIV)

Female patients:
– 2 x urethral swabs
– one dry for Chlamydia / gonorrhoea PCR
– one to smear on glass slide, then place in charcoal transport medium for M/C/S
– 2 x endocervical swabs
– one dry for Chlamydia / gonorrhoea PCR
– one to smear on glass slide, then place in charcoal transport medium for M/C/S
– 1 x high vaginal swab
– one to smear on glass slide, then place in charcoal transport medium for M/C/S
– first pass urine for chlamydia and gonorrhoea PCR
– clotted blood tube for serological tests (syphilis, hepatitis B, HIV serology) (after consent / counselling re: HIV)

Please note that often if they have one STD they will have another – i.e. they all need to be tested for gonorrhoea, Chlamydia (swabs + urine), syphilis, hepatitis B and HIV (serology)

– if they present with a genital ulcer they should be tested for syphilis, donovanosis, herpes – they need a dry swab and you can just write on the form “genital ulcer disease PCR” and the lab will know what to do

The empirical treatment is :

– PO azythromycin 1 g + IM ceftriaxone 500 mg with 2 ml lignocaine 1% + EITHER repeat 1 g azythromycin at 7 days OR doxycycline 100 mg BD for 14 days

– ceftriaxone has to be given IM if it’s only one dose; if it is given IV the current guidelines are that they receive one dose every day for 3 days – so, since most of our patients with suspected STDs go home, please make sure the ceftriaxone is given IM and NOT IV
Follow up should be done through one of the Sexual Health Clinics as they are very good at following up results, testing what hasn’t been tested for and also tracing contacts.
There are several clinics around Perth and they don’t have to pay anything when they are seen:
– Royal Perth Hospital Sexual Health Clinic
– Fremantle Hospital Sexual Health Services
– FPWA Sexual Health Services Northbridge
– Derbarl Yerrigan Health Services Perth
– Women’s Health Services Northbridge

You can search on Google for Department of Health WA, Sexual Health Clinics and you’ll find a list with all the clinics available + contact numbers (http://www.health.wa.gov.au/services/category.cfm?Topic_ID=8).
There are Sexual Health Clinics around country WA as well, also available on the Department of Health website – if the patients are planning to leave Perth, please refer them to those clinics.
As last instance, GPs can follow up as well.

There has been a significant increase in the number of STDs, in particular gonorrhoea and chlamydia, and they are very keen for these patients to have proper treatment, follow up and contact tracing.

If you forget all this, search on Google the “Silver Book” on the website of the Department of Health http://silverbook.health.wa.gov.au/

 

 

 

 

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