Emergency Medicine

150 Infectious Disease and Foreign Travel Emergencies

Sexually Transmitted Diseases

DIAGNOSIS

1 A sexually transmitted disease (STD) may be caused by non-specific infection,

Chlamydia, gonococcus, HSV, human papilloma virus, Trichomonas, scabies

or lice, syphilis, and of course human immunodeficiency virus (HIV).

2 Males may present with dysuria, urethral discharge, penile ulceration, warts,

epididymo-orchitis and balanitis.

3 Females may present with vaginal discharge, vaginal pruritus, ulceration,

warts, menstrual irregularities and abdominal pain.

(i) Pelvic inflammatory disease is commonly sexually acquired (see

p. 379).

4 Take swabs for bacterial, viral and chlamydial studies for microscopy,

culture and nucleic acid amplification, if you intend to commence treatment.

(i) Discuss the swabs and transport medium with your microbiology

lab if you are unsure

(ii) Arrange a first-voided urine specimen for nucleic acid testing for

Chlamydia trachomatis or Neisseria gonorrhoeae.

MANAGEMENT

1 All STDs deserve expert diagnosis, treatment, follow-up and partner-contact

tracing most readily available in the genitourinary medicine clinic (Special

Clinic).

2 As many patients are reluctant to attend these clinics, explain carefully the

local appointment system, what to expect, and how to locate the clinic, and

refer the patient on.

(i) Advise males not to empty the bladder for at least 4 h before

attendance.

3 Commence empirical antibiotic treatment in the homeless or itinerant

patient considered unlikely to attend any clinic.

(i) Give azithromycin 1 g orally as a single dose plus ceftriaxone

500 mg i.m. for urethritis.

4 In addition, consider treating the patient with an immediately painful condi-

tion such as genita l herpes simplex:

(i) Give aciclovir 400 mg orally t.d.s. or famciclovir 250 mg orally

t.d.s. for 5 days.

5 Admit a patient under the medical or gynaecology team for treatment of the

acute manifestations of HIV infection, secondary syphilis, acute Reiter’s

syndrome, disseminated gonococcal infection, severe primary genital

herpes, or acute severe salpingitis.