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STI screening – people with risk factors should be screened for Chlamydia, gonorrhoea, HIV and syphilis.
Refer individual and partners to GUM service. Risk factors: under 25 years, no condom use, recent (less than 12 month)/ frequent change of partner, symptomatic partner.
Treatment options are below though in most cases a prompt referral to GUM for investigation and management is the most appropriate action.
Refer to BASHH website for full details.
Opportunistically screen all patients aged 15-25 years
Treat partners and refer to GUM service.
If high risk of STI or if treatment fails, consider referral to GUM
Treat with antibiotics as directed by recent urine cultures or
Notes
See section: 5.1.12 Quinolones
All topical and oral azoles give 75% cure
Various clotrimazole or fluconazole products are available to purchase over the counter, along with advice, from pharmacies. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet.
See 5.2.1 Triazole antifungals and 7.2.2 Vaginal and vulval infections
In pregnancy avoid oral azoles and use intravaginal treatment
Oral metronidazole is as effective as topical treatment. There is less relapse at 4 weeks with 7 days treatment than with 2g single dose.
Topical treatment gives similar cure rates but is more expensive. Vaginal preparations are unsuitable for use during menstruation.
Treating partners does not reduce relapse. Refer to GUM if recurrent.
See section 7.2.2 Vaginal and vulval infections
Patients with suspected Gonorrhoea should be referred to specialist Genito-Urinary Medicine services for treatment and contact tracing.
Refer to
BASHH website for full details
Refer to GUM and treat partners simultaneously.
In pregnancy or breastfeeding avoid 2g single dose metronidazole.
Topical clotrimazole gives symptomatic relief (not cure) if metronidazole declined.
See section 7.2.2 Vaginal and vulval infections
Test for Chlamydia & N. gonorrhoea. If positive, refer all patients and contacts to GUM clinic.
Tetracyclines and quinolones are contra-indicated in pregnancy - consult obstetrician.
Recommend review after treatment to assure cure.
or
Notes
Patients with suspected Gonorrhoea should be referred to specialist Genito-Urinary Medicine services for treatment and contact tracing.
Refer to BASHH website for full details
See section: 5.1.3 Tetracyclines, 5.1.11 Metronidazole, 5.1.12 Quinolones
Guidance adapted from Sexually Transmitted Infections in Primary Care (RCGP 2013)
If the diagnosis is unclear then take a viral swab for HSV/VZV. Also see risk factors for additional STI screening.
Oral antivirals are indicated within 5 days of start of episode or while new lesions are still forming, or if symptoms persist.
Supportive treatment:
Prodromal symptoms occur up to 48 hours before appearance of lesions, often milder than the initial episode with faster resolution. Symptoms = milder/self-limiting, therefore manage in partnership with patient.
Options are:
Supportive treatment
Episodic prescription:
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