Introduction
STI: infections due to unprotected sexual intercourse, mother-to-child, blood transfusions. Body fluids, or skin to skin.
Contributing factors to STIs (&HIV AIDS) in adolescents
Explorative nature of Adolescents and youth
Multiple sexual partners
Unplanned sexual acts
Substance use
Biologic factors
Sexual violence
The STI and HIV infection share similar risk factors
STI facilitates HIV acquisition & effective STI management reduces HIV infection
STI Management approach
Three approaches to STI diagnosis and management
Etiologic:
A diagnosis is based on laboratory test results
Clinical:
Provider’s deduction based on patient's history, signs, and symptoms.
Syndromic:
Standardized treatment approach based on symptoms/ syndromes
Treat causes that result in similar symptoms to treat at the same time
Symptoms of STI and their common causes
Discharge: Urethral or vaginal discharge, burning sensation on urination:
Most commonly caused by gonorrhea and chlamydia
PID: Pelvic inflammatory disease
Most commonly caused by gonorrhea and chlamydia
Genital ulcer: ulcers on the penis, vagina, and another genital area, can occur in other body parts
Mostly caused by syphilis, HSV, and chancroid.
Practical Considerations for Management of STIs in adolescents and youth
Establishing a good rapport, carrying out history taking and physical examination taking care of a youth-friendly approach
Arriving at the right diagnosis: risk assessment
Communicating the diagnosis. its implications, discussing treatment options and providing treatment
Linkage with HIV counseling and testing
Follow up visits
Promotion of safer sex
Prevention of recurrence/risk reduction counseling
Notifying and managing partners
Risk assessment for STI
STI drug treatment
Follow national STI management guideline
Urethral discharge syndrome is:
Ceftriaxone 250mg IM stat/Spectinomycin 2 gm IM stat Plus
Azithromycin 1gm po stat/Doxycycline 100 mg po bid for 7 days/Tetracycline 500 mg po qid for 7 days/Erythromycin 500 mg po qid for 7 days in cases of contraindications
Re infection /persistence with non-compliant patient re-treat with proper counseling
Persistence with compliant patients: Provide Metronidazole 2 gm po. stat/Tinidazole 1gm po once for 3 days (Avoid Alcohol!) PLUS
Azithromycin 1 g orally in a single dose (only if not used during the initial episode to address doxycycline resistant M.genitalium)
Referral: for treatment failure
For vaginal discharge
Risk Assessment Positive
Ceftriaxone 250mg IM stat/Spectinomycin 2 gm IM stat plus
Azithromycin 1gm to stat/Doxycycline 100 mg po bid for 7 days plus
Metronidazole 500 mg bid for 7 days
Risk Assessment Negative
If the discharge is white or curd-like add Clotrimazole vaginal pessary 200 mg at bedtime for 3 days
Lower abdominal pain syndrome (PID) Outpatient
Ceftriaxone 250 mg IM stat /Spectinomycin 2gm i.m stat Plus Azithromycin 1gm po stat/Doxycycline 100 mg po b.i.d for 14 days Plus Metronidazole 500 mg po b.i.d for 14 days
Admit if there is no improvement within 72 hours
syphilis is painless. HSV and chancroid cause painful ulcers.
Treatment for Non-Vesicular Genital Ulcer
Benzathine penicillin 2.4 mu IM stat /Doxycycline(in penicillin allergy) 100mg bid for 14 days plus Ciprofloxacin 500mg bid orally for 3 days /Erythromycin 500mg qid for 7 days plus Acyclovir 400mg bid orally for 10 days (or 200mg five times per day of 10 days) Treatment for Vesicular, multiple, or recurrent genital ulcers
Acyclovir 200 mg five times per day for 10 days Or
Acyclovir 400 mg TID for 7 days
Treatment for recurrent infection: Acyclovir 400 mg tid for 7 days
Treatment of scrotal swelling syndrome
Ceftriaxone 250mg i.m stat/ Spectinomycin 2gms i.m stat. Plus Azithromycin 1gm po stat/ Doxycycline 100mg po bid for 7 days/ Tetracycline 500mg qid for 7 days Treatment of inguinal bubo
Doxycycline 100 mg bid orally for 14 days /Erythromycin 500mg PO qid for 14 days plus Ciprofloxacin 500mg bid orally for 3 days
If patient have a genital ulcer, add Acyclovir 400mg tid orally for 10 days( or 200mg five times per day for 10days)
Note: surgical incisions are contraindicated; aspirate pus with a hypodermic needle through the healthy skin
Treatment of neonatal conjunctivitis (ophthalmia neonatorum)
Ceftriaxone 50mg/kg IM stat maximum dose 125/ Spectinomycin 25 mg/kg IM stat maximum dose 75mg plus Erythromycin 50mg/kg orally in four divided doses for 14 days
Adolescent and youth and HIV/AIDS
Basic Facts on HIV/AIDS among Adolescents and Youth
An average of 1.75 million adolescents were living with HIV worldwide
Account for 5% of PL HIV and about 11 percent of new adult HIV infections
Adolescent girls accounted for three-quarters of all new HIV infections among adolescents in 2020
Most (88 %) live in sub-Saharan Africa
Global Summary of HIV Epidemic, UNAIDS 2021 estimate
Adolescent and youth PLHIV, by region, 2020
Estimated number of AY PLHIV, by region, 2020
Gender disparities in AY HIV infection
AIDS related death trend
HTC in adolescents
Do not ignore HIV infection potential in young people
Take Advantage of your first meeting
Promote beneficial disclosure
Take the opportunity given by a negative HIV test
Promote for joint counseling with sexual partner
Apply the WHO 5Cs principles in all models of HIV testing service
Consent
Confidentiality
Counseling
Correct test result
Connection/ Linkage to prevention, care and treatment
Adolescent HIV status disclosure
Counselling adolescents on potential benefits and risks of their HIV status Adolescents empowered and supported to determine if, when, how and to whom to disclose. Opportunity to ask questions, discuss issues they face Support on essential post-diagnosis and/or post-disclosure support. Disclosure to an adolescent about their own HIV status should be during school age
Adherence support to A&YLHIV
Adherence is a key to
Sustained HIV suppression,
Reduce risk of drug resistance,
Improve overall health
Improve quality of life, and survival as well as decrease risk of HIV transmission
Prevent therapeutic failure
HIV prevention interventions
There is no single magic bullet for HIV prevention Combination prevention packages Effective, acceptable and scalable behavioral, Structural and biomedical interventions are needed to prevent new HIV infections Peer support group Share facts on HIV and AIDS
Share experiences on prevention of HIV, challenges and difficulties and discuss solutions
PMTCT in AY
All pregnant adolescents Enrollement in routine ANC
Access to routine HIV testing
Access to prevention, treatment and care services
Access to lifetime ART as soon as diagnosed
Access appropriate ounselling services including adherence
Access to follow service including viral load
Access to follow-up and testing for HIV
SUMMARY
What are the three management styles in STI and which one is followed in Ethiopia?
What are the common syndromes in adolescent and youths?
What is the most common challenge of HIV in adolescents?
What prevention mechanism works for HIV and STI prevention in Ethiopia?
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