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9. Genito-urinary diseases
Genital infections (GI)
T h e d iag nosis and treatm ent of g enital infections present sev eral d ifficulties: clinical
features are not specific; m any infections are asym ptom atic; laboratory tests av ailable in
th e field are not alw ays reliable; m ixed infections are com m on; partners need to be
treated sim ultaneously in case of sexually transm itted infections a1nd th e risk of
recurrence or treatm ent failure is increased in HIV-infected patients.
T h us, th e W H O h as introd uced th e synd rom ic m anag em ent of GI and d ev eloped
stand ard ised case m anag em ent flow ch arts: based on th e id entification of consistent
g roups of sig ns and sym ptom s (synd rom es), patients are treated for th e path og ens/
infections2 th at m ay cause each synd rom e.
Look for a genital infection if a patient complains of: See
U reth ral d isch arg e U reth ral d isch arg e, pag e 231
P ainful or d ifficult urination (d ysuria)
Abnorm al v ag inal d isch arg e Abnorm al v ag inal d isch arg e, pag e 233
Vulv ar itch ing /burning
P ain with intercourse (d yspareunia)
P ainful or d ifficult urination (d ysuria)
Genital blisters or sores Genital ulcers, pag e 236
Burning sensation in th e v ulv a or perineum
S kin g rowth s in th e g enital (or anal) area Venereal warts, pag e 243
Lower abd om inal pain (in wom en)
Lower abd om inal pain, pag e 239
U pper g enital tract infections, pag e 240
Basic principles of GI management:
– T h e patient can be effectiv ely treated with out laboratory testing . S om e tests m ay h elp
in d iag nosing v ag inal and ureth ral d isch arg e, but th ey sh ould nev er d elay treatm ent
(results sh ould be av ailable with in one h our). 9
– T h e patient sh ould be treated at h is/h er first encounter with th e h ealth care prov id er
(no patient sh ould be sent h om e with out treatm ent, e.g . wh ile waiting for laboratory
results).
– S ing le d ose reg im ens are preferred wh en ind icated .
– In th e case of ureth ral d isch arg e, abnorm al v ag inal d isch arg e (except cand id iasis),
g enital ulcers (except h erpes) and sexually transm itted upper g enital tract infection,
th e sexual partner sh ould receiv e a treatm ent. In th e case of cand id iasis, g enital
h erpes and v enereal warts, th e partner is treated only if sym ptom atic.
– P atients w ith sexually transm itted infections sh ould receiv e inform ation on th eir
d isease(s) and treatm ent and be counselled on risk red uction and H IV testing .
Cond om s sh ould be prov id ed for th e d uration of treatm ent.
1 Genital infections may be sexually transmitted (e.g. gonorrhoea, chlamydia) or not (e.g. most cases of
candidiasis).
2 Keep in mind that in Schistosoma haematobium endemic areas, genital symptoms may also be due to, or
associated with, genitourinary schistosomiasis (see page 151).
229
Genital infections (GI)
T h e d iag nosis and treatm ent of g enital infections present sev eral d ifficulties: clinical
features are not specific; m any infections are asym ptom atic; laboratory tests av ailable in
th e field are not alw ays reliable; m ixed infections are com m on; partners need to be
treated sim ultaneously in case of sexually transm itted infections a1nd th e risk of
recurrence or treatm ent failure is increased in HIV-infected patients.
T h us, th e W H O h as introd uced th e synd rom ic m anag em ent of GI and d ev eloped
stand ard ised case m anag em ent flow ch arts: based on th e id entification of consistent
g roups of sig ns and sym ptom s (synd rom es), patients are treated for th e path og ens/
infections2 th at m ay cause each synd rom e.
Look for a genital infection if a patient complains of: See
U reth ral d isch arg e U reth ral d isch arg e, pag e 231
P ainful or d ifficult urination (d ysuria)
Abnorm al v ag inal d isch arg e Abnorm al v ag inal d isch arg e, pag e 233
Vulv ar itch ing /burning
P ain with intercourse (d yspareunia)
P ainful or d ifficult urination (d ysuria)
Genital blisters or sores Genital ulcers, pag e 236
Burning sensation in th e v ulv a or perineum
S kin g rowth s in th e g enital (or anal) area Venereal warts, pag e 243
Lower abd om inal pain (in wom en)
Lower abd om inal pain, pag e 239
U pper g enital tract infections, pag e 240
Basic principles of GI management:
– T h e patient can be effectiv ely treated with out laboratory testing . S om e tests m ay h elp
in d iag nosing v ag inal and ureth ral d isch arg e, but th ey sh ould nev er d elay treatm ent
(results sh ould be av ailable with in one h our). 9
– T h e patient sh ould be treated at h is/h er first encounter with th e h ealth care prov id er
(no patient sh ould be sent h om e with out treatm ent, e.g . wh ile waiting for laboratory
results).
– S ing le d ose reg im ens are preferred wh en ind icated .
– In th e case of ureth ral d isch arg e, abnorm al v ag inal d isch arg e (except cand id iasis),
g enital ulcers (except h erpes) and sexually transm itted upper g enital tract infection,
th e sexual partner sh ould receiv e a treatm ent. In th e case of cand id iasis, g enital
h erpes and v enereal warts, th e partner is treated only if sym ptom atic.
– P atients w ith sexually transm itted infections sh ould receiv e inform ation on th eir
d isease(s) and treatm ent and be counselled on risk red uction and H IV testing .
Cond om s sh ould be prov id ed for th e d uration of treatm ent.
1 Genital infections may be sexually transmitted (e.g. gonorrhoea, chlamydia) or not (e.g. most cases of
candidiasis).
2 Keep in mind that in Schistosoma haematobium endemic areas, genital symptoms may also be due to, or
associated with, genitourinary schistosomiasis (see page 151).
229
