Syndromic testing and treatment is a public health approach in areas with high rates of STIs. There are many causes of anal and rectal inflammation. The Silver Book is limited to sexually transmitted causes, but surgical e.
Crohn's disease should always be considered. Herpes often causes ulceration and accompanying anal pain, itch and discomfort, while gonorrhoea causes a more generalised inflammation and exudate. A primary herpes proctitis tends to be extremely painful and uncomfortable. LGV is usually symptomatic while a gonococcal proctitis is only rarely the cause of much discomfort. In suspected proctitis, proctoscopy should be performed unless patient discomfort makes this impossible, and the following investigations are suggested:.
In cases where a sexually transmitted cause is suspected, treatment should be given immediately before the results of tests are available. Treat for both gonorrhoea and chlamydia and consider the need for specific herpes therapy. Vaginal discharge may originate from either the vagina, cervix or upper genital tract.
Vaginal discharges are commonly due to bacterial vaginosis, candidiasis and trichomoniasis although the latter is rare in urban areas. On examination there is usually increased discharge noted at the introitus and, on inserting a speculum, a pooling of vaginal discharge in the posterior fornix or adherent to the vaginal walls.
It is important to note the colour and consistency of the discharge, its odour, and whether the vaginal walls are inflamed. Laboratory tests allow precise diagnosis, and should be performed.
If the patient complains of or shows signs of a vaginal discharge:. Women often present with lower abdominal pain. The causes range from minor but uncomfortable problems such as constipation or period pain, to life-threatening problems such as a ruptured ectopic pregnancy or appendicitis.
The term PID refers to infections of the female upper genital tract — uterus, fallopian tubes, ovaries or pelvic cavity. It can be caused by gonorrhoea, chlamydia or anaerobic bacteria, or a variety of bacteria commonly found in the vagina, such as the different bacteria that can cause bacterial vaginosis, especially post-instrumentation.
Symptoms include constant pain in the lower abdomen that worsens with Syndromic approach to sexually transmitted infections statistics such as running or going up and down stairs, or pain with intercourse deep dyspareunia. There can be fever or raised temperature, malaise, irregular or heavy periods, or pain can start after a recent period.
Abdominal examination can show tenderness in the iliac fossae, guarding or rebound tenderness. The following investigations should be performed where PID is considered:. Go back to Top. Search this site Search all sites. About us Improving health in WA Health for Open search bar Open navigation Submit search. Print this page Twitter Youtube LinkedIn. Home Silver book Sexually transmitted infection syndromes.
Silver book Search silver book General principles Back. Organism There are many causes of anal and rectal inflammation. STI Atlas external site Investigations In suspected proctitis, proctoscopy should be performed unless patient discomfort makes this impossible, and the following investigations are suggested: Treatment In cases where a sexually transmitted cause is suspected, treatment should be given immediately before the results of tests are available.
In addition, the following procedures are recommended: Vaginitis Symptoms There may be an odour Syndromic approach to sexually transmitted infections statistics in the case of bacterial vaginosis or trichomoniasis or itch candidiasis or vulval swelling or soreness trichomoniasis or candidiasis. Vaginal infections as opposed to cervical infections may cause increased volume of vaginal discharge usually noticed by the patient, i.
Signs On examination there is usually increased discharge noted at the introitus and, on inserting a speculum, a pooling of vaginal discharge in the posterior fornix or adherent to the vaginal walls. Symptoms Cervical discharge is usually more scanty and may not be noticed by the patient, i. Cervical discharge may be due to STIs such as gonorrhoea, chlamydia or genital herpes. Alternatively, they may be due to physiological causes such as hormones or exposed columnar epithelium ectopy causing increased mucoid or mucopurulent discharge at the cervix.
Coexisting urethral infection can occur in women with sexually acquired cervicitis. A history of Syndromic approach to sexually transmitted infections statistics without urinary frequency is an important clue to the possible presence of an STI.
Signs On speculum examination a purulent or mucopurulent discharge from the endocervical canal is an important sign as most cases are likely to be due to gonorrhoea or chlamydia. Often this is associated with an inflamed, oedematous cervix with contact bleeding when taking swabs or smears. Often a previously unnoted cervical discharge is seen on Syndromic approach to sexually transmitted infections statistics tip of the swab.
In some cases of clinically evident mucopurulent cervicitis, no pathogens are able to be isolated. STI Atlas external site Investigations and specimen collection Laboratory tests allow precise diagnosis, and should be performed. If the patient complains of or shows signs of a vaginal discharge: Take a medical history and undertake a physical examination. Examine the urethra and vulva for redness and discharge. If urethral discharge pus is present, swab for culture. Pass a speculum, "Syndromic approach to sexually transmitted infections statistics" visualise the vagina and cervix.
Collect a high vaginal swab. Note if there is a fishy odour. Collect endocervical specimens for gonorrhoea and chlamydia using a swab or NAAT no transport medium. Collect first void urine for gonorrhoea and chlamydia NAAT.
If the patient has urinary frequency, take a mid-stream specimen for culture and sensitivity. Perform a pelvic examination on every new patient where there is abdominal painor clinical cervicitis. Special considerations History of receptive anal intercourse and no anal symptoms: A proctoscope needs to be inserted if possible and the swabs obtained under direct vision. If the patient declines or proctoscope not available, patients can be instructed how to take blind anal swabs themselves.
Also collect two throat swabs one for culture and sensitivity [charcoal or non-charcoal agar gel transport medium] and one for NAAT [no transport medium] if there is a history of receptive oral sex. No slide is necessary for microscopy. Collect blood for serological tests — syphilis, HIV and hepatitis B. Also test for hepatitis C if there is a history of injecting drug use. Immediate treatment Without waiting for laboratory results, proceed as follows: In all cases, educate the patient about safer sex practices and promote condom use.