Download MBBS Venereology and Leprosy Presentations 4 Sti Counselling Lecture Notes

STI Counselling

? Counselling has been defined by Burnard

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(1999) as " the means by which one person

helps another to clarify his or her life situation

and to decide further lines of action "

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Role of counsellor

? Understands the reasons for these symptoms

(including past sexual behaviours)

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? Understands that only a complete course of treatment

wil help the situation

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? Decides how to avoid future infection

? Decides what to do to protect other people from their

symptoms/ il ness (e.g., referring the sexual partner for

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treatment)

Signs and symptoms of STI in males

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? Urethral discharge/ burning or pain during urination/

frequent urination

? Genital itching

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Swel ing in groin/ scrotal swel ing

Blisters or ulcers on the genitals, anus, mouth, lips

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? Itching or tingling in genital area

Ano-rectal discharge

Warts on anal, genital region or surrounding area

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Signs and symptoms of STI in females

? Abnormal vaginal discharge
? Genital itching
? Pain during sexual intercourse

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? Lower abdominal pain
? Blisters/ulcers on the genitals, anus or

surrounding area, mouth, lips

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Steps of counselling

1) Information
2) Risk assessment and risk reduction
3) Investigation and treatment

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4) Partner management
5) Follow up
Information

? STI, HIV/AIDS, Oppurtunistic infections

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? Explore any myths and misconceptions and

clarify the same

? Repeat and summarise information

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? Ask questions to check whether they have

understood

Risk assessment

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? Detailed sexual history
1 . Greet the patient and introduce yourself
2 . Take consent
3. Ask about history of presenting complaint

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and duration
4. Ask about sexual orientation

homo/heterosexual .

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5. Ask about marital status
6. Ask about last sexual encounter (date]


7. Nature of contact- M arital / non marital

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8. Type of contact ? genitogenital, orogenital,

anogenital

9. Type of contraception used and consistency of

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usage

10. Number of sex partners in the last 3 months-

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regular/ casual


11. Ask if patient has ever paid for sex

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12. If patient or his partner has been tested for

HIV or any other STD in past?

13. If patient or his partner has ever been diagnosed with

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any STD in past


14. If patient or his partner has any recurring STD

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complaints


15. If patient s partner has similar complaints currently

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16. Ask if patient has ever had sexual contact under

influence of alcohol

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17. History of use of any drug oral/ IV/ Needle sharing

High risk sexual behaviour

? Unprotected

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genitogenital/anogenital/orogenital

intercourse except in a long term

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monogamous relationship

? Having multiple sex partners
? Having a high risk partner ( who has multiple

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sex partners or other risk factors)

? IV drug users
? Sex trade work
Risk reduction

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? Address each and every high risk behaviour

mentioned by the patient

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? Give a specific suggestion for how to make it

safer

? Strongly recommend use of condom

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? Correct misinformation

Investigations and treatment

? HIV testing ( Pre test and post test counselling

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)

? VDRL
? HBsAg, Anti HCV antibodies

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? Genital ulcers- Tzanck smear/Gram stain/Dark

ground illumination

? Discharge (uretheral/cervical/vaginal)- Gram

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stain/KOH mount/Wet mount/Culture/PCR
? Emphasis on completing the treatment
? Suggest abstinence while on treatment
? Follow up visit after completing the course of

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treatment

Partner management

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-- STI re-infection

-- Further spread of STI

-- Possible long term effects of untreated STI

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for the partner
Approaches to partner management

? Referral by index client

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? Referral by STI service provider
(CONTACT TRACING)

QUIZ
1) Following occupational (needle stick)

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exposure, which of the following diseases has

the highest risk of transmission?
a) HIV

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b) HCV
c) HBV
d) All of the above

Answer

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c) HBV ( 9-30%)

HCV (1-10%)
HIV ( 0.3 %)
2) What is the drug of choice for syphilis

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infection?

Answer
Penicillin

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3) Which of the following types of sexual contact

has the highest risk of HIV transmission?
a) Orogenital
b) Genitogenital

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c) Anogenital
d) All have the same risk of transmission

Answer
C) Anogenital

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4) In which of the following diseases

lymphadenopathy is NOT seen?
a) Syphilis
b) Herpes genitalis

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c) Donovanosis
d) Chancroid

? Answer - Donovanosis
5) On gram staining " school of fish" appearance

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is seen in :
a) Chancroid
b) Donovanosis
c) Lymphogranuloma venerum

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d) None

Answer
a) Chancroid

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Thank you!!