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 areaAno-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 counselling1) Information
2) Risk assessment and risk reduction
3) Investigation and treatment
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4) Partner management5) Follow up
Information
? STI, HIV/AIDS, Oppurtunistic infections
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? Explore any myths and misconceptions andclarify the same
? Repeat and summarise information
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? Ask questions to check whether they haveunderstood
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 status6. 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/ casual11. Ask if patient has ever paid for sex
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12. If patient or his partner has been tested forHIV 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 sharingHigh 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 itsafer
? Strongly recommend use of condom
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? Correct misinformationInvestigations 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/Darkground 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) HCVc) 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 contacthas the highest risk of HIV transmission?
a) Orogenital
b) Genitogenital
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c) Anogenitald) All have the same risk of transmission
Answer
C) Anogenital
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4) In which of the following diseaseslymphadenopathy is NOT seen?
a) Syphilis
b) Herpes genitalis
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c) Donovanosisd) 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) NoneAnswer
a) Chancroid
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Thank you!!