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Clinical Aspects and Differential Diagnosis

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STIs
Infection Patient presenting symptoms Physical Findings on exam Laboratory or Diagnostic exams Management/ treatment Patient counseling/
teaching 		Referrals (if any)
Trichomoniasis In women: vaginal discharge with an unpleasant odor, painful urination, itching of the genitals (Passos, 2017).
In men: asymptomatic. Pregnant women: risk of premature birth.		 The vulva may look erythematous and edematous with irritation. Profuse, frothy, homogeneous vaginal secretion. Minor punctate bleeding from the cervix and vagina with ulceration. Macular colpitis occurs in 2-5% of patients. A sample of vaginal secretion from women or urine from men is viewed under a microscope. No further tests are needed if the parasite can be seen under a microscope. Otherwise, rapid tests for antigens and nucleic acid amplification are used. Antibiotics metronidazole (Flagyl, Noritate, Nuvessa) and tinidazole (Tindamax). Sex partners should be treated even if they have no symptoms. No sex for 7-10 days after treatment.
Yeast infection Itching and irritation in the vagina and vulva; burning sensation during intercourse or when urinating;
redness and swelling of the vulva; vaginal pain; vaginal rash;
thick white, odorless, cheesy secretion;
watery secretion.		 Irritation, secretion and severe itching of the vagina and vulva. A sample of vaginal secretion for a yeast test. For mild to moderate severity and infrequent episodes: short-term vaginal therapy – taking antifungal drugs for three to seven days. Preparations in the form of creams, ointments, tablets and suppositories, which include miconazole (Monistat 3) and terconazole.
Your doctor may prescribe a single, single oral dose of fluconazole (Diflucan), or two single doses three days apart (for non-pregnant women).		 Increased risk of vaginal yeast infection during first regular intercourse. Infections can be associated between the mouth and genital contact (oral-genital sex).
Gonorrhea Symptoms begin within 2-14 days after infection.
In men: burning or painful sensations when urinating; increased frequency or urgency of urination, purulent secretion from the penis, swelling or redness when opening the penis, swelling or pain in the testicles, persistent sore throat.
In women, symptoms may mimic common vaginal yeast or bacterial infections: vaginal secretion, pain or burning sensation when urinating, urge to urinate more often, heavy periods or bloody secretion, sore throat, pain during intercourse, sharp pain in the lower abdomen, heat.		 In women: mucopurulent secretion from the urethra, cervix or vagina; loose appearance of the cervix; and soreness on movement of the cervix. In men: mucopurulent secretion from the urethra. Less commonly, edema of the penis, tenderness and edema of the epididymis. Urinalysis to check for bacteria in the urethra. A smear of the affected area. Ceftriaxone by injection and azithromycin by mouth. In the case of antibiotic resistance, higher doses of ceftriaxone are sometimes required. Sex partners of the last two months should be treated.
An asymptomatic carrier can spread the infection. Condoms must be used to prevent gonorrhea.

Reference

Passos, M. R. L. (Ed.). (2017). Atlas of sexually transmitted diseases: clinical aspects and differential diagnosis. Springer.

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