Chapter 22
Symptoms of Sexually Transmitted Infections
STI Signs and Symptoms
Common signs and symptoms which suggest an STI are listed in the table below, along with their possible causes.
| Symptoms | Possible cause |
|---|---|
| Discharge from the penis—pus, clear or yellow-green drip | Commonly: Chlamydia, gonorrhea |
| Abnormal vaginal discharge |
|
| Anorectal discharge | Chlamydia, gonorrhea |
| Lower abdominal pain (possible pelvic inflammatory disease) | Chlamydia, gonorrhea, trichomoniasis |
| Swollen and/or painful testicles | Chlamydia, gonorrhea |
| Warts on the genitals, anus, or surrounding areas | HPV, especially types 6 and 11 |
| Ulcers on the genitals, anus, or surrounding areas | Genital herpes, syphilis, chancroid |
Early Identification of STIs
Ideally, an STI would be identified (and treated) early, to avoid complications and stop the spread of infection. To help detect STIs early, for every client seeking family planning, a provider should:
- Ask about the client’s sexual history and assess their risk of getting an STI.
- Ask whether the client or their partner(s) has symptoms of STIs, such as genital sores/pain/swelling, abnormal genital or anorectal discharge, or lower abdominal pain.
- Look for signs of STIs when doing a pelvic or genital examination.
- For clients with signs and/or symptoms of STIs, promptly make a syndromic diagnosis and provide appropriate treatment, or in some settings perform STI testing as needed (rapid or laboratory testing, depending on availability—see next page) or refer the client to another facility for appropriate care.
- For clients without STI signs or symptoms but who are at high risk for acquiring STIs, encourage them to get screened for syphilis and, when feasible, also for gonorrhea and chlamydia.
In addition, a family planning provider should:
- Advise on condom and lubricant use, as appropriate to the client’s needs.
- Offer assistance with notifying sexual partners of all clients diagnosed with an STI and those who have symptoms and signs of an STI; this can be done using different strategies based on the client’s preferences for each partner.
In settings where STI testing is available, providers should, where appropriate:
- Offer hepatitis B testing, preferably using rapid screening tests that can be conducted during the same visit, and: if positive, the client should be referred for assessment of treatment eligibility; if negative, the client should consider hepatitis B vaccination when recommended and available (see the table on prevention measures in Avoiding STIs on the next page for recommended hepatitis B vaccination among adults).
- Offer tests for gonorrhea and chlamydial infections, if available. Based on the history and risk, collect samples from the throat, vagina, and anus. If possible, offer the client the opportunity to collect samples themselves (self-collection), as some find this more acceptable.
- Inform clients at high risk of STI exposure that syphilis and HIV testing should be done regularly—at least once a year.
- Advise clients to look out for any genital sores, warts, or unusual discharge in themselves or their sexual partner(s) and, if present, seek health care as soon as possible.