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GENITAL SYMPTOMSAssess the patient with genital symptoms and his/her partner/sAssessNoteSymptoms Ask about genital discharge, rash, itch, lumps, ulcers and manage as below. Manage other symptoms as on symptom pages.Abuse Ask about rape/sexual assault or if patient unhappy in relationship. If yes 53. Manage and refer the recently raped/sexually assaulted patient urgently 53.Safe sex Ask if patient or regular partner has new or multiple partners, uses condoms unreliably or has substance abuse 83.Family planning Assess patient’s family planning needs 91. Exclude pregnancy. If pregnant 93.Examination Woman: look for abdominal masses, discharge, rash or lumps, cervical tenderness or pelvic masses. Man: look for discharge, inguinal lymph nodes, ulcers, scrotal swelling and/or masses.HIV If status unknown test for HIV 60. The HIV patient needs routine HIV care 61.RPR Check RPR/VDRL if patient has an STI, is pregnant or was raped or whose partner has an STI or is RPR positive. If positive 28.Pap smear Do a Pap smear if indicated 27 once an abnormal discharge has been treated 25. If cervix looks abnormal/suspicious of cancer, refer same week.Advise the patient with genital symptoms and his/her partner/s• Educate patient about the cause of symptoms and if a sexually transmitted infection (STI), that this increases the risk of HIV transmission.• Urge the patient to adhere to treatment and to abstain from penetrative sex for the duration of treatment.• Stress the importance of partner treatment and issue 1 notification slip with the patient’s diagnosis in code (as below) for each partner.• Discuss safe sex: provide male and female condoms, advise patient to stick to one partner at a time and offer referral for medical male circumcision if available.Treat the patient with genital symptomsDischargeDysuriaScrotal swellingItchUlcer/sLump/sMan 24 Woman 25 Man 24 Woman 31 24Discharge in woman 25 Glans penis 24 Pubic area 27 26 Groin 5 Skin 27Treat the patient’s partner/s according to the patient’s diagnosis as well as the partners’ symptoms (if any)Patient’s diagnosis (code)Partner treatmentVaginal discharge (VDS) Cefixime 400mg orally stat and doxycycline 100mg 12 hourly for 7 days and metronidazole 2g stat 1Lower abdominal pain in woman (LAP) Cefixime 400mg orally stat and doxycycline 100mg 12 hourly for 7 days and metronidazole 2g stat 1Male urethritis (MUS) Cefixime 400mg orally stat and doxycycline 100mg 12 hourly for 7 days and metronidazole 2g stat 1Scrotal swelling (SSW) Cefixime 400mg orally stat and doxycycline 100mg 12 hourly for 7 days and metronidazole 2g stat 1Genital ulcer (GUS)Benzathine penicillin 2.4MU IM stat and erythromycin 500mg 6 hourly for 7 days and aciclovir 400mg 8 hourly for 7 daysRPR positiveBenzathine penicillin 2.4MU IM statBalanitis (BAL)Clotrimazole vaginal pessary 500mg inserted stat or clotrimazole vaginal cream inserted 12 hourly for 6 daysPubic lice (PL) Benzyl benzoate 25%Bubo Doxycycline 100mg 12 hourly for 14 days and ciprofloxacin 500mg 12 hourly for 3 days 21If pregnant or breastfeeding, give amoxicillin 500mg 8 hourly for 7 days instead of doxycycline and avoid metronidazole in the 1st trimester. 2 If pregnant or breastfeeding, give erythromycin 500mg 6 hourly for 14 days instead of doxycyclineand ciprofloxacin.23