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VAGINAL DISCHARGE• It is normal for women to have a vaginal discharge. Abnormal discharges are itchy or different in colour or smell. Not all women with a discharge have an STI.• First assess and advise the patient with vaginal discharge and her partner/s 23.Is there lower abdominal pain or cervical tenderness?NoTreat for bacterialvaginosis:• Metronidazole 2gorally stat. Avoidin 1st trimesterof pregnancy. Noalcohol for 24 hoursafter metronidazole.NoPatient sexually active in last 3 months?Yes• Treat for vaginal discharge syndrome (VDS):--Cefixime 1 400mg orally stat and-- Doxycycline 100mg 12 hourly for 7 days (If pregnant orbreastfeeding, use amoxicillin 1 500mg 8 hourly for 7 daysinstead) and-- Metronidazole 2g orally stat. Avoid in 1st trimester ofpregnancy. No alcohol for 24 hours after metronidazole.• Treat the patient's partner/s 23.• Treat the baby with pus in eyes born to mother with VDS 97.YesRecognise the patient needing urgent attentionRefer same day if any of the following are present:• Recent miscarriage/delivery/abortion• Pregnant or missed or overdue period• Peritonitis (guarding or rigidity on examination)• Abnormal vaginal bleeding• Temperature ≥ 38°C• Abdominal massManagement:• If dehydrated or shocked: give IV fluids• If temp ≥ 38°C, give ceftriaxone 2 1g IV/IM stat andmetronidazole 400mg orally stat.Refer same day.If the vulva is red, scratched and inflamed, also treat for thrush:• Clotrimazole vaginal tablet 500mg inserted stat and• Clotrimazole vaginal cream applied twice a day for 6 days after symptoms resolve.• Avoid washing with soap.Persistent thrush:• Repeat clotrimazole.• Test for diabetes70 and HIV 60.Advise patient to return in 7 days if symptoms persist.Ongoing discharge, no thrush:Ask if possible re-infection or poor adherence to treatment.YesRepeat treatment. If still noimprovement, refer to doctorsame week.NoRefer to doctor same week.Treat for lower abdominal pain (LAP):• Ceftriaxone 250mg IM stat. If penicillin allergic give ciprofloxacin 500mg 12hourly for 3 days and• Doxycycline 100mg 12 hourly for 14 days (If breastfeeding, use amoxicillin500mg 8 hourly for 14 days instead) and• Metronidazole 400mg 12 hourly for 14 days (Avoid alcohol for 48 hours afterstopping treatment).• Treat the patient's partner/s 23.Review within 2–3 days.No improvementRefer to doctor same week.Improved1If severe penicillin allergic (angioedema, anaphylactic shock or bronchospasm) replace cefixime with ciprofloxacin 500 mg oral stat. If severe penicillin allergic and pregnant or breastfeeding, replace cefixime and amoxicillin with erythromycin500 mg 6 hourly for 7 days. Refer if no improvement within 48 hours. 2 Do not mix Ringer's lactate and IV ceftriaxone. Flush IV line with sodium chloride 0.9% before and after IV ceftriaxone.25
Genital Ulcer syndromeFirst assess and advise the patient with genital ulcer and his/her partner/s 23.The patient may have a blister, sore, ulcer, and/or swollen inguinal (groin) lymph nodes that might be tender or fluctuant and/or vaginal/urethral discharge.First treat for herpes• Give pain relief if necessary.• Keep lesions clean and dry.• Give aciclovir 400mg 8 hourly for 7 days.• Explain that herpes infection is lifelong and that herpes transmission can occureven when asymptomatic. The likelihood of HIV transmission is increased whenthere are ulcers.• HIV patients with genital herpes > 1 month have stage 4 HIV and needco-trimoxazole and ART 61.If patient sexually active in the past 3 months also treat for genital ulcer syndrome (GUS):• Benzathine penicillin 2.4MU IM stat and• Erythromycin 500mg 6 hourly for 7 daysIf penicillin-allergic replace benzathine penicillin with doxycycline 100mg 12 hourly for 14 days and replace erythromycin with ciprofloxacin 500mg 12 hourly for 3 days.If pregnant and penicillin allergic, give erythromycin 500mg 6 hourly for a total of 14 days.Check if patient also has swollen nodes and/or a discharge.Swollen node/sVaginal or urethral dischargeTreat patient and partner/s for bubo:Omit erythromycin above and give:• Doxycycline 100mg 12 hourly for 14 days and• Ciprofloxacin 500mg 12 hourly for 3 daysIf pregnant or breastfeeding, replace both witherythromycin 500mg 6 hourly for 14 days.If nodes painful and swollen:• Aspirate through healthy skin any fluctuant lymphnode every 3 days as needed.• Give pain relief if needed.• Review after 14 days. If no better, refer to doctor same week.Treat patient and partner/s for gonorrhoea and chlamydia:Omit erythromycin above and give:• Cefixime 1 400mg orally stat and• Doxycycline 100mg 12 hourly for 7 days (if pregnant or breastfeeding use amoxicillin 2500mg 8 hourly for 7 days instead)• Also give to woman patient metronidazole 2g orally stat (avoid alcohol for 24 hours).• Review after 7 days. If no better, refer to doctor same week.1Gonoccocal resistance to ciprofloxacin is common. If severe penicillin allergic (angioedema, anaphylactic shock or bronchospasm) replace cefixime with ciprofloxacin 500mg orally stat. Refer if no improvement within 48 hours.2If severe penicillin allergic and pregnant or breastfeeding, replace cefixime and amoxicillin with erythromycin 500mg 6 hourly for 7 days. Refer if no improvement within 48 hours.TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERS26WOMEN'S HEALTH
- Page 4 and 5: CONTENTS: SYMPTOMSAssess and manage
- Page 6 and 7: THE UNCONSCIOUS PatientManage the u
- Page 8 and 9: WEIGHT LOSSRecognise the patient wi
- Page 10 and 11: LYMPHADENOPATHY (enlarged lymph nod
- Page 12 and 13: COLLAPSE• Unconscious 1• Fit 2
- Page 14 and 15: HEADACHE• Sudden onset of severe
- Page 16 and 17: FACE SYMPTOMSRecognize the patient
- Page 18 and 19: NOSE SYMPTOMSRunny or blocked noseA
- Page 20 and 21: CHEST PAINRecognise the patient wit
- Page 22 and 23: WHEEZE/TIGHT CHESTInitial Managemen
- Page 24 and 25: ABDOMINAL PAIN WITH OR WITHOUT SWEL
- Page 26 and 27: DIARRHOEARecognise the ill patient
- Page 28 and 29: GENITAL SYMPTOMSAssess the patient
- Page 32 and 33: OTHER GENITAL SYMPTOMSFirst assess
- Page 34 and 35: ABNORMAL VAGINAL BLEEDING• BP < 9
- Page 36 and 37: URINARY SYMPTOMSRecognise patient w
- Page 38 and 39: JOINT SYMPTOMSRecognise the patient
- Page 40 and 41: NECK PAINRecognise the patient with
- Page 42 and 43: FOOT SYMPTOMS• If the problem is
- Page 44 and 45: BURNSAttend urgently to the patient
- Page 46 and 47: PAINFUL SKINFirm, red lump which so
- Page 48 and 49: GENERALISED ITCHY RASHIf status unk
- Page 50 and 51: GENERALISED NON ITCHY RED RASHIs pa
- Page 52 and 53: CHANGES IN SKIN COLOURYellow skinDa
- Page 54 and 55: SUICIDAL PatientRecognise the patie
- Page 56 and 57: CONFUSED Patient• The confused pa
- Page 58 and 59: TRAUMATISED/ABUSED PatientRecognize
- Page 60 and 61: TB: DIAGNOSISExclude TB in the pati
- Page 62 and 63: TB: ROUTINE CAREAssess the patient
- Page 64 and 65: Manage the patient with a positive
- Page 66 and 67: HIV: ROUTINE CAREAssess the patient
- Page 68 and 69: Advise the patient with HIV• Supp
- Page 70 and 71: ASTHMA AND COPD: DIAGNOSIS• The p
- Page 72 and 73: CHRONIC OBSTRUCTIVE PULMONARY DISEA
- Page 74 and 75: CARDIOVASCULAR DISEASE (CVD) RISK:
- Page 76 and 77: DIABETES: ROUTINE CAREAssess the pa
- Page 78 and 79: HYPERTENSION: DIAGNOSISCheck blood
Genital Ulcer syndromeFirst assess and advise the patient with genital ulcer and his/her partner/s 23.The patient may have a blister, sore, ulcer, and/or swollen inguinal (groin) lymph nodes that might be tender or fluctuant and/or vaginal/urethral discharge.First treat for herpes• Give pain relief if necessary.• Keep lesions clean and dry.• Give aciclovir 400mg 8 hourly for 7 days.• Explain that herpes infection is lifelong and that herpes transmission can occureven when asymptomatic. The likelihood of HIV transmission is increased whenthere are ulcers.• HIV patients with genital herpes > 1 month have stage 4 HIV and needco-trimoxazole and ART 61.If patient sexually active in the past 3 months also treat for genital ulcer syndrome (GUS):• Benzathine penicillin 2.4MU IM stat and• Erythromycin 500mg 6 hourly for 7 daysIf penicillin-allergic replace benzathine penicillin with doxycycline 100mg 12 hourly for 14 days and replace erythromycin with ciprofloxacin 500mg 12 hourly for 3 days.If pregnant and penicillin allergic, give erythromycin 500mg 6 hourly for a total of 14 days.Check if patient also has swollen nodes and/or a discharge.Swollen node/sVaginal or urethral dischargeTreat patient and partner/s for bubo:Omit erythromycin above and give:• Doxycycline 100mg 12 hourly for 14 days and• Ciprofloxacin 500mg 12 hourly for 3 daysIf pregnant or breastfeeding, replace both witherythromycin 500mg 6 hourly for 14 days.If nodes painful and swollen:• Aspirate through healthy skin any fluctuant lymphnode every 3 days as needed.• Give pain relief if needed.• Review after 14 days. If no better, refer to doctor same week.Treat patient and partner/s for gonorrhoea and chlamydia:Omit erythromycin above and give:• Cefixime 1 400mg orally stat and• Doxycycline 100mg 12 hourly for 7 days (if pregnant or breastfeeding use amoxicillin 2500mg 8 hourly for 7 days instead)• Also give to woman patient metronidazole 2g orally stat (avoid alcohol for 24 hours).• Review after 7 days. If no better, refer to doctor same week.1Gonoccocal resistance to ciprofloxacin is common. If severe penicillin allergic (angioedema, anaphylactic shock or bronchospasm) replace cefixime with ciprofloxacin 500mg orally stat. Refer if no improvement within 48 hours.2If severe penicillin allergic and pregnant or breastfeeding, replace cefixime and amoxicillin with erythromycin 500mg 6 hourly for 7 days. Refer if no improvement within 48 hours.TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERS26WOMEN'S HEALTH
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