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Sexually Transmitted Infections

Symptoms and findings

Chlamydia Chlamydia and gonorrhoea Gonorrhoea
- Patients are commonly asymptomatic, particularly in the case of pharyngeal or anal infection.
- In men, urethral discharge, dysuria, epididymitis
- In women, dysuria, intermenstrual bleeding, leucorrhoea, cervicitis, even PID
Genital herpes (HSV) Genital Herpes
- Local symptoms of primary and recurrent infection: blisters and ulceration, smarting, dysuria, enlarged lymph nodes in the inguinal area
- Systemic symptoms are possible in primary infection: fever, headaches, myalgia
Syphilis Syphilis
- Primary stage symptoms 3-4 weeks from infection: hard, painless ulcer in the genitals (picture F1), rectum or mouth, and local, painlessly enlarged lymph node
- Secondary stage symptoms 6-8 weeks from infection: systemic symptoms, enlarged lymph nodes, roseola rash (picture F2), syphilids, or clusters of papules on palms and soles of feet (picture F3)
See HIV HIV Infection, human papillomavirus (HPV) infection Human Papillomavirus (HPV) Infection, Mycoplasma genitaliumMycoplasma Genitalium Infection, LGV (chancres) Rare Sexually Transmitted Diseases: Chancres, hepatitis B Viral Hepatitis, hepatitis C Viral Hepatitis, mpox Mpox (Monkeypox)

Workup

Suspicion, no symptoms
- Nucleic acid detection tests for chlamydia and gonorrhoea, at least, in first-stream urine or swab sample, and HIV-AgAb
Symptoms, risk factors (a partner with diagnosed or suspected sexually transmitted infection, possibility for infection or a partner abroad, sex between men) or a diagnosed sexually transmitted infection
- Nucleic acid detection tests for chlamydia and gonorrhoea in first-stream urine or swab sample according to the anatomical site of infection (urethra, cervix, vagina, pharynx or anus), HIV-AgAb, Treponema pallidum antibodies, and, as necessary, hepatitis tests
Clinical suspicion or positive nucleic acid detection test for gonorrhoea
- Before starting treatment, use a Dacron swab to obtain a culture specimen (sensitivity test!) from the urethra, cervix, pharynx and rectum into a special transport tube (preserved at +4 °C, as necessary)
The diagnosis of genital herpes is usually clinical. The diagnosis should be confirmed once with a microbiological sample taken from a lesion for nucleic acid detection.
Incubation periods: gonorrhoea, less than 1 week, herpes 1-2 weeks, chlamydia 1-2 weeks, syphilis 1-2 months, and HIV 1-3 months
Partners should only be prescribed medication after testing; contact tracing!
For testing times, see Table T1.

Tests for sexually transmitted infections, and times of sampling after possible transmission. Samples can be taken immediately from patients with symptoms.

Disease	The earliest reliable time of sampling *	Diagnostic tests
Chlamydia	5 days	Nucleic acid detection test from first-stream urine or a swab sample
Gonorrhoea	5 days	Nucleic acid detection test from first-stream urine or a swab sample
Syphilis	3-4 weeks (1.5 months)	Serum Treponema pallidum antibodies (if reinfection is suspected, serum cardiolipin antibodies + serum Treponema Pallidum hemagglutination test)
HIV	3-4 weeks (3 months)	Serum HIV-AgAb
HSV (symptomatic)		Nucleic acid detection test
Hepatitis B	3-4 weeks (3-6 months)	Serum HBsAg
Hepatitis C	3-8 weeks (3-6 months)	Serum hepatitis C antibodies

* Inside the parentheses the time for repeat sample if the first sample was negative
Modified from a table in the Finnish Current Care Guideline for Sexually transmitted infections

Treatment

Chlamydia, see Chlamydia
Gonorrhoea, see Gonorrhoea
Genital herpes, see Genital Herpes
Control sample after the treatment of chlamydia or gonorrhoea: nucleic acid detection test in 4 weeks
Syphilis Syphilis is a dangerous communicable disease (check local regulations concerning required notifications); treatment in specialized care, as necessary
Medication for the treatment of some of these diseases may be free of charge for patients (check local policies and practices).
For treatment of other sexually transmitted infections, see relevant articles here.

Duty to report

Check local regulations and policies.
Sometimes the laboratory may also do some reporting.

References

[Sexually transmitted infections]. A Current Care Guideline. Working group appointed by the Finnish Medical Society Duodecim and the Association for the Prevention of Sexually Transmitted Diseases. Helsinki: the Finnish Medical Society Duodecim, 2018 (accessed 8.5.2024). Available in Finnish at http://www.kaypahoito.fi/hoi50087.

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