Genital infections — Clinical guidelines — MSF Clinical guidelines

What this guideline says

GMJ summary

This MSF clinical guideline presents a syndromic approach to diagnosing and treating genital infections in resource-limited settings. The guideline addresses the challenges of non-specific clinical features, asymptomatic infections, limited laboratory capacity, and mixed infections by using standardised case management flowcharts based on WHO methodology. Treatment is guided by syndromes (urethral discharge, abnormal vaginal discharge, genital ulcers, venereal warts, and lower abdominal pain in women) rather than laboratory-confirmed pathogens.

Key management principles include treating patients at first encounter without waiting for laboratory results, preferring single-dose regimens, treating sexual partners simultaneously for sexually transmitted infections, and providing risk-reduction counselling with HIV testing. The guideline emphasises that no patient should be sent home without treatment.

A substantial section addresses the comprehensive care of sexual violence survivors, including prophylactic treatments for HIV transmission (antiretroviral therapy within 48–72 hours), pregnancy prevention (levonorgestrel 1.5 mg single dose within 72 hours, extendable to 120 hours), sexually transmitted infection prevention (azithromycin 2 g + ceftriaxone 500 mg), hepatitis B vaccination, and essential mental health support.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. Treat patients at first encounter based on syndromic presentation without waiting for laboratory results; no patient should be sent home without treatment
2. For emergency contraception after rape: levonorgestrel PO 1.5 mg single dose within 72 hours (extendable to 120 hours); double dose (3 mg) if patient already taking enzyme-inducing drugs
3. For STI prevention after sexual violence: azithromycin PO 2 g + ceftriaxone IM 500 mg (or cefixime PO 400 mg) as single doses
4. Start antiretroviral post-exposure prophylaxis as early as possible if seen within 48–72 hours after exposure to HIV
5. Treat sexual partners simultaneously for urethral discharge, abnormal vaginal discharge (except candidiasis), genital ulcers (except herpes) and sexually transmitted upper genital tract infections
6. For candidiasis, genital herpes and venereal warts, treat partner only if symptomatic
7. Single-dose regimens are preferred when indicated to improve adherence
8. In Schistosoma haematobium endemic areas, consider genitourinary schistosomiasis as a cause of genital symptoms

Presenting symptoms and corresponding syndrome

Table extracted from the guideline

Source: Médecins Sans Frontières, Genital infections — Clinical guidelines — MSF Clinical guidelines. Reproduced in summary form.

From the guideline

Verbatim

“The patient should be treated at his/her first encounter with the health care provider (no patient should be sent home without treatment, e.g. while waiting for laboratory results).”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

Related on GMJ

Interconnected resources

GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.