Sexually transmitted infections (STIs) diagnostics in Lithuania

ABSTRACT

In Lithuania, various clinicians (general practitioners, urologists, g ynaecologists, dermatovenereologists, infectionists, etc.) diagnose and treat STIs. Therefore it's important to make updated STI management guidelines available for all health care specialists to designate adequate laboratory diagnosis and timely initiate appropriate treatment. From 2010-2020, the reported cases of syphilis ranged from 10.3 to 2, chlamydial infection 11.0 to 6, and gonococcal infection 9.4 to 1 per 100,000 inhabitants. After the coronavirus pandemic, syphilis cases increased, but the numbers of chlamydial, gonococcal, and mycoplasmal infections remained similar. A data review of the Hospital of LUHS Kauno Klinikos shows that in 2021, there were twice as many registered syphilis cases compared to 2020 or 2019. IUSTI guidelines on bacterial STI management are being adopted at a national level and distributed among clinicians through publications in the journal Lithuanian General Practitioner. Though theoretically, there are no major discrepancies concerning diagnostics and treatment schemes, in practice there are some inequalities in the country of the performing laboratory diagnostics for different STI microorganisms. The international guidelines on the organization of consultation for STIs indicate the necessity to offer all patients testing for syphilis, Chlamydia trachomatis, Neisseria gonorrhoeae (NAAT), and HIV. But in rural districts, the main test for STIs is genital smear microscopy in a laboratory as the primary level where most patients with STIs are processed have no laboratory facilities to determine the etiological agents by performing NAATS. First choice antibiotics for the treatment of Syphilis, Chlamydia trachomatis, and Mycoplasma genitalium are acceptable and being prescribed for patients. Uncomplicated gonorrhoeae treatment goes with chinolones more often than ceftriaxone because of the inconvenient organization of the administration of the latter. CONCLUSIONS. In Lithuania, the international guidelines on STIs diagnostics and treatment are followed in University hospitals considering all its aspects but at the district level, discrepancies in the adherence to it are common.