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Transcript
Sexually Transmitted
Diseases (STDs)
ACC, RNSG 1247
Sexually Transmitted Diseases
 Infectious
diseases most commonly
transmitted through sexual contact
 Can also be transmitted by
 Blood
 Blood
products
 Autoinoculation
Gonorrhea
Etiology and Pathophysiology


2nd most frequently reported STD in US
Caused by Neisseria gonorrheae
 Gram-negative bacteria



Direct physical contact with infected host
Killed by drying, heating, or washing with
antiseptic
Incubation: 3-8 days
Gonorrhea
Etiology and Pathophysiology
 Elicits
inflammatory process that can
lead to fibrous tissue and adhesions
 Can lead to :
 Tubal
pregnancy
 Chronic pelvic pain
 Infertility in women
Gonorrhea
Clinical Manifestations
 Men
 Initial
site of infection is urethra
 Symptoms

Develop 2 to 5 days after infection



Dysuria
Profuse, purulent urethral discharge
Unusual to be asymptomatic
Gonococcal Urethritis
Fig. 53-1
Gonorrhea
Clinical Manifestations
 Women
 Mostly
asymptomatic or have minor
symptoms
Vaginal discharge
 Dysuria
 Frequency of urination

Gonorrhea
Clinical Manifestations

Women (cont’d)

After incubation


Redness and swelling occur at site of contact
Greenish, yellow purulent exudate often develops


May develop abscess
Transmission more efficient from men to
women
Endocervical Gonorrhea
Fig. 53-2
Gonorrhea
Clinical Manifestations
Anorectal gonorrhea



Usually from anal intercourse
Soreness, itching, and anal discharge
Orogenital


Gonoccocal pharyngitis can develop
Gonorrhea
Complications
 Men
 Include
prostatitis, urethral strictures, and
sterility
 Often seek treatment early so less likely
to develop complications
Gonorrhea
Complications
 Women
 Include
pelvic inflammatory disease
(PID), Bartholin’s abscess, ectopic
pregnancy, and infertility
 Usually asymptomatic so seldom seek
treatment until complication are present
Gonorrhea
Diagnostic Studies
 History
and physical examination
 Laboratory tests
 Gram-stained
smear to identify organism
 Culture of discharge
 Nucleic acid amplification test
 Testing for other STDs
Gonorrhea
Treatment & Nursing Care
 Drug
therapy
 Treatment
generally instituted without
culture results
 Treatment in early stage is curative
 Most common

IM dose of ceftriaxone (Rocephin)
Gonorrhea
Treatment & Nursing Care cont’d
 All
sexual contacts of patients must be
evaluated and treated
 Patient should be counseled to abstain
from sexual intercourse and alcohol
during treatment
 Reexamine if symptoms persist after
treatment
Syphilis
Etiology and Pathophysiology

Caused by Treponema pallidum
 Spirochete bacterium
 Enters the body through breaks in skin or
mucous membranes
 Destroyed by drying, heating or washing
 May also spread via contact with lesions and
sharing of needles
Syphilis
Etiology and Pathophysiology
 Incubation
10 to 90 days
 Spread in utero after 10th week of
pregnancy
 Infected
mother has a greater risk of a
stillbirth or having a baby who dies shortly
after birth
Syphilis
Etiology and Pathophysiology
 Association
with HIV
 Syphilitic lesions on the genitals
enhance HIV transmission
 Evaluation includes testing for HIV with
patient’s consent
Syphilis
Clinical Manifestations
 Variety
of signs/symptoms that can
mimic other disease
 Primary stage
 Chancres
appear
Painless indurated lesions
 Occur 10 to 90 days after inoculation
 Lasting 3 to 6 weeks

Primary Syphilitic Chancre
Fig. 53-4
Syphilis
Clinical Manifestations

Secondary stage

Systemic






Begins a few weeks after chancres
Blood-borne bacteria spread to all major organ systems
Flu-like symptoms
Bilateral symmetric rash
Mucous patches
Condylomata lata
Secondary Syphilis
Fig. 53-5
Syphilis
Clinical Manifestations
 Latent
or hidden stage
 Immune
system is suppressing infection
 No signs/symptoms at this time
 Diagnosed by positive specific treponema
antibody test for syphilis with normal
cerebrospinal fluid
Syphilis
Clinical Manifestations
 Tertiary
or late stage
 Manifestations
rare
 Significant morbidity/mortality rates
 Gummas
 Cardiovascular system
 Neurosyphilis
Syphilis
Complications
 Occur
mostly in late syphilis
 Irreparable damage to bone, liver, or
skin from gummas
 Pain from pressure on structures such
as intercostal nerves by aneurysms
Syphilis
Complications
 Scarring
of aortic valve
 Neurosyphilis
 Tabes dorsalis
 Sudden attacks of pain
 Loss of vision and sense of position
Syphilis
Diagnostic Studies
 History
including sexual history
 PE
 Examine
lesions
 Note signs/symptoms
 Dark-field
microscopy
 Serologic testing
 Testing for other STDs
Syphilis
Treatment & Nursing Care
 Drug
therapy
 Benzathine
penicillin G (Bicillin)
 Aqueous procaine penicillin G
Syphilis
Treatment & Nursing Care cont’d
 Monitor
neurosyphilis
 Confidential counseling and HIV testing
 Case finding
 Surveillance
Chlamydial Infections
Etiology and Pathophysiology
 #1
reported STD in US
 Caused by Chlamydia trachomatis
 Gram-negative
 Transmitted
bacteria
during vaginal, anal, or
oral sex
 Incubation period: 1 to 3 weeks
Chlamydial Infections
Etiology and Pathophysiology

Risk factors
 Women and adolescents
 New or multiple sexual partners
 History of STDs and cervical ectopy
 Coexisting STDs
 Inconsistent/incorrect use of condoms
Chlamydial Infections
Clinical Manifestations
 “Silent
disease”
 Symptoms
 Infection
may be absent or minor
often not diagnosed until
complications appear
Chlamydial Infections
Clinical Manifestations
 Men
 Urethritis
Dysuria
 Urethral discharge

 Proctitis
Rectal discharge
 Pain during defecation

Chlamydial Infections
Clinical Manifestations
 Men
(cont’d)
 Epididymitis
Unilateral scrotal pain
 Swelling
 Tenderness
 Fever
 Possible infertility and reactive arthritis

Chlamydial Infection
Fig. 53-6
Chlamydial Infections
Clinical Manifestations
 Women
 Cervicitis
Mucopurulent discharge
 Hypertrophic ectopy

 Urethritis
Dysuria
 Frequent urination
 Pyuria

Chlamydial Infections
Clinical Manifestations
 Women
(cont’d)
 Bartholinitis

Purulent exudate
 Perihepatitis

Fever, nausea, vomiting, right upper quadrant
pain
Chlamydial Infections
Clinical Manifestations
 Women
(cont’d)
 PID
Abdominal pain, nausea, vomiting, fever,
malaise, abnormal vaginal bleeding,
menstrual abnormalities
 Can lead to chronic pain and infertility

Chlamydial Infections
Diagnostic Studies
 Laboratory
 Nucleic
tests
acid amplification test (NAAT)
 Direct fluorescent antibody (DFA)
 Enzyme immunoassay (EIA)
 Testing for other STDs
 Culture for chlamydia
Chlamydial Infections
Treatment & Nursing Care
 Drug
therapy
 Doxycycline

(Vibramycin)
100 mg BID for 7 days
 Azithromycin

(Zithromax)
1 g in single dose
 Alternatives
include erythromycin, ofloxacin
(Floxin), or levofloxacin (Levaquin)
Chlamydial Infections
Treatment & Nursing Care cont’d
 Abstinence
from sexual intercourse for
7 days after treatment
 Follow-up care for persistent
symptoms
 Treatment of partners
 Encourage use of condoms
Genital Herpes
 Not
a reportable disease in most states
 True incidence difficult to determine
 Caused by herpes simplex virus (HSV)
Genital Herpes
Etiology and Pathophysiology
 Enters
through mucous membranes or
breaks in the skin during contact with
infected persons
 HSV reproduces inside cell and
spreads to surrounding cells
Genital Herpes
Etiology and Pathophysiology
 Two
different strains
 HSV-1

Causes infection above the waist
 HSV-2

Frequently infects genital tract and perineum
 Either
strain can cause disease on
mouth or genitals
Genital Herpes
Clinical Manifestations
 Primary
(initial) episode
 Burning
or tingling at site
 Small vesicular lesion appear on penis,
scrotum, vulva, perineum, perianal areas,
vagina, or cervix
Genital Herpes
Clinical Manifestations
 Primary
(initial) episode (cont’d)
 Primary
lesions present for 17 to 20 days
 New lesions sometimes continue to
develop for 6 weeks
 Lesions heal spontaneously
Genital Herpes
Clinical Manifestations
 Recurrent
genital herpes
 Occurs
in 50% to 80% in following year
 Triggers
Stress
 Fatigue
 Sunburn
 Menses

Genital Herpes
Clinical Manifestations
 Recurrent
genital herpes (cont’d)
 Prodromal
symptoms of tingling, burning,
itching at lesion site
 Lesions heal within 8 to 12 days
 With time, lesions will occur less frequently
Genital Herpes
Complications
 Aseptic
meningitis
 Lower neuron damage

Autoinoculation to extragenital sites
 High risk of transmission in pregnancy with
episode near delivery
 Herpes
simplex virus keratitis
Autoinoculation of
Herpes Simplex Virus
Fig. 53-8
Genital Herpes
Diagnostic Studies
 History
and physical examination
 Viral isolation by tissue culture
 Antibody assay for specific HSV viral
type
Genital Herpes
Treatment & Nursing Care
 Drug
therapy
 Inhibit
viral replication
 Suppress frequent recurrences
Acyclovir (Zovirax)
 Valacyclovir (Valtrex)
 Famciclovir (Famvir)

 Not
a cure but shorten duration, healing
time and reduce outbreaks
Genital Herpes
Treatment & Nursing Care cont’d

Symptomatic care







Genital hygiene
Loose-fitting cotton underwear
Lesions clean and dry
Sitz baths
Barrier methods during sexual activity
Drying agents
Pain: dilute urine with water, local anesthetic
Genital Warts
 Most
common STD in the US
 Often asymtomatic so patient maybe
unaware of infection
 Caused by human papillomavirus (HPV)
 Usually
 Highly
types 6 and 11
contagious
 Frequently seen in young, sexually
active adults
Genital Warts
Etiology and Pathophysiology
 Minor
trauma causes abrasions for
HPV to enter and proliferate into warts
 Epithelial cells infected undergo
transformation and proliferation to form
a warty growth
 Incubation period 3 to 4 months
Genital Warts
Clinical Manifestations
 Discrete
single or multiple growths
 White to gray and pink-fleshed colored
 May form large cauliflower-like masses
Genital Warts
Clinical Manifestations
 Warts
in men: penis, scrotum, around
anus, in urethra
 Warts in women: vulva, vagina, cervix
 Can have itching with anogenital warts
& bleeding on defecation with anal
warts
Genital Warts
Diagnostic Studies
 Serologic
 HPV
and cytologic tests
DNA test to determine if women with
abnormal Pap test results need follow-up
 Identify women who are infected with
high-risk HPV strains
Genital Warts
Diagnostic Studies
 Primary
goal: Removal of symptomatic
warts
 Removal
may or may not decrease
infectivity
 Difficult to treat
 Often require multiple office visits and
variety of treatment modalities
Genital Warts
Treatment & Nursing Care

Chemical




Trichloroacetic acid (TCA)
Bichloroacetic acid (BCA)
Podophyllin resin
 For small external genital warts
Patient managed


Podofilox (Condylox.Condylox gel0
Imiquimod (Aldara)
 Immune response modifier
Genital Warts
Treatment & Nursing cont’d
 If
warts do not regress with previously
mentioned therapies
Cryotherapy with liquid nitrogen
 Electrocautery
 Laser therapy
 Use of α-interferon
 Surgical excision

Genital Warts
Treatment & Nursing Care cont’d
 Recurrences
and reinfection possible
 Careful long-term follow-up advised
 Vaccine to prevent cervical cancer,
precancerous genital lesion, and
genital warts due to HPV
Nursing Care : STD
Nursing Diagnoses
 Risk
for infection RT ?
 Anxiety RT ?
 Ineffective health maintenance
RT ?
Ethical/Legal Implications
 In
your opinion, what is the best way to
balance the needs of an individual
patient with STD with those of the
general public?