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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?
