SEXUALLY

TRANSMITTED
DISEASES

Nelia B. Perez RN, MSN

Class 2015
Sexually Transmitted Diseases
• Infectious diseases most commonly transmitted
through sexual contact
• Can also be transmitted by
• Blood
• Blood products
• Autoinoculation
National Health Picture on STDs
• As of January 2013, the Department of
Health (DOH) AIDS Registry in the
Philippines reported 10,514 people living
with HIV/AIDS.
• Most Common in the Philippines
- Chlamydia
- Gonorrhea
- Genital Herpes
- HIV / AIDS
- Syphillis
- Ectoparasitic Infections
 General Overview
• Highest incidence: adolescents &
young adults
• Sexual abuse
• Primary Prevention
• Advocate for adolescent education
re: sex and sexually transmitted
disease. (AAP, 2001)
• Abstinence
• Condoms

4
 Healthy People 2020
• Goal: Promote healthy
sexual behaviors,
strengthen community
capacity, and increase
access to quality
services to prevent
sexually transmitted
diseases and their
complications.

5
Factors contributing to spread
• Asymptomatic nature of STDs
• Gender disparities
• Age disparities
• Lag time between infection and
complications
• Social, economic and behavioral factors

6
 Risk Factors
• IV drug use
• Other substance abuse
• High-risk sexual activity
• Younger age at beginning of sexual activity
• Inner city residence
• Poverty/lower socioeconomic status
• Poor nutrition
• Poor hygiene

7
• SterilityConsequences
• Neurologic damage
• Ophthalmic infection – other
congenital problems for
newborn
• Cancer
• Death

8
Unwanted Pregnancy

• Negative pregnancy test: a teachable

moment
• Abortion
• Medical
• Surgical
• Post op care

9
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
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 bacteria
• Transmitted 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 may be absent or minor
• Infection 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 tests
• Nucleic 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
 Chlamydia
• Prevention: limit the number of sexual partner & use
condoms & spermicides

What are the Nursing Implications?

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 Herpes
• Treatment: use Betadine on lesions to dry &
prevent secondary infections, however,
Acyclovir (Zovirax) eases symptoms &
lessens reoccurrence but is not a cure
• If Untreated: in fetus/newborns there is a risk
of spontaneous abortion; neonatal herpes;
mental retardation, death
• Prevention: limit number of sexual partners
and using condoms & spermicidal foam may
reduce transmission
Nursing Implications?
Genital Warts
• Most common STD in the US
• Often asymtomatic so patient maybe unaware of
infection
• Caused by human papillomavirus (HPV)
• Usually types 6 and 11
• Highly 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 and cytologic tests
• HPV 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
CMV - Cytomegalovirus
• Found is saliva, urine, semen, and vaginal
secretions
• symptoms include pharyngitis, malaise,
fever and lymphadenopathy, heterophil
antibody negative, blood smears may
show atypical lymphocytes
• may be fatal to those patients with AIDS
 CMV
• Treatment:
most resolve spontaneoulsy
• therapy is often required for
immunosuppressed patients
• Ganciclovir
 Trichomoniasis
• Symptoms:
• Most men with
trichomoniasis do
not have signs or
symptoms;
• some men may
temporarily have an
irritation inside the
penis, mild
discharge, or slight
burning after
urination or
ejaculation.
Trichomoniasis
• Symptoms
• frothy, yellow-green vaginal
discharge with a strong odor
• discomfort during intercourse and
urination,
• irritation and itching of the female
genital area.
• lower abdominal pain
• Incubation: 4 to 10 days
Trichomoniasis
• Organism:
Trichomoniasis
is caused by
the single-
celled
protozoan
parasite,
Trichomonas
vaginalis.
Trichomoniasis
• Infectivity: The vagina is the most
common site of infection in women, and
the urethra (urine canal) is the most
common site of infection in men.
• The parasite is sexually transmitted
through penis-to-vagina intercourse or
vulva-to-vulva (the genital area outside
the vagina) contact with an infected
partner.
• Women can acquire the disease from
infected men or women, but men
usually contract it only from infected
women.
 Trichomoniasis
• Treatment: Trichomoniasis can usually be cured with
the prescription drug, metronidazole, given by mouth
in a single dose.
• If Untreated: increases a woman's susceptibility to
HIV infection if she is exposed to the virus.
• Pregnant women with trichomoniasis may have babies who
are born early or with low birth weight (less than five
pounds).
• Prevention: limit number of sexual partners and
using condoms & spermicidal foam may reduce
transmission
Nursing Implications?
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?
ACQUIRED IMMUNODEFICIENCY
SYNDROME
Means of transmission
• Of the 10,514 HIV positive cases reported from 1984 to
2013, 92% (9,637) were infected through sexual contact,
4% (420) through needle sharing among injecting drug
users, 1% (59) through mother-to-child transmission,
<1% (20) through blood transfusion and needle prick
injury <1% (3). No data is available for 4% (375) of the
cases.
• Cumulative data shows 33% (3,147) were infected
through heterosexual contact, 41% (3,956) through
homosexual contact, and 26% (2,534) through bisexual
contact.
• From 2007 there has been a shift in the predominant
trend of sexual transmission from heterosexual contact
(20%) to males having sex with other males (80%)
• Overseas workers from the Philippines (e.g., seafarers,
domestic helpers, etc.) account for about 20 percent of
all HIV/AIDS cases in the country.
HIV (Human Immunodeficiency Virus)
AIDS (Acquired Immunity Deficiency Syndrome)

• HIV is NOT the same as having AIDS, it is

only the virus that causes AIDS.
• Currently there is NO cure but drug therapies
"show great promise in managing HIV
infection".
• "HIV infected people are healthy and do not
realize they have been infected. HIV
primarily infects certain white blood cells that
manage the operation of the immune system.
HIV (Human Immunodeficiency Virus)
AIDS (Acquired Immunity Deficiency Syndrome)

• Eventually, the virus can disable the immune

system, leaving the person with HIV infection
vulnerable to a number of life-threatening
illnesses.
• People who have HIV infection may not have
symptoms for many years, especially if they
receive good medical care and effective
therapies" (American College Health
Association [ACHA] , 2001).
 HIV (Human Immunodeficiency Virus)
AIDS (Acquired Immunity Deficiency Syndrome)
• "When symptoms do develop, they are usually similar
at first to those of common minor illnesses, such as
the "flu", except that they last longer and are more
severe.
• Persistent tiredness, unexplained fevers, recurring
night sweats, prolonged enlargement of the lymph
nodes, and weight loss are all common.
 HIV (Human Immunodeficiency Virus)
AIDS (Acquired Immunity Deficiency Syndrome)

• People with HIV infection can transmit the

virus to others - even if they have no
symptoms and even if they do not know they
have been infected.
• HIV can be transmitted (1) by sexual contact
(anal, vaginal, & oral); (2) by direct exposure
to infected blood; and (3) from an HIV-
infected woman to her fetus during pregnancy
or childbirth, or to her infant during
breastfeeding" (ACHA, 2001).
 HIV (Human Immunodeficiency Virus)
AIDS (Acquired Immunity Deficiency Syndrome)
• Prevention:
• "make careful choices about sexual activity,
• communicate assertively with your sexual partner
and negotiate for safer sexual practices,
• remove alcohol and drugs from sexual activity,"
and
• "use latex condoms for intercourse" (ACHA,
2001).