STIs
BY: Diana Blum MSN
Metropolitan Community College
Statistics
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Each year more than 100,000 women are left sterile
19 million infections occur in USA each year
Mostly in 15-24 year olds
Drug Abuse and multiple sex partners are risk factors
Highest in African Americans, Hispanics, and Caucasians
Nursing
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Know your feelings
Don’t be judgmental
Provide quality care
Reporting is Mandatory: HIV/AIDS, Gonorrhea, Syphilis,
Chlamydia, viral Hepatitis
• Get list of sexual partners
• This slows transmission
• They need treatment as well
Diagnostics
•Serologic Tests: done to detect infection
•Smears and Cultures: many have
discharges/lesions that need
identification and treatment options
Chlamydia
• Chlamydia Infection-caused by virus like bacteria
“chlamydial trachomatis”
• Symptoms usually take 1-3 weeks after infected
• S/s Men
– penile discharge
– Painful
• S/s
woman and frequent urination
– Vaginal discharge & lower abdominal pain
– No symptoms may be experienced
Assessment & Treatment
• Contact transmission by MM in the mouth eyes,
urethra, vagina, rectum
• Take sexual hx
• Chlamydial antigen test
• Cell tissue culture
• Treatment-single dose azithromyacin-Zithromax, or 7
day course of Vibramyacin(doxycycline), no sex til
cured
• Complications: newborns get eye infection or infant
pneumonia, sterility, sperm duct obstruction, PID,
Ectopic Pregnancy, 5x’s more likely to get HIV
chlamydia
Chlamydia Vaginitis
Gonorrhea
• Caused by neissara gonorrhoeate
• S/s female
– Vaginal discharge
– Redness swelling of external genitalia
– Burning on urination
– Abdominal pain
– Abnormal menstruation
– Rectal infection can cause: discharge, anal itch, soreness, bleeding,
painful defecation, sore throat
• S/s male
– d/c from penis that is white or green
– Burning on urination
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Transmission can occur from mom to baby
Can not get from toilet seat, door knob, towel
It is possible to be asymptomatic
Symptoms occur 2days to 3 weeks after exposure the disappear
Men are usually more syptomatic
Complications: Sterility, damage to heart, damage to joints, PID, increase
risk of HIV
Treatment
• Single dose of Rocephin IM, Cipro IM or Orthoflex IM followed by 7 days of
oral vibromyacin
• If untreated, can cause sterility
• Person remains infectious if untreated, even though symptoms disappear
after 3-4 weeks
• PCN not used because of resistance issues
• F/U with MD
• Care plan page 1167
Gonorrhea
Syphillis
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Caused by a spirochete Treponoma Pallidum.
9756 cases in 2006 in USA
Can be passed through placenta causing congenital syphilis
S/s progress in 4 stages
Page 1158
First stage
• Chancre-may last from 1 to 5 weeks
• Disappears and becomes a painless red ulcer that may last from 1-5 weeks
then it moves to the blood
• Highly contagious
• Chancre usually noticed 1-12 weeks after initial contact
Primary syphilis-chancre
Primary syphilis - chancre
Primary syphyilis
Second Stage
• Contagious
• Occurs 6 weeks from contact
• Rash on extremities palms of hands, soles of feet and trunk then pustules
develop
• S/S: fever sore throat, general ache
Third Stage-Latent stage
• No Symptoms
• Disease may be spread by blood contact not by sex act itself
• Major organs being invaded
Fourth Stage-Late stage
• Usually 3 years after initial contact
• S/s: BLINDNESS
– MENTAL ILLNESS
– PARALYSIS
– HEART DISEASE
– ARTHRITIS
– NUMB EXTREMITIES
– ULCERS ON SKIN AND ORGANS
– PAIN
– EASIER CHANCE OF GETTING HIV
Diagnosis and Treatment
• Dx based on blood confirmation of organism
• Treatment of choice Pen G injections
• patients allergic to penicillin may be treated with doxycycline 300mg daily
for 21 days or oral amoxycillin 3gm twice daily with 1 gm of probenecid for
2 weeks.
• F/U with Doctor
• No sex for 1 month after treatment
Herpes Simplex
• Type II
– transmitted by sexual contact
– Can be transferred by hand contact
– Virus that causes cold sores (HSV1)
– Avoid Direct Kissing
• S/s
– Painful itching sores around genitals
– Rash ,then blisters
– Flu-like symptoms and burning on urination
– Appearance and lab tests used to dx
Herpes Simplex
• Women
Men
Treatment for Herpes
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No cure
May keep in check with antivirals
Wash towels/ personal items
Complications: cervical cancer and need for c-sections
Trichomoniasis
• Caused by the parasite Trichomonas Vaginalitis
• 7 million new cases each year
• Usually transmitted sexually but can live on damp clothes and towels
• If found the partner will also need to be treated even if no symptoms
present
S/s women
• blood spotting in vaginal discharge
• heavy, yellowish-green or gray, frothy vaginal discharge
• infection in the urethra
– the tube that carries urine from the bladder out of the body
• itching, burning or pain in the vagina
• lower abdominal pain
• musty vaginal odor
• pain and/or burning when urinating
• pain or discomfort during sexual intercourse (dyspareunia)
• swelling in the groin
• swollen and irritated vagina and cervix
• urinating more than usual
• vaginal or vulval redness
• worsening symptoms when menstruating
Trichomoniasis
• S/s men
– Few or no symptoms
– infection of the urethra or prostate gland, which is
involved in semen production
– painful and/or difficult urination
– thin, whitish discharge from the penis
– tingling inside the penis
– Treatment
• Flagyl is drug of choice
• Diagnostics by microscopic study and cultures
Trichomoniasis
Condylomata Acumulata
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Venereal warts
Caused by HPV (pap smears are highly important)
Incubation is 3 weeks to 8 months
Warts are pink or red and soft with cauliflower like appearance
BX done for diagnosis
High reoccurrence rate
Pregnancy Stimulates large growth
Treatment-removing visible parts of warts for symptom relief via surgery,
cryotherapy, acid burn off or interferon injection
Condylamata
Condylamata
Vulva
Bacterial Vaginosis
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Caused by Gardenella Vaginalis
Associated with multiple sex partners and douching
S/s are grey discharge and fishy odor, itching
Treatment is Flagyl
Client teaching-no alcohol when taking meds as can have a rx with
vomiting, tachycardia and hypotension
 Note! Flagyl is contraindicated during
pregnancy so a menstrual history or
pregnancy test should be obtained before
administration
Vaginitis
 Etiology:
 bacteria
 protozoa
 viruses
 yeasts
 The acidic environment (pH less than
5.0) of the vagina inhibits the growth
of many pathogens. Several factors
increase risk for infection.
Factors that increase Risk
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Skin diseases
Skin irritation
Perfumes
Nylon underwear
antibiotics
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Diagnosis made from description of
symptoms and identification of
pathogens in sample of vaginal
discharge
 Types of vaginitis
 candidiasis caused by Candida
albicans, a fungus (cottage cheese like
discharge)
 trichomoniasis, caused by
Trichomonas vaginalis, a protozoan
Ways to decrease risk
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Avoidance or irritants-chemicals, dyes, soaps
Cotton underwear, nonrestrictive clothing
Frequent cleansing with neutral agents
Heat in the form of sitz baths or irrigation
Avoid sexual intercourse during course of treatment
Review box 49-2 and condom use on page 1170