Sexually Transmitted Diseases


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Sexually Transmitted Diseases

  2. 2. Sexually Transmitted Infections <ul><li>Sexually transmitted (venereal) diseases are infections that are often, if not always, passed from person to person through sexual contact. It is sometimes grouped by the signs and symptoms they cause. </li></ul><ul><li>Syphilis, genital herpes, and chancroid all cause ulcers (sores) on the skin or membranes lining the vagina or mouth. </li></ul><ul><li>Gonorrhea and chlamydial infections cause urethritis (inflammation and discharge of the urethra) in men; cervicitis (inflammation and discharge of the cervix) in women; pelvic infections in women and eye infections in newborns. </li></ul>
  3. 3. <ul><li>Transmission </li></ul><ul><ul><li>Intimate contact </li></ul></ul><ul><ul><ul><li>Vaginal </li></ul></ul></ul><ul><ul><ul><li>Oral </li></ul></ul></ul><ul><ul><ul><li>Anal </li></ul></ul></ul><ul><ul><li>Intercourse </li></ul></ul>
  4. 4. <ul><li>Etiology </li></ul><ul><ul><li>Bacteria </li></ul></ul><ul><ul><li>Chlamydia </li></ul></ul><ul><ul><li>Viruses </li></ul></ul><ul><ul><li>Fungi </li></ul></ul><ul><ul><li>Protozoa </li></ul></ul><ul><ul><li>Parasites </li></ul></ul>
  5. 5. <ul><li>Prevalence </li></ul><ul><ul><li>Occur in over 50% of people at some point </li></ul></ul><ul><ul><li>Women/infants disproportionately affected </li></ul></ul><ul><ul><li>Highest in ages 15-24 </li></ul></ul>
  6. 6. <ul><li>Risk Factors </li></ul><ul><ul><li>Decreased use of condoms </li></ul></ul><ul><li>Characteristics </li></ul><ul><ul><li>Most can be prevented by use of latex condoms </li></ul></ul><ul><ul><li>Heterosexual/homosexual activities </li></ul></ul><ul><ul><ul><li>Includes non-penetrating intimate exposure </li></ul></ul></ul><ul><ul><li>Sexual partners must be treated </li></ul></ul><ul><ul><li>Two or more STIs frequently </li></ul></ul>
  7. 7. <ul><li>Complications </li></ul><ul><ul><li>Pelvic inflammatory disease </li></ul></ul><ul><ul><li>Ectopic pregnancy </li></ul></ul><ul><ul><li>Infertility </li></ul></ul><ul><ul><li>Chronic pelvic pain </li></ul></ul><ul><ul><li>Neonatal illness and death </li></ul></ul><ul><ul><li>Genital cancer </li></ul></ul>
  8. 8. <ul><li>Prevention and Control </li></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Detection </li></ul></ul><ul><ul><li>Effective diagnosis </li></ul></ul><ul><ul><li>Treatment of infected persons </li></ul></ul><ul><ul><li>Evaluation, treatment, counseling of sex partners </li></ul></ul>
  9. 9. <ul><li>Reportable Disorders </li></ul><ul><ul><li>All RHU’S/CHO </li></ul></ul><ul><ul><ul><li>Gonorrhea </li></ul></ul></ul><ul><ul><ul><li>Syphilis </li></ul></ul></ul><ul><ul><ul><li>AIDS </li></ul></ul></ul><ul><ul><li>Most RHU’S/CHO </li></ul></ul><ul><ul><ul><li>Chlamydial infections </li></ul></ul></ul>
  10. 10. Gonorrhea <ul><li>Causative agent: Neisseria gonorrhea </li></ul><ul><li>Typically passed by direct contact between the infectious mucous membranes like the genitals, anus, and mouth of one person with the mucous membranes of another. </li></ul><ul><li>Incubation period: 3-4 days </li></ul><ul><li>Signs and Symptoms: </li></ul><ul><li>Males: burning urination and pus discharges from infection of urethra </li></ul><ul><li>Females: vaginal discharge, cervicitis, vulvovaginitis, dysuria </li></ul><ul><li>Complications: </li></ul><ul><li>Pelvic inflammatory disease, ectopic pregnancy, arthritis , dermatitis, heart damage, ophthalmia noenatorum </li></ul>
  11. 11. Nursing intervention <ul><li>Prophylactic antibiotic treatment for gonorrhea </li></ul><ul><li>Encourage follow up cultures in 4-7 days after treatment and again at 6 months. </li></ul><ul><li>Teach importance of abstinence from sexual intercourse until cultures are negative </li></ul><ul><li>Urge client to inform sexual partner so that he or she may be treated for infection. </li></ul><ul><li>Important to take the full course of antibiotics. </li></ul>
  12. 13. Syphilis <ul><li>Causative agent: Treponema pallidum </li></ul><ul><li>Incubation period: 10-90 days; average is 20-30 days. </li></ul><ul><li>Pathophysiology </li></ul><ul><ul><li>Enters body through break in skin/mucous membrane </li></ul></ul><ul><ul><li>Spreads through blood and lymph </li></ul></ul><ul><ul><li>Congenital syphilis transfers through placental circulation </li></ul></ul>
  13. 14. <ul><li>Transmission: direct contact with primary chancre lesion, body secretions (saliva, blood, vaginal discharge, semen) </li></ul><ul><li>Complications: development of late syphilis and the resultant systemic involvement of cardiovascular and central nervous system </li></ul>
  14. 15. NURSING INTERVENTION <ul><li>Administration of parenteral penicillin is treatment of choice. </li></ul><ul><li>If pregnant mother is treated before the 18 th week of gestation, the fetus will usually be born unafected. </li></ul><ul><li>Preventive education regarding sexual exposure, adequate case finding and treatment of contacts. </li></ul><ul><li>All cases are reported to local public health authorities </li></ul>
  15. 17. Chlamydia <ul><li>Causative agent: Chlamydia Trachomatis </li></ul><ul><li>Passed during sexual intercourse; infants can become infected during vaginal delivery. Highly contagious. </li></ul><ul><li>Incubation period: 2-35 days </li></ul><ul><li>Signs and Symptoms </li></ul><ul><li>Males: discharges from penis, burning and itching of urethral opening, burning sensation during urination </li></ul><ul><li>Females: slight vaginal discharges, itching of vagina, painful intercourse, abdominal pain, fever in later stages </li></ul><ul><li>Treatment: antibiotics as prescribed ( Doxycycline and azithromycin) </li></ul><ul><li>Complications </li></ul><ul><li>Infant pneumonia, eye infections in infants which can lead to blindness, stillbirths and pre-maturity </li></ul>
  16. 18. NURSING INTERVENTION <ul><li>Urge client to have sexual partner treated. </li></ul><ul><li>Emphasize the importance of long term drug therapy because of the pathogens unique life cycle, which make it difficult to eliminate. </li></ul><ul><li>Antibiotic treatment </li></ul>
  17. 19. HUMAN PAPILLOMAVIRUS (GENITAL WARTS) <ul><li>Genital warts is a sexually transmitted disease (STD) that is caused by human papilloGenital warts is a sexually transmitted disease (STD) that is caused by human papillomavirus (HPV). </li></ul><ul><li>The virus is passed by direct contact during sex with a wart or skin that is infected with the virus. </li></ul><ul><li>It is possible to get the warts on hands and in the mouth through contact during foreplay or kissing. </li></ul>
  18. 24. Herpes simplex virus <ul><li>Herpes simplex virus (HSV) infections are very common worldwide. </li></ul><ul><li>HSV-1 (often called oral-facial herpes) is transmitted through kissing or sharing drinking utensils; cold sores or fever blisters </li></ul><ul><li>HSV-2 (often called genital herpes) through sexual contact. </li></ul><ul><li>Both HSV-1 and HSV-2 can cause infections around the face, mouth, and genitals. </li></ul>
  19. 25. ASSESSMENT <ul><li>Initial sensation of tingling and itching before rupture of a lesion. </li></ul><ul><li>Signs of primary infection usually consists of local inflammation, pain, malaise, fever headache, and muscle aches </li></ul><ul><li>Genitals may become reddened with painful blisters, which burst into lesion that gradually heal. </li></ul>
  20. 28. NURSING INTERVENTION <ul><li>Teach importance of genital hygiene and avoidance of unprotected sexual contact </li></ul><ul><li>Teach good hygiene practices. If the lesions break open, the fluid contains the virus. The virus can be spread by contact and can cause a lesion in any area of the body. </li></ul>
  21. 29. <ul><li>VAGINAL INFLAMMATORY CONDITIONS </li></ul>
  22. 30. Common predisposing factors <ul><li>Excessive douching </li></ul><ul><li>Oral contraceptives, steroids </li></ul><ul><li>Antibiotics that usually wipe out normal vaginal flora. </li></ul><ul><li>Improper cleaning after voiding and defecating. </li></ul>
  23. 31. BACTERIAL VAGINOSIS <ul><li>Causative organisms: E. coli, haemophillus vaginalis and gardnerella vaginalis. </li></ul><ul><li>Profuse yellowish discharge, “fishy smell” </li></ul><ul><li>Itching, redness, burning, edema, which are exacerbated by voiding and defecation. </li></ul>
  24. 32. <ul><li>Treatment : antibacterial/ antiprotozoal medication. </li></ul><ul><li>Complication : Bacterial vaginosis may increase susceptibility to STD’s and HIV infection if woman is exposed to either </li></ul><ul><li>Sexually transmitted </li></ul>
  25. 33. CANDIDIASIS <ul><li>Characteristics: </li></ul><ul><li>Organisms: CANDIDA ALBICANS (fungus) </li></ul><ul><li>Internal itching, beefy red irritations, inflammation of vaginal epithelium </li></ul><ul><li>White cheese-like, odorless discharge that clings to the vaginal mucosa </li></ul><ul><li>Occurs frequently and is difficult to cure </li></ul><ul><li>Increased risk in women with diabetes and women taking birth control pills, during pregnancy and after treatment of antibiotics </li></ul><ul><li>Treatment: antifungal vaginal medication. </li></ul>
  26. 35. Trichomoniasis <ul><li>Causative Agent: Trichomonas vaginalis (protozoan) </li></ul><ul><li>Usually passed by direct sexual contact. Can be transmitted through contact with wet objects, such as towels and wash clothes. </li></ul><ul><li>Signs and Symptoms </li></ul><ul><li>Females : white or greenish-yellowish odorous discharges, vaginal itching and soreness, painful urination </li></ul><ul><li>Males : Slight itching of penis, painful urination, clear discharge from penis </li></ul><ul><li>Treatment: curable with an oral medication ( antibacterial/antiprotozoan medication </li></ul><ul><li>Prevention: avoid extended time in nylon or tight fitting undergarments. </li></ul>
  29. 38. NURSING INTERVENTION <ul><li>Appropriate cleansing from front of vulva to back of perineal area. </li></ul><ul><li>Frequently, infection is worse around menstrual period. Teach clients to change tampons at least 3 -4 times a day or use external pads. </li></ul><ul><li>Client should not douche; </li></ul><ul><li>Discourage use of feminine hygiene sprays because they can cause irritation. </li></ul><ul><li>Avoid constricting clothing and non-cotton underwear. </li></ul>
  30. 39. ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) AND HIV <ul><li>Main problem: AIDS, technically, is the end stage of HIV infection, characterized by profound serious immunosuppresion. </li></ul><ul><li>Causative agent: RETROVIRUS </li></ul><ul><li>Mode of transmission: </li></ul><ul><li>1. person to person </li></ul><ul><li>2. parenteral </li></ul><ul><li>3. placental </li></ul>
  31. 40. <ul><li>Incubation period: 6 months to 5 years </li></ul><ul><li>Single exposure? Still, you’ll have 90% possibility of contracting the disease </li></ul><ul><li>Diagnostics offered by DOH: </li></ul><ul><li>ELISA screening </li></ul><ul><li>Western blot usual confirmatory test for ELISA </li></ul>
  32. 41. NURSING INTERVENTION <ul><li>Isolation technique: STANDARD/ UNIVERSAL or Blood and Body fluids PRECAUTION </li></ul><ul><li>NUTRITIONAL REHABILITATION </li></ul><ul><li>Treatment opportunistic infections </li></ul>
  33. 42. <ul><li>5 P’s of Nursing Interventions: </li></ul><ul><li>P romote homeostasis </li></ul><ul><li>P romote comfort </li></ul><ul><li>P revent infections </li></ul><ul><li>P sychological support </li></ul><ul><li>P rovide information and education </li></ul>
  34. 44. SUMMARY <ul><li>CHARACTERISTIC MANIFESTATIONS: </li></ul><ul><li>Candidiasis --- cheeselike discharge </li></ul><ul><li>Gonorrhea --- thick purulent discharge </li></ul><ul><li>Syphillis --- painless charcre </li></ul><ul><li>Vaginosis --- “fishy smell” </li></ul><ul><li>Trichomoniasis --- frothy, green-yellow discharge </li></ul><ul><li>Genital warts --- cauliflower bumps </li></ul>
  35. 45. <ul><li>“ if you sleep with a boy whom you’re not familiar with, it means you also slept with his old gilrfriends” </li></ul>
  36. 46. <ul><li>“ as nurses, we are focused on the PREVENTION and CONTROL of STD’s. We implement different isolation or precautionary techniques depending on the condition of the patient and the mode of transmission” </li></ul>