SEXUALLY TRANSMITTED DISEASES

1. SEXUALLYTRANSMITTED
DISEASES
PRESENTED BY
MONIKA DEVI
MSC.(N)
HCN, SRHU

2. DEFINITION

3. MODES OF TRANSMISSION
 STIs are spread through contact:
 Penis
 Vagina
 Rectum
 Breaks in skin
 Mucous membranes And Needle Sharing
 Blood contact
 Vertical transmission (Mother-to-child)

4. CONT…
Infectious diseases most commonly transmitted
 through sexual contact.
Can also be transmitted by
 Blood
 Blood products
 Autoinoculation

5. AREAS OF INFECTION

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. PATHOGEN
Pathogen = Bacteria
1. Chlamydia
2. Gonorrhea
3. Bacterial Vaginosis*
4. Syphilis
Pathogen= Virus
1. Herpes
2. Hepatitis B
3. Genital Warts (HPV)
4. HIV/AIDS
Pathogen= Parasite
1. Pubic Lice
2. Scabies
3. Trichomoniasis

8. COMMON SYMPTOM
 Pain during urination
 Bump/sores
 Bleeding between periods
 Unusual discharge
 Pain during intercourse
 Rash
 Many people can have no symptoms (asymptomatic)
and still pass on a STI.

9. BACTERIAL INFECTION
 Infections caused by
bacteria,
 This agent represents
about half of the stis
identified.
 Bacterial infections are
curable.
 Medication does not
protect against future
exposure.

10. CHLAMYDIA AND GONORRHEA
Transmission
 Direct mucous membrane contact with the germ during
 sexual contact.
 Using condoms and
 dental dams lowers chance of transmission.
Testing
 · Culture sample (can be done during pap smear)
 · Urine sample

11. GONORRHEA
Etiology and Pathophysiology :-
 2nd most frequently reported STD in US
 Caused by Neustria gonorrhea
 Gram-negative bacteria
 Direct physical contact with infected host
 Killed by drying, heating, or washing with antiseptic
 Incubation: 3-8 days

12. CLINICAL MANIFESTATION
OF GONORRHEA
In Men
 Initial site of infection is urethra
 Symptoms
 Develop 2 to 5 days after infection
 Dysuria
 Profuse, purulent urethral discharge
 Unusual to be asymptomatic

13. CLINICAL MANIFESTATION
OF GONORRHEA
In Women
 Mostly asymptomatic or have minor symptoms
 Vaginal discharge
 Dysuria
 Frequency of urination
 After incubation
 Redness and swelling occur at site of contact.

14. CONT…
In women
 Greenish, yellow purulent exudate often develops
 May develop abscess
 Transmission more efficient from men to women.
Anorectal gonorrhea
 Usually from anal intercourse
 Soreness, itching, and anal discharge
 Orogenital
 Gonoccocal pharyngitis can develop

16. COMPLICATION
In Men
 Include prostatitis, urethral strictures, and sterility
 Often seek treatment early so less likely to
 develop complications
In Women
 Include pelvic inflammatory disease (PID),
 Bartholin’s abscess, ectopic pregnancy, and
 infertility
 Usually asymptomatic so seldom seek treatment
 until complication are present

17. 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

18. TREATMENT & NURSING CARE
OF GONORRHEA
Drug therapy
 Treatment generally instituted without culture results
 Treatment in early stage is curative
Most common
 IM dose of ceftriaxone (Rocephin)
 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

19. SYPHILIS
 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

20. ETIOLOGY AND PATHOPHYSIOLOGY
OF SYPHILIS
 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 Association
with HIV.
 Syphilitic lesions on the genitals enhance HIV
transmission.
 Evaluation includes testing for HIV with patient’s
Consent.

21. CLINICAL MANIFESTATION
Primary stage
 Painless indurate lesions
 Occur 10 to 90 days after inoculation
 Lasting 3 to 6 weeks
Secondary stage
 Systemic
 Begins a few weeks after chancres
 Blood-borne bacteria spread to all major organ systems
 Flu-like symptoms

22. CONT..
 Bilateral symmetric rash
 Mucous patches
 Condylomata lata
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

23. CONT…
Tertiary or late stage :-
 Manifestations rare
 Significant morbidity/mortality rates
 Gummas
 Cardiovascular system
 Neurosyphilis

24. 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
 Scarring of aortic valve
 Neurosyphilis
 Tabes dorsalis
 Sudden attacks of pain
 Loss of vision and sense of position

25. DIAGNOSTIC STUDIES
 History including sexual history
 PE
 Examine lesions
 Note signs/symptoms
 Dark-field microscopy
 Serologic testing
 Testing for other STDs

26. TREATMENT AND NURSING
CARE
Drug therapy
 Benzathine penicillin G (Bicillin)
 Aqueous procaine penicillin G
 Monitor neurosyphilis
 Confidential counseling and HIV testing
 Case finding
 Surveillance

27. CHLAMYDIAL INFECTION
Caused by Chlamydia trachomatis
 Gram-negative bacteria
 Transmitted during vaginal, anal, or oral sex
 Incubation period: 1 to 3 weeks
Risk factors
 Women and adolescents
 New or multiple sexual partners
 History of STDs and cervical ectopy
 Coexisting STDs
 Inconsistent/incorrect use of condoms

28. CLINICAL MANIFESTATION
 “Silent disease”
 Symptoms may be absent or minor
 Infection often not diagnosed until complications
appear
In Men
 Urethritis
 Dysuria
 Urethral discharge
 Proctitis

29. CONT…
 Epididymitis
 Unilateral scrotal pain
 Swelling
 Tenderness
 Fever
 Possible infertility and reactive arthritis
 Rectal discharge
 Pain during defecation

30. IN WOMEN
 Cervicitis
 Mucopurulent discharge
 Hypertrophic ectopy
 Urethritis
 Dysuria
 Frequent urination
 Pyuria
 Bartholinitis
 Purulent exudate
 Perihepatitis

31. WOMEN CONT…
 PID
 Abdominal pain, nausea, vomiting, fever, malaise,
abnormal vaginal bleeding, menstrual abnormalities.
 Can lead to chronic pain and infertility
 Fever, nausea, vomiting, right upper quadrant pain

32. DIAGNOSTIC STUDIES
 Laboratory tests
 Nucleic acid amplification test (NAAT)
 Direct fluorescent antibody (DFA)
 Enzyme immunoassay (EIA)
 Testing for other STDs
 Culture for chlamydia

33. TREATMENT AND NURSING CAREOF
CHLAMYDIAL INFECTION
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

34. CONT…
 Abstinence from sexual intercourse for 7 days after
treatment.
 Follow-up care for persistent symptoms
 Treatment of partners
 Encourage use of condoms

35. PREVENTION
 limit the number of sexual partner &
 use condoms & spermicides

36. GENITAL HERPES
 Not a reportable disease in most states
 Caused by herpes simplex virus (HSV)
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

37. CONT…
Two different strains
1. HSV-1
 Causes infection above the waist.
2. HSV-2
 Frequently infects genital tract and perineum
 Either strain can cause disease on mouth or genitals

38. CLINICAL MANIFESTATION OF
GENETIC HERPES
 Primary (initial) episode
 Burning or tingling at site
 Small vesicular lesion appear on penis, scrotum,
vulva, perineum, perianal areas, vagina, or cervix
 Primary lesions present for 17 to 20 days
 New lesions sometimes continue to develop for 6
weeks
 Lesions heal spontaneously

39. GENETIC HERPES
CONT…
Recurrent genital herpes :-
 Occurs in 50% to 80% in following year
 Triggers
 Stress
 Fatigue
 Sunburn

40. CONT..
 Menses
 Prodromal symptoms of tingling, burning,
itching at lesion site
 Lesions heal within 8 to 12 days
 With time, lesions will occur less frequently

41. COMPLICATIONS
 Aseptic meningitis
 Lower neuron damage
 Autoinoculation to extragenital sites
 High risk of transmission in pregnancy with episode near
delivery
 Herpes simplex virus keratitis

42. DIAGNOSTIC STUDIES
 History and physical examination
 Viral isolation by tissue culture
 Antibody assay for specific HSV viral type

43. TREATMENT AND 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

44. 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

45. GENETIC HERPES
1. Treatment: use Betadine on lesions to dry & prevent
secondary infections, however, Acyclovir (Zovirax)
eases symptoms & lessens reoccurrence but is not a
cure
2. If Untreated: in fetus/newborns there is a risk of
spontaneous abortion; neonatal herpes; mental
retardation, death
3.Prevention: limit number of sexual partners and
using condoms & spermicidal foam may reduce
transmission
 Nursing Implications

46. GENITAL WARTS
 Most common STD in the US
 Often asymptomatic so patient maybe unaware of
infection
 Caused by human papilloma virus (HPV)
 Usually types 6 and 11
 Highly contagious
 Frequently seen in young, sexually active adults

47. CONT…
 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

48. CLINICAL MANIFESTATION
 Discrete single or multiple growths
 White to gray and pink-fleshed colored
 May form large cauliflower-like masses
 Warts in men: penis, scrotum, around anus, in
urethra
 Warts in women: vulva, vagina, cervix
 Can have itching with an genital warts & bleeding
on defecation with anal warts

49. DIAGNOSTIC STUDIES
 Serologic and cytological 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
 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

50. 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

51. 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

52. 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

53. 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.

54. TREATMENT
 Most resolve spontaneoulsy
 Therapy is often required for
 Immunosuppressed patients
 Ganciclovir

55. 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.

56. TRICHOMONIASIS
CONT…
Organism:- Trichomoniasis is caused by the
 single celled protozoan parasite,
 Trichomonas
 vaginalis

57. SIGN 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.

58. CONT..
Symptoms in women :-
 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

59. 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).

60. PREVENTION
 limit number of sexual partners and
 using condoms & spermicidal foam may reduce
 transmission

61. 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.

62. CONT..
 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).

63. CONT..
 "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.

64. CONT…
 • 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);

65. CONT…
 (2) by direct exposure to infected blood; and
 (3) from an HIVinfected woman to her fetus
during pregnancy
or childbirth, or to her infant during
breastfeeding" (ACHA, 2001).

66. 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).

67. THANKS