about STD

1. Sexually Transmitted Diseases
• Infectious diseases most commonly transmitted
through sexual contact
• Can also be transmitted by
• Blood
• Blood products
• Autoinoculation

2. 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

3. 3
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. 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. 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. 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. 7
• SterilityConsequences
• Neurologic damage
• Ophthalmic infection – other
congenital problems for
newborn
• Cancer
• Death

8. 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

10. 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

11. 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

12. Gonococcal Urethritis
Fig. 53-1

13. Gonorrhea
Clinical Manifestations
• Women
• Mostly asymptomatic or have minor symptoms
• Vaginal discharge
• Dysuria
• Frequency of urination

14. 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

15. Endocervical Gonorrhea
Fig. 53-2

16. Gonorrhea
Clinical Manifestations
• Anorectal gonorrhea
• Usually from anal intercourse
• Soreness, itching, and anal discharge
• Orogenital
• Gonoccocal pharyngitis can develop

17. Gonorrhea
Complications
• Men
• Include prostatitis, urethral strictures, and sterility
• Often seek treatment early so less likely to
develop complications

18. 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

19. 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

20. 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)

21. 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

22. Syphilis

23. 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

24. 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

25. Syphilis
Etiology and Pathophysiology
• Association with HIV
• Syphilitic lesions on the genitals enhance HIV
transmission
• Evaluation includes testing for HIV with patient’s
consent

26. Syphilis
Clinical Manifestations
• Variety of signs/symptoms that can mimic other
disease
• Primary stage
• Painless indurated lesions
• Occur 10 to 90 days after inoculation
• Lasting 3 to 6 weeks

27. Primary Syphilitic Chancre
Fig. 53-4

28. 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

29. Secondary Syphilis
Fig. 53-5

30. 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

31. Syphilis
Clinical Manifestations
• Tertiary or late stage
• Manifestations rare
• Significant morbidity/mortality rates
• Gummas
• Cardiovascular system
• Neurosyphilis

32. 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

33. Syphilis
Complications
• Scarring of aortic valve
• Neurosyphilis
• Tabes dorsalis
• Sudden attacks of pain
• Loss of vision and sense of position

34. Syphilis Diagnostic
Studies
• History including sexual history
• PE
• Examine lesions
• Note signs/symptoms
• Dark-field microscopy
• Serologic testing
• Testing for other STDs

35. Syphilis
Treatment & Nursing Care
• Drug therapy
• Benzathine penicillin G (Bicillin)
• Aqueous procaine penicillin G

36. Syphilis
Treatment & Nursing Care cont’d
• Monitor neurosyphilis
• Confidential counseling and HIV testing
• Case finding
• Surveillance

37. 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

38. 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

39. Chlamydial Infections Clinical
Manifestations
• “Silent disease”
• Symptoms may be absent or minor
• Infection often not diagnosed until complications
appear

40. Chlamydial Infections Clinical
Manifestations
• Men
• Urethritis
• Dysuria
• Urethral discharge
• Proctitis
• Rectal discharge
• Pain during defecation

41. Chlamydial Infections Clinical
Manifestations
• Men (cont’d)
• Epididymitis
• Unilateral scrotal pain
• Swelling
• Tenderness
• Fever
• Possible infertility and reactive arthritis

42. Chlamydial Infection
Fig. 53-6

43. Chlamydial Infections Clinical
Manifestations
• Women
• Cervicitis
• Mucopurulent discharge
• Hypertrophic ectopy
• Urethritis
• Dysuria
• Frequent urination
• Pyuria

44. Chlamydial Infections Clinical
Manifestations
• Women (cont’d)
• Bartholinitis
• Purulent exudate
• Perihepatitis
• Fever, nausea, vomiting, right upper quadrant
pain

45. 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

47. 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

48. 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)

49. 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

50. Chlamydia
• Prevention: limit the number of sexual partner & use
condoms & spermicides
What are the Nursing Implications?

51. Genital Herpes
• Not a reportable disease in most states
• True incidence difficult to determine
• Caused by herpes simplex virus (HSV)

52. 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

53. 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

54. 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

55. 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

56. Genital Herpes Clinical
Manifestations
• Recurrent genital herpes
• Occurs in 50% to 80% in following year
• Triggers
• Stress
• Fatigue
• Sunburn
• Menses

57. 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

58. 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

59. Autoinoculation of Herpes
Simplex Virus
Fig. 53-8

60. Genital Herpes
Diagnostic Studies
• History and physical examination
• Viral isolation by tissue culture
• Antibody assay for specific HSV viral type

61. 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

62. 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

63. 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?

64. 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

65. 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

66. Genital Warts
Clinical Manifestations
• Discrete single or multiple growths
• White to gray and pink-fleshed colored
• May form large cauliflower-like masses

67. 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

68. 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

69. 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

70. 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

71. 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

72. 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

73. 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

74. CMV
• Treatment:
most resolve spontaneoulsy
• therapy is often required for
immunosuppressed patients
• Ganciclovir

75. 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.

76. 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

77. Trichomoniasis
• Organism:
Trichomoniasis
is caused by
the single-
celled
protozoan
parasite,
Trichomonas
vaginalis.

78. 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.

79. 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?

80. Nursing Care : STD
Nursing Diagnoses
• Risk for infection RT ?
• Anxiety RT ?
• Ineffective health maintenance
RT ?

81. 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?

82. ACQUIRED IMMUNODEFICIENCY
SYNDROME

83. 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.

84. • 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%)

85. • Overseas workers from the Philippines (e.g., seafarers,
domestic helpers, etc.) account for about 20 percent of
all HIV/AIDS cases in the country.

86. 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.

87. 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).

88. 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.

89. 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).

90. 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).