Sexually transmitted infections (STI)
Bacterial, viral, and parasitic infections of the reproductive tract caused by microorganisms transmitted through vaginal, anal, or oral sexual intercourse
Is Chlamydia a curable STI?
yes
How is chlamydia transmitted to others?
vaginal, anal, and oral sex and by childbirth
What diagnostic testing is recommended for chlamydia?
-Culture fluid from endocervical swabs
-NAAT from urine
-Conjunctival secretions in neonates
Females should be screened annually
What are some symptoms of chlamydia?
-Usually asymptomatic
Vaginal discharge, endocervicitis, inflammation of the rectum and lining of the eye, can infect the throat, dysuria, urinary frequency, dyspareunia
Treatment of Chlamydia
Azithromycin
Doxycycline
**Will also treat for gonorrhea
Chlamydia
- Most common bacterial STI in the US
- caused by chlamydia trachomatis (parasite)
Gonorrhea
- Second most common reported infection
- HIGHLY contagious and reportable to health departments
- caused by: aerobic gram-negative intracellular diplococcus
- IS CURABLE
What is the site of infection for Gonorrhea?
Columnar epithelium of endocervix
How is Gonorrhea transmitted?
Almost exclusively by sexual intercourse
Sometimes childbirth
Testing for Gonorrhea
Gram stain or culture for bacteria
NAAT
Females should screen annually
Symptoms of Gonorrhea
May be asymptomatic
-Dysuria, urinary frequency, dyspareunia, abnormal vaginal discharge (yellow and foul), endocervisitis, arthritis, PID, Bartholin abscess
Treatment for Gonorrhea
Ceftriaxone and azithromycin
Patient Education for Gonorrhea
- Sexual partners need evaluation, testing, and treatment also
- Abstinence from sexual activity until therapy is complete and symptoms gone
- Retesting in 3 months to rule out reoccurrence
What can happen to the babies who are born to mothers with gonorrhea?
Neonatal conjunctivitis which can lead to blindness
P-LI-SS-IT Model
P-permission–gives permission to talk about experience
LI-Limited Info–info given about STI
SS-Specific Suggestions-attempt to help change behavior and prevent reoccurrence
IT-Intensive therapy-referring to treatment elsewhere
Genital Herpes Simplex
Lifelong recurrent viral disease
NO CURE
How is genital herpes transmitted?
Contact with mucous membranes or breaks in the skin with visible or nonvisible lesions
How is diagnosis for genital herpes confirmed?
via viral culture or fluid from vesicle
Treatment for Genital Herpes
NO CURE
Antivirals used to treat first episode, reoccurrence and transmission
Primary Episode symptoms of genital herpes
Most severe and prolonged
-multiple painful vesicular lesions, mucopurulent discharge, superinfection, fever, chills, malaise, dysuria, headache, genital irritation, lymphadenopathy, inguinal tenderness
Recurrent infection of genital herpes
More localized and quicker resolution
-tingling, itching, pain, unilateral genital lesions
Syphilis
Curable bacterial infection caused by spirochete Treponema pallidum
-serious systemic disease
Mode of Transmission Syphilis
sexual intercourse
Treatment for Syphilis
Benzathine penicillin injection
-If penicillin allergy use doxycycline
Primary Syphilis Infection Symptoms
Chancre
Painless bilateral adenopathy
Secondary Syphilis Infection Symptoms
Flu-like symptoms
Rash on trunk, hands, and feet
Alopecia
Adenopathy
Latency Syphilis Infection
Absence of manifestations
Positive serology
Tertiary Syphilis Infection
Life-threatening heart disease
Neurologic disease
Tumors on skin bones and liver
Usually not reversible
Pelvic Inflammatory disease (PID)
Inflammation of the upper reproductive tract
-Results from ascending polymicrobial infection frequently caused by untreated chlamydia or gonorrhea
Symptoms and Results of PID
Ectopic pregnancy, pelvic abscess, subfertility, abdominal pain, pelvic adhesions, depression, adnexal tenderness, cervical motion tenderness
What is used to diagnose PID?
Endometrial biopsy, transvaginal ultrasound, laparoscopic examination
Nursing Management for PID
Maintain hydration, analgesics for pain, semi-fowler’s position to facilitate drainage, education about prevention of reoccurrence, sexual counseling
Human Papillomavirus (HPV)
Most common VIRAL infection in the US
Will see genital warts (condylomata)
Symptoms of HPV
Most Asymptomatic
Visible genital warts
May develop into cervical cancer
Diagnostic tests for HPV
Pap smears and HPV test
Treatment for HPV
NO CURE
HPV vaccine for prevention and education on treatment of lesions
-Cervarix, Gardasil, and Gardasil 9
Hepatitis A and B
An acute systemic viral infection that can be transmitted sexually; inflammation of the liver
How does Hepatitis A spread? Acquired?
via the GI tract
from polluted water, uncooked shellfish, food handled by a hepatitis carrier with poor hygiene, and oral/anal contact
How does Hep B spread?
via saliva, blood, semen, menstrual blood, and vaginal secretions
Hepatitis A Symptoms
Flu-like symptoms w/ malaise, skin rash, fatigue, anorexia, nausea, pruritus, fever, and upper right quadrant pain
Hep B Symptoms
Similar to Hep A but with less fever and skin involvement
Ectoparasitic Infections
common cause of skin rash and pruritus around the world
Scabies and Pubic Lice
Scabies
intensely pruritic dermatitis caused by a mite
-female mite burrows under the skin and lays eggs which hatch
Symptoms of Scabies
Pruritus, lesions, rash
How is HIV transmitted?
sexual intercourse, sharing needles, mother to fetus, transfusion of infected blood or blood products
Three Stages of HIV infection
1) Acute seroconversion
2) Asymptomatic Infection
3) AIDS
Goals of HIV drug therapy
- decrease viral load below level of detection
- restore bodies ability to fight off pathogens
- improve quality of life
- reduce morbidity and mortality
What is the therapeutic management technique for HIV?
HAART-highly active antiretroviral therapy
-combines at least ARV drugs
Vaginitis
inflammation and infection of the vagina
What are the 3 most common causes of vaginitis?
Candida-fungus
Trichomonas-protozoan
Gardnerella-bacterium
Vulvovaginal Candidiasis
One of the most common causes of vaginal discharge
- yeast, monilial, or fungal infection
- NOT considered an STI
Nursing Management for Vulvovaginal Candidiasis
Teaching preventative measures: cotton underwear, avoid irritants, hygiene, avoid douching/super absorbent tampons, avoiding sex and alcohol
Bacterial Vaginosis
Most prevalent cause of vaginal discharge
Risk factors: multiple sex partners, douching, lack of vaginal lactobacilli
