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Sexually Transmitted Diseases (STDs)

Sexually Transmitted Diseases (STDs). ACC, RNSG 1247. Sexually Transmitted Diseases. Infectious diseases most commonly transmitted through sexual contact Can also be transmitted by Blood Blood products Autoinoculation. Gonorrhea Etiology and Pathophysiology.

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Sexually Transmitted Diseases (STDs)

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  1. Sexually Transmitted Diseases (STDs) ACC, RNSG 1247

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

  3. GonorrheaEtiology 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

  4. GonorrheaEtiology and Pathophysiology • Elicits inflammatory process that can lead to fibrous tissue and adhesions • Can lead to : • Tubal pregnancy • Chronic pelvic pain • Infertility in women

  5. GonorrheaClinical 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

  6. Gonococcal Urethritis Fig. 53-1

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

  8. GonorrheaClinical 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

  9. Endocervical Gonorrhea Fig. 53-2

  10. GonorrheaClinical Manifestations • Anorectal gonorrhea • Usually from anal intercourse • Soreness, itching, and anal discharge • Orogenital • Gonoccocal pharyngitis can develop

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

  12. GonorrheaComplications • Women • Include pelvic inflammatory disease (PID), Bartholin’s abscess, ectopic pregnancy, and infertility • Usually asymptomatic so seldom seek treatment until complication are present

  13. GonorrheaDiagnostic Studies • History and physical examination • Laboratory tests • Gram-stained smear to identify organism • Culture of discharge • Nucleic acid amplification test • Testing for other STDs

  14. GonorrheaTreatment & Nursing Care • Drug therapy • Treatment generally instituted without culture results • Treatment in early stage is curative • Most common • IM dose of ceftriaxone (Rocephin)

  15. GonorrheaTreatment & 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

  16. SyphilisEtiology 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

  17. SyphilisEtiology 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

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

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

  20. Primary Syphilitic Chancre Fig. 53-4

  21. SyphilisClinical 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

  22. Secondary Syphilis Fig. 53-5

  23. SyphilisClinical 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

  24. SyphilisClinical Manifestations • Tertiary or late stage • Manifestations rare • Significant morbidity/mortality rates • Gummas • Cardiovascular system • Neurosyphilis

  25. SyphilisComplications • 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

  26. SyphilisComplications • Scarring of aortic valve • Neurosyphilis • Tabes dorsalis • Sudden attacks of pain • Loss of vision and sense of position

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

  28. SyphilisTreatment & Nursing Care • Drug therapy • Benzathine penicillin G (Bicillin) • Aqueous procaine penicillin G

  29. SyphilisTreatment & Nursing Care cont’d • Monitor neurosyphilis • Confidential counseling and HIV testing • Case finding • Surveillance

  30. Chlamydial InfectionsEtiology 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

  31. Chlamydial InfectionsEtiology 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

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

  33. Chlamydial InfectionsClinical Manifestations • Men • Urethritis • Dysuria • Urethral discharge • Proctitis • Rectal discharge • Pain during defecation

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

  35. Chlamydial Infection Fig. 53-6

  36. Chlamydial InfectionsClinical Manifestations • Women • Cervicitis • Mucopurulent discharge • Hypertrophic ectopy • Urethritis • Dysuria • Frequent urination • Pyuria

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

  38. Chlamydial InfectionsClinical Manifestations • Women (cont’d) • PID • Abdominal pain, nausea, vomiting, fever, malaise, abnormal vaginal bleeding, menstrual abnormalities • Can lead to chronic pain and infertility

  39. Chlamydial InfectionsDiagnostic Studies • Laboratory tests • Nucleic acid amplification test (NAAT) • Direct fluorescent antibody (DFA) • Enzyme immunoassay (EIA) • Testing for other STDs • Culture for chlamydia

  40. Chlamydial InfectionsTreatment & 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)

  41. Chlamydial InfectionsTreatment & 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

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

  43. Genital HerpesEtiology 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

  44. Genital HerpesEtiology 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

  45. Genital HerpesClinical Manifestations • Primary (initial) episode • Burning or tingling at site • Small vesicular lesion appear on penis, scrotum, vulva, perineum, perianal areas, vagina, or cervix

  46. Genital HerpesClinical 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

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

  48. Genital HerpesClinical 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

  49. Genital HerpesComplications • Aseptic meningitis • Lower neuron damage • Autoinoculation to extragenital sites • High risk of transmission in pregnancy with episode near delivery • Herpes simplex virus keratitis

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

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