Sexually Transmitted Infections

Sexually Transmitted Infections

STIs are infections spread through intimate/sexual contact.

Your deck focuses on:

• transmission

• symptoms

• diagnosis

• treatment

• complications

• prevention

• nursing assessment

• patient teaching

What are STIs?

STIs can pass from one person to another during intimate contact and that many infections occur in adolescents and young adults.

examples:

• Chlamydia

• Gonorrhea

• Genital herpes

• Hepatitis B

• HIV

• HPV

• Syphilis

• Trichomoniasis

ATI/NCLEX idea

Do not assume every STI causes obvious symptoms.

Many can be:

➡ asymptomatic

and still spread.

Why STIs Matter?

• STIs remain a major public-health problem

• they can cause permanent consequences

• some infected people do not tell partners

• nurses must recognize their own feelings and avoid judgment Sexually Transmitted Infections

ATI nursing principle

Provide care without:

• shame

• judgment

• assumptions

Use neutral, respectful questions.

STI Statistics

CDC-style statistics from 2021 and 2022.

The important exam idea is not memorizing the exact numbers.

Know that:

• chlamydia is very common

• gonorrhea remains common

• syphilis has increased

• congenital syphilis is a major concern

Diagnostic Tests

Serologic tests

Blood tests can detect infections such as:

• hepatitis

• syphilis

• HIV

• herpes simplex

• CMV

Smears/swabs/cultures

Used for:

• discharge

• lesion exudate

• infected tissue/fluid

The picture on this slide shows examples:

• HPV → cervical swab

• syphilis → blood test

• gonorrhea/chlamydia → swab/urine

• HIV → blood/oral testing

• herpes → blood or lesion fluid

• trich/BV → vaginal swab/urine

Specimens are handled as infectious material. Sexually Transmitted Infections

ATI point

Know:

NAAT/swab/urine = common for gonorrhea/chlamydia

blood testing = common for syphilis/HIV

Pathophysiology Overview

many organisms can be sexually transmitted, but highlights 8 important ones:

• syphilis

• gonorrhea

• chlamydia

• trichomonas

• hepatitis B

• herpes

• HIV

• HPV Sexually Transmitted Infections

Best way to organize them

Bacterial

• chlamydia

• gonorrhea

• syphilis

Parasitic

• trichomoniasis

Viral

• HSV

• HIV

• HPV

• hepatitis B

Drug Therapy

groups STI medications into:

• antibacterial agents

• antivirals

• dermatologic agents

• HAART Sexually Transmitted Infections

The image shows older HAART categories including:

• NRTIs

• NNRTIs

• protease inhibitors

• fusion inhibitors

ATI idea

Bacteria → antibiotics

Viruses → antivirals/antiretroviral therapy

Reporting STIs

cases of several infections must be reported to public health, including:

• HIV/AIDS

• gonorrhea

• syphilis

• chlamydia

• chancroid

• viral hepatitis

Public-health workers can notify exposed contacts so they can be evaluated and treated.

Nursing concept

This is:

➡ public-health reporting/contact tracing

The goal is to reduce transmission.

STI Clinical Guidelines

This is mostly an information/reference slide.

It shows that STI care includes:

• assessment/evaluation

• prevention

• laboratory testing

• treatment recommendations

NCLEX thinking

STI care is more than giving medication.

You also need:

testing + prevention + partner management + follow-up

Chlamydia

Chlamydial Infection

This slide introduces:

• signs/symptoms

• complications

• diagnosis

• treatment

The image shows possible symptoms.

Men

• penile discharge

• painful/burning urination

• testicular swelling

Women

• vaginal discharge

• painful/burning urination

• abnormal bleeding between periods Sexually Transmitted Infections

***•How long after infection are symptoms usually noted?

•Why is erythromycin ophthalmic ointment used for the newborn?

Chlamydia Complications

• affects both men and women

• can permanently damage the female reproductive system

• can make future pregnancy difficult

• increases risk for ectopic pregnancy

• is often asymptomatic

• can still be transmitted without symptoms

• requires antibiotic treatment for patient and sexual partners

• should prompt screening for other STIs Sexually Transmitted Infections

ATI/NCLEX must know

Chlamydia can be silent.

But untreated infection can lead to:

➡ reproductive damage
➡ infertility
➡ ectopic pregnancy

Partner teaching

Both patient and partner(s) need appropriate treatment.

Chlamydia Pictures

The image shows possible sites:

• genital/cervical discharge

• eye infection

• throat infection

Important idea

Chlamydia is not only a genital infection.

It can affect:

• eyes

• throat

• genital tract

Azithromycin

Azithromycin (Zithromax) as a bacterial antibiotic used for chlamydia.

It also says:

• azithromycin is a macrolide-related antibiotic

• antacids can decrease absorption

• separate antacids from azithromycin by at least 2 hours

• antibiotic use can allow yeast overgrowth

• azithromycin does not treat yeast infection Sexually Transmitted Infections

ATI teaching

If patient develops:

• vaginal itching

• new discharge

after antibiotics, think possible:

➡ yeast overgrowth

***vaginal itching or discharge.

This cause yeast infection called thrush. Sometimes the use of Zithromax allows yeast to grow and the above symptoms to occur. Zithromax does not work against yeast.

This may lead to Vaginitis.

Gonorrhea

• gonorrhea is not acquired from toilet seats, doorknobs, or towels

• symptoms may disappear, but infection can remain if untreated

• follow-up after antimicrobial therapy is important Sexually Transmitted Infections

Important concept

Symptoms improving does not automatically mean infection is gone.

Gonorrhea Signs and Symptoms

The slide introduces:

• symptoms

• complications

• diagnosis

• treatment

The image shows:

Females

• abdominal pain

• increased vaginal discharge

• painful urination

• painful intercourse

• bleeding between periods

Males

• penile discharge

• swollen testes

• painful urination

• urethral/penile inflammation

***What other modes of transmission may occur other than sexual contact?

When do symptoms typically occur after exposure?

Why is penicillin not used as much as it was in the past?

Gonorrhea Details

gonorrhea:

• is caused by bacteria

• affects urethra, rectum, throat

• can infect cervix in females

• can disseminate to heart, meninges, skin, and joints

• spreads through vaginal, oral, or anal sex

• can infect newborns during birth

• may cause painful urination and abnormal discharge

• may be asymptomatic

• is treated with antibiotics

• NAAT is now the preferred diagnostic tool Sexually Transmitted Infections

ATI high yield

Gonorrhea can be asymptomatic.

NAAT = preferred test

Nucleic Acid Amplification Test

NAAT detects genetic material from an organism.

Exam memory

NAAT → gonorrhea/chlamydia

Gonorrhea Teaching/Treatment

• use condoms to prevent reinfection

• sexual partners should be examined and treated

• many women are asymptomatic

• a chancre belongs to syphilis, not gonorrhea

• gonorrhea is bacterial and can be cured with antibiotics Sexually Transmitted Infections

The medication line on this slide contains dosing text that appears internally inconsistent. For studying this deck, the safe concept to memorize is:

gonorrhea → ceftriaxone-based antibiotic treatment + partner management

rather than relying on the exact dose written on that slide.

Gonorrhea vs Chlamydia

The picture compares both.

Main idea:

Both are:

• bacterial

• sexually transmitted

• often occur together

• affect genital organs

• spread through sexual fluids/contact with mucous membranes

ATI idea

Because coinfection can occur:

➡ test for more than one STI when appropriate.

Syphilis

• syphilis is bacterial

• usually spread by sexual contact

• starts as a painless sore

• can remain inactive for years

• untreated disease can damage heart, brain, and other organs

• RPR is one lab test used in evaluation

• early disease is treated with penicillin Sexually Transmitted Infections

Memory

Syphilis = painless chancre

Syphilis Cause and Transmission

Treponema pallidum

Syphilis can spread through:

• sexual contact

• skin/mucous membrane contact with lesions

• pregnancy → fetus

ATI

Pregnancy + syphilis = concern for:

➡ congenital syphilis.

Stages of Syphilis

This image shows progression:

1. Primary

2. Secondary

3. Latent

4. Tertiary

The tertiary stage image shows possible:

• neurologic problems

• cardiovascular problems

• gummas

Very high yield

Primary = painless chancre

Secondary = rash

Latent = no symptoms

Tertiary = organ damage

Syphilis Review

Another transition/review slide:

• signs/symptoms

• complications

• diagnosis

• treatment

Primary and Secondary Syphilis

Primary syphilis

Your slide says:

• one or more chancres

• small, red, painless ulcers

• genital, rectal, or oral

• appear around 10–90 days after exposure

• can heal without treatment

But:

healing does not mean infection is gone.

---

Secondary syphilis

Your slide describes:

• copper-colored rash

• palms and soles

• moist wart-like lesions

• mouth patches

• lymph node enlargement

• fever

• hair loss

• weight loss

• body aches

• sore throat

Treatment is antibiotic-based, especially penicillin G. Sexually Transmitted Infections

ATI clue

Painless chancre → primary

Rash on palms/soles → secondary

***The medication used to treat syphilis is penicillin G, therefore monitoring for an allergic reaction

after administering the drugs would be the highest priority action because of the considerable

risk of an anaphylactic reaction. The nurse should ensure that ordered blood studies are

performed before the administration of the drug. After the administration of the drug, the nurse

should assess the patient for fever, influenza-like symptoms, and malaise. The nurse should

wear gloves to assess skin and mucous membranes because of the disease process, not the

drug administration.

Syphilis Stages Graphic

This picture reinforces:

Primary

Chancre

Secondary

Rash, possibly palms/soles

Latent

Asymptomatic

Late/tertiary

• neurologic damage

• cardiovascular damage

• gummas

Memory

Syphilis starts local, then can become systemic.

HSV-1

our slide says:

HSV-1 commonly causes:

➡ oral herpes/cold sores

Transmission may occur through:

• kissing

• oral sex

• intimate contact Sexually Transmitted Infections

HSV-1 vs HSV-2

The image simplifies:

HSV-1

Usually oral

HSV-2

Usually genital

But both can infect oral or genital sites.

The important exam idea is:

➡ herpes is a lifelong viral infection

Herpes Simplex Review

Your slide asks about:

• prevention

• diagnosis

• treatment

• recurrence

Speaker notes say treatment should start:

➡ during prodromal symptoms or very early in an outbreak. Sexually Transmitted Infections

Prodrome

Early warning symptoms before lesions appear.

Can include:

• tingling

• burning

• itching

•What prevention strategies are used for herpes simplex?

•Although herpes simplex virus types 1 and 2 are similar, type 1 is usually nongenital, with lesions typically above the waist.

•Type 2 is considered an STI because it is most often below the waist and is transmitted by genital contact.

•How long does it take to get results of a Herp-Check?

•Patients should know to start the drug when preliminary (prodromal) symptoms of recurrence are experienced or within 1 day of the outbreak of lesions.

Genital Herpes

• usually HSV-2

• spreads through skin-to-skin sexual contact

• can be mild or asymptomatic

• can still spread without obvious symptoms

• may cause pain, itching, sores

• there is no cure

• medicine can reduce symptoms and transmission risk

• condoms can reduce spread

• autoinoculation can occur by touching lesions then another body area Sexually Transmitted Infections

ATI

Do not say:

“Antivirals cure herpes.”

Correct:

➡ they control outbreaks and reduce symptoms/transmission.

***Herpes simplex lesions can spread through autoinoculation, when a client touches an active lesion then touches another area of the body.

Acyclovir

This slide focuses on:

acyclovir

Used to treat herpes.

The slide notes it can:

• relieve symptoms

• lower viral activity

but does not eradicate latent virus. Sexually Transmitted Infections

Patient teaching

Start as early as prescribed when recurrence symptoms begin.

Trichomoniasis

Trichomoniasis

Your slide says trichomoniasis:

• is caused by a parasite

• may cause foul-smelling discharge

• may cause genital itching

• may cause painful urination

• men may have no symptoms

• is treated with metronidazole

• patient and sexual partners should be treated at the same time Sexually Transmitted Infections

ATI clue

Trich = parasite

Metronidazole

Treat partner

***The use of alcohol while taking Flagyl has serious side effects. Dark urine is expected, doses

should not be doubled, and the drug should be taken with a full glass of water.

It’s important that the patient and sexual partners be treated at the same time to avoid reinfection.

Trichomoniasis Complications

The image says many patients may have:

➡ minimal/no symptoms

and infection may persist.

The image also links trichomoniasis with increased risk of:

• HIV acquisition/transmission

• PID

• pregnancy complications

ATI

Again:

No symptoms does not mean no infection.

Trichomoniasis Symptoms

frothy, yellowish vaginal discharge with foul odor Sexually Transmitted Infections

Other image findings include:

• burning/itching

• redness/swelling

• painful urination

• painful intercourse

Memory

Trich = frothy + foul

Human Papillomavirus

• HPV is very common

• can cause genital warts

• many people have no symptoms

• infected people can still transmit it

• there is no cure for the virus itself

• treatment may remove warts

• vaccine prevents important HPV strains linked to genital warts and cervical cancer Sexually Transmitted Infections

ATI

HPV may be:

➡ asymptomatic

and still transmitted.

***•Multiple warts can become so large that they obstruct the vaginal opening or rectal canal.

•When do genital warts tend to grow large?

HPV Strains

Low-risk HPV

Often linked to genital warts.

High-risk HPV

Linked to malignancy/cancer.

The slide specifically highlights:

• 6 and 11 → genital warts

• 16 and 18 → higher cancer risk

Memory

Low-risk = warts

High-risk = cancer risk

Genital Warts

• skin-colored growths

• often painless

• may itch/burn

• caused by HPV

• risk factors include unprotected sex, multiple partners, smoking, immunocompromise

Treatment options shown include:

• cryotherapy

• topical therapy

• laser

• surgery

Genital Warts Treatment

flesh-colored or cauliflower-like.

It also mentions treatment with:

imiquimod (Aldara)

and HPV vaccination for prevention. Sexually Transmitted Infections

ATI visual clue

Cauliflower-like genital lesion → HPV/genital warts