NURS 340 - Sexually Transmitted Diseases, Human Immunodeficiency Virus & Hepatitis

chlamydia

the most commonly reported infectious disease

gonorrhea

the second most commonly reported infectious disease

bacteria

STDs caused by _____ are cured with antibiotics with the exception of the newly emerging antibiotic-resistant strains

viruses

STDs caused by _____ cannot be cured

viruses

STDs caused by _____ are chronic diseases leading to a lifetime of symptom management and infection control

gonorrhea

STD: can be transmitted via fluids even if a male does not ejaculate

complicated gonorrhea

type of gonorrhea: includes salpingitis, epididymitis, systemic gonococcal infection, and gonococcal meningitis

uncomplicated gonorrhea

type of gonorrhea: refers to limited cervical or urethral infection

Urethritis

Purulent discharge

Painful urination

Urinary frequency

Epididymitis

symptoms of gonorrhea in males:

epididymitis

a painful condition of the testicles that can lead to infertility if untreated

Purulent discharge

Urinary frequency

symptoms of gonorrhea in females, if present:

gonorrhea

STD: females are often asymptomatic, or symptoms may be confused with a bladder or vaginal infection

gonorrhea, chlamydia

STD: females are often asymptomatic. treatment may not be sought, which could allow the disease to continue to spread, increasing the risk for pelvic inflammatory disease (PID)

Diffuse abdominal pain

Fever

Chills

symptoms of pelvic inflammatory disease (PID):

ceftriaxone [rocephin]

treatment for gonorrhea:

Refer partners of past 60 days

Return for evaluation if symptoms persist

Remain sexually abstinent for 77 days

Use therapy until complete and symptoms are gone in both client and partners

Medication teaching

nursing implications for gonorrhea:

gonorrhea

STD: remain sexually abstinent for 77 days

gonorrhea

STD: efforts should be made to treat ALL the patient’s sexual partners from the last 60 days—VERY important to assess this

chlamydia

STD: infects the genitourinary tract and rectum of adults and causes conjunctivitis and pneumonia in neonates

chlamydia

STD: because the cervix of teenage girls and young women is not fully matured and may be more susceptive to infection, they are an especially high-risk group if they are sexually active

chlamydia

STD: both males and females are commonly asymptomatic. referred to as the "silent disease"

Nongonococcal urethritis (NGU)

Painful urination

Urethral discharge

Epididymitis

symptoms of chlamydia in males, if present:

chlaymdia

STD: causes nongonococcal urethritis (NGU) in males

Mucopurulent cervicitis (MPC)

Vaginal discharge

symptoms of chlamydia in females, if present:

chlaymdia

STD: causes mucopurulent cervicitis (MPC) in females

doxycycline, azithromycin, levofloxacin

treatment for chlamydia:

gonorrhea and chlamydia

best practice is to dual-treat for _____, regardless of culture results

Refer partners of past 60 days

Counsel client to use condoms and to avoid sex for 7 days after start of therapy and until symptoms are gone in both client and partners

Medication teaching

Annual screening recommended for all sexually active women under 25, and women over 25 with new or multiple sexual partners

nursing implications for chlamydia:

chlamydia

STD: counsel client to use condoms and to avoid sex for 7 days after start of therapy and until symptoms are gone in both client and partners

chlamydia

STD: annual screening recommended for all sexually active women under 25, and women over 25 with new or multiple sexual partners

primary syphilis

stage of syphilis: chancre is formed at the site of entry. the lesion begins as a macula, progresses to a papule, and later ulcerates

Chancre

symptoms of primary syphilis:

secondary syphilis

stage of syphilis: occurs when the organism enters the lymphatic system and spreads throughout the body

secondary syphilis

stage of syphilis: causes palm and plantar rashes

Skin rash

Lymphadenopathy

Lesions of the mucous membranes

symptoms of secondary syphilis:

tertiary syphilis

stage of syphilis: causes gumma of the face

Damage to internal organs

Gummatous lesions

symptoms of tertiary syphilis:

latent syphilis

type of syphilis: a period when an individual is free of symptoms but has serological evidence

latent syphilis

type of syphilis: organisms persist in the infected person's body without causing signs or symptoms

latent syphilis

type of syphilis: subdivided into early and late phases

congenital syphilis

type of syphilis: transmitted transplacentally—from mother to baby through the placenta

congenital syphilis

type of syphilis: extremely detrimental to the fetus. can cause premature stillbirth, blindness, deafness, facial abnormalities, crippling, or death of the fetus

syphilis

STD: all pregnant women are screened at the first prenatal visit, and again in the third trimester (!!!)

ocular syphilis

type of syphilis: can occur at any stage

men

suspected cases of ocular syphilis are more likely to be _____

ocular syphilis

type of syphilis: if left untreated, can lead to blindness

benzathine penicillin G [bicillin] 2.4 million units IM x 1 dose

treatment for primary, secondary, or early latent (< 1 year) syphilis:

benzathine penicillin G [bicillin] 7.2 million units total over 3 weeks, 1 dose per week

treatment for late latent syphilis:

Counsel to be tested for HIV and other STIs

Screen all partners of past 3 months

Reexamine client at 3 and 6 months

Universal precautions should be used with all syphilis patients

nursing implications for syphilis:

syphilis

STD: screen all partners of past 3 months

syphilis

STD: reexamine client at 3 and 6 months

genital herpes

types of herpes: more likely to be recurrent

genital herpes

STD: after the initial infection the virus remains latent in the sacral nerve of the central nervous system and may reactivate periodically with or without visible vesicles

Painful lesions that begin as vesicles and ulcerate and crust within 1 to 4 days

Dysuria

Rectal pain

symptoms of genital herpes:

acyclovir, famciclovir, valacyclovir

*there is no cure, but antiviral medications can prevent or shorten outbreaks during the time the person takes the medication

treatment for genital herpes:

suppressive therapy

reduces frequency of genital herpes recurrences

genital herpes

STD: there is no cure, but antiviral medications can prevent or shorten outbreaks during the time the person takes the medication

Refer partners for evaluation

Teach client about likelihood of recurrent episodes and ability to transmit to others even if asymptomatic

Condom use

Annual Pap smear

Health care providers should wear gloves when in direct contact with possible infectious lesions or mucous membranes

nursing implications for genital herpes:

genital herpes

STD: teach client about likelihood of recurrent episodes and ability to transmit to others even if asymptomatic

HPV

STD: specific types cause cervical cancer, accounting for 70% of cervical cancer cases

Genital warts

symptoms of HPV:

genital warts

appear as textured surface lesions, with what is sometimes described as a cauliflower appearance

eliminate the warts

once HPV infection occurs, the goal of therapy is to:

Education about HPV vaccine

Warts and surrounding tissues contain HPV, so removal of warts does not completely eradicate virus

Examination of partners not necessary, since treatment is only symptomatic

Condom use may or may not reduce transmission

Medication application

nursing implications for HPV:

HPV

STD: examination of partners not necessary, since treatment is only symptomatic

HPV

*warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur

STD: condom use may or may not reduce transmission

NO! warts and surrounding tissues contain HPV, so removal of warts does not completely eradicate virus

does removal of genital warts completely eradicate the virus?

imiquimod 3.75% or 5% cream

treatment for HPV:

HPV

STD: there is no cure, but one-third of lesions will disappear without topical treatment

gardasil vaccine

prevention for HPV:

trichomoniasis

STD: caused by a protozoan parasite

trichomoniasis

STD: can survive on infected objects, so can be spread through the sharing of objects

trichomoniasis

STD: an untreated infection in pregnancy can cause complicated labor, which is detrimental to the fetus

Frothy, bubbly, greenish vaginal discharge

Painful intercourse

Abdominal discomfort

symptoms of trichomoniasis in females:

trichomoniasis

STD: causes frothy, bubbly, greenish vaginal discharge in females

metronidazole

treatment for trichomoniasis:

Avoid sexual intercourse during treatment

Avoid alcohol during treatment

nursing implications for trichomoniasis:

trichomoniasis, bacterial vaginosis (BV)

STD: patient MUST avoid alcohol during treatment (!!!)

bacterial vaginosis (BV)

STD: most commonly occurs in young females

bacterial vaginosis (BV)

STD: infection is linked to an imbalance of good and bad bacteria

bacterial vaginosis (BV)

STD: does not typically occur until an individual becomes sexually active

bacterial vaginosis (BV)

STD: CANNOT be transmitted through toilet seats, bedding, or swimming pools

bacterial vaginosis (BV)

STD: when a patient is diagnosed, we are NOT concerned about contact investigation or treating the partner

bacterial vaginosis (BV)

STD: diagnosed by the presence of clue cells under a microscope or an amine (fishy) odor when KOH is added

bacterial vaginosis (BV)

STD: providers may diagnose through a "whiff test"—the provider smells the sample for the presence of a fishy odor

metronidazole

treatment for BV:

Educate clients to avoid douching

Avoid alcohol during treatment

nursing implications for BV:

bacterial vaginosis (BV)

*douching can put individuals at risk for proliferation of BV and other infections, such as yeast

STD: educate clients to avoid douching

HIV

a virus that attacks the body's immune system

stage 1—primary infection

stage of HIV: occurs within a month of contracting the virus

*flu-like symptoms*

Fever

Chills

Rash

Night sweats

Muscle aches

Sore throat

Fatigue

Swollen lymph nodes

Mouth ulcers

symptoms at the primary infection stage of HIV:

stage 1—primary infection

stage of HIV: an antibody test at this stage is usually negative, so it is often not recognized as HIV

stage 1—primary infection

stage of HIV: the individual is likely to go undetected

stage 2—clinical latency

stage of HIV: no obvious signs are present

stage 2—clinical latency

stage of HIV: HIV antibodies appear in the blood

NO! although most antibodies serve a protective role, HIV antibodies do not. their presence helps in the detection of HIV because tests show their presence in the bloodstream

do HIV antibodies serve a protective role?

stage 2—clinical latency

stage of HIV: during this prolonged incubation period, clients experience a gradual deterioration of the immune system and can transmit the virus to others

stage 2—clinical latency

stage of HIV: antiretroviral period, or ART, should be used during this stage

stage 2—clinical latency

stage of HIV: known as an intermediate chronic infection

CD4 T-cell count decreases and viral load increases

what happens to an individuals CD4 T-cell count and viral load in stage 2 of HIV (clinical latency)?