Sexually Transmitted Diseases

Syphilis

Gonorrhea

Chlamydia

Trichomoniasis

most common curable STIs

Hepatitis B

Herpes simplex type B virus (HSV or herpes)

Human immunodeficiency virus (HIV)

Human papillomavirus (HPV)

viral STIs considered "incurable" but modifiable through medical interventions

Neisseria gonorrhoeae (gram-negative diplococcus)

Causative agent of Gonorrhea

Gonorrhea

Transmitted through Sexual contact (vaginal, anal, oral); perinatal transmission during childbirth. The bacteria attach to mucosal epithelial cells of the genitourinary tract, rectum, oropharynx, or conjunctiva, causing purulent inflammation and tissue damage.

3-21 days; average 3-5 days

Incubation period of Gonorrhea

Gonorrhea manifestations

Men: Dysuria, purulent urethral discharge, epididymitis.

Women: Vaginal discharge, dysuria, pelvic pain, intermenstrual bleeding, possible pelvic inflammatory disease (PID).

Newborns: Ophthalmia neonatorum (eye infection).

Gonorrhea diagnostics

Gram stain (intracellular diplococci), culture, nucleic acid amplification test (NAAT).

Gonorrhea complications

PID, infertility, ectopic pregnancy, neonatal blindness, disseminated gonococcal infection (DGI).

Gonorrhea management

Medical: Ceftriaxone 500 mg IM single dose + Doxycycline 100 mg PO BID × 7 days (for possible chlamydia coinfection).

For pregnant women: Ceftriaxone 125-250 mg IM + erythromycin 500 mg orally for seven days.

Nursing: Health education, condom use, partner treatment, reportable disease follow-up.

Treponema pallidum (spirochete bacterium). Has no other hosts but humans

Causative agent of Syphilis

Syphilis

Transmitted via Sexual contact, blood transfusion, vertical (mother to fetus). Bacteria enter through mucous membranes → spread via bloodstream and lymphatics → cause systemic infection with progressive tissue damage.

10-90 days

Incubation period of Syphilis

Primary Syphilis

Painless chancre at infection site (genitals, anus, mouth). Typically heals on its own within 3-6 weeks but is highly contagious.

Secondary Syphilis

Skin rash (palms, soles), mucous patches, fever, lymphadenopathy.

Latent Syphilis

there are no signs or symptoms, but Treponema pallidum is still alive in the body. The patient is not contagious. Can still affect organs like the heart, brain, and nerves. This phase can last for years.

Tertiary Syphilis

Neurosyphilis, cardiovascular damage, gummatous lesions.

Gummas

soft, gummy lesions that develop anywhere in the body, most commonly on the skin, bones, mouth, liver, and stomach. They can obstruct blood flow and cause tissue necrosis.

late-stage syphilis

causes severe damage to organs, such as the liver and bones. It may affect the upper respiratory tract and cause perforation of the nasal septum or the palate. In severe cases, it destroys bones and organs, leading to fatal complications.

Syphilis diagnostics

Darkfield illumination test: Effective for moist lesions.

Fluorescent treponemal antibody absorption test: Uses exudates from lesions.

VDRL (Venereal Disease Research Laboratory): A slide test and rapid plasma reagin test.

CSF analysis: For suspected neurosyphilis.

Syphilis complications

Severe damage to organs (liver, heart, nervous system).

Cardiovascular issues (e.g., aortic aneurysms).

Brain damage leading to cognitive issues.

Severe illness or death in newborns.

Syphilis management

Medical: Benzathine Penicillin G 2.4 million units IM single dose (early) or weekly × 3 (late). Infants born to mothers with syphilis should be given silver nitrate eye prophylaxis.

Nursing: Screen sexual partners, education on prevention, report to health authorities, monitor for Jarisch-Herxheimer reaction post-treatment.

Congenital syphilis

a syphilis infection in a newborn baby resulting from transmission from an infected mother

signs of early congenital syphilis

A bullous rash (syphilitic pemphigus) on the skin.

Mucous patches on lips, mouth, and throat.

Possible nasal discharge with T. pallidum present.

late congenital syphilis symptoms

Interstitial keratitis: A common eye lesion that may cause blindness.

Deafness: May appear later in childhood.

Hutchinson's teeth: Peg-shaped upper central incisors and other dental abnormalities.

Syphilis manifestation

Painful genital ulcer(s) with ragged edges and purulent base. Tender inguinal lymphadenopathy (buboes).

Jarisch-Herxheimer reaction

a sudden and typically transient reaction that may occur within 24 hours of being administered antibiotics for an infection by a spirochete

Haemophilus ducreyi (gram-negative bacillus)

Causative agent of Chancroid

Chancroid

Transmitted via Sexual contact with skin breaks. Bacteria invade skin/mucosa → cause necrotizing ulceration and inflammation of genital tissues → may involve lymphatic system.

1 to 14 days, with an average of 3 to 5 days.

Incubation period of Chancroid

typical signs and symptoms of Chancroid

Small lesions appear on the groin or inner thighs, often on the penis in males and vulva, vagina, or cervix in females. Lesions are painful and rapidly ulcerate, becoming soft and malodorous. They bleed easily and produce pus. Inguinal adenitis may develop, leading to large ulcers or buboes. Phimosis may develop during healing.

Chancroid diagnostics

Clinical presentation, culture of H. ducreyi, exclusion of syphilis and HSV. Darkfield examination and serologic test.

Chancroid complications

Phimosis, urethral fistula, secondary infection, scarring.

Chancroid management

Medical: Azithromycin 1 g PO single dose or Ceftriaxone 250 mg IM single dose.

Nursing: Encourage wound hygiene, abstain from sex until healed, treat partners.

Treatment for Chancroid

Azithromycin 500 mg orally as a single dose

Erythromycin 500 mg one cap BID for seven days

Ceftriaxone 250 mg IM in a single dose

Chlamydia trachomatis

Causative agent of Chlamydia

Chlamydia

Transmission via Sexual contact, perinatal (eye/lung infection in newborns). The organism infects columnar epithelial cells → causes inflammation and scarring, particularly in reproductive organs.

Chlamydial manifestations

Men: Urethritis, dysuria, mucoid discharge.

Women: Cervicitis, vaginal discharge, dysuria, abdominal pain, PID risk, Endometritis, salpingitis.

Newborns: Conjunctivitis, pneumonia.

7-21 days

Incubation period for chlamydia

Chlamydia diagnostics

NAAT (preferred), culture, DFA, Enzyme-linked immunosorbent assay (ELISA).

Chlamydia complications

PID, infertility, ectopic pregnancy, reactive arthritis (Reiter's syndrome).

Chlamydia management

Medical: Doxycycline 100 mg BID × 7 days or Azithromycin 1 g orally single dose.

Nursing: Partner notification and treatment, abstinence until completion of therapy, health education.

Trachoma

Caused by Chlamydia trachomatis. Major preventable cause of blindness. It is transmitted from eye to eye via contaminated hands, flies, or fomites. Poor hygiene and inadequate sanitation contribute to its spread.

clinical manifestations of Trachoma

Conjunctivitis begins with small lymphoid follicles.

Conjunctival scarring leads to eyelid distortion and corneal ulceration.

Corneal scarring may lead to blindness.

Treatment for Trachoma

Topical tetracycline or erythromycin ointment applied to the affected area.

If ointment is unavailable, erythromycin 500 mg QID x three weeks

Trichomonas vaginalis (protozoan parasite)

Causative agent of Trichomoniasis

Trichomoniasis

Parasite infects squamous epithelium of genitourinary tract → inflammation and discharge.

4-28 days.

Incubation period of Trichomoniasis

Trichomoniasis manifestation

Women: Frothy yellow-green discharge, foul odor, vaginal itching, "strawberry cervix."

Men: Often asymptomatic or mild urethritis.

Trichomoniasis diagnostics

Wet mount microscopy (motile trichomonads), NAAT, culture.

Trichomoniasis complication

Preterm delivery, increased HIV susceptibility.

Trichomoniasis management

Medical: Metronidazole 2 g single dose or 500 mg BID × 7 days (for both partners).

Nursing: Educate on abstinence during treatment, avoid alcohol with metronidazole, promote safe sex practices.

Human papillomavirus (types 6, 11, 16, 18, etc.)

Causative agent for HPV

Human papillomavirus

HPV infects epithelial cells via Skin-to-skin or sexual contact → induces proliferation → formation of warts or precancerous lesions (especially in cervical and anal mucosa).

HPV manifestation

Genital warts (condyloma acuminata): soft, flesh-colored, cauliflower-like lesions.

Often asymptomatic; high-risk types cause cervical dysplasia and cancer

HPV Diagnostics

Visual inspection, Pap smear, HPV DNA testing.

HPV complications

Cervical, anal, vulvar, penile, and oropharyngeal cancers.

HPV management

Medical: Topical imiquimod, cryotherapy, trichloroacetic acid, laser ablation.

Prevention: HPV vaccination (Gardasil 9) for males and females (ages 9-45).

Nursing: Promote vaccination, regular Pap smears, condom use.

HIV-1 or HIV-2 (retrovirus)

Causative agent of HIV

Human Immunodeficiency Virus (HIV) Infection

Transmitted via Unprotected sex, blood transfusion, needle sharing, mother-to-child (perinatal, breastfeeding). Attacks CD4+ T-helper cells → progressive immune deficiency → leads to AIDS (Acquired Immunodeficiency Syndrome) if untreated.

HIV Manifestations

Acute phase: Fever, sore throat, lymphadenopathy, rash.

Asymptomatic phase: May last years with gradual CD4 decline.

AIDS phase: Opportunistic infections (TB, PCP, candidiasis), Kaposi's sarcoma, wasting syndrome.

HIV diagnostics

Screening: ELISA, rapid HIV test.

Confirmation: Western blot, PCR.

Monitoring: CD4 count, viral load.

HIV management

Medical: Antiretroviral therapy (ART) - combination of ≥3 drugs (e.g., Tenofovir + Lamivudine + Efavirenz).

Nursing: Adherence education, infection prevention, psychosocial support, confidentiality, partner counseling and testing.

HIV Complications

AIDS-related illnesses, malignancies, opportunistic infections.

Acquired Immunodeficiency Syndrome (AIDS)

clinical manifestation of HIV infection. When the immune system breaks down, individuals become susceptible to many infections, which can eventually lead to death. Symptoms are atypical, and patients present with opportunistic infections

A healthy adult has a CD4 count between 500-1,500/mm³. When the count falls below 200/mm³, the person is diagnosed with AIDS.

Diagnosing AIDS

common opportunistic infections in HIV/AIDS

Pneumocystis jirovecii pneumonia (PCP)

Oral candidiasis

Toxoplasmosis of the CNS

Chronic diarrhea or wasting syndrome

Pulmonary/extrapulmonary tuberculosis

Cancers

Reverse transcriptase inhibitors and Protease inhibitors

two main categories of antiretroviral drugs for HIV

Reverse transcriptase inhibitors

Inhibit the enzyme reverse transcriptase, which is needed for HIV replication.

Protease inhibitors

Inhibit the enzyme protease, which is needed for the assembly of viral particles.

Counseling/education: Providing information about HIV/AIDS, transmission, and treatment.

Compliance: Ensuring that the client follows the treatment plan.

Contact tracing: Identifying and providing treatment to partners.

Condoms: Providing condoms and instructions on their proper use.

Four C's in the management of HIV/AIDS