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Chapter 41: Care of Patients With Sexually Transmitted Infections

Learning Objectives (1 of 2)

  1. Differentiate prevention, signs and symptoms, treatment, and complications associated with common sexually transmitted infections (STIs) in male and female patients.
    This objective emphasizes understanding the diverse characteristics of STIs, focusing on various infections in both genders, and the implications for patient care.

  2. Explain the procedure for the various tests for STIs.
    It involves knowledge of diagnostic methods used to identify STIs, including the type of tests and their significance in treatment planning.

  3. Identify the nurse’s role in preventing, identifying, reporting, and treating common STIs.
    This highlights the critical responsibilities nurses have in overall patient care regarding STIs, including education, support, and intervention.

Learning Objectives (2 of 2)

  1. Devise a teaching plan for a patient who has experienced a first incidence of genital herpes.
    This requires creating a comprehensive educational strategy tailored to the patient's needs after their initial herpes outbreak.

  2. Instruct all patients on ways to prevent contracting or transmitting human immunodeficiency virus (HIV).
    This establishes the need for direct patient education on prevention techniques to minimize HIV transmission risk.

  3. Teach all patients ways to prevent STIs.
    This focuses on ensuring patients are informed about general preventive measures against STIs.

Common Diagnostic Tests

  • Smears and Cultures:
    Used to identify pathogens responsible for STIs through direct sampling from affected areas.

  • Biopsies:
    May be necessary for differential diagnosis in certain STIs, particularly when malignancy is a concern.

  • Staining Procedures:
    Utilized to enhance the visibility of microbial organisms in samples.

Pelvic Inflammatory Disease

  • Definition: Inflammation in the pelvic cavity, most commonly caused by two sexually transmitted organisms - Neisseria gonorrhoeae and Chlamydia trachomatis.

  • Symptoms: Severe abdominal and pelvic pain, fever and chills, and a foul-smelling purulent vaginal discharge.

  • Treatment: Managed with intravenous (IV) antimicrobials, symptom relief measures, and thorough patient support and education.

Candidiasis

  • Definition: A yeast infection resulting from a change in the vaginal pH.

  • Symptoms: Include itching, burning upon urination, and a white, cheese-like discharge.

  • Treatment: Options include vaginal miconazole or clotrimazole for 3 to 7 days or a single dose of oral fluconazole.

Bacterial Vaginosis

  • Definition: Occurs when the normal lactobacillus in the vagina is replaced by Mycoplasma hominis or anaerobic bacteria.

  • Symptoms: Characterized by a grayish-white discharge that possess a characteristic fishy odor.

  • Treatment: Primarily involves metronidazole or clindamycin.

Risk Factors for Sexually Transmitted Infections

  • Demographics: Women aged 15 to 24 are diagnosed with STIs at a significantly higher rate than men.

  • Vaginal pH Alteration: A change in vaginal pH can heighten a woman's risk of acquiring an STI.

  • Contact Duration: Semen remains in contact with female mucous membranes for an extended period, increasing exposure.

  • Contraceptive Choices: Certain contraceptive methods may elevate a woman's risk of infection.

Chlamydia

  • Transmission: Spread through direct sexual contact; often asymptomatic; may involve urethral discharge and dysuria.

  • Prevalence: It is one of the most common STIs in the USA.

  • Treatment: A single dose of azithromycin is recommended, particularly for patients with adherence issues to ensure effective treatment and avoid recurrence.

Gonorrhea

  • Transmission: Transmitted easily through direct sexual contact; newborns can be affected during vaginal delivery if the mother has the disease.

  • Incubation Period: Symptoms typically appear 2-6 days post-exposure; infections can be asymptomatic.

  • Precautions: Adherence to standard contact precautions and regular hand hygiene is critical.

  • Education: Patients should be educated about prevention, the importance of treatment adherence, naming all contacts for treatment, and the need for follow-up cultures to confirm treatment effectiveness.

Prevention of Human Papillomavirus (HPV)

  • Vaccination Recommendations: Administer HPV vaccinations to all girls and boys aged 11 to 12 years old through 18 years old.

    • Types of Vaccines: Gardasil 9 and Cervarix are emphasized.

    • Efficacy and Safety: Both vaccines are highly efficacious against cervical, vaginal, vulvar, and anal cancers, well-tolerated, and deemed safe.

  • Wart Exposure: Warts may appear flat or raised, resembling rough cauliflower-like growths, commonly found on the vulva, penis, perianal region, vaginal or rectal walls, or cervix, and spread during sexual contact.

Genital Herpes

  • Causative Agents: Caused by herpes simplex virus types 1 and 2, which are highly contagious via direct contact.

  • Symptoms: Symptoms include itching or tingling prior to the outbreak, followed by vesicle formation on the vulva, vagina, cervix, scrotum, or penis, as well as fever, headache, malaise, myalgia, and inguinal lymph node swelling. Dysuria may occur if urine contacts eroded skin.

  • Disease Course: Genital vesicles ulcerate, crust, and typically resolve spontaneously in approximately two weeks.

Hepatitis B

  • Transmission Routes: Spread through sexual contact, blood exposure, and perinatal transmission via the placenta in infected mothers.

  • Symptoms: Can include anorexia, vomiting, abdominal pain, dark urine, jaundice, skin rashes, arthralgias, and arthritis.

  • Prevention: Emphasizes the appropriate handling of all blood or bodily fluids to prevent transmission, alongside measures to prevent needle-stick injuries.

HIV

  • Transmission: Transmitted through intimate contact with infected body secretions, blood exposure, or perinatal transmission from mother to newborn. Currently, there is no cure for HIV.

  • Diagnosis: Begins with an antibody test, followed by an antigen/antibody test. A subsequent nucleic acid test (NAT) may also be necessary.

  • Management of Infection: Early intervention and appropriate management are crucial for improving the quality of life and life span.

    • Pregnancy Considerations: Pregnant patients must remain on medication; certain drug combinations can significantly reduce transmission to the fetus. Breastfeeding should be avoided.

Syphilis

  • Initial Presentation: Begins with a chancre; spread occurs through direct contact. The organism, Treponema pallidum, a spirochete, requires a warm, moist environment for survival.

  • Transmission Types: Transmitted through direct body contact, with the possibility of congenital transmission.

  • Stages of Syphilis: The disease progresses through four stages.

  • Serological Testing: A positive serology test typically appears during the secondary stage of syphilis.

Reporting Sexually Transmitted Infections

  • Legal Compliance: STIs must be reported to the local public health agency as per state and local laws.

  • Current Reportable Diseases: Among others, syphilis, gonorrhea, and chlamydia are reportable diseases as per the CDC public health guidelines. Requirements may vary by state for reporting other STIs.

Transmission of Sexually Transmitted Infections

  • Primary Transmission Routes: STIs are primarily passed through intimate contact such as genital to genital, mouth to genital, or genital to rectum contact.

  • Bloodborne Infections: Infections like HIV and hepatitis B and C may also transmit through blood contact.

  • Vertical Transmission: Bloodborne infections can transmit to a fetus before birth.

  • Possible Routes: Includes sexual intercourse, oral-genital contact, infected blood exposure, and contact with infected bodily fluids as potential transmission routes.

Factors for the Rise of STIs

  • Contributing Factors: Rising STI numbers have been linked to an increase in sexually active teenagers, the opportunity for multiple partners, inadequate knowledge about STI signs and symptoms, and reluctance in reporting diseases.

Prevention of STIs (1 of 2)

  • Early Education: Essential for adolescents to understand STIs.

  • Counseling for At-risk Populations: Direct education and counseling for those at risk of STIs.

  • Identification: A critical component is identifying asymptomatic and symptomatic individuals who are unlikely to seek treatment.

  • Effective Treatment: Effective diagnosis and treatment for infected individuals form a cornerstone of STI prevention.

Prevention of STIs (2 of 2)

  • Partner Evaluation: Evaluation, treatment, and counseling of sexual partners of infected individuals are crucial to break the transmission cycle.

  • Vaccination: Pre-exposure vaccination for individuals at risk of vaccine-preventable STIs is a key preventive measure.

  • Follow-Up: Ongoing follow-up of at-risk patients or those undergoing treatment is necessary to ensure continuous care and monitoring.