common STI's

COMMON SEXUALLY TRANSMITTED INFECTIONS SEEN IN THE MEDICAL SURGICAL NURSING SETTING

OVERVIEW

• Comprehensive sexual history taking
    - Gonorrhea
    - Chlamydia
    - Syphilis

COMPREHENSIVE SEXUAL HISTORY

• Importance of taking a routine sexual history to learn about patient’s sexual health and behavior.

• Should be taken from all adolescent and adult patients without regard to gender, race, ethnicity, socioeconomic status, sexual orientation, or gender identity.

SET THE STAGE

• Bring up sexual history as part of overall history:
    - Explain that questions are asked of all patients.
    - Ensure confidentiality.

BEGIN WITH THREE SCREENING QUESTIONS

1. Have you been sexually active in the past year?

2. Do you have sex with men, women, or both?

3. How many people have you had sex with in the past year?

THE PROCESS

For Multiple Partners or New Partner

• Ask about:
    - STD/HIV protection
    - Partners
    - Substance use
    - History of STDs
    - Trauma/violence
    - Pregnancy plans/protection
    - Sexual function and satisfaction
    - Other concerns

For Long-Term Monogamous Partner

• Ask about:
    - Pregnancy plans/protection
    - Trauma/violence
    - Sexual function and satisfaction
    - Other concerns

For Not Sexually Active

• Ask about:
    - Past partners (if patient is new)
    - Any questions or concerns

FOLLOW UP AS APPROPRIATE

• Example actions:
    - STD and HIV testing
    - Counseling and education
    - Referrals

WHO NEEDS SCREENING DUE TO HIGHER RISK?

• Younger individuals or those who initiated sex at a young age

• Multiple sex partners, especially if new partner in last 60 days

• Inconsistent condom use

• History of past STIs

• IV drug use or substances used during sex

• Presents with drainage or genital ulceration

• Men who have sex with men (MSM)

• Trans patients

GATHERING SOCIAL AND SEXUAL HISTORY

1. Greet your patient and discuss confidentiality:
     - Introduce yourself, including your name and pronouns
     - Discuss limits of confidentiality
     - Confirm the name/pronouns you can share

2. Transition into gathering a social history:
     - Explore sexual orientation, living with HIV, gender identity, and relationship status
     - Ask about safety in relationships and previous negative healthcare experiences

3. Transition into gathering a sexual history:
     - Reassure about confidentiality
     - Inquire about sexual activity in the last six months and interest in being sexually active
       - Number of partners, new partners, etc.
     - Discuss sexual health conversations with partners and HIV/STI testing history
     - Discuss toys used and cleaning practices
     - Explore future family plans

THE FIVE P'S OF SEXUAL HISTORY

• The Centers for Disease Control and Prevention (CDC) has developed a simple categorization of topics:
    - Partners
    - Practices
    - Past History of STDs
    - Protection from STDs
    - Pregnancy Plans

EDUCATION ON HIV AND STD PREVENTION

• Important points for patients:
    - Low likelihood of transmitting HIV through oral sex, but still possible to contract STDs
    - Sharing sex toys without protection can transmit STDs
    - Condoms significantly reduce STD risk, though do not provide complete protection
    - Condoms should still be used even if both partners are HIV positive to prevent STD transmission and superinfection
    - Having an STD increases the risk of contracting HIV

CHLAMYDIA

CHLAMYDIA TRACHOMATIS

• Most common bacterial STI

• Highest prevalence in patients under 25 years old

• Most often asymptomatic

• Sites of infection vary by sex:
    - Cis-Female: Cervicitis, endometritis, salpingitis, PID
    - Cis-Male: Epididymitis, prostatitis
    - All patients: Urethritis, pharyngitis, proctitis

COMPLICATIONS & TREATMENT

• Possible complications include PID, tubal scarring, ectopic pregnancies, and infertility

• Treatment Plan:
    - Antibiotic therapy (Azithromycin or Doxycycline)
    - Patients and partners must abstain for 7 days
    - Notify partners of the infection

GONORRHEA

NEISSERIA GONORRHOEAE

• Gram-negative bacterium infecting the urethra, pharynx, genital tracts, and rectum

• Can become systemic or disseminated, which is less common in Chlamydia

• If diagnosed with Gonorrhea, co-treatment for Chlamydia is always recommended

CLASSIC CASES OF GONORRHEA

• Symptoms often include:
    - Sexually active female with green-colored vaginal discharge, possible shuffling gait to avoid pelvic pain, purulent discharge on the cervix
    - Sexually active male with penile discharge and dysuria; may report staining of underwear
    - Typically associated with history of new or multiple partners and inconsistent condom use

CLINICAL PRESENTATION BY SITE

• Cervicitis

• Urethritis

• Proctitis

• Pharyngitis

• Endometritis

• Salpingitis

• Epididymitis/Prostatitis

TESTING FOR GONORRHEA & CHLAMYDIA

• Nucleic Acid Amplification Testing (NAAT):
    - Highly sensitive
    - Can use urine or direct swab test from various sites
    - Preferred first void urine sample
    - Patients can be trained on self-swabbing

• Gram Stain & Culture:
    - Higher sensitivity in a hospital setting but more costly
    - Gram stain is particularly effective for diagnosing Gonorrhea

DISSEMINATED GONOCOCCAL INFECTION

• DGI occurs when Neisseria gonorrhoeae invades the bloodstream

• Symptoms include septic arthritis, polyarthralgia, tenosynovitis, and skin lesions

• Treatment involves IV antibiotics and management of complications

SYPHILIS

TREPONEMA PALLIDUM

• High-risk groups for infection include MSM, HIV co-infection, presence of genital ulcer, and IV drug users

• Treatment and symptoms vary by stage:
    - Primary Stage:
      - Painless chancre that heals in 6-9 weeks untreated
      - Well delineated with indurated margins
    - Secondary Stage:
      - Infectious white papules in moist areas (Condyloma Lata)
      - Maculopapular rash on palms and soles (painless)
    - Latent Stage:
      - Asymptomatic yet still tests positive
      - Typically lasts over two years
    - Tertiary Stage:
      - Neurosyphilis, soft tissue tumors, aneurysms, valve damage

• Treatment:
    - Penicillin IM (dose and length vary by stage)
    - For PCN allergic patients: doxycycline, tetracycline, or Ceftriaxone for neurosyphilis

• Testing:
    - RPR and VDRL are blood tests used for diagnosis and monitoring treatment effectiveness.