STDs

Sexually Transmitted Infections (STI)

Overview

  • Speaker: Diane Robillard, DNP, RN

  • Course: NURS 3805

  • Date: 3/13/2026

  • Chapter 57

Learning Objectives

  • Summarize the nursing role in the prevention and control of STDs.

  • Describe nursing management for patients who have STDs.

  • Explain care and treatment for the following STIs:

    • Gonorrhea

    • Syphilis

    • Chlamydia

    • Genital herpes

    • Genital warts

  • Understand implications of STIs across the lifespan.

Testing for STIs

  • Methods of Testing:

    • Physical Examination: Inspection and palpation are used to assess signs of STIs.

    • Genital or rectal swab: Collecting samples of discharge for laboratory analysis.

  • Patient Education:

    • Emphasize that STI damage cannot always be reversed.

Statistics

  • Each year, there are approximately 26 million cases of STIs reported in the United States.

  • Discussion Points: Why is this number high? Assess the efficacy of current STD programs and condom use.

  • Importance of informing and educating patients about the risks and preventive measures.

CDC Treatment Guidelines

  • The Centers for Disease Control and Prevention (CDC) provides authoritative treatment guidelines for STIs.

Types of STIs

Bacterial STIs

  • Examples:

    • Gonorrhea

    • Syphilis

    • Chlamydia

  • Treatment: Generally curable with appropriate antibiotics.

Viral STIs

  • Examples:

    • Genital Herpes

    • Genital warts (HPV)

    • HIV

  • Treatment: Typically involves management and control, not a cure.

Nursing Management

Preventive Measures

  • Employ strategies to prevent infection in patients, which include:

    • Educating patients to inspect their partner’s genitals.

    • Suggesting urination immediately after intercourse may provide some protection.

    • Encouraging washing of genitalia and exposed areas with soap and water after sexual activity.

    • Ensuring proper use of condoms for all sexual partners.

Nursing Assessment

  • Objective Data to collect:

    • Fever

    • Visual assessment for lesions, warts, or rash

    • Purulent discharge from any openings

    • Signs of inflammation around openings

    • Relevant laboratory findings

Nursing Diagnosis and Planning

  • Risk for infection

  • Anxiety related to the diagnosis

  • Ineffective health maintenance due to lack of knowledge regarding STIs

  • Patient goals include:

    • Demonstrating understanding of transmission modes and risks

    • Completing treatment and follow-up protocols

    • Notifying or assisting in the notification of sexual contacts

Gonorrhea

  • Incubation Period: 3-8 days

  • Bacterial Characteristics:

    • Second most frequently reported STI.

    • Killed easily with washing.

    • Direct physical contact can transmit infection.

    • Present in genitalia, rectum, and oropharynx.

  • Treatment Recommendations:

    • CDC Guidelines:

    • Start treatment without waiting for culture results.

    • First-line regimen includes:

      • Ceftriaxone 250 mg IM in a single dose or cefixime PO PLUS

      • Azithromycin 1 g orally in a single dose

  • Important Consideration: Ensure treatment of sexual partners.

  • Prophylactic Treatment for Neonates:

    • Erythromycin ophthalmic ointment administered to prevent ocular gonorrhea.

Syphilis

  • Pathogen: Treponema pallidum

  • Transmission: Enters through skin or mucous membrane breaks.

    • Congenital syphilis can occur after the 10th week of pregnancy, leading to neonatal death or fetal demise.

  • Progression of Syphilis:

    • Without treatment, can progress through stages:

    1. Primary Syphilis: Incubation 10-90 days.

    2. Secondary Stage: Symptoms include flu-like indicators like fever, sore throat, headaches, fatigue, and generalized adenopathy.

    3. Tertiary Stage: Most severe complications, such as gumma (infectious granuloma).

  • Drug Therapy for Syphilis:

    • Benzathine penicillin G (Bicillin) or penicillin G for all stages.

    • Recurring or persistent symptoms should be retreated.

    • Required treatment of all sexual partners within the last 90 days.

Chlamydia

  • Pathogen: Chlamydia trachomatis

  • Incidence: Most commonly reported STI, higher rates in women.

  • Incubation Period: 1-2 weeks, often asymptomatic at onset.

  • CDC Recommendation: Routine testing for women under 26 years.

Genital Herpes

Characteristics

  • Not usually reported; commonly caused by HSV-1 and HSV-2.

  • Prevalence: 1 in 6 Americans aged 14-49.

  • Highest risk of neonatal transmission occurs near delivery time.

Collaborative Care

  • Diagnosis based on symptoms and cultures.

  • Symptomatic Care:

    • Focus on pain relief.

    • Recommendations include:

    • Maintaining genital hygiene

    • Wearing loose-fitting cotton underwear

    • Keeping lesions clean and dry

    • Sitz baths for discomfort management

    • Abstaining from sexual activity during lesion outbreaks

  • Antiviral Drugs:

    • Used to manage outbreaks and reduce transmission rates.

Genital Warts

Characteristics

  • Caused by Human Papillomavirus (HPV).

  • Collaborative care focuses on treatment to prevent transmission and removal of visible warts.

HPV Vaccination

  • Vaccination can prevent infection from several high-risk HPV types.

  • Impact of HPV Vaccination:

    • Evidence shows reduction in HPV infections post-vaccination:

    • 88% drop in infections among teen girls since vaccine introduction in 2006.

    • 81% drop in young adult women.

    • Studies from Scotland indicated no cases of invasive cervical cancer in women vaccinated by age 14, and lower cervical cancer rates in women vaccinated between ages 14-22 compared to unvaccinated counterparts.

Case Study

  • Patient Profile: A 26-year-old presents with small wart-like growths on the labia and perineum.

  • History: Engaged in sexual encounter 3 months prior with a male partner claiming his genital bump was "nothing to worry about".

  • Key Questions:

    1. What is the primary concern regarding the patient's presentation?

    2. What specific questions should the nurse ask to gather more information?

    3. What treatment options are available if the infection is confirmed?

Summary

  • Importance of Nursing Roles: Critical in educating, diagnosing, and managing STIs, and in preventing further transmission.

  • Patient Empowerment: Teaching patients about prevention, risk factors, and treatment adherence is imperative for better health outcomes.