STDs Flashcards
Taking care of a person with STDs will include…
- taking a sexual history
- inspection of the genitalia
- admin of treatment and education about prevention of transmission
STD Incidence
- at epidemic level
- youth between ages of 15-24 and minorities have the highest incidence
STD impact of women
- STIs more easily transmitted from men to women (receiver of sexual fluid)
- Women experience fewer early symptoms of STIs
- At higher risk for PID genital cancers, and reproductive complications
- Adolescent females have a more vulnerable cervix
Other vulnerable populations
- infants
- adolescents of both sexes
- older adults
Risk factors for STDs
- sexual partners and behaviors
- age
- substance use
Prevention and control
- starts with screening
- CDC recommended assessment
- transmission of most STDs can be prevented by use of latex condoms
CDC recommended assessment
5 P’s:
- Partners
- Prevention of pregnancy
- Protection from STIs
- Practice
- Past hx of STIs
Once infected, control strategies include…
- avoid intercourse with infected partner
- use protection, if having intercourse with infected partner
- partner notification
Genital Herpes
(HSV)
-Caused by the herpes simplex viruses HSV-1 and HSV-2
Genital Herpes Pathophysiology
Gain entry via mucocutaneous surfaces.
Begins to multiply causing cell destruction and vesicle formation
Genital Herpes Manifestations
- May have no symptoms
- Painful red vesicles 2-14 days after exposure
- Small, painful blisters filled with clear fluid
- First outbreak average duration 10-20 days
- Recurrent infections 4-5 days
Genital Herpes Diagnosis and treatment
- Presumptive diagnosis
- No cure
Genital Herpes Pharmacologic Therapy
-Acyclovir (Zovirax)
Acyclovir (Zovirax)
- antiviral
- reduce the length and severity of each outbreak
- treatment of choice for genital herpes
- also used to suppress the virus, thereby decreasing the number of outbreaks
- oral form is most effective for the first episode and recurrences and is given for 7-10 days or until lesions heal
- can be given IV
Acyclovir (Zovirax) and HIV patients
evidence shows that some strains of HSV are becoming resistant to Acyclovir, particularly in HIV-positive patients.
Other antivirals used for treatment and suppression with Genital Herpes
- Valacyclovir (Valtrex)
- Famciclovir (Famvir)
HPV
Human Papillomavirus
- Genital warts
- most common genital infection in US
- women at greater risk
- Majority of infected individuals asymptomatic
HPV Pathophysiology
- HPV transmitted by vaginal, anal, oral-genital contact
- incubation period 2-3 months
HPV Manifestations
- some exhibit none
- others exhibit genital warts
HPV Diagnosis and treatment
- clinical appearance on physical examination
- regular screening, Pap tests
- identify precancerous lesions
HPV Pharmacologic therapies
- no drug to cure virus itself
- topical agents
- Gardasil, Cervarix vaccinations
HPV Topical agents
- Podofilox, imiquimod (client applied)
- Podophyllum, trichloroacetic acid (provider administered)
Chlamydia
- most commonly reported bacterial STI
- asymptomatic in most women
Chlamydia risk factors
- any sexually active individuals, especially females 14-19
- personal or partner hx
- cervical ectopy
- adolescent sexual activity
- oral contraceptives
- drug or alcohol use that increases risky sexual behavior
Chlamydia is the leading cause of…
preventable blindness
-newborns
Chlamydia pathophysiology
- Chlamydia trachomatis
- intracellular bacterium that resembles viruses in that it can reproduce only within a host cell
- enters body as an elementary body, a form which it is capable of entering uninfected cells
- infection begins when the organism enters a cell, becomes a parasite, and reproduces until the cell ruptures and about 1,000 new elemental bodies are disseminated to adjoining cells
Chlamydia Manidestations
- incubation period 1-3 weeks
- may be present for months, years
- still potentially infectious
Chlamydia complications
untreated:
- PID
- infertility
- ectopic pregnancy
Chlamydia Diagnostic Tests
- gram stain of discharge
- add nucleic acid hybridization test
- NAATs diagnostic method of choice
Chlamydia Pharmacologic Therapy
- Azithromycin, doxycycline
- both partners treated
Gonorrhea
- caused by Neisseria gonorrhoeae
- most common STI in the US
- “GC” or “the clap”
Gonorrhea Pathophysiology
pyogenic bacteria that causes:
- men: acute pain and inflammation of epididymis and periurethral glands
- women: PID, endometritis, salpngitis, pelvic peritonitis
Gonorrhea Manisfestations
Men: dysuria, serous, milky, purulent penile discharge
Women: dysuria, urinary frequency, abnormal menses. Increased vaginal discharge, dyspareunia
- Anorectal gonorrhea: pruritus, mucopurulent discharge, bleeding, pain
- Gonococcal pharyngitis
Gonorrhea Complications
- PID in women
- newborn: blindness, infection of joints, potentially lethal
- epididymitis, prostatitis in men resulting in infertility
- spread of infection to blood, joints
- increased susceptibility to, transmission of HIV
epididymitis
inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm
Collaboration for Gonorrhea
- eradication of organism
- prevention of reinfection or transmission
Diagnostic Tests for Gonorrhea
- Cultures
- Urinalysis
- Gram stain
- Tests for other STIs
Syphilis
- Complex systemic STI
- Treponema pallidum
Syphilis Pathophysiology
- break in skin, mucous membrane
- spread through blood, lymphatic system
- congenital syphilis
congenital syphilis
transferred to fetus through placental circulation
Syphilis Manifestations: Primary
- chancre, regional lymph node enlargement
- 3 to 4 weeks after infectious contact
- little or no pain
- highly infectious
Syphilis Manifestations: Secondary
- 6 weeks after initial chancre
- skin rash, mucous patches in oral cavity, sore throat
- generalized lympadenopathy, condyloma lata
condyloma lata
flat, broad-based papules, unlike the pedunculated structure of genital warts
Syphilis Manifestations: Latent and tertiary
- 2 or more years after initial infection
- sexual transmission is possible in latent syphilis
- two types: benign late syphilis and diffuse inflammatory response
Syphilis Diagnosis and treatment
- Venereal Disease Research Laboratory (CDRL)
- FTA-ABS confirmatory
Venereal Disease Research Laboratory (VDRL) & RPR
blood tests that measure antibody production
-rapid plasma reagin
FTA-ABS confirmatory
fluorescent treponema antibody absorption
- specific for T. pallidum and can be used to confirm VDRL and RPR findings
- used when clinical presenting syphilis, but negative VDRL
Pharmacologic Therapies for Syphilis
- PCN G
- IM in single dose: treatment may result in Jarisch-Herzheimer rxn
PID
- caused by untreated STD
- serious condition
- infection of a woman’s reproductive organs
- often complication of chlamydia and gonorrhea
- no tests for PID, usually diagnosed based on medical hx, physical exam.
- may not have symptoms
- if you do, pain in lower abdomen, fever, unusual discharge with a bad odor from vagina, pain/bleeding during sex, burning when pee, bleeding between periods
Can PID be cured?
yes, if diagnosed early, it can be treated.
won’t undo any damage that has already happened to your reproductive system
What happens if PID is not treated?
- formation of scar tissue both outside and inside the fallopian tubes that can lead to tubal blockage
- ectopic pregnancy
- infertility
- long term pelvic/abdominal pain
Nursing Process with STD
- Short and long term implications
- Symptom relief
- Treatment
- Prevention of further transmission
- Additional screening if condition is chronic
Nursing Assessment with STD
Focused interview:
- Data collection: sexual practices, health hx, info about genital areas, reproduction, sexual activity
- Physical assessment: reports of pain, discharge, inflammation
Nursing Diagnoses associated with STD
- acute pain
- sexual dysfunction
- deficient knowledge
Planning with STD
Patient:
- describes strategies for reducing risk,
- develops plan to communicate with sexual contacts,
- abstains from sexual activity until STI resolved, -takes appropriate actions to avoid infecting others
*Pain is controlled to a tolerable level
Implementation: Relieve Acute Pain
Relieve acute pain
- oral analgesics
- teach client to keep HSV blisters clean, dry
- dysuria, suggest pouring water over genital while urinating
- suggest use of sitz baths 15-30 minutes
Implementation: Sexual Dysfunction
- Provide supportive, nonjudgmental environment
- discussion of feelings, asking questions
- offer information, referrals
Implementation: Discuss Disease Management
- recognize prodromal symptoms of recurrence
- need for abstinence (from prodromal symptoms until lesions healed)
- use of topical acyclovir
- use of latex condoms due to viral shedding at any time
- need for handwashing
- culture and sensitivity performed on infected lesions
- need to discuss infection with partner
Evaluation
- client has resolution of STI
- Client explains strategies to prevent infection of others
- Client abstains from sexual activity until STI treated
- Client describes barrier methods to reduce risk of contracting STI
