Nursing Care of the Client: Sexually Transmitted Diseases ( STDs )

1. Nursing Care of the Client: Sexually Transmitted Diseases (STDs)

2. What are STDs? • STDs are infections that are spread from person to person through intimate sexual contact. • STDs are dangerous because they are easily spread and it is hard to tell just by looking who has an STD. • 1 in 4 sexually active teens has an STI. • Also known as venereal disease.

3. BACTERIA Chlamydia Gonorrhea Syphilis Chancroid Lymphogranuloma venereum Genital mycoplasmas Group B streptococci PROTOZOA Trichomoniasis STDs is • VIRUSES • Humanimmunodeficiency virus • Herpessimplex virus, types I and 2 • Cytomegalovirus • Viral hepatitis A and B • Humanpapillomavirus • PARASITES • Pediculosis (may or may not be sexually transmitted) • Scabies (may or may not be sexually transmitted)

4. PREVENTION • Preventing infection (primary) • Prompt diagnosis and treatment of current infections (secondary)

5. Prevention • Change of behavior • Prevention counseling: • Identification of risk factors (sexual history and behavior, drug-related risk, blood-related risk) • Techniques for effective counseling (using open-ended questions, using understandable language, and reassuring the woman that treatment will be provided regardless of consideration such as ability to pay, language spoken, or lifestyle)

6. Prevention • Safer sex practices • Knowledge of partner • Condom use • Male compliance • Negotiation of use • Storage • Abstinence of activities with fluid exchange

7. Common Symptoms for Female Some symptoms you may have are: • Sores, bumps or blisters near your genitals, anus (butt hole) or mouth • Burning or pain when you urinate (pee) • Itching, bad smell or unusual discharge from your vagina or anus (butt hole) • Bellyache (pain in your lower abdomen) • Bleeding from your vagina between your menstrual periods • Remember: Sometimes symptoms don't show up for weeks or months or years.

8. Common Symptoms for Male Some symptoms you may have are: • Sores, bumps or blisters near your genitals, anus (butt hole) or mouth • Burning or pain when you urinate (pee) • Drip or discharge from your penis • Itching, pain or discharge from your anus (butt hole) • Remember: Sometimes symptoms don't show up for weeks or months.

9. Bacterial Sexually Transmitted Infections

10. Chlamydia trachomatis

11. Chlamydia trachomatis • Most common and fastest spreading STI • Infections are often silent and highly destructive • Difficult to diagnose

12. Chlamydia trachomatis • Risk factors • Age (younger than 20 years) • Early onset of sexual activity • Multiple partners • Nonuse of barrier methods of birth control

13. Chlamydia trachomatis • Transmittal • Genital to genital • Oral to genital • Anal to genital • Vagina to rectum • Mother to newborn Infectivity: people can infect other when they have symptoms & some times when they do not, the partner is infected in approximately 33% of the sexual contacts with an infected partner

14. Chlamydia trachomatis • Untreated infectious lead to: • males- inflammation of testicles, infected prostate, infertility • females – acute salpingitis, pelvic inflammatory disease, ectopic pregnancies tubal infertility, cervical ulcaration increase risk of acquiring HIV infections • fetus/newborns – conjunctivitis, pneumonia, death, eye & ear infections

16. Chlamydia trachomatis • Symptoms: • males - 1-25% show no symptoms; watery or milky discharge from penis, burning sensation upon urination: • females - 70% show no symptoms; mucoid or purulent vaginal discharge &/or bleeding (postcoital), dysuria, abnormal cramping, abdominal pain, fever, painful urination. • Oral - sore throat • Rectal - inflammation, itching • Incubation: 1 to 4 weeks

17. Chlamydia trachomatis – Symptoms (Woman) In prepubertal girls, chlamydia it can cause a mild vaginal discharge and odor (called vaginitis); in postpubertal women it can cause an off-white discharge and odor which comes from an infected cervic. In women, it can be especially dangerous because it can silently linger for months and progress to Pelvic Inflamatory Disease (PID. which can lead to infertility, chronic pain, and even death. • Even babies can get this infection: one half of all babies being delivered through the birth canal of an infected women will develop a Chlamydial conjunctivitis (pink eye) a week after birth. About a quarter of babies passing down the infected birth canal will get a Chlamydia pneumonia.

18. Chlamydia trachomatis – Symptoms (Men) • Chlamydia symptoms in men:50% of men have no symptoms • Swollen and tender testicles Pain or burning during urination • Pus (discharge from the penis)

19. Chlamydia trachomatis • Screening • asymptomatic women at high risk in whom infection would otherwise go undetected • sexually active adolescents, • women between ages 20 and 25 years, • women older than 25 years who do not use barrier contraceptives, • women older than 25 years with new or multiple partners. • women with two or more of the risk factors for chlamydia should be cultured. • all pregnant women at the first prenatal visit and in the third trimester (36 weeks) if the woman was positive previously or if she is younger than 25 years or has a new sex partner or multiple sex partners.

20. Chlamydia trachomatis • Diagnosis is by • culture (expensive and la­bor intensive), • DNA probe (less expensive but less sensi­tivity), • enzyme immunoassay (less expensive but less sen­sitivity), • nucleic acid amplification (expensive but about 90% sensitivity) • Obtain culture • to remove mucus and discharge from the cervical os. • the cervix should be swabbed with cotton or rayon swabs • contains many endocervical (columnar) cells

21. Chlamydia trachomatis • Treatment: • Doxycycline, 100 mg orally twice a day for 7 days • Azithromycin, 1 g orally once • Pregnant female • Erythromycin base, 500 mg orally qid for 7 days • Amoxicillin, 500 mg orally TID for 7 days

22. Chlamydia trachomatis • All exposed sexual partners should be treated. • Woman treated with doxycycline or azithromycin do not need to be retested unless symptoms continue. • Women treated with erythromycin may be retested 3 weeks after completing the medication

23. Gonorrhea

24. Gonorrhea • aerobic, gram-negative diplococci, N. gonorrhoeae • Oldest communicable disease • Drug-resistant • Penicilinase-producing

25. Gonorrhea • Transmittal • Genital to genital • Oral to genital • Anal to genital • Vagina to rectum • Mother to newborn • Incubation: 2 to 7 days • Result • pelvic inflammatory disease (PID) • Infertility • ectopic or tubal pregnancy • blockage of urethra, problems with erection

26. Gonorrhea • Symptoms: • males - discharge of pus from penis, burning sensation upon urination, blood in urine & around 10% show no symptoms especially with the first infection

27. Gonorrhea • Females symptoms Asymptomatic Purulent endocervical discharge Menstrual irregularity Pelvic pain Painful menses Dysuria

28. Gonorrhea • Rectal • Profuse purulent discharge • Rectal pain • Blood in the stool • itching, • fullness • Pressure • oral - sore throat & swollen glands

29. Gonorrhea • Pregnancy • Premature rupture of membranes • Preterm birth • Chorioamnionitis • Neonatal sepsis • Intrauterine growth restriction • Maternal postpartum sepsis

30. Gonorrhea • Newborn • Ophthalmia neonatorum

31. Gonorrhea • Screening • Allwomen • All pregnant at first prenatal visit • Infected oa with risky behaviors – at 36 weeks • Diagnosis • Cultures with selective media are considered the gold standard for diagnosis of gonorrhea. • Cultures should be obtained from the endocervix, rectum, and when indicated, the pharynx. • should have a chlamydial culture and serologic test for syphilis

32. Gonorrhea • Treatment: • Ceftriaxone, 125 mg IM once • Ciprofloxacin, 500 mg orally once • Ofloxacin, 400 mg orally once • Levofloxacin, 250 mg orally once PLUS Azithromycin, 1 g orally once • Doxycycline, 100 mg orally bid for 7 days • Pregnant • Ceftriaxone, 125 mg IM once • If cephalosporin allergic Spectinomycin, 2 g IM once • PLUS • Erythromycin base, 500 mg orally qid for 7 days or Amoxicillin, 500 mg orally tid for 7 days • Lacting • Ceftriaxone, 125 IM once • If cephalosporin allergic, Spectinomycin, 2 g IM one PLUS • Erythromycin base, 500 mg orally qid for 7 days orAmoxicillin 500 mg orally tid for 7 days

33. Syphilis Treponema pallidum

34. Syphilis • T. pallidum, a motile spirochete • Transmission by entry in subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse • Also transmitted through kissing, biting, or oral-genital sex • Transplacental transmission may occur at any time during pregnancy

35. Syphilis • Can lead to serious systemic disease and even death • Infection manifests itself in distinct stages • Primary • Secondary • Tertiary

36. Syphilis • Incubation: • primary stage - 10 to 70 days, 21 days in most people; • secondary stage - weeks to a year; • late stage – years

37. Primary Syphilis: • SymptomsApproximately 5-90 days after sexual contact with an infected, contagious partner, a chancre (a painless papule which than eroded to form a nontender, swallow, indurated, clean ulcer with well-defined edges and an inflamed base up to 1 cm in diameter) appears at the site of the microbe’s entry. • The chancre is typically painless (this is in contrast with genital herpes which causes painful ulcers). • There may be associated swollen lymph nodes (small painless lumps that are centers of immune system activity) in the inguinal region (groin). It is contact with such a syphilitic chancre that the infection is transmitted. This initial chancre routinely heals itself spontaneously within three to eight weeks.

38. Primary Syphilis

39. SecondarySyphilis • SymptomsIf syphilis is left untreated, the infection will evolve and manifest itself, from 6 weeks to 6 month after the primary stage, with a widespred, systemic maculopapular rash on the palms and soles, and generalized lymphadenopathy, some times with fever, fatigue, headaches and muscular aches and pains. • If left untreated, these symptoms will resolve on their own…but the infectious microbe remains behind. It is at this point that syphilis passes into its latent phase.

40. Secondary Syphilis

41. Tertially Syphilis • SymptomsAfter many years, even as long as ten to thirty years, syphilis may progress to the point where it may result in serious organ system complications including skin, bone and vital nervous system or cardiovascular system maninfestations.

42. Tertial Syphilis

43. Tertiary syphilis

44. Syphilis • Screening • Pregnant women (primary visit, late trimester) • All women who diagnosed STI OR HIV • Diagnosis • serologic tests • Nontreponemal • VDRL (Veneral Disease Reserch Laboratories) • RPR (rapid plasma reagin) • Treponemal • FTA-ABS (Fluorescent treponemal antibody absorbed) • MHA-TP (microhemagglutination assay for antibody to T. Pallidum)

45. Syphilis • Management Nonpregnant • Primary, secondary, early latent disease • Benzathine penicillin G, 2.4 million units IM once • Late latent or unknown duration disease: • Benzathine penicillin G, 7.2 million units total, administered as three doses, 2.4 million units each, at 1-wk intervals • Penicillin allergy: • Doxycycline, 100 mg orally qid for 14 days or • Tetracycline, 500 mg orally qid for 14 days

46. Syphilis • Management pregnant • Primary, secondary, early latent disease • Benzathine penicillin G, 2.4 million units IM once • (Some experts recommend a second dose of benzathine penicillin, 2.4 million units, 1 wk later) • Late latent or unknown duration disease: • Benzathine penicillin G, 7.2 million units total, administered as three doses, 2.4 million units each, at 1 - wk intervals • Penicillin allergy: • No proven alternatives to penicillin in pregnancy. Pregnant women who have a history of allergy to penicillin should be desensitized and treated with penicillin

47. Syphilis • Management Lacting • Primary, secondary, early latent disease: • Benzathine penicillin G, 2.4 million unit IM once (Some experts recommend a second dose of benzathine penicillin, 2.4 million units, 1 wk later)Primary, secondary, early latent disease

48. Pelvic inflammatory disease (PID)

49. Pelvic inflammatory disease • Results from ascending spread of microorganisms from the vagina and endocervix to the upper genital tract • Involves: • the uterine tubes (salpingitis), • uterus (endometritis), • and more rarely, the ovaries • peritoneal surfaces • Cause • Multiple organisms • most cases are associated with more than one organism. • N. gonorrhoeae (In the past) • C. trachomatis (now 50%). • Type • Acute • Subacute • chronic

50. Pelvic inflammatory disease • Risk factors • young age, • multiple partners, • history of STIs. • IUDs • abortion • pelvic surgery • childbirth