Care of Patients with Sexually Transmitted Infections

1. Care of Patients with Sexually Transmitted Infections P. Maloney MSN/ED RN

2. Sexually Transmitted Infection • Sexually Transmitted Infection (STI) or (STD)-refers to those particular infections that are spread by intimate physical contact. • Mode of transmission include: sexual intercourse and contact with the genitals, rectum or mouth.

3. STI’s • Incidence: • Continues to rise throughout the world. • All sexually active people are at risk. • High Risk: • People with multiple sexual partners. • Adolescents and young adults.

4. STI’s What safe sex practices can help prevent the spread of STI’s?

5. STI’s • Healthy People 2020 has a goal to increase efforts to “promote responsible sexual behaviors, strengthen community capacity and increase access to quality services to prevent STI’s and their complications.” • Also, “prevent HIV infection and its relatedillness and death.

6. Common Infections Of The Female Reproductive System

7. Pelvic Inflammatory Disease • (PID)-refers to any inflammation of the pelvic cavity. • Salpingitis-infection located in the fallopian tubes. • Oophoritis-infection in the ovaries. • Peritonitis-infection in the pelvic peritoneum. The organism that causes the infection is introduced from the outside, then travels through the uterus then infects the pelvic organs.

8. PID Causes: • Usually caused by 2 sexually transmitted organisms; Neisseriagonorrhoeae and Chlamydia trachomatis. • PID is more common in sexually active women and women with multiple sexual partners. • Most common complication is infertility due to fallopian tube damage.

9. PID Acute PID Symptoms: • Severe abdominal pain • Fever • Foul-smelling purulent vaginal discharge • Woman appears acutely ill Acute PID is treated with IV antibiotics, symptom relief, patient support and teaching.

10. PID Chronic PID Symptoms: • Bachache • Feeling of pelvic heaviness • Disturbance in menstruation Chronic PID is treated symptomatically.

11. Candidiasis • Yeast infection that is not considered a STI but an increase in Candidiasis in sexually active women can increase the risk of STI’s. • Candidiasis is caused by a change in the vaginal pH which allows the yeast-like fungus to grow. • Symptoms: itching, burning on urination, and a white, cheese-like discharge. • Treatment includes vaginal anti-yeast creams.

12. Bacterial Vaginosis • Occurs when normal lactobacillus in the vagina is replaced by Mycoplasmahominisor anaerobic bacteria. • Causes: vaginal tissue trauma, and douching. • Symptoms: grayish-white discharge that has a fishy odor. • Treatment is usually with clindamycin.

13. Prevention of HPV • The Centers for Disease Control (CDC) has recommended the Gardasil Vaccine for all girls and women between the ages of 9 and 26. • The vaccine is also recommended for boys, age 11 to 21. • Gardasil provides protection against strains 6 and 11 that cause genital warts, and against strains 16 and 18, that cause cancer.

14. Gardasil for boys

15. Gardasil • Three doses are required: • Second dose is given 2 months after the first. • Third dose is given 6 months later.

16. Lesions of Sexually Transmitted Infections • In men, lesions related to STI’s may appear: • Under the prepuce • On the head or the body of the penis • On the scrotum • Perineal area • Inner thighs

17. Lesions in Women • In women, lesions of Sexually Transmitted Infections can appear: • On the vulva • Vagina • Cervix • Perianal area • Inner thighs

18. Reporting STI’s • The CDC and local health authorities establish regulations for reporting STI’s. • In all parts of the US the following STI’s are reportable: • Syphilis Hepatitis B • Gonorrhea PID • Chlamydia HIV • Chanchroid AIDS • Lynphogranulomavenereum

19. Reporting STI’s When someone is diagnosed with an STI, the public health department is responsible for collecting the names of sexual partners so that they can be contacted and treated. Many people do not wish to give out this information. Professionals who deal with these issues regularly, such as public health nurses often receive special training to obtain an appropriate history.

20. Transmission Of STI’s STI’s are primarily transmitted by: • Some type of intimate contact; either genital to genital, mouth to genital or genital to rectum. • Occurs in both heterosexual and homosexual relationships. • HIV or Hepatitis B or C may be passed by blood contact , by sharing of contaminated needles.

21. Transmission of STI’s • Accidental transmission may occur to medical personnel via needle or sharps injuries. • Blood-borne infections may be transmitted to the fetus before birth.

22. Diagnostic Tests • Non-invasive diagnostic tests have been developed that use urine samples. • Smears and cultures taken directly from the site. • Biopsies and microscopic tissue samples from affected areas. • Blood tests.

23. Chlamydia trachomatis • Most common STI in the US. • Transmitted by direct sexual contact. • Affects both male and female. • May be passed on to the newborn during vaginal delivery.

24. Chlamydia Male Symptoms: • Often asymptomatic • Dysuria, frequency of urination • Watery, mucous-like discharge Diagnosis: cervical culture Treatment: 7 day course of antibiotics, such as doxycycline, floxin, or levaquin. A single dose of azithromycin 1gm po for patients who are non-compliant.

25. HPV Spread during sexual contact. Highly contagious. Warts are flat or raised, cauliflower-like growths on vulva, penis, perineal area.

26. HPV Diagnosis: biopsy, colposcopy, pap smear. Treatment: freezing, laser therapy, cryotherapy, surgical removal. Topical treatments for external warts. Inteferon is used for difficult cases.

27. Genital Herpes • Caused by Herpes simplex virus. • Highly contagious. • Spread by direct contact. • Invades nerve cells located near the site of the infection. • Some patients have frequent recurrences.

28. Genital Herpes • Symptoms: • Fever, headache, malaise, myalgia • Burning genital pain • Dysuria • Painful intercourse • Vesicles in genital areas

29. Genital Herpes Treatment: No known cure. Treatment with acyclovir, famciclovir (anti-virals) Encourage increased fluids to dilute urine for greater comfort. Contact precautions.

30. Gonorrhea • Easily transmitted by direct sexual contact. • Incubation period is 2-6 days after exposure. • Transmitted to the newborn during vaginal delivery.

31. Gonorrhea Symptoms: • Male-dysuria with frequency • Scant to copious purulent discharge from the penis • Unilateral testicular pain Female: • Burning on urination • PID • Vaginal discharge

32. Gonorrhea Diagnosis: confirmed by the presence of the causative organism, Neisseriagonorrhoeae, in a vaginal or urethral smear. Treatment: A single dose of ceftriaxone IM is the treatment of choice.

33. Hepatitis B • Caused by hepatitis B virus (HBV) • Transmission via sexual contact, blood contact, and to the fetus via the placenta in the infected mother.

34. Hepatitis B Symptoms: • Anorexia, malaise, vomiting, abdominal pain • Dark urine, jaundice, skin rashes, arthritis. • Acute infection may be asymptomatic. • Infection may be persistent and result in a chronic carrier state.

35. Hepatitis B • Diagnosis: • Serologic testing for HBV infection gives definitive diagnosis. • Treatment: • No specific treatment is available. • Hepatitis B vaccine is recommended for people at risk for exposure, including health care workers.

36. Human Immunodeficiency Virus (HIV) • Transmitted by intimate sexual contact with body secretions of an infected person or exposure to infected blood . • Transmitted from mother to newborn.

37. HIV Symptoms: • Initially, flulike symptoms, several weeks after exposure. • Antibodies appear in blood a few months to a year after exposure. • Latent period results in reduced immune function.

38. HIV Diagnosis: • Laboratory testing. • The FDA has approved a rapid test for HIV screening that provides results in less than 1 hr. • A positive rapid HIV test requires further testing for confirmation.

39. Syphilis • Spread by direct body contact. • Organism is Treponemapallidum-a spirochete that requires a warm, wet environment to survive. • Can be destroyed by plain soap and water. • Can penetrate intact mucous membrane.

40. Syphilis 3 Stages: Primary- (after a 3-wk incubation period) • A hard, painless sore (chancre), appears on the mucous membrane of the mouth or the genitals. • Chancre with spirochete is very contageous. • Spirochetes enter the bloodstream 3-7 days after infection and begin to multiply rapidly causing a bacteremia. • Symptoms disappear within 3-8 weeks.

41. Syphilis Chancre

42. Syphilis Secondary Stage: Occurs 6 weeks later. Symptoms vary May have generalized skin rash. Serology test is positive. Symptoms may disappear if disease enters the latent period.

43. Syphilis • Tertiary (late period 1-20 yrs after the infection) • Spirochetes have had access to all body tissues. • “Gumma”-a soft encapsulated tumor, appears on any organ causing neurologic symptoms.

44. Syphilis Rash

45. Syphilis Diagnosis: • VDRL and RPR Tests performed on blood or spinal fluid. Treatment: • Single-dose penicillin G or adequate blood levels of penicillin given over an 8-14 day period.

46. Trichomoniasis • Sexually transmitted disease. • Symptoms: • Pruritis • Frothy gray-green vaginal discharge • Dysuria • Treatment: Flagyl single 2g dose for woman and partner.

47. Physical Exam • Physical exam for STI’s involves exposure of the most private parts of the anatomy. • Usually performed by a health care professional and a nurse. • Nurse’s responsibility to provide appropriate draping and give the patient privacy.

48. Prevention • Early education of adolescents concerning abstinence programs and safe sex practices. • Education and counseling of people at risk. • Effective diagnosis and treatment of infected people. • Evaluation, treatment and counseling of sex partners of peole who are infected with an STI.

49. Community Care • Most communities have clinics that provide screening and treatment for STI’s. • Services may be low cost or no cost. • Health Department and organizations such as Planned Parenthood are 2 of the agencies that provide pamphlets, posters and classes.