Timby/Smith: Introductory Medical-Surgical Nursing, 11/e Chapter 56: Caring for Clients With Sexually Transmitted Infections

Sexually Transmitted Infections Spread via sexual activity with infected person Significant public health problem Five most common AIDS, chlamydia, gonorrhea, syphilis, genital herpes, genial warts Easily cured (early, adequate treatment) Chlamydia, gonorrhea, syphilis Social, sexual, and biologic factors contribute to high incidence.

Question Is the following statement true or false? Three STIs are easily cured if caught early and treatment is completed as prescribed.

Answer True Rationale: Three STIs are easily cured if caught early and treatment is completed as prescribed. They are chlamydia, gonorrhea, and syphilis.

Epidemiology Study of the occurrence, distribution, and causes of human diseases Role of CDC: gathers statistics Reportable diseases Diseases not reportable by law: genital herpes, hepatitis B, venereal warts, etc. Women acquire STIs more often than men. Environmental conditions, trauma

Statistics Not Accurate The reported incidence of STIs is disproportionately higher in racial and ethnic minorities. This disparity may be the result of (1) limited access to healthcare, (2) poverty, (3) actual higher rate of disease occurrence, or (4) more reporting by public health clinics where many in these respective populations seek treatment.

Chlamydia Pathophysiology and Etiology: Chlamydia trachomatis Most common, fastest-spreading STI Spread by sexual intercourse, genital contact without penetration, transmission to infant during birth, autoinoculation Assessment Findings: Signs and Symptoms Sparse, clear urethral discharge; redness and irritation of infected tissue; burning on urination; women: lower abdominal pain; Men: testicular pain

Chlamydia—(cont.) Diagnostic Findings Microscopic examination Secretion cultures Concurrent infections Medical Management: antimicrobial drugs Nursing Management

Gonorrhea Pathophysiology and Etiology: Neisseria gonorrhoeae Facilitates HIV transmission Assessment Findings: Signs and Symptoms Skin rash, fever, painful joints Men: urethritis with purulent discharge, dysuria Women: white or yellow vaginal discharge, intermenstrual bleeding, dysuria

Gonorrhea—(cont.) Diagnostic Findings: microscopic or culture Tests Medical Management: antibiotics Complicated gonococcal infections Hospitalization; IV multiple-drug therapy; repeat antibiotic therapy Nursing Management

Question Is the following statement true or false? Gonorrhea is easily and quickly cured.

Answer False Rationale: While gonorrhea can be easily treated if caught early, treatment must be followed thoroughly and judiciously. Gonorrheal infections can be complicated, requiring hospitalization and multiple courses of parenteral IV antibiotics.

Syphilis Pathophysiology and Etiology: Treponema pallidum Three distinct stages Transmission from blood of infected person: directly from lesion; crossing placenta

Syphilis—(cont.) Assessment Findings: Signs and Symptoms Primary: genital, anal, cervical chancre Secondary: fever, malaise, rash, headache, sore throat, lymph node enlargement Tertiary: tabes dorsalis, ataxia, Charcot’s joints, cardiovascular complications Diagnostic Findings: microscopic examination of chancre, VDRL test, RPR, FTA-ABS test, CSF examination (if indicated)

Syphilis—(cont.) Medical Management Antibiotic therapy Penicillin G-IM; tetracycline; doxycycline Follow-up examinations and laboratory tests Nursing Management

Herpes Infection Pathophysiology and Etiology HSV–2: genital, perineal lesions HSV-1: cold sores; anogenital lesions Transmission: direct or sexual contact; autoinoculation Assessment Findings: Signs and Symptoms Vesicle(s) on penis, prepuce, buttocks, thighs, introitus, cervix; lesions; ulcers; swelling of inguinal lymph nodes; flulike symptoms; headache

Herpes Infection—(cont.) Diagnostic Findings: Microscopic Examination Medical Management: self-limiting Infection Antiviral drug therapy Nursing Management

Genital Warts Pathophysiology and Etiology: human papillomavirus (HPV) Transmission: genital–genital, genital–anal, or genital–oral contact; autoinoculation Uterine cervical abnormalities Assessment Findings: Signs and Symptoms Painless; appear as cluster of soft, fleshy growths on genitalia or cervix; in vagina; or on perineum, anus, throat, or mouth Application of vinegar; visual inspection

Question Is the following statement true or false? If vinegar is applied to lesions suspected of being caused by HPV, they will turn white.

Answer True Rationale: To easily confirm if a genital lesion is HPV, applying vinegar will cause it to turn white if it is, indeed human papillomavirus.

Genital Warts—(cont.) Medical and Surgical Management Limited infection: medication, chemical application Substantial infection: surgical excision, laser therapy, electrocautery, cryosurgery, parenteral administration of natural or recombinant interferon Nursing Management

Other Sexually Transmitted Infections Granuloma inguinale: Calymmatobacterium granulomatis (uncommon in United States) Characterized by lesions: genital, inguinal, anal areas Treatment: antimicrobials Chancroid: Haemophilus ducreyi bacillus Characterized by macule, vesicle–pustule formation, resulting in painful genital ulcer; enlarged, tender inguinal lymph nodes

Other Sexually Transmitted Infections—(cont.) Lymphogranuloma venereum: C. trachomatis Characterized by small erosion or papule, resulting in enlargement of adjacent lymph nodes, which can become necrotic Usual site of infection: genital area Treatment: doxycycline or erythromycin

Prevention Methods Abstain from sexual activities Monogamous sex Condoms Urinate after sexual intercourse Wash hands No unprotected sex

Condom Use Lubrication No natural membrane condoms Cool, dry place for storage Discard if expired Pinch space at tip Remove before penis is limp Disposal