Adult Medical-Surgical Nursing Reproductive Health Module: Sexually Transmitted Diseases 2: Chlamydia Genital Herpes

Chlamydia trachomatis

Chlamydia: Description A sexually transmitted infection caused by the bacterium chlamydia trachomatis which lives as a parasite within cells Requires host cell for invasion, intracellular growth and replication (property in common with viruses) Infects cervix, fallopian tubes in women and the urethra of men Co-infection with Neisseria gonorrhoeae is often found, requiring treatment for both

Chlamydia: Transmission Sexual intercourse Anal and oral sex Infected secretions pass from hand to eye Vertical through vaginal delivery: Leads to chlamydial conjunctivitis/ chlamydial pneumonia A leading cause of blindness in developing countries

Chlamydia: Prevention Use of condoms Avoid high risk sexual behaviour Avoid spreading sexual fluids into eyes

Chlamydia: Clinical Manifestations Often symptomless Dysuria and cystitis Symptoms of pelvic inflammatory disease: Lower abdominal pain Low back pain Irregular menses Mucopurulent vaginal discharge Chlamydia urethritis in men

Chlamydia: Diagnosis Patient history and clinical picture Fluorescent antibody examination of direct cervical smear Chlamydia is an intra-cellular organism not in cervical discharge: Swab placed and rotated just inside cervix to obtain cells. Urethral swab in men Enzyme immunoassay (EIA)

Chlamydia: Complications Pelvic inflammatory disease (PID) which risks: Infertility Ectopic pregnancy Male infertility Chlamydia conjunctivitis (also in newborn) Chlamydia pneumonia of newborn

Chlamydia: Treatment Antibiotic doxycycline or azithromycin. (Also ciprofloxacin or cephtriaxone if gonorrhea) Take advice if pregnant. May need Caesarean Section Avoid sexual contact: allows healing and prevents transmission Follow-up and treat partner/ sexual contacts with antibiotic course also Repeat chlamydia smear 2 weeks following completion of antibiotics Follow-up screen for HIV, HBV, syphilis

Chlamydia: Nursing Considerations Health education especially to adolescent target group related to: At risk practices and safer sex Importance of early diagnosis to prevent transmission, PID and complications Importance of compliance to prevent transmission (psychological support) Correct smear procedure for diagnosis

Genital Herpes

Genital Herpes: Description A sexually transmitted infection of the herpes simplex virus type 2 (HSV-2) A recurrent life-long infection causing herpetic lesions (blisters) on the cervix, vagina, external genitalia

Genital Herpes: Transmission Sexual contact Close human contact by mouth, oropharynx, mucosal surface, vagina, cervix (warm, moist environment) Skin lacerations, conjunctivae May be transmitted asexually or by self-transmission from a “cold sore” to genitalia Vertical to newborn at vaginal delivery

Herpes Virus: Classification Six Herpes viruses are known to affect humans: Herpes simplex type 1 (HSV-1): face and mouth “cold sores” Herpes simplex type 2 (HSV-2): genital herpes Varicella zoster (shingles) Epstein-Barr virus Cytomegalovirus (CMV) Human B-lymphotrophic virus

Genital Herpes: Pathophysiology Following entry of virus inflammatory blisters form in area Virus is killed at room temperature by drying When viral replication diminishes virus rests in ganglia of peripheral sensory nerves Reactivated when host subject to stress: life-time recurrent infection

Genital Herpes: Clinical Manifestations Itching and pain of affected genital area Oedematous area and “herpetic lesions”: blisters which ulcerate then encrust Labia, vagina, perianal skin, penis, foreskin (rarely extra-genital spread) Influenza-like symptoms Swollen lymph nodes in groin Dysuria Vaginal or penile discharge

Genital Herpes: Complications High risk of transmission even when no symptoms Risk of vertical transmission to newborn Severe emotional stress from diagnosis Rarely extra-genital spread to buttocks, eyes, aseptic meningitis Increased risk of HIV infection and other sexually transmitted disease

Genital Herpes: Medical Management There is no cure for the condition Treatment aims at relieving symptoms and preventing spread Importance of hand-washing, sexual precautions Antiviral agents (acyclovir, famciclovir): Suppress symptoms and shorten inflammatory period. Also used to prevent recurrence

Genital Herpes: Nursing Considerations Emotional support for distressing condition Health education related to transmission of the virus: Lifestyle, sexual behaviour, antiviral medications Importance of hand-washing Advice about relief of symptoms: Analgesics, good hygiene, Sitz baths, loose clothing (avoid creams which prevent drying of lesions)