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

2. Chlamydia trachomatis

3. 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

4. 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

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

6. 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

7. 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)

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

9. 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

10. 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

11. Genital Herpes

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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)