Chapter 41: Sexually Transmitted Infections-Patho (final) http://thepoint.lww.com/Book/Show Level 3

A 31 year-old male was diagnosed with genital herpes of the HSV-2 type 5 years ago. He is now broaching the subject with a woman he has recently formed a relationship with. Which of his statements is most accurate?

"Even when I'm not having a recurrence, I could still pass the virus on to you." HSV transmission can occur both during and between recurrences. HSV-2 is associated more with genital herpes than cold sores, and cold sores do not provide antibody protection. -Prior contact with the virus does not confer immunity.

A patient was diagnosed with human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). The nurse realizes that the patient needs further teaching about the disease process based on which of the following statements made by the patient?

"HIV only infects B cells." The retroviruses such as HIV have a unique mechanism of replication. After entry into the host cell, the viral RNA genome is first translated into DNA by a viral enzyme called reverse transcriptase. The viral DNA copy is then integrated into the host chromosome where it exists in a latent state, similar to the herpes viruses. -Reactivation and replication require a reversal of the entire process. Some retroviruses lyse the host cell during the process of replication. In the case of HIV, the infected cells regulate the immunologic defense system of the host, and their lysis leads to a permanent suppression of the immune response.

A patient is diagnosed with granuloma inguinale. Which of the following questions should the nurse ask the patient?

"Have you traveled outside of the country recently?" Granuloma inguinale is caused by a Gram-negative bacillus Klebsiella granulomatis, which is a tiny encapsulated intracellular parasite. This disease is almost nonexistent in the United States but is found most frequently in tropical areas such as India, Brazil, the West Indies, and parts of China, Australia, and Africa

A female client is diagnosed with chlamydia during a routine pelvic examination. Which statement by the client indicates that the nurse's teaching about management of the disease has been effective?

"My partner will need to take antibiotics at the same time I do." Simultaneous antibiotic treatment of both sexual partners is recommended. Abstinence from sexual activity is encouraged to facilitate cure.

In a patient suspected of having gonorrhea with active symptoms, which of the following does the nurse tell the patient about confirming the diagnosis?

"Since you have discharge, we can perform a culture." Patients with active gonorrhea can have a culture performed. This is the gold standard, as -Gram stains are often unreliable. -Blood work is not necessary to confirm the diagnosis. -Sexual partners should be tracked for transmission purposes, but it is not necessary to speak to sexual partners before diagnosing the patient.

In teaching a patient about genital warts, which of the following statements is correct for the nurse to say?

"The incubation period is 6 weeks to 3 months." The incubation period for human papilloma virus-induced genital warts ranges from 6 weeks to 8 months with a mean of 2 to 3 months.

Which of the following is essential for the nurse to include in the care plan for a patient with herpes simplex virus-1 (HSV-1)?

"This disease is transmitted by oral secretions." HSV is transmitted by contact with infectious lesions or secretions. HSV-1 is transmitted by oral secretions, and infections frequently occur in childhood. -The patient does not need to wear a mask. -Hand washing helps to limit the spread of contaminated secretions; however, it does not prevent the spread of infection.

A client is diagnosed with trichomoniasis. Which of the following is appropriate for the nurse to tell the patient?

"We need to contact your sexual partners." Trichomoniasis is a vaginal infection that may be associated with sexual activity. It is the only form of vaginitis that is known to be sexually transmitted and requires partner treatment. The nurse should inform the patient that sexual partners should be notified for treatment. The other statements are not correct.

A male client is diagnosed with gonococcal urethritis. He tells the nurse he had recent sexual contact with a woman but states she did not appear to have any disease. Which of the following is the nurse's best response to the client?

"Women may not know they have gonorrhea because they may not have symptoms." People with gonorrhea may be asymptomatic and may unwittingly spread the disease to their sexual partners. Many women with gonorrhea are asymptomatic or have minor symptoms that are overlooked. The disease may affect both the genitals and the other reproductive organs and cause complications such as pelvic inflammatory disease (PID). -Women who can transmit the disease have active infections.

After inoculation with HPV, genital warts may begin to grow. They usually manifest as soft, raised fleshy lesions on the external genitalia of either male or female. What is the incubation period for HPV-induced genital warts?

6 weeks to 8 months The incubation period for HPV-induced genital warts ranges from 6 weeks to 8 months, with a mean of 2 to 3 months. The other answers are incorrect.

Within how many days it is important to test anyone who has had sex with an individual who tests positive for gonorrhea?

60 All sex partners within 60 days prior to discovery of the infection should be contacted, tested, and treated.

It is important to test anyone who has had sex with an individual tests positive for gonorrhea, within how many days of the diagnosis?

60 days All sex partners within 60 days prior to discovery of the infection should be contacted, tested, and treated.

Which of the following information is essential for a nurse to include in the teaching plan for a patient receiving metronidazole for trichomoniasis?

Abstinence is recommended until the therapy is completed. The patient should refrain from sexual activity until therapy with metronidazole is completed due to the risk of transmitting the parasite to sexual partners. The other statements are not true.

There is no known cure for genital herpes, and methods of treatment are often symptomatic. Pharmacologic management of genital herpes includes which drugs?

Acyclovir The antiviral drugs acyclovir, valacyclovir, and famciclovir have become the cornerstone for management of genital herpes. The other drugs are not used in the treatment of genital herpes

A client has been diagnosed with a chlamydial infection. Select the pharmacological treatment of choice.

Azithromycin The CDC recommends the use of azithromycin or doxycycline in the treatment of chlamydial infection; -penicillin is ineffective. -Azithromycin or amoxicillin is the preferred choice in pregnancy.

A client presents to the out-client clinic complaining of gray discharge that has a fishy odor. The health care provider sees "clue cells" on wet-mount microscopic exam. This would most likely lead to the diagnosis of:

Bacterial vaginosis The diagnosis of bacterial vaginosis is made when at least three of the following signs or symptoms are present: abnormal gray discharge, vaginal pH above 4.5 (usually 5.0-6.0), positive fishy odor of vaginal discharge on addition of 10% potassium hydroxide, and appearance of characteristic "clue cells" on wet-mount microscopic studies. -T. vaginalisis an anaerobic protozoan that is shaped like a turnip and has three or four anterior flagella. -Chlamydia exists in two morphologically distinct forms during its unique life—a small infectious elementary body and a large noninfectious reticulate body. -The diagnosis of syphilis can be made rapidly by dark-field microscopic examination of the exudate from skin lesions. However, the test is reliable only when a specimen with actively motile T. pallidum is examined immediately by a trained microscopist. It does, however, evoke a humoral immune response and production of antibodies that provide the basis for serologic tests

The nurse provides prophylactic treatment for a neonate to prevent conjunctival gonorrhea. The nurse is aware that the intervention will reduce the risk of:

Blindness Neonates are routinely treated with various antibacterial agents applied to the conjunctiva within 1 hour of birth to protect against undiagnosed gonorrhea and other diseases. Neonates born to infected mothers can acquire the infection during passage through the birth canal and are in danger of developing gonorrheal conjunctivitis, with resultant blindness, unless treated promptly.

A 20-year-old female comes to the clinic for an annual exam. She reports having unprotected sexual intercourse with several men over the last year. Blood tests reveal that she is positive for human papillomavirus. The nurse teaches the patient about which of the following complications that may occur because of the infection?

Cervical cancer Human papillomaviruses (HPVs), members of the papovavirus family, cause cutaneous and genital warts, and several genotypes are associated with cervical cancer. The first vaccine (Gardasil) to prevent cervical cancer, precancerous genital lesions, genital warts, and anal and oropharyngeal cancers due to HPV types 6, 11, 16, and 18 was developed in 2006.

A female client is found to have genital warts during a routine pelvic examination. Which of the following sexually transmitted diseases will the nurse prepare to test for?

Human papillomavirus Condylomata acuminata, or genital warts, are caused by the human papillomavirus (HPV).

Select the correct statement regarding Herpes simplex virus.

Only two strains of the virus are considered sexually transmittable. Herpes simplex infections are highly contagious. There are eight types of HSV; however, only two are considered sexually transmitted. The virus can be reactivated, and it will transmit if lesions are not present.

A client asks the nurse there is anything that would greatly increase her risk of acquiring human papillomavirus (HPV). The best response by the nurse would be:

Oral-genital sex Transmission of HPV is usually through skin-to-skin contact, most often through penetration (oral-genital, manual-genital, and genital-genital contact). HPV can also be transmitted though nonsexual routes, including mother to newborn (vertical transmission) and fomites (objects such as clothing, towels, or utensils that harbor the agent).

A 23-year-old diagnosed with syphilis presents with palmar rash, sore throat, fever, and a red-brown lesion on the genital area. The symptoms have been present for 3 weeks. Select the stage of syphilis this client is currently in.

Secondary Manifestations of secondary syphilis include symptoms of a rash (especially on the palms and soles), fever, sore throat, stomatitis, nausea, loss of appetite, and inflamed eyes, which may come and go for a year but usually last for 3 to 6 months. Secondary manifestations may include alopecia and genital lesions called condylomata lata.

Which of the following assessment findings helps the nurse confirm that the patient has genital warts?

Soft, raised lesions on external genitalia Genital warts typically present as soft, raised, fleshy lesions on the external genitalia, including the penis, scrotum, perineum, and perianal skin.

For a woman, what is the most serious long term outcome of an infection resulting from exposure to the N. gonorrhea bacteria?

Sterility There may be infections of the uterus and development of acute or chronic infection of the fallopian tubes (i.e., salpingitis), with ultimate scarring and sterility. The other options are less serious in nature.

A patient presents with a rash on the palms of his hands, mucous membranes, and stomach. He is complaining of a sore throat and nausea. Which of the following conditions is the nurse concerned about?

Syphilis The patient who presents with a rash on his palms and mucous membranes and stomach with complaints of a sore throat and nausea could be experiencing the second stage of syphilis. -The other conditions mentioned do not present in this manner.

A young woman is almost ready to deliver, and she has an outbreak of genital herpes. Which of the following is the nurse's best action?

Tell the woman about a cesarean section. A woman who presents with a genital herpes outbreak prior to delivery should be told about a cesarean section, which is recommended to protect the newborn from transmission. -Washing the area and applying pain medication will not stop the transmission of this disease. - Oral pain medication is helpful during delivery; however, vaginal delivery is not recommended with this condition.

A patient develops Reiter's syndrome. Which of the following symptoms will the nurse assess? Select all that apply.

• Conjunctivitis • Pain in the joints Untreated chlamydia can develop into Reiter's syndrome, which presents with urethritis and conjunctivitis and arthritis of the knees, sacroiliac, and vertebral joints. - Cardiovascular pain and pneumonia are not presenting symptoms of this condition.

Unbeknownst to him, a 30 year-old male has contracted Treponema pallidum during a sexual encounter the night before. Place the following manifestations the microorganism in the chronological order that they would occur in the absence of treatment. Use all the options.

• Formation of aneurysms • Appearance of a rash on the man's palms and feet. • Latency • Development of painless chancres on the man's scrotum. The primary stage of syphilis includes chancre formation, while the secondary stage often involves a rash on the palms and feet. Latency occurs between the second and third stage, that latter often including cardiovascular effect such as aneurysm formation.

The health nurse is dealing with a case of untreated chlamydial infection. The nurse suspects the patient has developed Reiter syndrome. Which of the following clinical manifestations would support this diagnosis? Select all that apply.

• Pain when urinating. • Diffuse pinkness of the conjunctiva along with watery and itchy eyes. • Asymmetric complaints of stiffness and pain in knees and sacroiliac joints. The most serious complication of untreated chlamydial infection is the development of Reiter syndrome. This triad of symptoms includes urethritis, conjunctivitis, and arthritis of weight bearing joints, such as the knees, sacroiliac and vertebral joints. Pain when urinating occurs in both men and women and is associated with urethritis. -Women can also develop reactive arthritis (painful inflammation and stiffness of the joints), but the male-to-female ratio for this complication is 5:1. The arthritis begins 1-3 weeks after the onset of chlamydial infection. The joint involvement is asymmetric, with multiple affected joints and a predilection of the lower extremities. -Cervical tissue friability is not part of Reiter syndrome.