Porth's Patho: Sexually Transmitted Infections, Chapter 46

Which assessment finding correlates to advanced (tertiary) syphilis? -Dementia -Tremors -Nervousness -Stomatitis

-Dementia Tertiary syphilis can produce central nervous system lesions that produce dementia, blindness, or injury to the spinal cord, with ataxia and sensory loss. Stomatitis occurs in stage 2.

The nurse assesses a client during perineal care and finds a foul odor coming from the vaginal area. What is the best statement for the nurse to make? -"You need to make certain that you wash daily." -"You will need medication therapy. I am going to call the health care provider." -"Do you have any other symptoms?" -"You may have an infection."

-"Do you have any other symptoms?" A foul odor in itself is not a diagnosis. The nurse needs more assessment before planning intervention. The only statement that assesses further is the nurse asking "Do you have any other symptoms?" If the client has an infection or other condition, there may be symptoms such as itching, pain, and burning. Implementation cannot begin with the stated information.

A nurse in the newborn nursery has an infant with herpes simplex virus-1 (HSV-1). The mother asks, "How can this happen? What is the best information for the nurse to give the mother? -"The baby's immune system is weak." -"One of the health care providers must have transmitted the disease." -"There may be other babies with the virus." -"Do you know if you have this virus or any lesions around your genitalia?"

-"Do you know if you have this virus or any lesions around your genitalia?" The nurse needs to assess further before giving the mother information. If the mother has active lesions and has this virus, the disease could have been transmitted to the infant during childbirth.

For a client to be diagnosed with bacterial vaginosis, which assessment findings would the nurse report? Select all that apply. -"Fishy" odor -Positive urine culture -Pain in the lower back -Thin white discharge from the vaginal area -Vaginal pH of 3.0

-"Fishy" odor -Thin white discharge from the vaginal area Diagnosis of bacterial vaginosis is made when at least three of the following symptoms present: thin white discharge; fishy odor, which is increased when a saline solution is dropped onto the secretions; vaginal pH above 4.5; and characteristic cell appearance on wet-mount slides. A vaginal pH of 3.0, pain in the lower back, and positive urine cultures are not symptoms that would assist in the diagnosis of bacterial vaginosis.

A client was diagnosed with human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). The nurse realizes that the client needs further teaching about the disease process based on which statement? -"HIV only infects B cells." -"The infection requires a host cell." -"After infection the HIV virus can exist in a latent state." -"HIV is a retrovirus."

-"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.

Which assessment question is most likely to address the causation of a woman's new case of candidiasis? -"Do you use condoms during sexual activity?" -"Have you noticed any new growths on your vagina in recent months?" -"Have you been on antibiotics recently?" -"Have you recently begun a new sexual relationship?"

-"Have you been on antibiotics recently?" Recent antibiotic therapy frequently underlies causes of candidiasis. The disease is not normally transmitted by sexual contact, and tissue growth is not an associated sign.

A client is diagnosed with granuloma inguinale. Which question should the nurse ask the client? -"Have you traveled outside of the country recently?" -"Have you ever had genital herpes?" -"Have you been near anyone who has had the flu?" -"Have you had all of your vaccinations?"

-"Have you traveled outside of the country recently?" Granuloma inguinale is caused by a Gram-negative bacillus Klebsiella granulomatous, 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 client asks how his condition, Condylomata acuminata, is caused. What is the nurse's best response? -"The cause of this is unknown." -"A parasite is the cause of this condition." -"Human papillomavirus (HPV) is the cause of your condition." -"A bacteria caused your condition."

-"Human papillomavirus (HPV) is the cause of your condition."

A client comes to the clinic and is diagnosed with genital herpes. Which statement by the client indicates that the nurse's teaching about management of the disease has been effective? -"I will take the acyclovir every 8 hours for the next week." -"I will use antibacterial ointment on the area to relieve the pain." -"I will use condoms for intercourse until the medication is all gone." -"I will need to take all of the medication to be sure the infection is cured."

-"I will take the acyclovir every 8 hours for the next week." There is no known cure for genital herpes, and the methods of treatment are largely symptomatic. The antiviral drug valacyclovir has become the cornerstone for management of genital herpes. Valacyclovir, the active component of acyclovir, has good bioavailability, which enables improved dosing schedules and increased compliance.

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? -"I will use condoms during sex until I finish taking all the antibiotics." -"I will use antibiotic cream as directed twice a day until the infection is cured." -"My partner will need to take antibiotics at the same time I do." -"The infection is not contagious and will resolve on its own in a few days."

-"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 client suspected of having gonorrhea with active symptoms, what does the nurse tell the client about confirming the diagnosis? -"A Gram stain is done to confirm the disease." -"It is impossible to confirm without talking to your sexual partners." -"Since you have discharge, we can perform a culture." -"Blood work is necessary to document the elevation in white count."

-"Since you have discharge, we can perform a culture." Clients 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 client.

A woman asks "Why do I have to tell my sexual partner about chlamydia? I thought this was a "female" disease." What is the nurse's best response? -"You are right, but notifying your sexual partner is required by law due to the fact this is a reportable disease." -"The condition has the potential to cause other infections." -"The condition is not transmittable; however, you need to let your partner know what you are going through." -"The condition is transmittable to men and may cause infertility."

-"The condition is transmittable to men and may cause infertility."

While educating a group of adolescents about sexually transmitted infections, the nurse will mention which infection that is more prevalent than gonorrhea and considered to be a marker for high-risk sexual behavior? -Trichomoniasis -Candidiasis -Bacterial vaginosis -Vulvovaginitis

-Trichomoniasis

In teaching a client about genital warts, which statement is correct for the nurse to say? -"If you are infected, you will see warts right away." -"The warts often never develop and you will not know if you are a carrier." -"The infection will start about a day after you are exposed." -"The incubation period is 6 weeks to 3 months."

-"The incubation period is 6 weeks to 3 months."

A client asks why his partners need to know that he was diagnosed with syphilis. What is the nurse's best response? -"They will have to be treated prophylactically." -"We need to track everyone you have come in contact with." -"They do not have to know." -"You will have to abstain from sexual activity while being treated."

-"They will have to be treated prophylactically." The nurse needs to inform the client that his or her sexual partners need to be treated prophylactically, which is the reason for contacting them.

Which instruction is essential for the nurse to include in the care plan for a client with herpes simplex virus-1 (HSV-1)? -"Hand washing prevents the spread of infection." -"This disease is transmitted by oral secretions." -"Wear a mask at all times." -"This disease is not transmitted to others by contact."

-"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 client 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 young woman has contracted the human papillomavirus (HPV) and has developed genital warts. The client is eager to receive an HPV vaccine, citing the large number of television advertisements she has seen. How should the nurse best respond? -"These will only be effective if you already received an injection in your teens." -"Unfortunately, these vaccines may be less effective once you have HPV." -"Your doctor will likely recommend watchful waiting for the next few weeks." -"That treatment is something you'll have to discuss with your doctor."

-"Unfortunately, these vaccines may be less effective once you have HPV." Currently, there is no treatment to eradicate HPV once a person has become infected. Vaccines are ineffective against active infection of a certain type of HPV or colonization of the same. This is true regardless of whether a vaccine was administered in the client's teens. Referring the client to the physician without providing any anticipatory guidance would be inappropriate.

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. What is the nurse's best response to the client? -"You may have acquired this infection from another route; it can also be spread in droplet form from coughing or sneezing." -"Women do not develop gonorrhea infections; but they can become carriers and spread the disease to males." -"Women may not know they have gonorrhea because they may not have symptoms." -"A gonorrhea infection in women only affects the internal organs such as the ovaries; therefore, you would not have seen any signs of an active infection."

-"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.

A client asks the nurse how he will know if he has syphilis after sexual contact. What is the nurse's best response? -"You will not know, as many people are asymptomatic." -"You will have to ask your sexual partner if she has the disease." -"You will develop a sore on your penis or scrotum." -"We will need to do a blood test every 2 weeks."

-"You will develop a sore on your penis or scrotum." Clients exposed to syphilis develop a chancre sore on their penis or scrotum within an average of 3 weeks from exposure.

Within how many days it is important to test anyone who has had sex with an individual who tests positive for gonorrhea? -365 -90 -180 -60

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

Which client is at highest risk of developing trichomoniasis? -A client who completed a 10-day course of antibiotic therapy for a urinary tract infection -A client who is sexually active -A client who is taking 10 different medications -A client newly diagnosed with diabetes mellitus type 2

-A client who is sexually active A reported risk factor for trichomoniasis is sexual activity, as the parasite can be transmitted to sexual partners. The other symptoms are not listed as predisposing risk factors for this condition.

Which information is essential for a nurse to include in the teaching plan for a client receiving metronidazole for trichomoniasis? -After taking the medication, sit upright for half an hour. -Do not drink grapefruit juice while on this medication. -Abstinence is recommended until the therapy is completed. -Do not take food with this medication.

-Abstinence is recommended until the therapy is completed. The client should refrain from sexual activity until therapy with metronidazole is completed due to the risk of transmitting the parasite to sexual partners.

There is no known cure for genital herpes, and methods of treatment are often symptomatic. Pharmacologic management of genital herpes includes which drugs? -AZT -Acyclovir -Topical corticosteroid compounds -Nonsteroidal anti-inflammatory 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 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last 6 months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of medication is most likely to resolve her symptoms? -A penicillin antibiotic -An azole antifungal agent -An antiviral agent -A quinolone antibiotic

-An azole antifungal agent The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if certain conditions (such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use) enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.

Which collection sites should be used for sampling to accurately diagnose gonorrhea? Select all that apply. -Anal canal -Uterine lining -Urethra -Nasal passages -Oropharynx

-Anal canal -Urethra -Oropharynx A specimen should be collected from the appropriate site (i.e., endocervix, urethra, anal canal, or oropharynx), inoculated onto a suitable medium, and transported under appropriate conditions. The nasal passages and the uterine are not sites that would be used for the collection of Neisseria gonorrhoeae.

A client with painful genital herpes lesions relates pain as being a 7 out of 10. Which interventions should the nurse conduct? Select all that apply. -Apply topical anesthetic cream. -Apply cool compresses. -Apply ice packs. -Call the health care provider for oral analgesics. -Apply warmth for 20 minutes.

-Apply topical anesthetic cream. -Apply cool compresses. -Call the health care provider for oral analgesics. The client with painful genital herpes lesions may have relief with cool compresses, topical anesthetic creams, and oral analgesics. Warmth is not recommended, nor are ice packs.

A nurse is attempting to culture a lesion to determine if a client has genital herpes. What is the nurse's best action? -Culture a lesion first thing in the morning. -Wash the area well before attempting a culture. -Wait until day 5 to attempt to culture a lesion. -Attempt to culture a lesion as soon as it develops.

-Attempt to culture a lesion as soon as it develops. The likelihood of obtaining a positive culture decreases with each day that elapses after a lesion develops. It is best to attempt a culture as soon as it develops. The chance of obtaining a positive culture from a crusted lesion is slight. It does not matter what time of day it is when the culture is collected, nor does the area have to be washed.

A client has been diagnosed with a chlamydial infection. Select the pharmacologic treatment of choice. -Acyclovir -Ceclor -Azithromycin -Bactrim

-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 nurse is caring for a client being treated for chlamydial infection. Which medication would the nurse anticipate being prescribed? -Piperacillin-tazobactam -Penicillin -Ciprofloxacin -Azithromycin

-Azithromycin The US Centers for Disease Control and Prevention (CDC) recommends the use of azithromycin or doxycycline in the treatment of chlamydial infection. Penicillin and piperacillin-tazobactam are ineffective. Ciprofloxacin is commonly used to treat urinary tract infections or cellulitis.

A woman and her male partner both have contracted gonorrhea. The nurse should monitor both clients for signs and symptoms of what complication? -Acute kidney injury -Bacteremic heart valves -Cognitive changes -Thrombophlebitis

-Bacteremic heart valves Gonorrhea can invade the bloodstream, causing serious sequelae such as bacteremic involvement of joint spaces, heart valves, meninges, and other body organs and tissues. Renal, neurologic, and thrombotic changes are atypical.

A client presents to the outpatient 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: -Chlamydia -Syphilis -Bacterial vaginosis -Trichomonas vaginalis

-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. vaginalis 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: -Genital infection -Urethritis -Pruritus -Blindness

-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.

Laboratory analysis of vaginal discharge identifies hyphae on microscopic exam and pH of 4.2. The client most likely has: -N. gonorrhoeae -C. trachomatis -T. vaginalis -C. albicans

-C. albicans Candida albicans has a definitive morphology under the microscope of budding yeast filaments (hyphae) and a low pH.

Which sexually transmitted infection exists in two morphologically distinct forms, elementary and reticulate bodies? -Chancroid -Candidiasis -Chlamydia -Trichomonas vaginalis

-Chlamydia Chlamydia exists in two morphologically distinct forms during its unique life-a small infectious elementary body and a large noninfectious reticulate body. Trichomonas vaginalis is a large anaerobic, pear-shaped, flagellated protozoan. Chancroid is a disease of the external genitalia and lymph nodes caused by the gram-negative bacterium Haemophilus ducreyi. Candida albicans is the most commonly identified organism in vaginal candidiasis (yeast infection), but other candida species, such as Candida glabrata and Candida tropicalis may also be present.

The nurse is reviewing the uses and side effects of azithromycin. For which infection is azithromycin the antibiotic of choice? -Genital herpes -Gonorrhea -Syphilis -Chlamydial

-Chlamydial Azithromycin is the treatment of choice for chlamydial infections.

A couple presents to an infertility clinic. The health care provider will focus testing on which sexually transmitted infection (STI) that is very damaging to the reproductive system but rarely exhibits symptoms of infection? -Syphilis -Chlamydial infection -Gonorrhea -Herpes simplex virus infection

-Chlamydial infection Women with chlamydial infection may be asymptomatic and may unknowingly experience damage to the reproductive system. A large number of cases go unreported because most people with chlamydial infection are asymptomatic and do not seek testing. Herpes simplex virus (HSV), syphilis, and gonorrhea consistently produce symptoms in infected women.

An older adult client may be experiencing symptoms of tertiary syphilis. Which characteristic would the nurse associate with tertiary syphilis years after the initial infection? -Dementia -Chancre papules -Condylomata lata -Maculopapular rash

-Dementia Tertiary syphilis is a delayed response of the untreated disease. The symptomatic tertiary stage frequently affects the cardiovascular system, central nervous system, and the liver, bones, and testes. Central nervous system lesions can produce dementia, blindness, or injury to the spinal cord, with ataxia and sensory loss. Chancre is the primary syphilitic lesion. Second-stage syphilis is characterized by a maculopapular rash of the palms of the hands or soles of the feet. Condylomata lata are genital lesions that are highly infectious.

While in its dormant state, what structure provides residence for herpes simplex virus to allow for replication? -Subcutaneous tissue -Dorsal root ganglia -Mucous membrane -Local lymph nodes

-Dorsal root ganglia In genital herpes, the virus ascends through the peripheral nerves to the sacral dorsal root ganglia. The virus can remain dormant in the dorsal root ganglia, or it can reactivate, in which case the viral particles are transported back down the nerve root to the skin, where they multiply and cause a lesion to develop. During the dormant or latent period, the virus replicates in a different manner so that the immune system or available treatments have no effect on it. Local lymph nodes respond to the inflammation of reactivation; the mucous membrane becomes erythematous and painful when lesions form; subcutaneous tissue is not damaged by the vesicles and shallow ulcerations.

What is the US Centers for Disease Control and Prevention's recommended treatment for a chlamydial infection in men? -Ceftriaxone -Penicillin -Doxycycline -Ciprofloxacin

-Doxycycline The CDC recommends the use of azithromycin or doxycycline in the treatment of chlamydial infection. Penicillin is ineffective. Azithromycin is the preferred choice in pregnancy. Ceftriaxone is the recommended treatment for gonorrhea.

During infertility workup, the client is diagnosed with chlamydial infection. The health care provider will especially be looking for which complication of chlamydial infections that can interfere with egg transportation? -Uterine cancer -Amenorrhea -Vaginal adhesions -Fallopian tube damage

-Fallopian tube damage Chlamydia causes a wide variety of genitourinary infections; Chlamydia trachomatis infection is the most common reportable sexually transmitted infection (STI) in the United States. In women, untreated infection can lead to severe reproductive complications, including infertility, pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain; in men, it can cause prostatitis and epididymitis with subsequent infertility. The cervix frequently hypertrophies and becomes erythematous, edematous, and extremely friable. This can lead to greater fallopian tube damage. Chlamydial infections are not associated with any reproductive cancers or amenorrhea.

A client is diagnosed with chronic vulvovaginal candidiasis. Which assessment finding would be present to confirm this diagnosis? -Inability to become pregnant -Chronic itching in the vaginal area -Four episodes of vulvovaginal candidiasis (confirmed symptoms) so far this year -Reports of difficulty urinating

-Four episodes of vulvovaginal candidiasis (confirmed symptoms) so far this year Four or more episodes of vulvovaginal candidiasis in one year would classify the client as having chronic vulvovaginal candidiasis. Prophylaxis or maintenance therapy might be needed for long-term management of the problem. The other symptoms listed are not assessment findings that confirm this diagnosis.

Which event is associated with the primary stage of syphilis? -Development of central nervous system lesions -Palmar rash -Genital chancres -Development of gummas

-Genital chancres Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

A 22-year-old female client states she has vaginal itching with pain and small vesicles that appear on the vagina when she is stressed. The health care provider suspects the client most likely is experiencing which condition? -Chlamydia trachomatis infection -Molluscum contagiosum infection -Genital herpes -Genital warts

-Genital herpes The symptoms of primary genital herpes infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. Curd-like exudate and dome-like lesions fits the description of Molluscum contagiosum infection. Chlamydia trachomatis infection is a vaginal/cervical infection and does present with itching but not vesicles. Chancroid lesions start as macules and progress to pustules.

Which conditions may have been caused by herpes viruses? Select all that apply. -Genital ulcers -Epstein-Barr syndrome -Hives -Chicken pox -Flu

-Genital ulcers -Epstein-Barr syndrome -Chicken pox There are nine types of herpes viruses belonging to three groups that cause infections in humans. Neurotropic alpha group viruses are usually associated with genital herpes. Varicella zoster causes chickenpox and shingles. Lymphotropic beta group viruses cause Epstein-Barr virus. The flu and hives are not caused by herpes viruses.

A client presents to an STI clinic. Her primary complaint is related to purulent exudate and bleeding after intercourse. The health care worker will primarily focus on the diagnosis of which STI? -Chlamydial infection -Gonorrhea -Human papillomavirus infection -Genital herpes simplex virus infection

-Gonorrhea The gonococcus is a pyogenic (i.e., pus-forming), Gram-negative diplococcus that evokes inflammatory reactions characterized by purulent exudates. Internal human papillomavirus (HPV) condylomata acuminata warts are cauliflower-shaped lesions that affect the mucous membranes of the vagina, urethra, anus, or mouth. The initial symptoms of primary genital herpes (herpes simplex virus, HSV) infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles.

Which statement about gonorrhea is correct? -Gonorrhea is rare sexually transmitted infection. -Gonorrhea is a gram-positive diplococcus bacterium. -Gonorrhea is a reportable sexually transmitted infection. -The highest rate of gonorrhea is seen in older adults.

-Gonorrhea is a reportable sexually transmitted infection. Gonorrhea is a reportable sexually transmitted infection (STI). The gonococcus is a gram-negative diplococcus bacterium. The highest rate is seen in persons younger than 25 years of age. It is one of the most common STIs.

A female client presents at an STD clinic. She is in the first trimester of pregnancy and has tested positive for gonorrhea. Because strains of N. gonorrhoeae have become resistant to penicillin, the current treatment recommendation includes: -10-day supply of metronidazole -High-dose cefixime given in a single dose -Doxycycline over the course of 1 week -No treatment until after the baby is born

-High-dose cefixime given in a single dose The current treatment recommendation to combat penicillin- and tetracycline-resistant strains of gonorrhea is ceftriaxone or cefixime in a single injection. While a single injection of cefixime is still the standard treatment, some strains of N. gonorrhoeae have begun to show resistance to this dose. Metronidazole is one treatment of choice against anaerobic protozoans, which can cure Trichomonas vaginalis. The treatment of choice for syphilis is penicillin. Tetracycline or doxycycline is used for treatment in persons who are sensitive to penicillin, but these medications cannot be used in pregnancy. Obviously, the client will receive treatment. However, at time of delivery, the infant will be tested and treated as necessary.

A female client presents at an STD clinic. She is in the first trimester of pregnancy and has tested positive for gonorrhea. Because strains of N. gonorrhoeae have become resistant to penicillin, the current treatment recommendation includes: -No treatment until after the baby is born -High-dose cefixime given in a single dose -10-day supply of metronidazole -Doxycycline over the course of 1 week

-High-dose cefixime given in a single dose The current treatment recommendation to combat penicillin- and tetracycline-resistant strains of gonorrhea is ceftriaxone or cefixime in a single injection. While a single injection of cefixime is still the standard treatment, some strains of N. gonorrhoeae have begun to show resistance to this dose. Metronidazole is one treatment of choice against anaerobic protozoans, which can cure Trichomonas vaginalis. The treatment of choice for syphilis is penicillin. Tetracycline or doxycycline is used for treatment in persons who are sensitive to penicillin, but these medications cannot be used in pregnancy. Obviously, the client will receive treatment. However, at time of delivery, the infant will be tested and treated as necessary.

A female client is found to have genital warts during a routine pelvic examination. Which sexually transmitted infection will the nurse prepare to test for? -Adenovirus -Herpes simplex virus -Chlamydia trachomatis -Human papillomavirus

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

Which assessment finding is most clearly suggestive of initial genital herpes (herpes simplex virus, HSV) in a male client? -Production of cloudy, foul-smelling urine -Itching, pain, and the emergence of pustules on the penis -Emergence of hard, painless nodules on the shaft of the penis -Presence of purulent, whitish discharge from the penis

-Itching, pain, and the emergence of pustules on the penis The initial symptoms of primary genital herpes infection include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. In men, the infection can cause urethritis and lesions of the penis and scrotum. Rectal and perianal infections are possible with anal contact. Firm, subcutaneous nodules are not associated with herpes simplex virus (HSV), and the production of penile discharge and cloudy urine is not suggestive of the disease.

A older female client has developed some central nervous system symptoms not usually common in her family history. After months of no improvement, the provider ordered blood panels that returned as positive for syphilis. Having been married for decades, the provider suspects tertiary syphilis based on which finding(s)? Select all that apply. -Lack of voluntary coordination resulting in gait abnormality -Gradual loss of sight -Enlarged cervical lymph nodes -Kidney stone development -Slowly progressing dementia

-Lack of voluntary coordination resulting in gait abnormality -Gradual loss of sight -Slowly progressing dementia Symptoms of central nervous system lesions of tertiary syphilis include dementia, blindness, or injury to the spinal cord with ataxia (lack of voluntary coordination of muscle movements that can include gait abnormality) and sensory loss. It is not associated with kidney stone development or cervical lymph node enlargement.

A client was diagnosed with herpes simplex virus (HSV) several months ago and has adapted his lifestyle to limit the frequency and severity of recurrences. Which actions help facilitate this goal? Select all that apply. -Eating a nutritious diet -Limiting antibiotic use -Limiting stress -Getting adequate sleep -Limiting sun exposure

-Limiting stress -Getting adequate sleep Numerous factors, including emotional stress, lack of sleep, overexertion, other infections, vigorous or prolonged coitus, and premenstrual or menstrual distress, have been identified as triggering mechanisms for HSV recurrence. Diet, antibiotics, and sun exposure are not known to contribute to episodes of recurrence.

Select the treatment of choice for syphilis. -Long-acting penicillin in a single injection -Oral amoxicillin for 10 days -Topical clotrimazole cream -UV radiation to the genital area

-Long-acting penicillin in a single injection The treatment of choice for syphilis is penicillin. Because of the spirochetes' long generation time, effective tissue levels of penicillin must be maintained for several weeks. Long-acting injectable forms of penicillin are used.

A male client presents at the clinic with flulike symptoms and reports a weight loss of 10 pounds without trying. On physical examination, the client is found to have splenomegaly and large, tender, fluctuant inguinal lymph nodes. While taking the nursing history, it is discovered that the client prefers male sexual partners, and that 2 weeks ago the client had small, painless papules. What disease would the nurse suspect the client has? -Lymphogranuloma venereum -Genital herpes -Chancroid -Syphilis

-Lymphogranuloma venereum An important characteristic of lymphogranuloma venereum is the early (1 to 4 weeks later) development of large, tender and sometimes fluctuant inguinal lymph nodes called buboes.

For which STI should the nurse anticipate a prescription for antibiotics such as erythromycin or doxycycline since this infection will respond to antibiotic treatment? -Candidiasis -Human papillomavirus (HPV) infection -Lymphogranuloma venereum (LGV) -Herpes simplex virus type 2 (HSV-2) infection

-Lymphogranuloma venereum (LGV) Because HSV-2 and HPV infections and candidiasis have nonbacterial etiologies, these infections are insensitive to antibiotics. Lymphogranuloma venereum (LGV) is an acute and chronic venereal disease caused by Chlamydia trachomatis and is consequently sensitive to antibiotics.

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last 6 months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms? -Valacyclovir -Metronidazole -Penicillin -Azithromycin

-Metronidazole The character of the discharge, lack of recent sexual activity, and current antibiotic treatment point to infection with Trichomonas vaginalis, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, enable the protozoan to proliferate. Trichomoniasis responds well to treatment with metronidazole.

When counseling a client who is 3 months' pregnant and who recently went on a vacation to South America where she received several mosquito bites, the biggest complication the provider should prepare her for is delivering a child with which type(s) of defect? Select all that apply. -Spina bifida -Microcephaly -Hearing problems -Bilateral hip dysplasia -Eye concerns

-Microcephaly -Hearing problems -Eye concerns Zika virus show few symptoms. If the woman is infected by Zika during pregnancy, severe birth defects can occur, such as microcephaly, brain defects, hearing and eye defects, and impaired growth. Spina bifida is a birth defect that occurs when the spine and spinal cord do not form properly. It falls under the broader category of neural tube defects. The neural tube is the embryonic structure that eventually develops into the infant's brain and spinal cord and the tissues that enclose them. A folic acid deficiency during pregnancy also plays a significant role. Hip dysplasia is the medical term for a hip socket that does not fully cover the ball portion of the upper thighbone. This allows the hip joint to become partially or completely dislocated. It is not known to be associated with Zika virus infection.

Which condition is associated with domelike lesions on both the inner thighs and vaginal area that produce a curdlike exudate? -Chancroid -Genital herpes -Genital warts -Molluscum contagiosum

-Molluscum contagiosum The lesions described with the curdlike exudate fits the description of molluscum contagiosum lesions. None of the remaining options present with a curdlike exudate.

An male client presents with urethral itching, burning, pain, and a creamy, yellow discharge following unprotected sex with a new partner 3 days ago. The nurse anticipates the client to be diagnosed with which sexually transmitted infection? -Escherichia coli -Herpes infection -Chlamydia trachomatis -Neisseria gonorrhoeae

-Neisseria gonorrhoeae The gonorrhea infection commonly manifests 2 to 7 days after exposure. In men, the initial symptoms include urethral pain and a creamy yellow, sometimes bloody, discharge. The disorder may become chronic and affect the prostate, epididymis, and periurethral glands. Rectal infections are common in homosexual men.

The nurse determines that teaching was effective when a client who has been treated for Chlamydia states the importance of: -No follow-up is needed. -Repeating antibiotics for 1 week. -Retesting in 3 to 4 months. -Repeating a Pap smear.

-No follow-up is needed. With the exception of women who are pregnant, a test of cure 3 to 4 weeks after treatment is no longer recommended unless therapeutic compliance is in question.

Select the correct statement regarding herpes simplex virus. -The virus is not contagious. -Herpes simplex virus cannot be transmitted if lesions are not present. -Only two strains of the virus are considered sexually transmittable. -The virus will not reactivate.

-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 develops Reiter's syndrome. Which symptoms will the nurse assess? Select all that apply. -Pain in the joints -Pneumonia -Cardiovascular pain -Conjunctivitis

-Pain in the joints -Conjunctivitis 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.

A 30-year-old male has contracted an STI caused by Treponema pallidum. Which symptom did he most likely notice first? -A rash on his palms and feet -Painless chancres on the man's scrotum -Clear, odorless penile discharge -Purulent penile discharge

-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. The third stage often includes negative cardiovascular effect such as aneurysm formation. Penile discharge is atypical.

A client with herpes simplex virus (HSV) states, "I can stop taking my drugs because I'm cured. My lesions are gone." Knowing the pathophysiology behind the disappearance of HSV symptoms, the health care provider suspects the client is experiencing which phase of infection? -Inhibition of cell-mediated immunity -Periods of latency in the nervous system -Production of exotoxins -Replication of the squamous epithelium

-Periods of latency in the nervous system The clinical course of HSV infection is a product of the virus's ability to remain latent in the dorsal root ganglia for long periods. Latency refers to the ability to maintain disease potential in the absence of clinical signs and symptoms. When latent, the immune system is ineffective, but the virus does not actively inhibit the cell-mediated immune system. HSV does not produce exotoxins, and replication of squamous epithelium accounts for the warts caused by HSV.

A nurse is assessing a male who is reporting nonspecific symptoms of prostate and periurethral gland pain. Which characteristic discharge makes the nurse suspect gonorrhea? -Cauliflower-shaped lesions -Painful small vesicles -Persistent perianal itching -Purulent exudates

-Purulent exudates The gonococcus is a pyogenic (i.e., pus-forming), Gram-negative diplococcus that evokes inflammatory reactions characterized by purulent exudates. Internal human papillomavirus (HPV) condylomata acuminata warts are cauliflower-shaped lesions that affect the mucous membranes of the vagina, urethra, anus, or mouth. The initial symptoms of primary genital herpes (herpes simplex virus, HSV) infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles.

A client presents with gonorrhea. Which of the following is a primary nursing action? -Inserting a peripherally inserted central catheter -Reporting the case to the Centers for Disease Control and Prevention -Treating all members of the client's family -Keeping the client hospitalized for treatment

-Reporting the case to the Centers for Disease Control and Prevention Gonorrhea is a reportable sexually transmitted infection

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 -Tertiary -Primary -Latent

-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.

The nurse caring for a client with syphilis notes the Venereal Disease Research Laboratory (VDRL) test result is elevated. Which stage of syphilis is this client likely experiencing? -Latent -Secondary -Tertiary -Primary

-Secondary The VDRL is nonspecific and is used more for screening than for diagnosis. The VDRL is usually elevated during the second stage of this disease.

Select the most reliable test to diagnose syphilis. -Urine culture -Chest x-ray -Serology -Oral swab

-Serology Although PCR tests have been developed for syphilis, serology tests remain the mainstay for diagnosis. Two general types of serology tests are available: nonspecific (nontreponemal) tests and the specific treponemal tests. The other tests are not reliable.

Which assessment finding helps the nurse confirm that the client has genital warts? -Hard white lesions with dark centers -Dark brown or black papules on external genitalia -Soft, raised lesions on external genitalia -Dark red, hard lesions on external genitalia

-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. gonorrhoeae bacteria? -Dysuria -Postcoital bleeding -Bartholin gland abscesses -Sterility

-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 female client presents to the clinic with a rash on the palms of her hands, symptoms of hair loss, and the development of elevated, red-brown lesions that have begun to ulcerate and produce a foul discharge. Based on these symptoms, the nurse plans to test the client for which sexually transmitted infection? -Gonorrhea -Chlamydia -Genital herpes -Syphilis

-Syphilis The timing of the second stage of syphilis varies even more than that of the first, lasting from 1 week to 6 months. The symptoms of a rash (especially on the palms, mucous membranes, meninges, lymph nodes, stomach, soles, and liver), fever, sore throat, stomatitis, nausea, loss of appetite, and inflamed eyes may come and go for a year but usually last for 3 to 6 months. Secondary manifestations may include some loss of hair and condylomata lata. These lesions are elevated, red-brown lesions that may ulcerate and produce a foul discharge. They are 2 to 3 cm in diameter, contain many spirochetes, and are highly infectious.

A young woman is almost ready to deliver, and she has an outbreak of genital herpes. What is the nurse's best action? -Apply topical anesthetics generously as delivery will be painful. -Wash the area vigorously prior to delivery to decrease the risk of transmission to the baby. -Tell the woman about a cesarean section. -Make certain the woman takes pain medication prior to delivering.

-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.

An older adult female has slowly developed dementia and loss of vision. She is being evaluated for nursing home placement. Routine admission blood work reveals that the client tested positive for which STI associated with her current symptoms? -Tertiary syphilis -Gonorrhea -Chlamydia -Human papillomavirus infection

-Tertiary syphilis Tertiary syphilis is a delayed response of the untreated disease. The symptomatic tertiary stage frequently affects the cardiovascular system, central nervous system, liver, bones, and testes. In women, chlamydial infections may cause urinary frequency, dysuria, and vaginal discharge. In women, gonorrhea has recognizable symptoms, which include unusual genital or urinary discharge, dysuria, dyspareunia, pelvic pain or tenderness, unusual vaginal bleeding (including bleeding after intercourse), and fever. HPV infection is associated with genital warts that typically present as soft, raised, fleshy lesions on the external genitalia, including the penis, vulva, scrotum, perineum, and perianal skin. External warts may appear as small bumps, or they may be flat, rough surfaced, or pedunculated.

A client has been diagnosed with candidiasis. Which symptom was present to diagnose this condition? -Pustules -Severely painful lesions -Thick, white secretions -Urinary retention

-Thick, white secretions Candidiasis presents with thick, white curdlike secretions; however, it is possible the secretions can be thin. The other symptoms are not usually associated with this condition.

What is the primary reason that the nurse urges clients to be seen by their health care provider when they have genital warts? -To receive intravenous antibiotics -To be informed of the risk of premalignant and malignant changes -To have an MRI to screen for other conditions -To be informed of the chance of transmitting to others

-To be informed of the risk of premalignant and malignant changes The association with premalignant and malignant changes has increased concern regarding the diagnosis and treatment of this viral infection. Intravenous antibiotics are not used to treat viruses. The client does not have to see the health care provider to be told that they have a risk of transmitting this condition to others. There are several pharmacologic treatments for symptomatic removal of visible genital warts, and cryotherapy is one of them.

A client presents to the GYN clinic complaining of large amounts of frothy yellow-green discharge that smells very foul. Immediately, the health care provider is thinking this client most likely has: -Candidiasis -Chlamydial infection -Trichomoniasis -Bacterial vaginosis

-Trichomoniasis Trichomoniasis causes a copious, frothy, malodorous, green or yellow discharge. The characteristic vaginal discharge of candidiasis, when present, is usually odorless, thick, and cheesy. The predominant symptom of bacterial vaginosis is a thin, grayish white discharge that has a foul, fishy odor. Chlamydial STI may be asymptomatic, but most women have mucopurulent drainage or hypertrophic cervical changes on examination.

The primary reason genital herpes has reached epidemic proportions throughout the world relates to the fact that: -the lesions take a long time to incubate and the small papules are usually located inside the vagina. -the lesions (LSILs) occur on the cervix and can only be detected by a Pap test. -the organism spreads upward to the prostate gland in males and fallopian tubes in females. -a large percentage (70%) of those infected experience no symptoms of the disease.

-a large percentage (70%) of those infected experience no symptoms of the disease. Persons infected with HSV-1 remain at risk for acquiring HSV-2. Most cases of HSV-2 infection are subclinical, manifesting as asymptomatic or symptomatic but unrecognized infections. These subclinical infections can occur in people who have never had a symptomatic outbreak or they can occur between recognized clinical recurrences. Up to 70% of genital herpes is spread through asymptomatic shedding by people who do not realize they have the infection. Transient HPV infections can develop low-grade squamous intraepithelial lesions (LSILs) of the cervix as detected on a Pap test, colposcopy, or biopsy. Lesions of LGV can incubate for a few days to several weeks and thereafter cause small, painless papules or vesicles that may go undetected. If untreated, gonorrhea spreads from its initial sites upward into the genital tract. In males, it spreads to the prostate and epididymis; in females, it commonly moves to the fallopian tubes.

A sexually active female presents to the clinic with white copious vaginal discharge, itch, swelling, and dysuria. The nurse anticipates the client will be treated for the overgrowth of which organism? -Lactobacillus acidophilus -Escherichia coli -Neisseria gonorrhoeae -Candida albicans

Candida albicans Candida albicans is the most commonly identified organism in vaginal yeast infections. Women with vulvovaginal candidiasis commonly complain of vulvovaginal pruritus accompanied by irritation, erythema, swelling, dysuria, and dyspareunia. The characteristic discharge, when present, is usually thick, white, and odorless.

A client has been diagnosed with condylomata acuminata. The nurse recognizes that which treatment may be prescribed to removal visible warts? -Cryotherapy -Radiation therapy -Antibiotics -Antifungal cream

Cryotherapy Cryotherapy and pharmacologic treatments for symptomatic removal of visible genital warts are the recommended treatments for condylomata acuminata (genital wart) lesions. Treatment regimens can be classified as client-applied or provider-applied. Client-applied products include cytotoxic agents, an immune enhancer, or a green tea extract. Provider-administered treatments include topical cytotoxic agents. Antibiotics, antifungals, and radiation are not effective.

Select the condition that contributes to the risk of infertility in males. -Chancroid -Genital warts -Herpes simplex -Trichomoniasis

Trichomoniasis in men is a common cause of nongonococcal urethritis and is a risk factor for infertility, altering sperm motility and viability of sperm. The others do have the same risks for infertility.

A nurse is interviewing a client about issues with infertility. Which condition contributes to the risk of infertility in both men and women? -Trichomoniasis -Herpes simplex -Chancroid -Genital warts

Trichomoniasis increases the risk of infertility in women because the trichomonads serve as vectors for the spread of pathogens into the fallopian tubes. In men it contributes to decreased mobility and viability of sperm. The others do not have the same risks for infertility.