Ricci → Ch. 5: Sexually Transmitted Infections PrepU

What is the medication of choice for early syphilis?

penicillin G benzathine A single dose of penicillin G benzathine intramuscular injection is the medication of choice for early syphilis or early latent syphilis of less than 1 year's duration. Clients who are allergic to penicillin are usually treated with doxycycline or tetracycline. Ceftriaxone is not the medication of choice for syphilis.

A female client is prescribed metronidazole for the treatment of trichomoniasis. Which instruction should the nurse give the client undergoing treatment?

Avoid alcohol. The nurse should counsel the client taking metronidazole to avoid alcohol during the treatment because mixing the two causes severe nausea and vomiting. Avoiding extremes of temperature to the genital area is a requirement for clients with genital ulcers, not trichomoniasis. The nurse should instruct the client to avoid sex, regardless of using condoms, until she and her sex partners are cured, that is, when therapy has been completed and both partners are symptom-free. It is not required to increase fluid intake during treatment.

A client at 32 weeks' gestation has recently been diagnosed with acute herpes type 2. The client asks what can happen to the baby as a result of this infection. How should the nurse best respond?

"There is a chance your baby may have a form of cognitive challenge." Herpes type 2 (genital herpes) contamination can occur during birth. The infant is susceptible to cognitive challenge, premature birth, low birth weight, blindness, death as a result of this infection. The infant is not protected from the infection as it is contaminated during vaginal birth. Premature birth is a risk, not postdate birth.

A school health nurse is providing education to a group of adolescents regarding the proper procedure for male condom use. The nurse knows the teaching has been effective when which statement is made by a student?

"Withdraw the penis erect, holding the condom firmly against the penis." The teaching guidelines for proper condom use include: ensure the condom has been stored in a cool, dry place away from direct sunlight. Do not store condoms in wallet; put the condom on before any genital contact; put the condom on when penis is erect; ensure adequate lubrication during intercourse. If external lubricants are used, use only water-based lubricants. Oil-based or petroleum-based lubricants, such as body lotion or massage oil, can weaken latex condoms. Withdraw while penis is still erect, and hold condom firmly against base of penis. Remove carefully to ensure no semen spills out.

A pregnant woman is diagnosed with chlamydia and asks the nurse, "How will this infection affect my baby and pregnancy?" Which responses by the nurse are accurate? Select all that apply.

"Your newborn can be infected during birth." "Your newborn may have eye infections from this infection." "Your membranes may rupture earlier than normal." STIs' effects on the fetus or newborn such as chlamydia include the newborn being infected during birth with eye infections (neonatal conjunctivitis), pneumonia, low birth weight, increased risk of premature rupture of the membranes (PROM), preterm birth, and stillbirth.

A client has been recently diagnosed with genital herpes and asks, "Why am I having so many recurring outbreaks of the infection?" What is the nurse's best response?

"Stress-reducing strategies may help prevent the outbreaks." Recurrent genital herpes outbreaks are triggered by precipitating factors such as emotional stress and stress-reducing exercises may help. No cure exists, but antiviral drug therapy not antibiotics helps to reduce or suppress symptoms, shedding, and recurrent episodes. Genital herpes is a recurrent, lifelong "viral" not bacterial infection.

A nurse is presenting a program for a local women's group about STIs. When describing the information, the nurse would identify which infection as the most common cause of vaginal discharge?

candidiasis Although vaginal discharge can occur with any STI, genital/vulvovaginal candidiasis is one of the most common causes of vaginal discharge. It is also referred to as yeast, monilia, and a fungal infection. It is not considered an STI because candida is a normal constituent in the vagina and becomes pathogenic only when the vaginal environment becomes altered.

What is the gold standard for HSV diagnosis?

culture The gold standard for HSV diagnosis is a culture of the lesion. Serology may help determine new versus chronic infection when obtained concurrently with positive culture of the lesion. The other diagnostics may be used for diagnosis of skin disorders, but they would not be used for HSV.

A nurse is caring for clients who have a history of genital herpes infection. The client most at risk for an outbreak of genital herpes is the client who reports:

genital pruritus and paresthesia. Pruritus and paresthesia as well as redness of the genital area are prodromal symptoms of recurrent herpes infection. These symptoms occur 30 minutes to 48 hours before the lesions appear. Headache and fever are symptoms of viremia associated with the primary infection. Vaginal and urethral discharge is also a local sign of primary infection. Dysuria and lymphadenopathy are local symptoms of primary infection that may also occur with recurrent infection.

Which test would be most appropriate for detecting a yeast infection in a client with irritation of the vagina and vulva?

microscopic examination of a swab sampling Culture and microscopic examination of a swab sampling from the upper vagina may diagnose and confirm yeast forms in the client with vaginal irritation. Enzyme-linked immunosorbent assay is a test to diagnose HIV. Hormone receptor assay test is used to diagnose the tumor's dependency on estrogen and progesterone in the client with breast cancer. Transvaginal ultrasound is the screening test for endometrial cancer.

A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect which finding once the microorganism disseminates throughout the body?

painful joints The client with an anal gonorrheal infection experiences symptoms of gonorrhea where the microorganism has invaded the rectum. After the microorganism disseminates throughout the body, the client may manifest a skin rash, fever, and painful joints. Other symptoms such as infections of the urinary tract or vagina, sore throat, intermenstrual bleeding due to cervicitis, and painful urination are associated with the organism's invasion of those structures, depending on the nature of the sexual contact.

After teaching a group of college-aged students about condom use, the nurse determines that additional teaching is needed when the students make which statement?

"It's okay to use petroleum jelly with a latex condom." If external lubricants are used, use only water-based lubricants with latex condoms. Oil-based or petroleum-based lubricants, such as body lotion, massage oil, or cooking oil, can weaken latex condoms. Latex condoms are the best protetion from STIs. Condoms are applied before any genital contact because sperm is present in preejactulate fluid. Condoms also should be stored in a cool, dry place away from direct sunlight to prevent deterioration.

A nurse is providing care to a client with pediculosis pubis. Which information would the nurse include when teaching the client about this condition?

"Remove the nits with a fine-toothed comb." The nurse should instruct the client to remove the nits from the hair using a fine-toothed comb. Permethrin cream and lindane shampoo are used as treatment, not antibiotics. Bedding and clothing should be washed in hot water to decontaminate it. Sexual partners should be treated also, as well as family members who live in close contact with the infected person

A woman is to receive penicillin G 3,000,000 units IM q6h as syphilis treatment. The medication is available as 1,500,000 units/mL. How many milliliters will be administered in 24 hours? Record your answer using a whole number.

8 D/H x V 3,000,000/1,500,000 x 1 ml = 2 mL IM for each dose and 4 times a day = 8 mL in 24 hours

Working at the local health clinic, the nurse recognizes that STIs can often result in PID. When a client with a history of repeat STIs presents to the clinic reporting severe abdominal cramping and bleeding, the immediate concern is to ensure the client does not have:

ectopic pregnancy. Every day, more than one million people are newly infected with STIs that can lead to morbidity, mortality, and an increased risk of human immunodeficiency virus (HIV) acquisition (Fernandez-Romero, Deal, Herold, et al., 2015). STIs may contribute to cervical cancer, infertility, ectopic pregnancy, chronic pelvic pain, and death.

A female sex trade worker has been diagnosed with secondary syphilis. Which findings would most likely correlate with this diagnosis?

sore throat and flu-like symptoms With a secondary infection of syphilis, there would be no evidence of vaginal lesions present. Present would be a maculopapular rash (hands and feet); a sore throat; lymphadenopathy; and flu-like symptoms. Dysurea is not seen in the secondary infection. A yellow vaginal discharge is for gonorrhea.

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 six months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms?

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.

A client at 34 weeks' gestation has recently been diagnosed with human immunodeficiency virus (HIV). The client asks how HIV would be transmitted to the newborn. Which statement would be the nurse's best response?

It is recommended to formula-feed your newborn as it is transmitted through your breast milk." An infected mother can transmit HIV infection to her newborn before or during birth and through breastfeeding.The risk of perinatal transmission of HIV from an infected mother to her newborn is about 25%. This risk falls to less than 1% if the mother receives antiretroviral therapy during pregnancy. HIV can be spread to the infant through breastfeeding. HIV-infected mothers should be counseled to avoid breastfeeding and use formula instead.

A nurse is caring for a female client who is undergoing treatment for genital warts due to human papillomavirus (HPV). Which information should the nurse include when educating the client about the risk of cervical cancer? Select all that apply.

Obtaining Pap smears regularly helps early detection of cervical cancer. Recurrence of genital warts increases risk of cervical cancer. Use of latex condoms is associated with a lower rate of cervical cancer. When educating the client about cervical cancer, the nurse should inform the client that recurrence of genital warts increases the risk of cervical cancer and that she should obtain regular Pap smears to detect cervical cancer. Use of latex condoms reduces the risk of cervical cancer. Abnormal vaginal discharge does not necessarily indicate cervical cancer. There is no significant link between use of broad-spectrum antibiotics and increased risk of cervical cancer.

A 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis?

Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease. The treatment of choice for Trichomonas vaginalis is oral metronidazole or tinidazole, medications that are effective against anaerobic protozoans. Antifungals are not a relevant treatment and eradication of the infection is possible with treatment.

Pelvic infection is most commonly caused by:

sexual transmission. Pelvic infection is most commonly caused by sexual transmission but can also occur with invasive procedures such as endometrial biopsy, surgical abortion, hysteroscopy, or insertion of an intrauterine device.

A nurse is caring for a client with vaginitis. What instructions should the nurse provide to the client to prevent recurrent vaginal infections? Select all that apply

Avoid using deodorant tampons. Avoid the use of colored toilet tissue. Wear only cotton panties and ventilated pantyhose.

A client is diagnosed with trichomoniasis infection. The nurse prepares to teach the client about which medication?

metronidazole Oral metronidazole or tinidazole is used to treat trichomoniasis. Penicillin G is used to treat syphilis. Miconazole and fluconazole are used to treat candidiasis.

A nurse is preparing a teaching plan for a female client diagnosed with genital ulcers. Which instructions would the nurse include in this teaching plan? Select all that apply.

"Use a condom when having sexual intercourse with any noninfected partner." "Avoid having sex when any ulcers are present." "Air dry any lesions with a hair dryer on the low setting." Teaching a client with genital ulcers includes avoiding extremes of temperature such as ice packs or hot packs, using a condom with all new or uninfected sexual partners, avoiding sex during the prodromal period and when lesions are present, using lukewarm sitz baths for discomfort, and air-drying lesions with a hair dryer on the low setting.

A pregnant client arrives at the community clinic reporting fever blisters and cold sores on the lips, eyes, and face. The health care provider has diagnosed it as the primary episode of genital herpes simplex virus (HSV), for which antiviral therapy is recommended. Which information should the nurse offer the client when educating her about managing the infection?

Safety of antiviral therapy during pregnancy has not been established. The nurse should inform the client that there is no evidence to suggest that antiviral therapy is completely safe during pregnancy. HSV cannot be cured completely, even with timely antiviral drug therapy, and there may be recurrences. The viral shedding process continues for 2 weeks during the primary episode, and kissing during this period may transmit the disease. Recurrent HSV-infection episodes are shorter and milder.

At a health education class for teenagers, the nurse discusses the sexually transmitted infection chlamydia trachomatis. Which information would the nurse most likely include?

This infection is the most common infectious cause of infertility. The young have the most to lose from acquiring STIs, since they may not reach their full reproductive potential. In women, chlamydia is linked with cervicitis, salpingitis, ectopic pregnancy, pelvic inflammatory disease, and infertility. It is likely the most common infectious cause of infertility in women. Recombinant human papillomavirus vaccine is for the HPV STI. Antibiotics will cure this STI only.

An HIV-positive client who is on antiretroviral therapy reports anorexia, nausea, and vomiting. Which suggestion should the nurse offer the client to cope with this condition?

Use high-protein supplements. The nurse should instruct the client to use high-protein supplements to provide quick and easy protein and calories. The nurse should also instruct the client to eat dry crackers upon arising, not after every meal, and to eat six small meals a day, not three. Drinking fluids constantly while eating is not recommended. The nurse should instruct the client to separate the intake of food and fluids.

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 six months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms?

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 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.

A newborn is diagnosed with ophthalmia neonatorum. The nurse understands that this newborn was exposed to which infection?

gonorrhea Gonorrhea can be transmitted to the newborn in the form of ophthalmia neonatorum during birth by direct contact with gonococcal organisms in the cervix. The newborn would develop congenital syphilis if exposed in utero. Exposure to Candida would cause thrush in the newborn. Exposure to HIV during gestation could lead to the birth of an HIV-positive newborn.

A young woman comes to the walk-in clinic seeking treatment for chronic chlamydia trachomatis. Which finding is most likely because it often correlates with this diagnosis?

gonorrhea There is a common co-infection of chlamydia and gonorrhea when chlamydia is not treated with the necessary antibiotic medication combination. Anemia does not correlate with chlamydia, and there is no evidence that it precipitates liver disease. CNS disorders would be from syphilis.

A public health nurse is teaching a class on sexually transmitted infections (STIs). Which statements would the nurse include in the discussion? Select all that apply.

"65 million people live with incurable STIs." "After a single exposure, women are twice as likely as men to acquire a STI." "STIs contribute to cervical cancer." An estimated 65 million people live with an incurable STI. STIs are biologically sexist, presenting greater risk and causing more complications among women than among men. After only a single exposure, women are twice as likely as men to acquire infections. STIs may contribute to cervical cancer. Certain infections can be transmitted in utero to the fetus or during childbirth to the newborn.

A community health nurse is conducting an educational session at a local community center on sexually transmitted infections (STIs). The nurse considers the session successful when participants identify which statement as correct?

"Human papillomavirus is the cause of essentially all cases of cervical cancer." Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer, which is the fourth most common cancer in women in the United States. Up to 95% of cervical squamous cell carcinomas and nearly all preinvasive cervical neoplasms are caused by the HPV. Antibiotics will only cure those STIs caused from a bacterial infections. A viral STI infection is a lifetime infection. Gonorrhea and syphilis affects both men and women. Sexually transmitted infections (STIs) are infections of the reproductive tract caused by microorganisms transmitted through oral sexual intercourse.

A nurse is reading a journal article about chlamydia. The nurse would expect to find that what percentage of women are asymptomatic when infected with chlamydia?

70% Asymptomatic infection is common among both men and women, affecting 50% and 70%, respectively.

When describing sexually transmitted infections and testing, the nurse explains that a client is typically tested for chlamydia, gonorrhea, and syphilis at the same time for which reason?

It is not unusual for clients to have concurrent infections with more than one sexually transmitted infection (STI). It is common practice to test clients for chlamydia, gonorrhea, and syphilis because it is not unusual for clients to have concurrent infections with more than one STI. For chlamydia, the causative microorganism is a bacterium named Chlamydia trachomatis. For gonorrhea, the infection is caused by a bacterium named Neisseria gonorrhoeae. The spirochete Treponema pallidum is the causative microorganism of syphilis. The symptoms of these conditions are not identical. The causative microorganisms do not spread through the same medium.

A 40-year-old woman with gray, runny vaginal discharge that has a foul, fishy odor has been told that she most likely has vaginosis. What most likely contributed to her present condition?

a sharp reduction in the number of lactobacilli in the client's vaginal flora Vaginosis is a disorder characterized by a shift in the vaginal flora from one dominated by hydrogen peroxide-producing lactobacillus to one with greatly reduced numbers of lactobacillus species and an overgrowth of other organisms. Autoinoculation or sexual transmission of bacteria or protozoa is unlikely to contribute.

Which medication is used to suppress viral load of the HSV-2 infection?

acyclovir The antiviral agents acyclovir, valacyclovir, and famciclovir are recommended to suppress the viral load and decrease recurrence and shedding. Metronidiazole and clindamycin are not used for this action.

A nurse is engaged in primary prevention activities for HPV. The nurse would be most likely involved with which activity?

administering HPV vaccine Primary prevention is aimed at preventing the disease or condition before it occurs, so giving the HPV vaccine would be a primary prevention activity. If the woman does not receive primary prevention with the vaccine, then secondary prevention would focus on education about the importance of receiving regular Pap smears and, for women over age 30, including an HPV test to determine whether the woman has a latent high-risk virus that could lead to precancerous cervical changes.

A woman seen in the emergency department is diagnosed with primary syphilis. What finding is most likely?

chancres at the vaginal site Syphilis is divided into four stages: primary, secondary, latency, and tertiary. Primary syphilis is characterized by a chancre at the site of bacterial entry. Foul-smelling discharge would not be noted. Vesicles on the labia are not associated with syphilis. Bleeding from the vagina could be normal menses and does not correlate with syphilis.

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which most common STI in the United States would the nurse expect to include?

chlamydia Chlamydia is the most common and fastest-spreading bacterial STI in the United States, with 2.8 million new cases occurring each year. Gonorrhea is the second most frequently reported communicable disease in the U.S. The incidence of syphilis had been increasing for the past 6 years. One in five people older than age 12 is infected with the virus that causes genital herpes.

When describing sexually transmitted infections (STIs) to a group of adolescents, the nurse identifies which STIs as curable? Select all that apply.

chlamydia gonorrhea trichomoniasis Chlamydia is curable with antibiotic therapy. Gonorrhea is curable with antibiotic therapy. Trichomoniasis is curable with metronidazole or tinidazole. Although the warts can be removed, the virus remains and is not cured. Antivirals control the symptoms but do not cure the disease.

In which clients is it most important to understand the importance of an annual Papanicolaou test?

clients infected with the human papillomavirus (HPV) HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of hormonal contraceptives do not increase the risk of cervical cancer.

A client with a family history of cervical cancer is to undergo a Pap test. During the client education, what group should the nurse include as at risk for cervical cancer?

clients who have genital warts The presence of genital warts (condyloma) increases the risk of developing cervical cancer. Women with metrorrhagia or irregular menstrual cycles are at an increased risk of developing breast cancer, not cervical cancer. Clients who have never had a baby or those with a history of fibrocystic breast disease have an increased risk of developing breast cancer, but not cervical cancer.

The client is single, admits to not using condoms during sexual intercourse, and has had multiple partners over the past year. Which symptoms would alert the nurse to a possible gonorrheal infection? Select all that apply.

dysuria abnormal uterine bleeding mild sore throat abnormal vaginal discharge Assessment findings for gonorrhea may include: abnormal vaginal discharge, dysuria, abnormal vaginal bleeding, enlarged lymph nodes locally, PID, mild sore throat (for pharyngeal gonorrhea), and rectal infection (itching, soreness, bleeding, discharge).

A nurse in the sexual health clinic assesses a female client and notes wart-like lesions on the genital area and rectum. Which diagnosis best correlates with these findings?

human papillomavirus HPV presents itself with wart-like lesions that are soft, moist, or flesh colored and appear on the vulva and cervix, and inside and surrounding the vagina and anus. The other diagnoses do not present with wart-like lesions.

A client who has been treated for recurring gonorrhea visits the sexual health clinic reporting dysuria, urinary frequency, and whitish-yellow vaginal discharge. A pelvic examination reveals cervicitis. How would the nurse interpret these findings?

the possibility of a chlamydia infection Any woman suspected of having gonorrhea should be tested for chlamydia also because coinfection (45%) is extremely common. The nursing management of chlamydia and gonorrhea includes treatment of both. The prevalence of chlamydia and gonorrhea is increasing dramatically.

A parent at an educational session on sexually transmitted infections (STIs) asks the nurse if there are vaccines available to prevent STIs. What is the nurse's best response?

"A vaccine has been approved vaccines to prevent the human papillomavirus." Vaccine-preventable STIs can be effectively prevented through preexposure vaccination. Vaccines are under development or are undergoing clinical trials for certain STIs, including HIV and HSV. The only vaccines currently available are for prevention of HAV, HBV, and HPV infection. Vaccination efforts focus largely on integrating the use of these available vaccines into STI prevention and treatment activities.

A client is being discharged from the gynecological unit after treatment for an acute pelvic inflammatory disease (PID). What priority instruction regarding disease management should the nurse include?

Discuss the necessity of completing the antibiotic therapy. It is the priority that the client understands the need to finish the antibiotic therapy required to treat PID in order to eradicate the offending bacterial infection. The STI brochures may be appropriate, but they are not the priority and neither is arranging for follow-up health care provider visits. If the client can access the women's health clinic, a referral can be made, but it is not the priority.

The nurse is caring for clients who have STIs. Which client is most at risk for becoming infertile due to the infection?

a woman diagnosed with chlamydia Chlamydia trachomatis is the bacterium that is the leading cause of preventable infertility in women and the most common STI in the United States. Chlamydia is transmitted during vaginal, anal, or oral sex, leading to infections in the associated tissues of these areas. Lymphogranuloma venereum (LGV) is an STI that results from the three strains of Chlamydia trachomatis.

During unprotected sex, a 17-year-old female high school senior has been exposed to the human papillomavirus (HPV). The school nurse would recognize that the student is at a considerable risk of developing which diagnosis?

condylomata acuminata HPV is an identified precursor to condylomata acuminata, or genital warts. Herpes, gonorrhea, and candidiasis are not likely to result directly from HPV.

Which finding would the nurse most likely find in a male diagnosed with a chlamydia trachomatis infection?

dysuria A male with the diagnosis of chlamydia will first experience dysuria as the primary symptom. The other symptoms listed do not correlate to men with the diagnosis of chlamydia.

A client with primary syphilis is allergic to penicillin. The nurse would expect the primary care provider to prescribe which agent?

doxycycline Clients who are allergic to penicillin are given doxycycline or erythromycin. Acyclovir is used to treat genital herpes. Ceftriaxone may be used for gonorrhea. Podophyllum resin is used to treat genital warts.

When developing a program for STI prevention, which action would need to be done first?

educating on how to promote sexual health The key to successful treatment and prevention of STIs is education to promote sexual health. Behavior changes, increasing the availability of resources, and interfering with modes of transmission are important, but all of these require education.

A client is using high-dose estrogen oral contraceptives. The nurse would assess the client for which finding?

yeast infections The nurse should closely monitor for yeast infections in a client who uses high-dose estrogen oral contraceptives. Hormonal changes when using high-dose estrogen oral contraceptives can change the environment of the vagina and make it conducive to the growth of yeast cells. Use of high-dose estrogen oral contraceptives does not maximize risk of loss of appetite, hypertension, acidity, or heartburn.

A woman comes to the clinic reporting intense pruritus and a thick curd-like vaginal discharge. On examination, white plaques on observed on the vaginal wall. The nurse suspects which condition?

vulvovaginal candidiasis Pruritus, a thick, curd-like vaginal discharge, and white plaques on the vaginal wall are characteristic of vulvovaginal candidiasis. Trichomoniasis is characterized by a heavy yellow or green or gray frothy or bubbly discharge. Bacterial vaginosis is characterized by a thin white homogeneous vaginal discharge. Chlamydia is usually manifested by a mucopurulent vagina discharge.

A nurse is working as part of a team to address the prevention of sexually transmitted infections in the community. Based on the nurse's understanding of the groups at highest risk, the team would most likely focus their efforts on which population?

those under age 25 Sexually transmitted infections occur disproportionately in adolescents, with an estimated two-thirds of all STIs occurring among persons under the age of 25. Therefore, preventive interventions would focus on this population.

A client is suspected of having herpes simplex viral infection. The nurse would expect to prepare the client for which diagnostic test to confirm the infection?

viral culture of vesicular fluid Diagnosis of HSV is often based on clinical signs and symptoms and is confirmed by viral culture of fluid from the vesicles. The IgG/IgM antibody testing is frequently done for screening purposes. Papanicolaou (Pap) smears are an insensitive and nonspecific diagnostic test for HSV and should not be relied on for diagnosis. Treponemal testing is used to diagnose syphylis.

A client with genital warts is receiving treatment with a local application of trichloroacetic acid. Which client statement indicates adequate understanding of the procedure?

"I'm temporarily not contagious once the warts are destroyed." Genital warts when treated chemically will most likely be eradicated after three to six cycles of treatment. Eradication does not mean the condition is cured; the person is temporarily noncontagious once the warts are destroyed. All sexual contacts of the client need to be examined and treated.

A nurse is developing a program for the community on preventing STIs. Which measure would be most effective for a nurse to utilize?

education to promote sexual health The key to successful treatment and prevention of STIs is education to promote sexual health. Behavior changes, increasing the availability of resources, and interfering with modes of transmission are important, but all of these require education.

A nurse is caring for a client undergoing treatment for bacterial vaginosis. Which instruction should the nurse give the client to prevent recurrence of bacterial vaginosis?

Practice monogamy. Although the reasons for bacterial vaginosis are not yet fully understood, sex with multiple partners increases the risk, and therefore it should be avoided. Using oral contraceptives and smoking have not been associated with bacterial vaginosis. A colposcopy test is recommended for clients with high-risk HPV, not for diagnosing bacterial vaginosis

During a presentation on sexually transmitted infections (STIs), a participant asks the nurse why STIs occur more often in women. What would the nurse address as a possible reason?

The woman's moist vaginal environment is highly conducive to microbial growth. Researchers suggest that STIs occur more often in women than in men, probably because the moist, warm vaginal environment is conducive to microbial growth and because the vagina, as a receptive orifice, is more readily traumatized during sexual activity. The increased risk is not due to women engaging in sexual activity with multiple partners or a genetic predisposition.

A school health nurse is presenting information on sexually transmitted infections (STIs) to a high school class. The nurse feels confident that learning has taken place when the students report:

female adolescents are more susceptible to STIs due to their anatomy. STIs may cause chronic liver diseases and cancer due to hepatitis B (HBV) and C (HCV) infections. Genital cancer is associated with papillomavirus (HPV), and is AIDS caused by HIV. Adolescent males make up more than three-quarters of HIV diagnoses. Many health care providers fail to assess adolescent sexual behavior and STI risks or to screen for asymptomatic infection during clinic visits thus delaying treatments. STIs are not curable. Many female adolescents are more susceptible to STIs due to their anatomy.

A primary care provider tells a client to return 2 to 3 months after treatment to have a repeat culture done to verify the cure. This prescription would be appropriate for a woman with which condition?

gonorrhea Gonococcal infections can be completely eliminated by drug therapy. Genital warts are not curable and are identified by appearance, not culture. Genital herpes is not curable and is identified by the appearance of the lesions or cytologic studies. The diagnosis of syphilis is done using dark-field microscopy or serologic tests.

The nurse in the sexual health clinic is obtaining a health history of a client who is addicted to heroin, reporting chronic flu-like symptoms accompanied by pruritis, fatigue, anorexia, and constant upper right quadrant pain. Which sexually transmitted infection would the nurse suspect?

hepatitis A Hepatitis A produces flulike symptoms with malaise, skin rashes, fatigue, anorexia, nausea, pruritus, fever, and upper right quadrant pain. Symptoms of hepatitis B are similar to those of hepatitis A, but with less fever and skin rash involvement. The other STIs do not present with these types of symptoms.

The nurse in a sexual health clinic is reviewing the history of a 30-year-old homosexual client who is an IV drug addict and diagnosed with a sexually transmitted infection. Which therapy would the nurse expect to include in his care?

hepatitis A and hepatitis B recombinant vaccine Risk factors for HAV and HBV infection include having multiple sex partners, engaging in unprotected anal intercourse, and having a history of other STIs. The most effective means to prevent the transmission of hepatitis A or B is preexposure immunization. The hepatitis A and hepatitis B recombinant vaccine is available for the prevention of HAV and HBV. Every person seeking treatment for an STI should be considered a candidate for hepatitis B vaccination, and some individuals (e.g., men who have sex with men and injection-drug users) should be considered for hepatitis A vaccination. There is no vaccine to prevent HIV. Scientists believe that a safe and effective HIV vaccine is possible. The recombinant human papillomavirus vaccine is administered to younger males. The antifungal (acyclovir) therapy is not reasonable as the type of STI he has is not specified.

Which stage or period of syphilis occurs when the infected person has no signs or symptoms of syphilis?

latency A period of latency occurs when the infected person has no signs or symptoms of syphilis. Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.

A nurse is conducting an assessment of a client who is suspected of having pelvic inflammatory disease. Which finding would the nurse identify as mandatory for the diagnosis to be made? Select all that apply.

lower abdominal tenderness adnexal tenderness cervical motion tenderness To reduce the risk of missed diagnosis, the CDC has established criteria for the diagnosis of PID. Minimal criteria (all must be present) are lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Additional supportive criteria that support a diagnosis of PID include abnormal cervical or vaginal mucopurulent discharge and oral temperature above 101° F (38.3° C)

Which medications are appropriate to treat vaginal candidiasis? Select all that apply.

miconazole fluconazole Therapeutic management for vaginal candidiasis includes miconazole, clotrimazole, terconazole, and fluconazole. The other choices are antibiotics and are not effective treatment for a fungal infection such as vaginal candidiasis.

A nurse is reviewing the history of a client diagnosed with pelvic inflammatory disease. Which factors would the nurse identify as placing the client at increased risk for this condition? Select all that apply.

multiple sex partners intrauterine contraceptive device inserted 3 weeks ago vaginal douching approximately once a week All sexually active women are at risk of PID, but common risk factors include age less than 25 years old, residence in an inner city, multiple sexual partners, sex with a new partner, insertion of an intrauterine contraceptive (IUC) within the past 6 weeks, vaginal douching, history of STI in the woman or her partner, lack of barrier contraceptive use, and a previous episode of PID.

A female client comes to the clinic for an evaluation. Assessment reveals flu-like symptoms and a maculopapular rash on her trunk, and the palms of her hands and the soles of her feet. The client also reports hair loss and fatigue. She states, "I had a small ulcer near my vagina about 6 weeks ago that went away." Based on these findings, the nurse suspects that the client has syphilis at which stage?

secondary The client's assessment findings support secondary syphilis. Primary syphilis is characterized by a painless ulcer (chancre) at the site of bacterial entry that disappears within 1 to 6 weeks without intervention. Early and late latent syphilis are characterized by no symptoms but a positive serology.

A 40-year-old woman is being discharged from the walk-in health care clinic after a diagnosis of pelvic inflammatory disease. Which health teaching topic should the nurse address?

sexually transmitted infections STIs are responsible for genital tract infections that may lead to later complications in women such as pelvic inflammatory disease (PID). The other topics do not relate to PID.

A nurse is conducting a program about genital herpes infection at a community clinic. The nurse determines that additional discussion is needed when the group identifies which activity as a means of transmission?

sharing contaminated needles Herpes simplex virus is transmitted primarily by direct contact with an infected individual who is shedding the virus and may include kissing, sexual contact, and vaginal birth. Sharing contaminated needles is a means of transmitting HIV.

The nurse is caring for a 14-year-old girl who fears she might have a sexually transmitted infection (STI). What would the nurse expect to assess if the adolescent has trichomoniasis?

green vaginal discharge Symptoms of trichomoniasis include a yellow, green, or gray vaginal discharge with a foul odor. Urinary incontinence is not indicative of trichomoniasis, but dysuria is. Syphilis is associated with flu-like symptoms. Lesions on the vulva are a sign of venereal warts.

A client with syphilis did not receive treatment and has now progressed into the tertiary stage of the disorder. Which symptoms would the nurse expect the client to exhibit?

heart disease and inflammation of the aorta, eyes, brain, central nervous system, and skin The client with late or tertiary syphilis is noninfectious because the microorganism has invaded the central nervous system (CNS) as well as other organs of the body. Symptoms of tertiary syphilis include heart disease and neurologic disease that slowly destroys the heart, with inflammation of the aorta, eyes, brain, central nervous system, and skin. Symptoms of secondary syphilis include fever, malaise, rash, headache, sore throat, and lymph node enlargement. Ulcerated chancre occurs in the primary stage.

A 20-year-old female comes to the sexual health clinic for follow up related to a positive test for the human papillomavirus (HPV). The client asks the nurse, "Is there anything I can do to get rid of this?" What is the nurse's best response?

"There is currently no medical treatment to cure HPV." It is a lifelong recurrent viral disease treated but not cured with medical treatment. Immunization regimes such as the recombinant human papillomavirus quadrivalent vaccine are for HPV prevention not cure. Cryosurgery will eliminate HPV warts but not cure it. Antibiotics will not be effective for a virus.

A woman seen in the emergency walk-in clinic is diagnosed with chlamydia trachomatis. She asks the nurse how this disease is different from other sexually transmitted infectious diseases. What is the nurse's best response?

"This STI is characterized by an infection of your cervix." STIs like chlamydia result in a cervicitis that implies the presence of inflammation or infection of the cervix. It produces quantities of purulent discharge. Cervicitis is usually caused by gonorrhea or chlamydia. Chlamydia will not produce ulcers or warts and is not a STI that has itching associated with it.

A female client with genital herpes is prescribed acyclovir as treatment. After teaching the client about this treatment, which statement by the client indicates effective teaching?

"This drug will help to suppress any symptoms of the infection." No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. Advances in treatment with acyclovir 400 mg orally three times daily for 7 to 10 days, famciclovir 250 mg orally three times daily for 7 to 10 days, or valacyclovir 1 g orally twice daily for 7 to 10 days have resulted in an improved quality of life for those infected with HSV. However, according to the CDC, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued.

A pregnant woman recently diagnosed with the genital herpes virus asks the nurse for more information on the virus. Which responses by the nurse would be appropriate? Select all that apply.

"Transmission is through contact of infected mucous membranes." "Infections may be transmitted by individuals unaware that they have it." "The virus remains quiet until a stressful event occurs to reactivate it." Genital herpes simplex is transmitted by contact of mucous membranes or breaks in the skin with visible or nonvisible lesions. Most genital herpes infections are transmitted by individuals unaware that they have an infection. Kissing, sexual contact (including oral sex), and vaginal birth are means of transmission. The virus remains latent until stimuli such as fever, stress, ultraviolet radiation, or immunosuppression occurs and reactivates it.

After teaching a group of college students about the modes of transmission for herpes simplex virus, the nurse determines that additional teaching is needed when the group identifies which mode of transmission?

sharing contaminated needles Herpes simplex virus is transmitted primarily by direct contact with an infected individual who is shedding the virus and may include kissing, sexual contact, and vaginal birth. Sharing contaminated needles is a means of transmitting HIV.

A nurse in the sexual health clinic is assessing a male adolescent client, who is homosexual, for sexually transmitted infection (STI) risk factors. Which factor would the nurse identify as presenting the highest risk for STIs?

the age of the client Adolescents tend to think they are invincible and deny the risks of their behavior. This risky behavior exposes them to STIs. Adolescents frequently have unprotected intercourse and they engage in partnerships of limited duration. The other options are all risk factors, but just the fact he is a teenager places him more at risk for a STI as he will engage in risky sexual behaviors with a larger number of sexual partners without considering his risks. His sexual orientation should not place him at risk if precautions are taken.