Chapter 56: Caring for Clients with Sexually Transmitted Infections

A client in the clinic is being treated with podofilox resin for genital warts. What should the nurse teach the client about this medication regimen? a. Several repeated treatments will likely be needed. b. The drug must be taken on an empty stomach. c. The treatment may or may not be cured by the medication. d. Blood levels will need to be taken after one week.

a Podofilox is given topically, not orally, and blood levels are unnecessary. The goal is eradication of warts, but cure is not possible.

A nurse is teaching a client facts about the proper use of a condom. What would be the correct information? a. Use a silicone-based lubricant to prevent the condom from breaking; silicone does not deteriorate latex. b. Condoms may be kept in warm, dry places. c. It is acceptable to unroll or examine a condom before its use. d. Condoms may be used multiple times.

a Use a silicone-based lubricant to prevent the condom from breaking; silicone does not deteriorate latex. Condoms should be kept in cool, dry places. It is not acceptable to unroll or examine a condom before its use. Apply a new condom before each sex act.

Which of the following medications are used to suppress viral load of the HSV-2 infection? a. Acyclovir (Zovirax) b. Penicillin c. Metronidazole (Flagyl) d. Clindamycin (Cleocin)

a With Herpes simplex virus 2 (HSV-2), the antiviral agents acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir) are recommended to suppress the viral load and decrease recurrence and shedding. Flagyl and Cleocin are not used for this purpose.

A patient comes to the clinic with complaints of a painless sore on her lip 2 weeks after she had oral sex with her boyfriend. The nurse observes a chancre on the lips and the physician orders testing for syphilis. If results are positive, what is the likely stage the patient is in? a. Primary b. Secondary c. Latency d. Tertiary

a Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. A painless lesion at the site of infection is called a chancre. These lesions usually resolve spontaneously within 3 to 12 weeks, with or without treatment (Porth & Matfin, 2009).

The school health nurse is conducting a teaching session for parents to provide information about the human papillomavirus (HPV) vaccination. What prevention information should the nurse include in the session? a. The effect of the vaccination is optimized if it is administered before the child becomes sexually active. b. The vaccination is available only to girls but, in the long term, protects both genders from sexually transmitted infections. c. The HPV vaccination prevents the future need for cervical cancer screening in women. d. A Pap smear test is required prior to administration of the HPV vaccination.

a The nurse should advise the parents that the vaccination should ideally be administered before the onset of sexual activity, to prevent genital warts. The vaccination is available and effective when administered to both men and women. The HPV vaccination does not preclude women from having regular cervical cancer screening in the future. A Pap smear prior to the administration of the vaccination is not required, particularly for those woman who are not yet sexually active.

The nurse is assessing a client in the emergency department who grimaces and reports swelling of the testicles, burning on urination and a green discharge from the penis. The nurse suspects the client will be diagnosed with which infection? a. Gonorrhea b. Primary syphilis c. Herpes genitalis d. Trichomoniasis

a When symptoms of gonorrhea are present in male clients, the symptoms may include burning during urination and penile discharge. Clients with Neisseria gonorrhoeae infection also may report painful swollen testicles. The latter symptoms distinguishes this infection from the infections in the alternate options. Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. A painless lesion at the site of infection is called a chancre. Untreated, these lesions usually resolve spontaneously within about 2 months. With herpes genitalis primary infection may begin with macules (small flat spots on skin) and papules (small circumscribed elevations) and progress to vesicles (small, serous-filled elevated spots) and ulcers. The vesicular state often appears as a blister, which later coalesces, ulcerates, and encrusts. Influenza-like symptoms may occur 3 or 4 days after the lesions appear, often with inguinal lymphadenopathy (enlarged lymph nodes in the groin). Men with trichomoniasis may notice itching or irritation inside the penis, burning after urination or ejaculation, discharge from the penis.

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis? a. A painless genital ulcer that appeared about 3 weeks after unprotected sex b. Copper-colored macules on the palms and soles that appeared after a brief fever c. Patchy hair loss and red, broken skin involving the scalp, eyebrows, and beard areas d. One or more flat, wart-like papules in the genital area that are sensitive to touch

a A painless genital ulcer is a symptom of primary syphilis. Macules on the palms and soles after fever are indicative of secondary syphilis, as is patchy hair loss. Wart-like papules are indicative of genital warts.

The nurse is providing education about treatment for syphilis to a client who has a confirmed infection. The client states, "Penicillin causes me to have raised, red bumps all over my body. Will I have to take it again?" How should the nurse respond? a. "You can be treated with an alternative antibiotic called doxycycline." b. "There are many alternatives to taking antibiotics to treat syphilis." c. "Ceftriaxone is an antibiotic that is also effective in the treatment of this infection." d. "Topical application of an immune response modifier can be used instead."

a 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 with late latent or latent syphilis of unknown duration should receive three injections at 1-week intervals. Usually clients who are allergic to penicillin are treated with doxycycline or tetracycline. There are no alternative treatments for syphilis that are effective other than antibiotics. Ceftriaxone is used to treat gonorrhea. Immune response modifiers such as imiquimod, are topical agents used in the treatment of external lesions associated with the human papillomavirus (HPV).

Which of the following is the medication of choice for early syphilis? a. Penicillin G benzathine b. Doxycycline c. Tetracycline d. Rocephin

a 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. Patients who are allergic to penicillin are usually treated with doxycycline or tetracycline. Rocephin is not the medication of choice for syphilis.

A nurse is developing a plan of care for a female client experiencing her first outbreak of genital herpes. Which nursing diagnosis would the nurse most likely identify as the priority? a. Acute pain related to the development of the genital lesions b. Deficient knowledge related to the disease and its transmission c. Ineffective coping related to the increased stress associated with the infection d. Hyperthermia related to body's response to an infectious process

a Although deficient knowledge, ineffective coping, and hyperthermia are possible nursing diagnoses, the priority would be acute pain because the initial infection is usually very painful and lasts about 1 week.

A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea? a. Burning on urination b. Dry, hacking cough c. Diffuse skin rash d. Painless chancre

a Burning on urination may be a symptom of gonorrhea or urinary tract infection. A dry, hacking cough is a sign of a respiratory infection, not gonorrhea. A diffuse rash may indicate secondary stage syphilis. A painless chancre is the hallmark of primary syphilis. It appears wherever the organisms enter the body, such as on the genitalia, anus, or lips.

The nurse is presenting a community lecture about STIs, and emphasizes that some STIs are easily cured with early and adequate treatment. Which is not among these easily treated diseases? a. genital herpes b. chlamydia c. gonorrhea d. syphilis

a Chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes is not.

A nurse is teaching a health class to a group of clients likely to be at highest risk for gonorrhea. What is the age range of the clients? a. 15 to 24 years b. 25 to 29 years c. 30 to 45 years d. 60 to 70 years

a Gonorrhea is the second most frequently reported communicable disease in the United States. Its highest incidence occurs in the 15- to 24-year-old age group.

The nurse explained the difference between the herpes simplex viruses (HSV-1 and HSV-2). One characteristic of HSV-1 is that it: a. Affects the mouth and lips. b. Has a higher percentage of occurrence. c. Is less painful. d. Produces more frequent reoccurrences.

a HSV-1 is the oral type that causes painful itching blisters or cold sores in the mouth and around the lips.

Which of the following sexually transmitted infections (STIs) could be transmitted perinatally? a. Herpes simplex b. Chlamydia c. Gonorrhea d. Trichomoniasis

a Herpes simplex and syphilis can be transmitted perinatally and sexually. Chlamydia, gonorrhea, and trichomoniasis are transmitted sexually.

A client who has developed a painless penile ulcer is diagnosed with syphilis. What is the typical span of time between infection and developing symptoms with syphilis? a. 21 days b. 28 days c. 14 days d. 35 days

a In syphilis, the time between infection and the first occurrence of symptoms is about 21 days.

The nurse is assessing a client who reports stiff joints and alopecia. While taking the client's health history, the client reports having multiple sexual partners in the past 6 months and finding a lesion on her labia about 1 month before today's appointment. What should the nurse anticipate based on the signs and symptoms presented? a. The client will require treatment for the secondary stage of syphilis. b'. Treatment planning for a chlamydial infection is needed. c. Pelvic inflammatory disease is the likely cause of the hair loss. d. The client will require a colposcopy to confirm any diagnosis.

a In the secondary stage of syphilis, generalized signs of infection may include lymphadenopathy (abnormal enlargement of lymph nodes), arthritis, meningitis (inflammation of the pia mater, arachnoid, and the subarachnoid space), hair loss, fever, malaise, and weight loss. Hair loss and arthritis are not common symptoms associated with a chlamydial infection or pelvic inflammatory disease. The information collected in the health history confirms that the client has moved past the primary stage of the infection. A colposcopy is a diagnostic procedure carried out to determine if there have been any changes in cervical cells (dysplasia). Given the client's reported health history, secondary syphilis should be further investigated first.

Which is the fastest spreading bacterial STI in the United States? a. chlamydia b. gonorrhea c. herpes simplex 1 d. syphilis

a There were 1,307,893 reported cases of chlamydia in 2010. There were 309,341 reported cases of gonorrhea in 2010. Herpes simplex virus type 1 is not reported by law. Therefore, the data is not available. There were 13,774 reported cases of syphilis in 2010.

Which is the second most frequently reportable communicable disease in the United States? a. gonorrhea b. AIDS c. syphilis d. herpes simplex

a There were 309,341 reported cases of gonorrhea in 2010. It was the second most reported disease in 2010. There were 47,500 reported cases of AIDS in 2010. There were 13,774 reported cases of syphilis in 2010. Herpes simplex is not a reportable disease.

A nurse is teaching personal hygiene care techniques to a client with genital herpes. Which statement by the client indicates the teaching has been effective? a. "I will wear loose cotton underwear." b. "I will apply a water-based lubricant to my lesions." c. "I should rub rather than scratch in response to itching." d. "I can pour moisturizer over my lesions."

a Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. The use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions shouldn't be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch. The use of moisturizer on lesions isn't recommended.

The nurse is meeting with the mother of an 11-year-old girl to provide decision making support and education regarding human papillomavirus (HPV) vaccination. The mother states, "I am confused about why my 11 year old needs to be protected from a sexually transmitted infection. She is so young and not sexually active. Why does she need the vaccination now?" What is the nurse's best response? a. "The vaccination helps to prevent cervical cancer in adult women. It works better if she has it before she becomes sexually active. Let's talk about some of the concerns you have about the vaccination" b. "HPV vaccination is very common and most parents are choosing to protect their children. Although your child is not sexually active now, she will be soon and this will protect her from sexually transmitted infections." c. "You're daughter is at risk for ectopic pregnancy and even infertility without this vaccination. If you chose not to vaccinate, you are choosing to put your daughter at risk." d. "Although HPV infections are not very common, it is important to take precaution with vaccination. If you prefer, you can wait until your daughter is older than 15 years, because she would require fewer doses of the vaccine."

a When counseling clients regarding the HPV vaccination, it is important to use supportive communication to help reduce the client's anxiety and help them make the best decision for his or her health. The nurse should provide facts about the benefits of vaccination along with the potential long term consequences of abstaining from vaccination. The nurse should be careful when stating the child will be "protected from sexually transmitted infections." The HPV vaccination only protect against infections caused by HPV and the primary purpose of the vaccination is to prevent the development of certain cancers related to the infection. Telling the mother her daughter is at risk for ectopic pregnancy and infertility is ineffective because the nurse has not yet discussed the possible consequences of a HPV infections. The nurse is not communicating in a manner that would reduced the mother's anxiety. The response may be perceived as accusatory and judgmental. By telling the mother if she waits to vaccinate her daughter until she is 15 years old, the nurse is providing incorrect information. Children between the ages of 9 and 14 require fewer doses of the vaccination that children 15 and older up to 26 years of age.

The nurse educator is planning a health promotion class with a focus on sexually transmitted infections. What points regarding risk factors for chlamydia and gonorrhea should the nurse educator include? Select all that apply. a. "Your chances of contracting these infections are higher the more sexual partners you have." b. "Young adults and teenagers are a high risk age group for both these infections." c. "Women between 28 to 35 years of age are in a unique high risk category for both these infections." d. "Once treatment has been completed, reinfection with either of these infections is not possible." e. "If you have been notified that you have these infections, you are obligated to inform any past sexual partners."

a, b Any sexually active person can be infected with chlamydia or gonorrhea, and the risk increases with the number of sexual partners. The target group for preventive client teaching about gonorrhea and chlamydia is the adolescent and young adult population. The group with the greatest risk for chlamydia infection is young women 24 years of age and younger and may be associated with a cervix that has not matured fully; therefore, it is incorrect that women between the ages of 28 to 35 years are at higher risk. Retesting of woman 3 months' posttreatment is recommended due to the possibility of reinfection. Although education for men includes that they must inform their female partners of infection, informing sexual contacts is not a risk factor for the infection.

Which statements are true about chancroid? Select all that apply. a. caused by Hemophilus ducreyi. b. characterized by the appearance of a macule, followed by vesicle-pustule formation c. progresses to a painful genital ulcer and enlarged, tender lymph nodes in the inguinal area d. caused by Treponema pallidum e. causes the lymph nodes to become necrotic f. It may be treated with tetracycline.

a, b, c Chancroid is caused by the Hemophilus ducreyi bacillus. Chancroid is characterized by the appearance of a macule, followed by vesicle-pustule formation, and, finally, a painful genital ulcer and enlarged, tender lymph nodes in the inguinal area. Treponema pallidum causes syphilis. Lymph nodes may become necrotic with lymphogranuloma venereum. Chancroid is treated and cured with azithromycin, ceftriaxone, ciprofloxacin, or erythromycin.

The nurse is caring for a female client who has been diagnosed with Neisseria gonorrhoeae. The nurse is aware that if this client had not received treatment, what other serious issues could have resulted from this disease? Select all that apply. a. Increased risk of HIV infection b. Urethral stricture c. Infection and scarring of the Fallopian tubes d. Eye infection in an infant born to a woman with this disease e. Infection of the epididymis

a, c, d Complications of untreated Neisseria gonorrhea in a woman are infection of the cervix, endometrium, and Fallopian tubes. It has been shown to facilitate the transmission of HIV and it may transmitted to the eyes of a newborn. The development of infection of the epididymis and urethral strictures can only be seen in men.

A nurse is taking a class on public health and studying information about sexually transmitted infections (STIs). Which of the following would the nurse correctly recognize as true about STIs? Select all that apply. a. Health care providers are responsible for reporting STIs. b. Reported STIs are highest among Caucasian men. c. Cases of genital herpes are reportable by law. d. From 2005 to 2006, HIV/AIDS was the fastest-growing STI in the United States. e. STIs represent a diverse groups of infections.

a, e Sexually transmitted infections (STIs) are a diverse group of infections spread through sexual activity with an infected person. Reporting of new STI cases is the responsibility of either the health care provider or the testing laboratory. STIs such as genital herpes, hepatitis B, venereal warts (condylomata acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law. The reported incidence of STIs is disproportionately higher in racial and ethnic minorities. STIs occur more often in women than in men. Since the 1990s, yearly increases in new cases of HIV/AIDS have remained relatively stable.

The nurse recognizes the client is in which stage of syphilis when the client has no signs or symptoms of syphilis? a. Primary b. Latency c. Secondary d. Tertiary

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

A nurse practitioner who works for Planned Parenthood is responsible for health education seminars. During these presentations, the nurse always discusses the symptoms of the most common STI among young, sexually active people. This is: a. Candidiasis. b. Human papillomavirus. c. Endocervicitis. d. Salpingitis.

b At least 50% of sexually active men and women acquire genital HPV infection at some point in their lives.

A male client reports urethral pain and a creamy yellow, bloody discharge from the penis. The nurse associates these characteristics with which of the following sexually transmitted infections? a. Candidiasis b. Gonorrhea c. Chancroid d. Trichomoniasis

b In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.

Culture and sensitivity testing of a swab taken from a chancre on the penis of a 27-year-old man has confirmed the presence of Treponema pallidum. The nurse providing care for the patient should anticipate administering which of the following drugs? a. Vancomycin b. Penicillin c. Ciprofloxacin d. Azithromycin

b T. pallidum is the microorganism that is responsible for syphilis, a disease that is treated in the early stages by a single dose of penicillin G benzathine.

A 23-year-old sexually active woman is having a yearly check-up. The nurse advises the client that she should be screened for chlamydia: a. every 6 months. b. annually. c. if symptoms develop. d. every 5 years.

b The CDC recommends annual screening for chlamydia in all sexually active women younger than 26 years of age and in women with new or multiple sexual partners to reduce the incidence of PID.

The nurse is providing education to a client who has a positive nontreponemal test (NTT). The client states, "If I've already had a positive test and I know I have syphilis, why do I need to have another test?" How should the nurse respond? a. "An additional test needs to be done to determine which antibiotics you will need." b. "A second test can help confirm the diagnosis, because the NTT can give a false-positive result." c. "This test will help determine of the infection has moved to the third stage." d. "Another test can identify additional sexually transmitted infections you may have acquired."

b Treponemal tests, such as the fluorescent treponemal antibody absorption test (FTA-ABS) and the microhemagglutination assay test (MHA-TP), are used to verify that the screening test did not represent a false-positive result. The NTT and treponemal tests are only used for diagnostic purposes. They do not provide details to decide which antibiotic is best for the client's treatment. This decision is made based on any medication allergies or sensitivities the client may have. The tests do not offer information about the stage of the infection, only that it is present. Positive results usually are positive for life and, therefore, are not appropriate to determine therapeutic effectiveness. The nontreponemal and treponemal tests are used to diagnose syphilis only.

A 28-year-old sexually active male presented to a clinic because he was concerned about a round, painless sore on the shaft of his penis that had appeared 2 days prior to his visit. The nurse practitioner recognized the lesion as a "chancre," an indicator of primary syphilis. The nurse should tell the patient: a. "Abstain from sexual activity for 2 weeks, after which the lesion will resolve." b. "No treatment is necessary unless you notice a rash on your chest." c. "An antibiotic injection is the best treatment since the lesion has just occurred." d. "Without treatment, the lesion will increase in size and become painful."

c An untreated chancre will usually resolve within 2 months, but a generalized infection will occur as the microorganisms spread from the original site. A rash will occur in 2 to 8 weeks after the chancre. A single dose of penicillin G benzathine is the medication of choice for early syphilis.

A nurse practitioner advised the mother of a 16-year-old girl, who was diagnosed with human papillomavirus (HPV), that the infection can cause cancer of the _______ in the future. a. Vagina b. Urethra c. Cervix d. Uterus

c Certain types of HPV can cause cells of the cervix to become abnormal, contributing to 70% of cervical cancers.

The nurse has received several laboratory studies back at the clinic. Which of these results should be reported to the local health department? a. Wound infection with MRSA b. Positive influenza c. Positive gonorrhea d. Positive mononucleosis

c Gonorrhea and chlamydia are reportable communicable diseases. In any healthcare facility, a mechanism should be in place to ensure that all diagnosed patients are reported to the local public health department to ensure follow-up of the patient. The public health department also is responsible for interviewing the patient to identify sexual contacts so that contact notification and screening can be initiated.

In which group is it most important for the client to understand the importance of an annual Papanicolaou test? a. Clients with a history of recurrent candidiasis b. Clients with a pregnancy before age 20 c. Clients infected with the human papillomavirus (HPV) d. Clients with a long history of hormonal contraceptive use

c 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 don't increase the risk of cervical cancer.

The nurse is talking to a client who has come to the doctor's office to ensure that the client's sexually transmitted infection (STI) has been successfully treated. Which statement by the client requires further instruction? a. "I'm glad that the health care practitioner checked me for STIs when I came for my regular checkup because I didn't have any symptoms." b. "I will plan to use a dental dam from now on whenever I engage in oral sex." c. "It's great that I don't have to worry about having this infection again because I'm now immune to it." d. "I realize that using a condom with a spermicide will eliminate most chances of getting any type of a sexually transmitted infection."

c Having a sexually transmitted infection does not confer permanent immunity, so it is important that a client who is treated for an STI understands that the contact with an individual who has the same infection will result in the individual being infected again. All sexually active women under the age of 24 are to be checked yearly for STIs. The use of a dental dam during oral sex and condoms with spermicide help to prevent becoming infected with any type of STI.

The nurse is seeing a client who came into the sexual health clinic after discovering condylomata along her labia. The client states, "This makes no sense, I don't even know who I got this from and I have been so careful!" What is the nurse's best response? a. "If you make a list of your sexual partners over the past month you should be able to narrow down the person who is the source of your infection." b. "If a condom was used during all sexual contacts, it is unlikely the warts that you have were caused by the human papillomavirus (HPV)." c. "It sounds like you are feeling angry. Let's talk more about human papillomavirus (HPV) and strategies to stay healthy while you are being treated." d. "You are high risk simply because you are sexually active with more than one partner. Do you know how many partners all your partners have had?"

c In many cases, clients are angry about having warts from HPV and do not know who infected them because the incubation period can be long and partners may have no symptoms. Acknowledging emotional distress that occurs when a sexually transmitted infection is diagnosed and providing support and facts are important nursing actions. The client in this case is clearly feeling angry and overwhelmed. The nurse should first provide empathy and help the client focus on information regarding treatment in a solution focused way. Discussing the number of sexual partners and risk factors is important in prevention; however, given the client's emotional state the alternative responses would not be helpful and supportive. In addition, to inform the client that if a condom was used the virus cannot be transmitted is incorrect. Transmission can also occur through skin-on-skin contact in areas not covered by condoms.

A nurse is assisting with a physical examination of a male client. Which of the following signs and symptoms is most clearly suggestive of primary genital herpes? a. Presence of purulent, whitish discharge from the penis b. Emergence of hard, painless nodules on the shaft of the penis c. Itching, pain, and the emergence of pustules on the penis d. Production of cloudy, foul-smelling urine

c 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. Firm, subcutaneous nodules are not associated with herpes simplex virus (HSV), and the production of penile discharge and cloudy urine are not suggestive of the disease.

An adolescent informs the school nurse that she is afraid of contracting an STI but her boyfriend does not want to use condoms. What is the best response by the nurse? a. "You are too young to be having sex at all." b. "If he won't use a condom, then he doesn't care about you." c. "The use of condoms is one of the best ways to reduce the risk of acquiring an STI." d. "I can understand your concern and you should bring him here so that I can talk with him about STIs."

c The use of condoms to provide a protective barrier from transmission of STI related organisms has been broadly promoted, especially since the recognition of HIV/AIDS. At first referred to as a method to ensure safe sex, the use of condoms has been shown to reduce but not eliminate the risk of transmission of HIV and other STIs.

A student nurse is caring for a male patient diagnosed with gonorrhea. The patient is receiving ceftriaxone and doxycycline. The nursing instructor asks the student why the patient is receiving two antibiotics. What is the student nurse's best response? a. "There are many resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment." b. "The combination of these two antibiotics reduces the risk of reinfection." c. "Many people infected with gonorrhea are infected with chlamydia as well." d. "This combination of medications will eradicate the infection faster than a single antibiotic."

c Treatment of gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin is prescribed as well. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.

A patient with genital herpes is having an acute exacerbation. What medication would the nurse expect to be ordered to suppress the symptoms and shorten the course of the infection? a. Clotrimazole (Gyne-Lotrimin) b. Metronidazole (Flagyl) c. Podophyllin (Podofin) d. Acyclovir (Zovirax)

d Acyclovir (Zovirax) is an antiviral agent that can suppress the symptoms of genital herpes and shorten the course of the infection. It is effective at reducing the duration of lesions and preventing recurrences. Clotrimazole is used in the treatment of yeast infections. Metronidazole is the most effective treatment for trichomoniasis. Podophyllin is used to treat external genital warts. Acyclovir is used in the treatment of genital herpes.

A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea has presented at the clinic. The student knows that the care plan for this patient should be include what in the treatment of gonorrhea? a. Radiation therapy to destroy cancerous cells b. Avoidance of the use of tampons c. Vaginal smears every 6 months d. Concurrent treatment for chlamydia

d Because of the high incidence of coinfection with chlamydia and gonorrhea, treatment for gonorrhea should also include treatment for chlamydia. One cause of cervicitis is chlamydia. A management strategy used in the treatment of chlamydia is a cytologic examination of cervical smear. Avoiding the use of tampons is part of the self-care management of a patient with possible toxic shock syndrome (TSS). Gonorrhea is considered a sexually transmitted infection (STI), not a carcinoma.

The following outcome appears on the plan of care for a client with genital herpes: "Client demonstrates knowledge about measures to reduce the risk of transmission and recurrences." Which of the following, if reported by the client, would support achievement of this outcome? a. Avoids sexual activity when lesions are present b. Cleans lesions with strong anti-bacterial soap c. Applies occlusive dressings to lesions d. Consistently uses condoms with sexual activity

d Consistent use of condoms for sexual activity indicates that the client has knowledge of the disorder and its transmission, thereby taking steps to reduce the risk of transmission. This action supports achievement of the outcome. Sexual activity even when lesions are not present can still lead to transmission of the infection. Lesions should be cleaned with mild soap and water and patted dry; occlusive ointments, powders, or dressings should be avoided because they do not allow the lesions to dry.

A patient has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the patient? a. The virus causes "cold sores" of the lips. b. The virus may be cured with antibiotics. c. The virus, when active, may not be contracted during intercourse. d. Treatment is aimed at relieving symptoms.

d HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSV-1 causes "cold sores," and varicella zoster causes shingles.

A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention? a. Rashes on the palms of the hands and soles of the feet b. Cauliflower-like warts on the penis c. Painful red papules on the shaft of the penis d. Foul-smelling discharge from the penis

d Signs and symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are a sign of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

Which instruction should be given to a woman newly diagnosed with genital herpes? a. Obtain a Papanicolaou (Pap) test every 3 years. b. Have your partner use a condom when lesions are present. c. Use a water-soluble lubricant for relief of pruritus. d. Limit stress and emotional upset as much as possible.

d Stress, anxiety, and emotional upset seem to predispose a client to recurrent outbreaks of genital herpes. Sexual intercourse should be avoided during outbreaks, and a condom should be used between outbreaks; it isn't known whether the virus can be transmitted at this time. During an outbreak, creams and lubricants should be avoided because they may prolong healing. Because a relationship has been found between genital herpes and cervical cancer, a Pap test is recommended every year.

The nurse is seeing a client who was recently diagnosed with primary syphilis after reporting a painless penis lesion to his health care provider. The client states, "I don't want anyone to find out that I have this disease." How should the nurse respond? a. "Your health is personal and confidential. No one outside this room needs to know about your infection." b. "It is important that you inform your sexual partners you have this infection. I can sit with you while you make the necessary phone calls." c. "It is part of my role to contact anyone you have had sexual contact with. Please provide the contact information to me." d. "You're test results are reported to a public health department. You will need to share the information about your sexual contacts, and they will notify and screen those people."

d Syphilis is a reportable communicable disease. The public health department is responsible for identification of sexual contacts, contact notification and contact screening. Although the nurse can reassure the client that all personal health information is confidential, it is imperative that the people who the infection may have been transmitted to are notified so they may seek screening and, if needed, treatment. The client is not obligated to make the phone calls to the contacts directly. Best practice is to provide the information to the public health department and have the health care providers contact the individuals affected. Although the nurse seeing the client should ask for detailed information about the contacts, it is for the purpose of passing it forward to the public health department to initiate contact and screening.

A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure related to which STI? a. Genital herpes b. Hepatitis B c. Syphilis d. Gonorrhea

d To prevent gonococcal ophthalmia neonatorum, erythromycin or tetracycline ophthalmic ointment is instilled into the eyes of all newborns. This action is required by law in most states. The ointment is not used to prevent conditions related to genital herpes, hepatitis B, or syphilis.