Sexually Transmitted Infections

Features of Chancroid

- Lesions begin as macules to pustules then ruputure -Secondary infection may cause significant tissue damage

Candidiasis Causes

-Antibiotics, inhibit normal flora -Increased estrogen/ progesterone -Decreased immune function

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."

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?

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

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?

"Women may not know they have gonorrhea because they may not have symptoms."

Chlamydia

-Asymptomatic or symptomatic -Infects genitalia and extragential structures -Intracellular bacteria pathogen Bacterium: Chlamydia trachomatis

Treatment of Condylomata Acuminata

-Chemical or physical agents: trichloroacetic acid, 5 fluorouracil epinpehrine gel, podophyllin -Immune therapy (imiquimod, interferon alpha) -Surgery (cryosurgery, excisional procedures, laser)

Treatment of Bacterial Vaginosis

-Clue cells on wet- mount slide -metronidazole or clindamycin

Trichomoniasis

-Commonly associated w. other STI's, a good indicator for high risk sexual activity -Can be symptomatic but often asymptomatic -Can survive swimming pools and hot tubs Anaerobic protozoan: Trichomoniasis vaginalis

Chancroid

-External genitalia and lymph nodes -Commonly found in Subtropical areas (Africa/ parts of Asia) -Highly infectious: sex, mucous membranes, skin to skin contanct -Cofactor for HIV -Bacterium: Haemophilus ducreyi

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

60 days

A client has been diagnosed with syphilis after seeking care for a penile lesion. The nurse should anticipate which intervention?

Administration of injectable penicillin

In assessing a client, the nurse notes a grayish discharge from the vaginal area accompanied by a foul odor. What is the nurse's best action?

Asking about other symptoms

A nurse is attempting to culture a lesion to determine if a client has genital herpes. What is the nurse's best action?

Attempt to culture a lesion as soon as it develops.

Laboratory analysis of vaginal discharge identifies hyphae on microscopic exam and pH of 4.2. The client most likely has:

Candida albicans (C. albicans)

Condylomata Acuminata

Caused by the human papillomavirus (HPV) that infects epithelial cells and can cause a number of benign and malignant growths. HPV-induced genital warts have become one of the fastest-growing STIs of the past decade.

Primary Syphilis

Chancre at site of exposure

Genital Herpes

Genital herpes is caused by the herpes simplex virus (HSV), a large double-stranded DNA virus. Herpes simplex infections are highly contagious. Most cases of HSV-2 infection are subclinical, manifesting as asymptomatic or symptomatic but unrecognized infections. Up to 70% of genital herpes is spread through asymptomatic shedding by people who do not realize they have the infection.

Neurotropic Viruses

HSV-1 and HSV-2 are neurotropic viruses, meaning that they grow in neurons and share the biologic property of latency. 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.

HSV 1

Herpes simplex virus type 1 ***Cold sores on the mouth***

HSV 2

Herpes simplex virus type 2 -Vertical transmission: mom to baby -Active outbreak during labor will require a mother to have C-section ***Genital lesions***

Gonorrhea in Women

In females, it commonly moves to the fallopian tubes. Pharyngitis may follow oral-genital contact. In women, recognizable symptoms include unusual genital or urinary discharge, dysuria, dyspareunia, pelvic pain or tenderness, unusual vaginal bleeding (including bleeding after intercourse), fever, and proctitis. Symptoms may occur or increase during or immediately after menses because the bacterium is an intracellular diplococcus that thrives in menstrual blood but cannot survive long outside the human body. 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.

Gonorrhea in Men

In males, it spreads to the prostate and epididymis. Pharyngitis may follow oral-genital contact. Men are more likely to be symptomatic than women. In men, the initial symptoms include urethral pain and a creamy yellow, sometimes bloody, penile discharge (Fig. 41-7). The disorder may become chronic and affect the prostate, epididymis, and periurethral glands. Rectal infections are common in men who have sex with men.

What statements are true concerning genital warts? Select all that apply

It is prevalent in those under 25. It is most common in those with multiple sexual partners. It resolves on it's own without treatment.

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

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?

Metronidazole

Treatment of HPV

No current treatment

Which vaginal infection is associated w. increased supressed immune function? a. Cadidiasis b. Trichomoniasis c. Bacterial vaginitis d. Chancroid

Rationales: a. Cadidiasis (yeast infection/ thrush) is associated with diminished immune function. When the normal flora is decreased, Candidia albicans has room to thrive

Sexually Transmitted Infections

Sexually transmitted infections (STIs) encompass a broad range of infectious diseases that are spread by sexual contact. Many factors contribute to the increased prevalence and the continued spread of STIs, including the fact that STIs are frequently asymptomatic, which promotes the spread of infection by persons who are unaware that they are carrying the infection. Furthermore, partners of infected persons are often difficult to notify and treat.

Infections of the External Genitalia

Sexually transmitted infections can selectively infect the mucocutaneous tissues of the external genitalia, rectum, and oral pharynx, or produce both genitourinary and systemic effects.

Which assessment finding helps the nurse confirm that the client has genital warts?

Soft, raised lesions on external genitalia

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

Sterility

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?

Syphilis

Which client will the nurse determine is a candidate for continuous antiviral suppressive therapy for genital herpes?

The client with more than six outbreaks this year

Gonorrhea

The gonococcus is a pyogenic (i.e., pus-forming), gram-negative diplococcus that evokes inflammatory reactions characterized by purulent exudates. Gonococcal infection commonly manifests 3 to 5 days after exposure, but asymptomatic infections are common in both men and women. -Bacterium: Neisseria gonorrhoeae; Gram (-)

Treatment of Chancroid

There is no current FDA approved treatment

A client has been diagnosed with candidiasis. Which symptom was present to diagnose this condition?

Thick white secretions

Human Papilloma Virus (HPV)

Transmission of HPV is usually through skin-to-skin contact, most often through penetration (oral-genital, manual-genital, and genital-genital contact). HPV can also be transmitted though nonsexual routes including mother to newborn (vertical transmission) and fomites (objects such as clothing, towels, or utensils that harbor the agent). -HPV is usually asymptomatic -HPV can cause abnormal Pap results, genital warts, and cervical cancer -Low risk HPV strains: 16 and 11, usually associated w. warts -High risk HPV strains: 16, 18, 31, 33, 45, usually associated with cervical dysplasia and cervical cancer -HPV 16 and 18 account for 2/3 of cervical cancer

Candidiasis

Yeast Infection -Bacterium: Candida albicans

Latent Phase

an asymptomatic phase of syphilis, between secondary and tertiary stage, around 1-2 years

A client's presentation and recent sexual history are suggestive of gonorrhea. This suspected diagnosis can best be confirmed by:

culturing a sample of the client's penile discharge.

Hutchinson's Teeth

small, widely spaced teeth with notched biting surfaces, associated with congenital syphilis

Trichomoniasis Features

-Inflammation -Frothy, malodorous, green or yellow discharge -Strawberry spots on cervix -Cofactor for HIV transmission: recruits HIV target cells, weakens integrity of cells and defense against HIV, create microhemorrhages in gential tissue which serves as a portal for HIV entry

Candidiasis Features

-Inflammation -Itching -Thick, white, oderless discharge

Systemic Symptoms of Herpes Initial Outbreak

-Fever -Headache -Malaise -Muscle aches -Lymphadenopathy (swollen lymphnodes)

Chlamydia Features in Women

-Frequent urination -dysuria -discharge -cervical and fallopian damage -PID -Infertility -Ectopic pregnancy

Treatment of Chlamydia

-Gram stain, direct fluorescent antibody test, and enzyme-linked immunosorbent assay (antibodies against antigens) -Azithromycin -Doxycycline

Treatment of Candidiasis

-Identification of hyphae or spore on wet-mount slide -Antifungal drugs that inhibit cell wall metabolism -Topical terconazole or fluconazole (presciption)

Syphilis

-Infects genitalia and extragenitalia -Spread through sexual intercourse, kissing, touching -Primary, secondary, tertiary Bacterium (spirochetes): Treponema pallidum

Recurrent Herpes (Initial outbreak)

-Initial symptoms include: itching, tingling, and pain in the genital area -Eruption of small pustules and vesicles, approx. on 5th day -Lesions are extremely painful to touch and can cause dysurea, dyspareunia, and urine retention -Healing period lasts between 10-12 days, lesions develop scabs as they heal

Tertiary Syphilis

-Localized gumma lesions -CNS lesions -Cardiovascular effects

Bacterial Vaginosis

-Polymicrobial infection -Lack of H3O3 producing lactobacilli -Overgrowth of anaerobic organisms Bacterium: Garnerella vaginalis, Mobiluncus species, Mycoplasma hominis

Treatment of Gonorrhea

-Positive Gram stain/ culture -Urine sample -cefixime -doxycycline or azithromycin should follow cefixime to treat potential chlamydia exposure. Gonorrhea and chlamydia usually go hand in hand

Treatment of Syphilis

-Serology used to test -Two tests: Nonspecific and Specific -Nonspecific measures IgM antibodies -Specific measures antibodies capable of reacting w. bacterium, carried out after positive nonspecific test -Penicillin is the treatment of choice

Secondary Syphilis

-Skin rash -Fever -Sore throat -Stomatitis -Nausea -Anorexia -Eye inflammation -Alopecia -Genital Lesions

Recurrent Herpes (Post Initial Outbreak)

-Symptoms still include: itching, tingling, and pain in genital area -Episodes are much milder than initial -Shorter outbreak: about 3 days -Fewer lesions -Less viral shedding -Can be triggered by: emotional stress, lack of sleep, overexertion, other infections, prolonged or vigorous coitus, and PMS and menstrual distress

Bacterial Vaginosis Features

-Thin, grayish-white discharge -Foul, fishy odor -Minimal inflammatory potential -Increased risk of PID

Chlamydia Features in Men

-Urethritis -Discharge -Dysuria -Itching -Prostatitis -Epididymitis -Infertility -Reiter Syndrome: reactive arthitis that includes urethritis, conjuctivitis, and painless mucocutaneous lesions

Treatment of Herpes

-Viral culture -No cure -acyclovir, calacyclovir, and famciclovir (antivirals)