Chapter 56: Caring for Clients with Sexually Transmitted Infections

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?

Treatment is aimed at relieving symptoms. 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 nurse is teaching a community class about reducing the risk of STIs. Which recommendation would be included in the presentation?

Use latex condoms with nonoxynol-9 (a spermicide) when having oral, vaginal, or anal intercourse. Use latex condoms with nonoxynol-9 (a spermicide) when having oral, vaginal, or anal intercourse. Have monogamous sex with an uninfected partner. You should wash your hands or any other area that has been in direct contact with semen or vaginal mucus. Avoid unprotected sex until both sexual partners have completed treatment.

The nurse is providing education to a client who has been diagnosed with chlamydia. The client will begin treatment with azithromycin today. Which teaching point should the nurse reinforce with this client?

"Abstain from any sexual activity for 1 week after the antibiotic is complete." Client counseling includes abstinence for 1 week after treatment, in addition to the completion of the partner's treatment. Although handwashing is an important aspect of preventing the spread of infection, the nurse must emphasize prevention of chlamydia through the normal route of transmission of this infection, which is sexually. Coinfection with chlamydia often occurs in clients infected with gonorrhea. Chlamydia and gonorrhea are caused by bacteria that are transmitted during sexual relations. Both chlamydia and gonorrhea infections frequently do not cause symptoms in women and thus are often referred to as "silent" related to clinical presentation. It is important to retest women 3 months' posttreatment, due to the possibility of reinfection.

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?

"I will wear loose cotton underwear." 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 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?

"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." 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.

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?

"It's great that I don't have to worry about having this infection again because I'm now immune to it." 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 caring for a client who has just been diagnosed with chlamydia and is very upset. The client says, "I don't understand this. The person I had sex with did not have any symptoms at all. How could I have known?" What is the best response by the nurse to this client?

"Many people with chlamydia won't have symptoms for up to 3 weeks after being infected." As many as 75% of infected women and 25% of infected men are symptom free. It may take 1-3 weeks for symptoms to appear. Whether in passion or not, if symptoms are present, an individual would be able to see them. It is true that a condom would help decrease the incidence of an STI but the nurse should not try to condemn or judge the client with the STI. Knowing a client's sexual history is important but it does not answer the question that the client posed?

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?

"The use of condoms is one of the best ways to reduce the risk of acquiring an STI." 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.

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?

"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" 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.

A client visits the health clinic because he has developed a painless ulcer on the penis. The urologist suspects that the client has syphilis. When reviewing the client's health history, how many days ago would the nurse expect the client to report that he had unprotected sexual intercourse that may have led to his condition?

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

A client is diagnosed with chlamydia and is distraught. "How can I have this problem? I don't have any symptoms!" she says. The nurse teaches the client that the percentage of women with chlamydia who are asymptomatic is as high as:

75% As many as 75% of all infected women and 25% of all infected men are asymptomatic.

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis?

A painless genital ulcer that appeared about 3 weeks after unprotected sex 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.

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?

Acyclovir (Zovirax) 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.

Which of the following medications are used to suppress viral load of the HSV-2 infection?

Acyclovir (Zovirax) 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.

Which is the second most frequently reportable communicable disease in the United States?

gonorrhea 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.

In which group is it most important for the client 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 don't increase the risk of cervical cancer.

When obtaining the health history from a client, which factor would lead the nurse to suspect that the client has an increased risk for sexually transmitted infections (STIs)?

Five different sexual partners The number of sexual partners is a risk factor for the development of STIs. A rash could be related to numerous underlying conditions. A weight gain of 5 lbs in one year is not a factor increasing one's risk for STIs. A change in the color of vaginal discharge such as yellow, milky, or curd-like, not clear, would suggest a STI.

A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention?

Foul-smelling discharge from the penis 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.

A client is diagnosed as being in the primary stage of syphilis. Which of the following would the nurse expect as a finding?

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

A 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?

Gonorrhea 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.

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?

Gonorrhea 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 nurse is caring for a client with syphilis. Which nursing interventions would be included on the plan of care? Select all that apply.

Inform the client that notification of the sexual partner by the department of public health is important for the evaluation and treatment. Inquire about the client's allergy history in anticipation of antibiotic treatment. Collect health information and a sexual history. When caring for a client with syphilis, the nurse collects health information and a sexual history, inquires about the client's allergy history in anticipation of antibiotic treatment, and informs the client that notification of the sexual partner by the department of public health is important for his or her evaluation and treatment. The nurse would not anticipate an antiviral medication to be ordered because syphilis is a bacteria. Placing the client on contact precautions is not necessary because syphilis is spread through sexual contact and childbirth.

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?

Itching, pain, and the emergence of pustules on the penis The initial symptoms of primary genital herpes infection include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. 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.

A 16-year-old patient comes to the free clinic and is diagnosed with primary syphilis. The patient states that she contracted this disease by holding hands with someone who has syphilis. What is the most appropriate nursing diagnosis for this patient?

Knowledge deficit related to modes of transmission Syphilis is spread mainly by sexual contact and may be congenital. The patient displays knowledge deficit about the modes of transmission for syphilis.

The nurse recognizes the client is in which stage of syphilis when the client has no signs or symptoms of syphilis?

Latency 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.

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

The nurse has received several laboratory studies back at the clinic. Which of these results should be reported to the local health department?

Positive gonorrhea 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.

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?

The client will require treatment for the secondary stage of syphilis. 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.

The nurse is caring for a male patient with gonorrhea. The patient asks how he can reduce his risk of contracting another sexually transmitted infection (STI). The nurse should instruct the patient to do which of the following?

Wear a condom every time he has intercourse. Wearing a condom during intercourse considerably reduces the risk of contracting STIs. The other options may help reduce the risk for contracting an STI but not to the extent wearing a condom will. A monogamous relationship reduces the risk of contracting STIs.

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:

annually. 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.

Which is the fastest spreading bacterial STI in the United States?

chlamydia 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.

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?

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