1. Timby/Smith: Introductory Medical-Surgical Nursing, 11/e
Chapter 56: Caring for Clients With Sexually Transmitted Infections

2. Sexually Transmitted Infections
Spread via sexual activity with infected person
Significant public health problem
Five most common
AIDS, chlamydia, gonorrhea, syphilis, genital herpes, genial warts
Easily cured (early, adequate treatment)
Chlamydia, gonorrhea, syphilis
Social, sexual, and biologic factors contribute to high incidence.

3. Question Is the following statement true or false?
Three STIs are easily cured if caught early and treatment is completed as prescribed.

4. Answer
True
Rationale: Three STIs are easily cured if caught early and treatment is completed as prescribed. They are chlamydia, gonorrhea, and syphilis.

5. Epidemiology
Study of the occurrence, distribution, and causes of human diseases
Role of CDC: gathers statistics
Reportable diseases
Diseases not reportable by law: genital herpes, hepatitis B, venereal warts, etc.
Women acquire STIs more often than men.
Environmental conditions, trauma

6. Statistics Not Accurate
The reported incidence of STIs is disproportionately higher in racial and ethnic minorities.
This disparity may be the result of (1) limited access to healthcare, (2) poverty, (3) actual higher rate of disease occurrence, or (4) more reporting by public health clinics where many in these respective populations seek treatment.

7. Chlamydia Pathophysiology and Etiology: Chlamydia trachomatis
Most common, fastest-spreading STI
Spread by sexual intercourse, genital contact without penetration, transmission to infant during birth, autoinoculation
Assessment Findings: Signs and Symptoms
Sparse, clear urethral discharge; redness and irritation of infected tissue; burning on urination; women: lower abdominal pain; Men: testicular pain

8. Chlamydia—(cont.) Diagnostic Findings Microscopic examination
Secretion cultures
Concurrent infections
Medical Management: antimicrobial drugs
Nursing Management

9. Gonorrhea Pathophysiology and Etiology: Neisseria gonorrhoeae
Facilitates HIV transmission
Assessment Findings: Signs and Symptoms
Skin rash, fever, painful joints
Men: urethritis with purulent discharge, dysuria
Women: white or yellow vaginal discharge, intermenstrual bleeding, dysuria

10. Gonorrhea—(cont.) Diagnostic Findings: microscopic or culture Tests
Medical Management: antibiotics
Complicated gonococcal infections
Hospitalization; IV multiple-drug therapy; repeat antibiotic therapy
Nursing Management

11. Question Is the following statement true or false?
Gonorrhea is easily and quickly cured.

12. Answer
False
Rationale: While gonorrhea can be easily treated if caught early, treatment must be followed thoroughly and judiciously. Gonorrheal infections can be complicated, requiring hospitalization and multiple courses of parenteral IV antibiotics.

13. Syphilis Pathophysiology and Etiology: Treponema pallidum
Three distinct stages
Transmission from blood of infected person: directly from lesion; crossing placenta

14. Syphilis—(cont.) Assessment Findings: Signs and Symptoms
Primary: genital, anal, cervical chancre
Secondary: fever, malaise, rash, headache, sore throat, lymph node enlargement
Tertiary: tabes dorsalis, ataxia, Charcot’s joints, cardiovascular complications
Diagnostic Findings: microscopic examination of chancre, VDRL test, RPR, FTA-ABS test, CSF examination (if indicated)

15. Syphilis—(cont.) Medical Management Antibiotic therapy
Penicillin G-IM; tetracycline; doxycycline
Follow-up examinations and laboratory tests
Nursing Management

16. Herpes Infection Pathophysiology and Etiology
HSV–2: genital, perineal lesions
HSV-1: cold sores; anogenital lesions
Transmission: direct or sexual contact; autoinoculation
Assessment Findings: Signs and Symptoms
Vesicle(s) on penis, prepuce, buttocks, thighs, introitus, cervix; lesions; ulcers; swelling of inguinal lymph nodes; flulike symptoms; headache

17. Herpes Infection—(cont.)
Diagnostic Findings: Microscopic Examination
Medical Management: self-limiting Infection
Antiviral drug therapy
Nursing Management

18. Genital Warts Pathophysiology and Etiology: human papillomavirus (HPV)
Transmission: genital–genital, genital–anal, or genital–oral contact; autoinoculation
Uterine cervical abnormalities
Assessment Findings: Signs and Symptoms
Painless; appear as cluster of soft, fleshy growths on genitalia or cervix; in vagina; or on perineum, anus, throat, or mouth
Application of vinegar; visual inspection

19. Question Is the following statement true or false?
If vinegar is applied to lesions suspected of being caused by HPV, they will turn white.

20. Answer
True
Rationale: To easily confirm if a genital lesion is HPV, applying vinegar will cause it to turn white if it is, indeed human papillomavirus.

21. Genital Warts—(cont.) Medical and Surgical Management
Limited infection: medication, chemical application
Substantial infection: surgical excision, laser therapy, electrocautery, cryosurgery, parenteral administration of natural or recombinant interferon
Nursing Management

22. Other Sexually Transmitted Infections
Granuloma inguinale: Calymmatobacterium granulomatis (uncommon in United States)
Characterized by lesions: genital, inguinal, anal areas
Treatment: antimicrobials
Chancroid: Haemophilus ducreyi bacillus
Characterized by macule, vesicle–pustule formation, resulting in painful genital ulcer; enlarged, tender inguinal lymph nodes

23. Other Sexually Transmitted Infections—(cont.)
Lymphogranuloma venereum: C. trachomatis
Characterized by small erosion or papule, resulting in enlargement of adjacent lymph nodes, which can become necrotic
Usual site of infection: genital area
Treatment: doxycycline or erythromycin

24. Prevention Methods Abstain from sexual activities Monogamous sex
Condoms
Urinate after sexual intercourse
Wash hands
No unprotected sex

25. Condom Use Lubrication No natural membrane condoms
Cool, dry place for storage
Discard if expired
Pinch space at tip
Remove before penis is limp
Disposal