1. BY: Diana Blum MSN Metropolitan Community College
STIs
BY: Diana Blum MSN
Metropolitan Community College

2. Statistics Each year more than 100,000 women are left sterile
19 million infections occur in USA each year
Mostly in year olds
Drug Abuse and multiple sex partners are risk factors
Highest in African Americans, Hispanics, and Caucasians

3. Nursing Know your feelings Don’t be judgmental Provide quality care
Reporting is Mandatory: HIV/AIDS, Gonorrhea, Syphilis, Chlamydia, viral Hepatitis
Get list of sexual partners
This slows transmission
They need treatment as well

4. Diagnostics Serologic Tests: done to detect infection
Smears and Cultures: many have discharges/lesions that need identification and treatment options

5. Chlamydia
Chlamydia Infection-caused by virus like bacteria “chlamydial trachomatis”
Symptoms usually take 1-3 weeks after infected
S/s Men
penile discharge
Painful and frequent urination
S/s woman
Vaginal discharge & lower abdominal pain
No symptoms may be experienced

6. Assessment & Treatment
Contact transmission by MM in the mouth eyes, urethra, vagina, rectum
Take sexual hx
Chlamydial antigen test
Cell tissue culture
Treatment-single dose azithromyacin-Zithromax, or 7 day course of Vibramyacin(doxycycline), no sex til cured
Complications: newborns get eye infection or infant pneumonia, sterility, sperm duct obstruction, PID, Ectopic Pregnancy, 5x’s more likely to get HIV

7. Gonorrhea Caused by neissara gonorrhoeate S/s female Vaginal discharge
Redness swelling of external genitalia
Burning on urination
Abdominal pain
Abnormal menstruation
Rectal infection can cause: discharge, anal itch, soreness, bleeding, painful defecation, sore throat
S/s male
d/c from penis that is white or green

8. Transmission can occur from mom to baby
Can not get from toilet seat, door knob, towel
It is possible to be asymptomatic
Symptoms occur 2days to 3 weeks after exposure the disappear
Men are usually more syptomatic
Complications: Sterility, damage to heart, damage to joints, PID, increase risk of HIV

9. Treatment
Single dose of Rocephin IM, Cipro IM or Orthoflex IM followed by 7 days of oral vibromyacin
If untreated, can cause sterility
Person remains infectious if untreated, even though symptoms disappear after 3-4 weeks
PCN not used because of resistance issues
F/U with MD
Care plan page 1167

10. Syphillis Caused by a spirochete Treponoma Pallidum.
9756 cases in 2006 in USA
Can be passed through placenta causing congenital syphilis
S/s progress in 4 stages
Page 1158

11. First stage Chancre-may last from 1 to 5 weeks
Disappears and becomes a painless red ulcer that may last from 1-5 weeks then it moves to the blood
Highly contagious
Chancre usually noticed 1-12 weeks after initial contact

12. Second Stage Contagious Occurs 6 weeks from contact
Rash on extremities palms of hands, soles of feet and trunk then pustules develop
S/S: fever sore throat, general ache

13. Third Stage-Latent stage
No Symptoms
Disease may be spread by blood contact not by sex act itself
Major organs being invaded

14. Fourth Stage-Late stage
Usually 3 years after initial contact
S/s: BLINDNESS
MENTAL ILLNESS
PARALYSIS
HEART DISEASE
ARTHRITIS
NUMB EXTREMITIES
ULCERS ON SKIN AND ORGANS
PAIN
EASIER CHANCE OF GETTING HIV

15. Diagnosis and Treatment
Dx based on blood confirmation of organism
Treatment of choice Pen G injections
patients allergic to penicillin may be treated with doxycycline 300mg daily for 21 days or oral amoxycillin 3gm twice daily with 1 gm of probenecid for 2 weeks.
F/U with Doctor
No sex for 1 month after treatment

16. Herpes Simplex Type II transmitted by sexual contact
Can be transferred by hand contact
Virus that causes cold sores (HSV1)
Avoid Direct Kissing
S/s
Painful itching sores around genitals
Rash ,then blisters
Flu-like symptoms and burning on urination
Appearance and lab tests used to dx

17. Treatment for Herpes No cure May keep in check with antivirals
Wash towels/ personal items
Complications: cervical cancer and need for c-sections

18. Trichomoniasis Caused by the parasite Trichomonas Vaginalitis
7 million new cases each year
Usually transmitted sexually but can live on damp clothes and towels
If found the partner will also need to be treated even if no symptoms present

19. S/s women blood spotting in vaginal discharge
heavy, yellowish-green or gray, frothy vaginal discharge
infection in the urethra
the tube that carries urine from the bladder out of the body
itching, burning or pain in the vagina
lower abdominal pain
musty vaginal odor
pain and/or burning when urinating
pain or discomfort during sexual intercourse (dyspareunia)
swelling in the groin
swollen and irritated vagina and cervix
urinating more than usual
vaginal or vulval redness
worsening symptoms when menstruating

20. Trichomoniasis S/s men Few or no symptoms
infection of the urethra or prostate gland, which is involved in semen production
painful and/or difficult urination
thin, whitish discharge from the penis
tingling inside the penis
Treatment
Flagyl is drug of choice
Diagnostics by microscopic study and cultures

21. Condylomata Acumulata
Venereal warts
Caused by HPV (pap smears are highly important)
Incubation is 3 weeks to 8 months
Warts are pink or red and soft with cauliflower like appearance
BX done for diagnosis
High reoccurrence rate
Pregnancy Stimulates large growth
Treatment-removing visible parts of warts for symptom relief via surgery, cryotherapy, acid burn off or interferon injection

22. Bacterial Vaginosis
Caused by Gardenella Vaginalis
Associated with multiple sex partners and douching
S/s are grey discharge and fishy odor, itching
Treatment is Flagyl
Client teaching-no alcohol when taking meds as can have a rx with vomiting, tachycardia and hypotension
Note! Flagyl is contraindicated during pregnancy so a menstrual history or pregnancy test should be obtained before administration

23. Vaginitis
Etiology:
 bacteria
 protozoa
 viruses
 yeasts

24. The acidic environment (pH less than 5
The acidic environment (pH less than 5.0) of the vagina inhibits the growth of many pathogens. Several factors increase risk for infection.

25. Factors that increase Risk
Skin diseases
Skin irritation
Perfumes
Nylon underwear
antibiotics

26. Diagnosis made from description of symptoms and identification of pathogens in sample of vaginal discharge

27. Types of vaginitis
 candidiasis caused by Candida albicans, a fungus (cottage cheese like discharge)
 trichomoniasis, caused by Trichomonas vaginalis, a protozoan

28. Ways to decrease risk Avoidance or irritants-chemicals, dyes, soaps
Cotton underwear, nonrestrictive clothing
Frequent cleansing with neutral agents
Heat in the form of sitz baths or irrigation
Avoid sexual intercourse during course of treatment
Review box 49-2 and condom use on page 1170