![CONT..
Eventually, the virus can disable the immune system,
leaving the person with HIV infection vulnerable to a
number of life-threatening illnesses.
People who have HIV infection may not have
symptoms for many years, especially if they receive
good medical care and effective therapies" (American
College Health Association [ACHA] , 2001).](https://image.slidesharecdn.com/sexuallytransmitteddiseases-190912083808/75/Sexually-transmitted-diseases-62-2048.jpg)
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Sexually transmitted diseases
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- 3. MODES OF TRANSMISSION STIs are spread through contact: Penis Vagina Rectum Breaks in skin Mucous membranes And Needle Sharing Blood contact Vertical transmission (Mother-to-child)
- 4. CONT… Infectious diseases mostcommonly transmitted through sexual contact. Can also be transmitted by Blood Blood products Autoinoculation
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- 6. RISK FACTORS IVdrug use Other substance abuse High-risk sexual activity Younger age at beginning of sexual activity Inner city residence Poverty/lower socioeconomic status Poor nutrition Poor hygiene
- 7. PATHOGEN Pathogen = Bacteria 1.Chlamydia 2. Gonorrhea 3. Bacterial Vaginosis* 4. Syphilis Pathogen= Virus 1. Herpes 2. Hepatitis B 3. Genital Warts (HPV) 4. HIV/AIDS Pathogen= Parasite 1. Pubic Lice 2. Scabies 3. Trichomoniasis
- 8. COMMON SYMPTOM Painduring urination Bump/sores Bleeding between periods Unusual discharge Pain during intercourse Rash Many people can have no symptoms (asymptomatic) and still pass on a STI.
- 9. BACTERIAL INFECTION Infectionscaused by bacteria, This agent represents about half of the stis identified. Bacterial infections are curable. Medication does not protect against future exposure.
- 10. CHLAMYDIA AND GONORRHEA Transmission Direct mucous membrane contact with the germ during sexual contact. Using condoms and dental dams lowers chance of transmission. Testing · Culture sample (can be done during pap smear) · Urine sample
- 11. GONORRHEA Etiology and Pathophysiology:- 2nd most frequently reported STD in US Caused by Neustria gonorrhea Gram-negative bacteria Direct physical contact with infected host Killed by drying, heating, or washing with antiseptic Incubation: 3-8 days
- 12. CLINICAL MANIFESTATION OF GONORRHEA InMen Initial site of infection is urethra Symptoms Develop 2 to 5 days after infection Dysuria Profuse, purulent urethral discharge Unusual to be asymptomatic
- 13. CLINICAL MANIFESTATION OF GONORRHEA InWomen Mostly asymptomatic or have minor symptoms Vaginal discharge Dysuria Frequency of urination After incubation Redness and swelling occur at site of contact.
- 14. CONT… In women Greenish,yellow purulent exudate often develops May develop abscess Transmission more efficient from men to women. Anorectal gonorrhea Usually from anal intercourse Soreness, itching, and anal discharge Orogenital Gonoccocal pharyngitis can develop
- 16. COMPLICATION In Men Includeprostatitis, urethral strictures, and sterility Often seek treatment early so less likely to develop complications In Women Include pelvic inflammatory disease (PID), Bartholin’s abscess, ectopic pregnancy, and infertility Usually asymptomatic so seldom seek treatment until complication are present
- 17. GONORRHEA DIAGNOSTIC STUDIES Historyand physical examination Laboratory tests Gram-stained smear to identify organism Culture of discharge Nucleic acid amplification test Testing for other STDs
- 18. TREATMENT & NURSINGCARE OF GONORRHEA Drug therapy Treatment generally instituted without culture results Treatment in early stage is curative Most common IM dose of ceftriaxone (Rocephin) All sexual contacts of patients must be evaluated and treated Patient should be counseled to abstain from sexual intercourse and alcohol during treatment Reexamine if symptoms persist after treatment
- 19. SYPHILIS Caused byTreponema pallidum Spirochete bacterium Enters the body through breaks in skin or mucous membranes Destroyed by drying, heating or washing May also spread via contact with lesions and sharing of needles
- 20. ETIOLOGY AND PATHOPHYSIOLOGY OFSYPHILIS Incubation 10 to 90 days Spread in utero after 10th week of pregnancy Infected mother has a greater risk of a stillbirth or having a baby who dies shortly after birth Association with HIV. Syphilitic lesions on the genitals enhance HIV transmission. Evaluation includes testing for HIV with patient’s Consent.
- 21. CLINICAL MANIFESTATION Primary stage Painless indurate lesions Occur 10 to 90 days after inoculation Lasting 3 to 6 weeks Secondary stage Systemic Begins a few weeks after chancres Blood-borne bacteria spread to all major organ systems Flu-like symptoms
- 22. CONT.. Bilateral symmetricrash Mucous patches Condylomata lata Latent or hidden stage Immune system is suppressing infection No signs/symptoms at this time Diagnosed by positive specific treponema antibody test for syphilis with normal cerebrospinal fluid
- 23. CONT… Tertiary or latestage :- Manifestations rare Significant morbidity/mortality rates Gummas Cardiovascular system Neurosyphilis
- 24. COMPLICATIONS Occur mostlyin late syphilis Irreparable damage to bone, liver, or skin from gummas. Pain from pressure on structures such as intercostal nerves by aneurysms Scarring of aortic valve Neurosyphilis Tabes dorsalis Sudden attacks of pain Loss of vision and sense of position
- 25. DIAGNOSTIC STUDIES Historyincluding sexual history PE Examine lesions Note signs/symptoms Dark-field microscopy Serologic testing Testing for other STDs
- 26. TREATMENT AND NURSING CARE Drugtherapy Benzathine penicillin G (Bicillin) Aqueous procaine penicillin G Monitor neurosyphilis Confidential counseling and HIV testing Case finding Surveillance
- 27. CHLAMYDIAL INFECTION Caused byChlamydia trachomatis Gram-negative bacteria Transmitted during vaginal, anal, or oral sex Incubation period: 1 to 3 weeks Risk factors Women and adolescents New or multiple sexual partners History of STDs and cervical ectopy Coexisting STDs Inconsistent/incorrect use of condoms
- 28. CLINICAL MANIFESTATION “Silentdisease” Symptoms may be absent or minor Infection often not diagnosed until complications appear In Men Urethritis Dysuria Urethral discharge Proctitis
- 29. CONT… Epididymitis Unilateralscrotal pain Swelling Tenderness Fever Possible infertility and reactive arthritis Rectal discharge Pain during defecation
- 30. IN WOMEN Cervicitis Mucopurulent discharge Hypertrophic ectopy Urethritis Dysuria Frequent urination Pyuria Bartholinitis Purulent exudate Perihepatitis
- 31. WOMEN CONT… PID Abdominal pain, nausea, vomiting, fever, malaise, abnormal vaginal bleeding, menstrual abnormalities. Can lead to chronic pain and infertility Fever, nausea, vomiting, right upper quadrant pain
- 32. DIAGNOSTIC STUDIES Laboratorytests Nucleic acid amplification test (NAAT) Direct fluorescent antibody (DFA) Enzyme immunoassay (EIA) Testing for other STDs Culture for chlamydia
- 33. TREATMENT AND NURSINGCAREOF CHLAMYDIAL INFECTION Drug therapy Doxycycline (Vibramycin) 100 mg BID for 7 days Azithromycin (Zithromax) 1 g in single dose Alternatives include erythromycin, ofloxacin (Floxin), or levofloxacin (Levaquin
- 34. CONT… Abstinence fromsexual intercourse for 7 days after treatment. Follow-up care for persistent symptoms Treatment of partners Encourage use of condoms
- 35. PREVENTION limit thenumber of sexual partner & use condoms & spermicides
- 36. GENITAL HERPES Nota reportable disease in most states Caused by herpes simplex virus (HSV) Etiology and Pathophysiology Enters through mucous membranes or breaks in the skin during contact with infected persons HSV reproduces inside cell and spreads to surrounding cells
- 37. CONT… Two different strains 1.HSV-1 Causes infection above the waist. 2. HSV-2 Frequently infects genital tract and perineum Either strain can cause disease on mouth or genitals
- 38. CLINICAL MANIFESTATION OF GENETICHERPES Primary (initial) episode Burning or tingling at site Small vesicular lesion appear on penis, scrotum, vulva, perineum, perianal areas, vagina, or cervix Primary lesions present for 17 to 20 days New lesions sometimes continue to develop for 6 weeks Lesions heal spontaneously
- 39. GENETIC HERPES CONT… Recurrent genitalherpes :- Occurs in 50% to 80% in following year Triggers Stress Fatigue Sunburn
- 40. CONT.. Menses Prodromalsymptoms of tingling, burning, itching at lesion site Lesions heal within 8 to 12 days With time, lesions will occur less frequently
- 41. COMPLICATIONS Aseptic meningitis Lower neuron damage Autoinoculation to extragenital sites High risk of transmission in pregnancy with episode near delivery Herpes simplex virus keratitis
- 42. DIAGNOSTIC STUDIES Historyand physical examination Viral isolation by tissue culture Antibody assay for specific HSV viral type
- 43. TREATMENT AND NURSING CARE Drug therapy Inhibit viral replication Suppress frequent recurrences Acyclovir (Zovirax) Valacyclovir (Valtrex) Famciclovir (Famvir) Not a cure but shorten duration, healing time and reduce outbreaks
- 44. TREATMENT & NURSINGCARE CONT’D Symptomatic care Genital hygiene Loose-fitting cotton underwear Lesions clean and dry Sitz baths Barrier methods during sexual activity Drying agents Pain: dilute urine with water, local anesthetic
- 45. GENETIC HERPES 1. Treatment:use Betadine on lesions to dry & prevent secondary infections, however, Acyclovir (Zovirax) eases symptoms & lessens reoccurrence but is not a cure 2. If Untreated: in fetus/newborns there is a risk of spontaneous abortion; neonatal herpes; mental retardation, death 3.Prevention: limit number of sexual partners and using condoms & spermicidal foam may reduce transmission Nursing Implications
- 46. GENITAL WARTS Mostcommon STD in the US Often asymptomatic so patient maybe unaware of infection Caused by human papilloma virus (HPV) Usually types 6 and 11 Highly contagious Frequently seen in young, sexually active adults
- 47. CONT… Minor traumacauses abrasions for HPV to enter and proliferate into warts Epithelial cells infected undergo transformation and proliferation to form a warty growth Incubation period 3 to 4 months
- 48. CLINICAL MANIFESTATION Discretesingle or multiple growths White to gray and pink-fleshed colored May form large cauliflower-like masses Warts in men: penis, scrotum, around anus, in urethra Warts in women: vulva, vagina, cervix Can have itching with an genital warts & bleeding on defecation with anal warts
- 49. DIAGNOSTIC STUDIES Serologicand cytological tests HPV DNA test to determine if women with abnormal Pap test results need follow-up Identify women who are infected with high-risk HPV strains Primary goal: Removal of symptomatic warts Removal may or may not decrease infectivity Difficult to treat Often require multiple office visits and variety of treatment modalities
- 50. TREATMENT & NURSINGCARE Chemical Trichloroacetic acid (TCA) Bichloroacetic acid (BCA) Podophyllin resin For small external genital warts Patient managed Podofilox (Condylox.Condylox gel0 Imiquimod (Aldara) Immune response modifier
- 51. TREATMENT & NURSING CONT’D If warts do not regress with previously mentioned therapies Cryotherapy with liquid nitrogen Electrocautery Laser therapy Use of α-interferon Surgical excision
- 52. GENITAL WARTS TREATMENT &NURSING CARE CONT’D Recurrences and reinfection possible Careful long-term follow-up advised Vaccine to prevent cervical cancer, precancerous genital lesion, and genital warts due to HPV
- 53. CMV - CYTOMEGALOVIRUS Found is saliva, urine, semen, and vaginal secretions. symptoms include pharyngitis, malaise, fever and lymphadenopathy, heterophil antibody negative, blood smears may show atypical lymphocytes. may be fatal to those patients with AIDS.
- 54. TREATMENT Most resolvespontaneoulsy Therapy is often required for Immunosuppressed patients Ganciclovir
- 55. TRICHOMONIASIS Infectivity: The vaginais the most common site of infection in women, and the urethra (urine canal) is the most common site of infection in men. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva (the genital area outside the vagina) contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women.
- 56. TRICHOMONIASIS CONT… Organism:- Trichomoniasis iscaused by the single celled protozoan parasite, Trichomonas vaginalis
- 57. SIGN SYMPTOMS Most menwith Trichomoniasis do not have signs or symptoms; some men may temporarily have an Irritation inside the penis, Mild discharge, or Slight burning after urination or ejaculation.
- 58. CONT.. Symptoms in women:- Frothy, yellow-green vaginal discharge with a strong odor Discomfort during intercourse and urination, Irritation and itching of the female genital area. Lower abdominal pain Incubation: 4 to 10 days
- 59. TREATMENT Trichomoniasis can usuallybe cured with the prescription drug, metronidazole, given by mouth in a single dose. If Untreated: increases a woman's susceptibility to HIV infection if she is exposed to the virus. Pregnant women with Trichomoniasis may have babies who are born early or with low birth weight (less than five pounds).
- 60. PREVENTION limit numberof sexual partners and using condoms & spermicidal foam may reduce transmission
- 61. HIV (HUMAN IMMUNODEFICIENCYVIRUS) AIDS (ACQUIRED IMMUNITY DEFICIENCY SYNDROME) HIV is NOT the same as having AIDS, it is only the virus that causes AIDS. Currently there is NO cure but drug therapies "show great promise in managing HIV infection". "HIV infected people are healthy and do not realize they have been infected. HIV primarily infects certain white blood cells that manage the operation of the immune system.
- 62. CONT.. Eventually, thevirus can disable the immune system, leaving the person with HIV infection vulnerable to a number of life-threatening illnesses. People who have HIV infection may not have symptoms for many years, especially if they receive good medical care and effective therapies" (American College Health Association [ACHA] , 2001).
- 63. CONT.. "When symptomsdo develop, they are usually similar at first to those of common minor illnesses, such as the "flu", except that they last longer and are more severe. Persistent tiredness, unexplained fevers, recurring night sweats, prolonged enlargement of the lymph nodes, and weight loss are all common.
- 64. CONT… • Peoplewith HIV infection can transmit the virus to others - even if they have no symptoms and even if they do not know they have been infected. • HIV can be transmitted (1) by sexual contact(anal, vaginal, & oral);
- 65. CONT… (2) bydirect exposure to infected blood; and (3) from an HIVinfected woman to her fetus during pregnancy or childbirth, or to her infant during breastfeeding" (ACHA, 2001).
- 66. PREVENTION "Make carefulchoices about sexual activity, Communicate assertively with your sexual partner And negotiate for safer sexual practices, Remove alcohol and drugs from sexual activity," And "Use latex condoms for intercourse" (ACHA, 2001).
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