Dirk Benedict R. MirandaPHC IIMisamis UniversityMerasol Duyag, MANBSN-IISexually Transmitted Infections/DiseaseSexually Transmitted Infections/Disease

Syphilis

Description:

Syphilisis asexually transmitted disease (STD)or sexually transmitted infection (STI) that, when left untreated, can progress to a late stage that causes serious health problems. The infection alternates withperiods of being active and inactive (latent). When the infection is active, symptoms occur. But when theinfection is latent, no symptoms appear even though you still have syphilis. Anyone who comes into close physical contact with a person who has syphilis can develop syphilis. You don'thave to have sexual intercourse to get syphilis—exposure can result from close contact with an infected person'sgenitals, mouth, or rectum.

Causative Agent:

Syphilis is caused by a type of bacterium (Treponema pallidum) that usually enters the body through themucous membranes.An infected person can pass the disease to others (is contagious) whenever a sore or arash is present.Treponema pallidum - Spirochete that cannot live outside the human body. Enters through a break in the skin.

Laboratory Procedures:

Syphilis has several clinical manifestations, making laboratory testing a very important aspect of diagnosis. InNorth America, many unsuspected cases are discovered by laboratory testing. The etiological agent,

Treponema pallidum

, cannot be cultured, and there is no single optimal alternative test. Serological testing isthe most frequently used approach in the laboratory diagnosis of syphilis. The present paper discusses the various serological and alternative tests currently available along with their limitations, and relates their resultsto the likely corresponding clinical stage of the disease. The need to use multiple tests is discussed, and theimportance of quality control is noted. The complexity of syphilis serology means that the services of referencelaboratories and clinical experts are often needed.

Incubation period:

An incubation period is the time between exposure to a disease and the development of the first symptom. A skin sore called a chancre is the first symptom of sexually transmitted syphilis. A chancre usually appears between 3 weeks and 3 months after a person has been infected with syphilis.

Signs and Symptoms:

The first or primary sign of syphilis is usually a sore(s), which is painless and appears at the site of initialcontact. It may be accompanied by swollen glands, which develop within a week after the appearance of theinitial sore. The sore may last from one to five weeks, and may disappear by itself even if no treatment isreceived. Approximately six weeks after the sore first appears, a person will enter the second stage of thedisease. The most common symptom during this stage is a rash, which may appear on any part of the body including trunk, arms, legs, palms, soles, etc. Other symptoms may occur such as tiredness, fever, sore throat,headaches, hoarseness, loss of appetite, patchy hair loss and swollen glands. These signs and symptoms willlast two to six weeks and generally disappear in the absence of adequate treatment. The third stage, called latesyphilis (syphilis of over four years' duration), may involve illness in the skin, bones, central nervous systemand heart.If detected and treated, syphilis can be cured withantibiotics. If not treated, syphilis may linger and may progress to the late stage where more serious health problems, such as blindness, heart disorders, mentaldisorders, nervous system problems, and even death, can occur. Treatment is needed to cure the infection,prevent complications, and prevent the spread of the infection to others. It is critical to treat a pregnant woman who has syphilis—without treatment, syphilis can cause a miscarriage or stillbirth or cause a baby to be born with the disease (congenital syphilis). Antibiotics effectively treat syphilis during any stage. Antibiotictreatment cannot reverse the damage caused by the complications of late-stage syphilis, but it can preventfurther complications.

Medical & Nursing Management:

The rise in the number of cases of syphilis suggests that some individuals are not practising safer sex and/orthat health education programmes are ineffective. The increasing incidence could also be a consequence of more people attending for sexual health checks. Syphilis is primarily a sexually transmitted disease, although apregnant woman may pass the disease to her fetus via the placenta, and rarely healthcare professionals may acquire the disease through open lesions. If allowed to run its full course the disease can have devastatingeffects on the individual. Regular screening of at-risk groups, screening at antenatal clinics and genitourinary medicine clinics, promotion of safer sex activities and health education may aid prevention. The nurse is ideally placed to provide patients with information that may prevent infection or help to minimize its severity.

GonorrheaDescription:

Gonorrhea is asexually transmitted disease(STD). It is a bacterial infection of theurethrain men and the urethra,cervix, or both in women. Gonorrhea can also infect the rectum, anus, throat, pelvic organs, and, inrare cases, the conjunctiva, which is the membrane that lines the eyelid and eye surface.

Other names:

Popular names for gonorrhea are clap, drip, dose, and strain.

Causative agent:

Gonorrhea is caused by a bacterium,

Neisseria gonorrhoeae

.This bacterium has pili to attach to the mucosaltissue of humans.Possesing a complex cell wall, it is able to avoid the immune system and cause disease by means of endotoxins(toxins attached on bacteria cell wall).This causes inflammation and the symptomsassociated with the disease.

Laboratory Procedure:

Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testingfrom the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to alaboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample. A quick laboratory test for gonorrhea that can be done in some clinics or doctor’s officesis a Gram stain. A Gram stain of a sample from a urethra or a cervix allows the doctor to see the gonorrhea bacterium under a microscope. This test works better for men than for women.

Incubation period:

The symptoms usually have an incubation period of 3 – 5 days and during the 3rd days the symptoms may reveal themselves. There are cases were in the symptoms are only revealed after 2 weeks or so.This is a case to case basis.

Signs and Symptoms:

Signs include a burning sensation when urinating and a yellowish white discharge from the penis. Sometimesmen with gonorrhea get painful or swollen testicles. Gonorrhea is treated with antibiotic medicine, taken by mouth or given as a shot. Many people with gonorrhea also have chlamydia (another sexually transmitteddisease). Because of this, you may be given more than one drug to treat both diseases. Your sexual partner orpartners should also have treatment even if they have no symptoms. The initial symptoms and signs in womeninclude a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection,regardless of the presence or severity of symptoms.

Medical and Nursing Management:

The recommended treatment for uncomplicated infections is a third-generation cephalosporin or afluoroquinolene plus an antibiotic (e.g., doxycycline or erythromycin) effective against possible coinfection with

Chlamydia trachomatis

. Sex partners should be referred and treated. The current CDC TreatmentGuidelines recommend treatment of all gonococcal infections with antibiotic regimens effective againstresistant strains. The recommended antimicrobial agents are ceftriaxone, cefixime, ciprofloxin, or oflaxacin.Nurse does obtain patient’s history, Encourage treatment and follow up care and identify patient’s sexualcontacts.

TrichomoniasisDescription:

Trichomoniasisrefers to an infection of the genital andurinary tract. Is perhaps the most common curable sexually transmitted disease worldwide, yet few resources are devoted to its control. It is associated withpotentially serious complications such as preterm birth and human immunodeficiency virus acquisition andtransmission.It is the most commonsexually transmitted disease, affecting about 120 million women worldwide each year.

Other names:

Trich (pronounced Trick), vaginitis

Causative Agent:

Trichomonas vaginalis

is the causative agent of trichomoniasis,

a common cause of vaginitis.

Laboratory Procedures:

the doctor collects the specimen during a pelvic examination by inserting aspeculuminto the vagina and thenusing a cotton-tipped applicator to collect the sample. The sample is then placed onto a microscopic slide andsent to a laboratory to be analyzed. An examination in the presence of trichomoniasisptaulas may also revealsmall red ulcerations on the vaginal wall or cervix.

Incubation Period:

The incubation period of the disease is thought to be from about one to four weeks. This is only a roughestimate because of the difficulty of studying such an infection.

Signs and Symptoms:

Most men with trichomoniasis do not have signs or symptoms; however, some men may temporarily have anirritation inside the penis, mild discharge, or slight burning after urination or ejaculation. Some women havesigns or symptoms of infection which include a frothy, yellow-green vaginal discharge with a strong odor. Theinfection also may cause discomfort during intercourse and urination, as well as irritation and itching of thefemale genital area. In rare cases, lower abdominal pain can occur. Symptoms usually appear in women within5 to 28 days of exposure. In many cases women may hold the parasite for some years without any signs(dormant). The parasite can't be transmitted through oral or anal sex. Treatment for both pregnant and non-pregnant patients usually utilizesmetronidazole(Flagyl) 2000mg oral one time by mouth. Sexual partners,even if asymptomatic, should be concurrently treated.

Medical & Nursing Management:

Nurse management will let the patient avoid alcohol during treatment, urine may turn dark orange or brown. Avoid douches, sprays, and powders, let the patient use loose-fitting clothing and cotton underwear, the do thefollow up care and contact clients sex partner. The treatment of choice ismetronidazole(Flagyl), except in thefirsttrimesterof pregnancy , whenclotrimazoleis used topically. It is important not to drink alcohol while taking this drug (the combination can lead toabdominal painand vomiting).

AIDSDescription:

AIDS stands for Acquired Immune Deficiency Syndrome:



Acquired means you can get infected with it;



Immune Deficiency means a weakness in the body's system that fights diseases.



Syndrome means a group of health problems that make up a disease. AIDS is caused by a virus called HIV, the Human Immunodeficiency Virus. If you get infected with HIV, your body will try to fight the infection. It will make "antibodies," special molecules to fight HIV. Fatal diseasecaused by a rapidly mutating retrovirus that attacks the immune system and leaves the victim vulnerable toinfections, malignancies, and neurological disorders.Other names:

Acquired immune deficiency syndrome

acquired immunodeficiency syndrome

(

AIDS

)

•

What is it?

HIV is the acronym for the Human Immunodeficiency Virus, a virus that attacks the body'simmune system, leading to full-blown AIDS (Acquired Immunodeficiency Syndrome). AIDS isdevastating because it leaves the body susceptible to life-threatening infections and certain kinds of cancers.

•

How is it contracted?

Through oral, anal, or vaginal sex, and from an HIV-positive mother to her baby. To prevent it, use a condom every time you have sex; find out the sexual history of any new partners, including their HIV status; and don't share needles if you do intravenous drugs. If you'repregnant and are HIV-positive, talk to your doctor about how to prevent passing the virus along to yourchild.

•

Incubation Period:

Some people develop symptoms shortly after being infected, but for many ittakes more than ten years for symptoms to appear.