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Chapter 53: Nursing Management: Sexually Transmitted Diseases
Sexually transmitted diseases
(STDs) are infectious diseases transmitted most commonlythrough sexual contact.
Types of STD infections include bacterial (gonorrhea, chlamydia, syphilis) and viral (genitalherpes, genital warts).
Most infections start as lesions on the genitalia and other sexually exposed mucousmembranes. Wide dissemination to other body areas can then occur.
A latent, or subclinical, phase is present with all STDs. This can lead to a long-term persistent infection and transmission of disease from asymptomatic (but infected) person toanother contact.
Different STDs can coexist within one person.
is the second most frequently reported STD in United States.
It is caused by
 Neisseria gonorrhoeae,
a gram-negative diplococcus.
Gonorrhea is spread by direct physical contact with an infected host, usually during sexualactivity (vaginal, oral, or anal).
The initial site of gonorrhea infection in men is usually the urethra.
Symptoms of urethritis consist of dysuria and profuse, purulent urethral dischargedeveloping 2 to 5 days after infection.
Women with gonorrhea are often asymptomatic or have minor symptoms that are oftenoverlooked. A few women may complain of vaginal discharge, dysuria, or frequency of urination.
Complications of gonorrhea in men are prostatitis, urethral strictures, and sterility fromorchitis or epididymitis.
Because women with gonorrhea who are asymptomatic seldom seek treatment,complications are more common and include pelvic inflammatory disease (PID), Bartholin’sabscess, ectopic pregnancy, and infertility.
Typical clinical manifestations of gonorrhea, combined with a positive finding in a Gram-stained smear of the purulent discharge from the penis, gives an almost certain diagnosis inmen. A culture must be performed to confirm the diagnosis in women.
The most common treatment for gonorrhea is a single IM dose of ceftriaxone (Rocephin).Patients with coexisting syphilis are likely to be cured by same drugs used for gonorrhea.
All sexual contacts of patients with gonorrhea must be evaluated and treated to preventreinfection after resumption of sexual relations.
The cause of 
Treponema pallidum,
a spirochete which enters the body throughvery small breaks in skin or mucous membranes.
In addition to sexual contact, syphilis may be spread through contact with infectious lesionsand sharing of needles among IV drug users.
If syphilis is not treated, specific stages are characteristic of disease progression.
In the
appear. During this time, draining of microorganisms intolymph nodes causes regional lymphadenopathy. Genital ulcers may also be present.
Without treatment, syphilis progresses to a
Manifestationsinclude flu-like symptoms of fever, sore throat, headaches, fatigue, and generalizedadenopathy.
third stage
is most severe stage. Manifestations include gummas,
aneurysms, heartvalve insufficiency, and heart failure, and general paresis.
Syphilis is commonly diagnosed by a serologic test. Benzathine penicillin G (Bicillin) or aqueous procaine penicillin G remains the treatment for all stages of syphilis.
Chlamydial infections
are the most commonly reported STD in the United States.
They are caused by
Chlamydia trachomatis,
a gram-negative bacterium that is transmittedduring vaginal, anal, or oral sex.
Chlamydial infections are associated with gonococcal infections, which makes clinicaldifferentiation difficult. In men, urethritis, epididymitis, and proctitis may occur in bothdiseases. In women, bartholinitis, cervicitis, and salpingitis (inflammation of the fallopiantube) can occur in both diseases. Therefore, both
and gonorrhea are usuallytreated concurrently even without diagnostic evidence.
Complications from chlamydial infections in men result in epididymitis with possibleinfertility and reactive arthritis.
Complications from chlamydial infections in women may result in PID, which can lead tochronic pelvic pain and infertility.
DNA amplification tests are the most sensitive diagnostic methods available to detectchlamydial infections.
Chlamydial infections respond to treatment with doxycycline (Vibramycin) or azithromycin(Zithromax).
Genital herpes
is caused by herpes simplex virus type 2 (HSV-2).
The virus enters through mucous membranes or breaks in skin during contact with infected person.
In general, HSV type 1 (HSV-1) causes infection above waist, involving gingivae, dermis,upper respiratory tract, and CNS.
HSV type 2 (HSV-2) most frequently infects the genital tract and perineum (locations belowwaist).
In a
 primary episode
of genital herpes the patient may complain of burning or tingling at thesite of inoculation. Multiple small, vesicular lesions may appear on penis, scrotum, vulva, perineum, perianal region, vagina, or cervix.
 Recurrent genital herpes
occurs in 50% to 80% of individuals during the year following the primary episode. Stress, fatigue, sunburn, and menses are noted triggers. Symptoms of recurrent episodes are less severe, and lesions usually heal within 8 to 12 days.
The diagnosis of genital herpes is confirmed through isolation of the virus from activelesions by means of tissue culture.
Three antiviral agents are available for treatment: acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). These drugs inhibit herpetic viral replication and are prescribed for primary and recurrent infections.
Genital warts are caused by the human papillomavirus (HPV). There are over 100 types of  papillomaviruses, and about 40 of these affect the genital tract.
Most individuals who have HPV infection do not know they are infected because symptomsare often not present.
Some HPV types appear to be harmless and self-limiting, whereas others are linked tocervical and vulvar cancer in women and anorectal and squamous cell carcinoma of the penis in men.
Genital warts are discrete single or multiple papillary growths that are white to gray and pink-flesh colored. They may grow and coalesce to form large, cauliflower-like masses.
In men, warts may occur on the penis and scrotum, around the anus, or in the urethra. Inwomen, warts may be located on the vulva, vagina, or cervix and in the perianal area.
Diagnosis of genital warts can be made on the basis of gross appearance of lesions.
Genital warts are difficult to treat and often require multiple office visits with a variety of treatments.
Treatment consists of chemical or ablative (removal with laser or electocautery) methods.Because treatment does not destroy the virus, recurrences and reinfection are possible, andcareful long-term follow-up is advised.
A vaccine is now available to prevent precancerous genital lesions and genital warts due tohuman HPV (types 6, 11, 16, and 18).

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