8: NURSING CARE OF CLIENTS WITH STD/STI/HIV/AIDS ✓ Gonorrhea, syphilis, and chlamydia are examples of STIs

1. Overview that are caused by bacteria

2. Symptoms 2. Parasites
3. When to see a doctor ✓ Trichomoniasis is an STI caused by a parasite
4. Causes
3. Viruses
5. Risk factors
6. Transmission
✓ STIs causes by viruses include HPV, genital herpes, and HIV
7. Complications
8. Prevention Other kinds of infections – can be spread through sexual activity, but
9. Diagnosis it’s possible to be infected without sexual contact
10. Tests Examples:
11. Screening 1. Hepatitis A, B, and C viruses
12. STD testing 2. Shigella infection, and
• Chlamydia and Gonorrhea HIV, Syphilis, Hepatitis 3. Giardia infection
Overview: Risk Factors:
• Sexually transmitted diseases (STDs) – or sexually transmitted Anyone who is sexually active risks some degree of exposure to an
infections (STIs) are generally acquired by sexual contact STD or STI. Factors that may increase that risk include:
• The bacteria, viruses, or parasites that cause sexually 1. Having unprotected sex. Vaginal or anal penetration by an
transmitted diseases may pass from person to person in blood, infected partner who isn’t wearing a latex condom significantly
semen, or vaginal and other bodily fluids. increases the risk of getting an STI. Improper or inconsistent use
• Sometimes these infections can be transmitted non-sexually, of condoms can also increase risk.
such as from: 2. Oral sex may be less risky, but infections can still be transmitted
a. Mothers to their infants during pregnancy or childbirth, or without a latex condom or a dental dam – a thin, square piece
through of rubber made with latex or silicone
b. Blood transfusions 3. Having sexual contact with multiple partners. The more people
c. Shared needles (e.g. drug users) you have sexual contact with, the greater your risk.
• STIs don’t always cause symptoms (polygamous). If possible, stay in a monogamous relationship.
✓ It’s possible to contract sexually transmitted infections from 4. Having a history of STIs. Having one STI makes it much easier for
people who even seem perfectly healthy and may not even another STI to take hold. Make sure you are healthy.
know they have an infection 5. Being forced to engage in sexual activity. Dealing with rape or
Symptoms: assault is difficult, but it’s important to see a doctor as soon as
• STDS or STIs have a range of signs and symptoms, including no possible to receive screening, treatment, and emotional support.
symptoms 6. Misuse of alcohol or use of recreational drugs. Substance
• They may go unnoticed (asymptomatic symptoms) until misuse can inhibit your judgment, making you more willing to
complications occur or a partner is diagnosed. participate in risky behaviors.
• Signs and symptoms that might indicate an STI include: 7. Injecting drugs. Needle sharing spreads many serious infections,
1. Sores or bumps on the genitals or in the oral (mouth for oral including HIV, hepatitis B and hepatitis C.
sex) or rectal area (entry from genital area) 8. Being young: Half the new STIs occur in people between the ages
2. Painful or burning urination of 15 and 24. (proper sex education is a must)
3. Discharge from the penis (foul/non-foul, puss/non-puss – Transmission from mothers to infants:
water) • Certain STIs – such as gonorrhea, chlamydia, HIV, and syphilis –
4. Unusual or odorous vaginal discharge (foul/non-foul, can be passed from mothers to their infants during pregnancy or
puss/non-puss) delivery
5. Unusual vaginal bleeding • STIs in infants can cause serious problems or even death
6. Pain during sex • All pregnant women should be screened for these infections and
7. Sore, swollen lymph nodes, particularly in the groin but treated
sometimes more widespread • In Philippine setting: Doctor or BHW will first order blood test for
8. Lower abdominal pain screening for pregnant women.
9. Fever Complications
10. Rash over the trunk, hands, or feet • Because many people in the early stages of an STD or STI
• Signs and symptoms may appear a few days after exposure. experience no symptoms, screening for STIs is important to
However, it may take years before you have any noticeable prevent complications
problems, depending on the organism causing the STI • Possible complications include:
When to see a doctor? 1. Pelvic pain
See a doctor immediately: 2. Pregnancy complications
1. You are sexually active and may have been exposed to an STI 3. Eye inflammation
partner 4. Arthritis
2. You have signs and symptoms of an STI Prevention
Make an appointment with a doctor: 1. Abstain
1. When you’re considering becoming sexually active or when ✓ The most effective way to avoid STIs is to not have (abstain
you’re 21 – whichever comes first from) sex.
2. Before you start having sex with a new partner. 2. Stay with one uninfected partner
Causes:
1. Bacteria

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 ✓ Another reliable way of avoiding STIs is to stay in a long-
term relationship in which both people have sex only with
each other (monogamy) and neither partner is infected.
3. Wait and test.
✓ Avoid vaginal and anal intercourse with new partners until
you have both been tested for STIs. Ask how many partners
he/she has, sexual practices, etc.
✓ Oral sex is less risky but use a latex condom or dental dam
to prevent skin-to-skin contact between the oral and genital
mucous membranes.
4. Get vaccinated.
✓ Getting vaccinated early, before sexual exposure, is also
effective in preventing certain types of STIs
✓ Vaccines are available to prevent human papillomavirus
(HPV), hepatitis A and hepatitis B vaccines
• The Centers for Disease Control and Prevention (CDC)
recommends the HPV vaccine for girls and boys ages 11 and
12, although it can be given as early as aged 9.
• If not fully vaccinated at ages 11 and 12, the CDC
recommends getting the vaccine through age 26.
o Why? Because age 15-26 is the age of client who
are active in engaging sexual intercourse at these
ages.
• The Hepatitis B vaccine is usually given to newborns, and
the Hepatitis A vaccine is recommended for 1-year olds.
• Both vaccines are recommended for people who aren’t
already immune to these diseases and for those who are at
increased risk of infection, such as men who have sex with
men and IV drug users.
o It is best to have vaccines or be vaccinated
especially if you are engaged in these practices.
5. Use condoms and dental dams consistently and correctly
✓ Use a new latex condom or dental dam for EACH SEX ACT,
whether oral, vaginal, or anal
✓ Never use an oil-based lubricant, such as petroleum jelly
or baby oil, with a latex condom or dental dam because it
is not the ideal gel for the latex condom. These products
are not compatible with the latex condom
✓ Best to use a water-based lubricant like KY Jelly
✓ Condoms made from natural membranes are not
recommended because they’re not effective at preventing
STIs
✓ Also, keep in mind that while latex condoms reduce your
risk of exposure to most STIs, they provide less protection
for STIs involving exposed genital sores, such as HPV or
herpes
o Remember: There is no cure for virus. If virus is present,
only the symptoms that are present are treated. Once
you acquire a virus, the virus will only wait for you to be
immunocompromised so the symptoms will be present.
o If you’re using condom, it doesn’t reduce the risk of
exposure, especially the STI or STD’s mode of
transmission is skin to skin contact (exposed to sore,
HPV or Herpes), you will surely get infected.
✓ Also, non-barrier forms of contraception don’t protect
against STIs:
A. Birth control pills
B. IUDs
• You are probably protected from getting
pregnant, since you are using pills and IUD, so the
sperm cannot go inside the cervix area.
6. Don’t drink alcohol excessively or use drugs
• If you’re under the influence, you’re more likely to take sexual
risks.
• Alter your judgement and personality
7. Communicate.
• Before any serious sexual contact, communication with your
partner about practicing safer sex, your preferences to use
condom, and having both of yourselves be tested before
getting to the sexual act.
• Be sure you specifically agree on what activities will and won’t
be OK.
8. Consider male circumcision
✓ For men, there’s evidence that circumcision can help reduce
the risk of acquiring HIV from a woman with HIV by as much
as 60%
✓ Male circumcision may also help prevent transmission of
genital HPV and genital herpes.
o Why? Because the uncircumcised penis, there is a
covering. If the male does not know how to clean his
uncircumcised genitals and had sex with particular partner
who have HPV or herpes, there may be secretions left
inside the covering of the penis.
o If the male does not know how to clean it properly, it will
develop and if the male continues to have sex, the people
who had sex with him will be infected. It will not be
detected since this virus is usually asymptomatic. Then
there will be a huge risk of attaining the virus.
9. Consider using preexposure prophylaxis (PrEP).
• The Food and Drug Administration (FDA) has approved the use
of two combination drugs to reduce the risk of HIV infection
in people who are at very high risk (sexual workers who are
the top list high risk personnel and people having multiple
partners (polygamous), people who are drug users, pregnant
mothers who have STD/STI, receiving blood transfusions
without proper blood screening, and rape victims)
• They’re emtricitabine plus tenofovir disoproxil fumarate
(Truvada) and emtricitabine plus tenofovir alafenamide
fumarate (Descovy) – these are the medications that are
approved by the Food and Drug Administration in the
Philippines to reduce the risk of HIV infections.
• Your doctor will prescribe these drugs for HIV prevention only
if you don’t already have HIV
• You will need an HIV test before you start taking PrEP and
then every three months as long as you’re taking it
• Your doctor will also test your kidney function before
prescribing Truvada and continue to test it every six months.
o This is because Truvada is a strong drug
• If you have Hepatitis B, you should be evaluated by an
infectious disease or liver specialist before beginning therapy
• These FDA drugs must be taken every day, exactly as
prescribed. If you use Truvada daily, you can lower your risk
of getting HIV from sex by about 99% and from injection drug
use by more than 74%, according to the U.S. Centers for
Disease Control and Prevention
✓ Research suggests that Descovy is similarly effective in
reducing the risk of getting HIV from sex
✓ However, Descovy hasn’t been studied in people who have
receptive vaginal sex
✓ Using additional prevention, such as condoms, can lower
your risks even more and prevent other STIs
Diagnosis:
• If your sexual history and current signs and symptoms suggest
that you have a sexually transmitted disease (STD) or a sexually
transmitted infection (STI), your doctor will do a physical or
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 pelvic exam to look for signs of infection, such as a rash, warts,
or discharge
Tests
• Laboratory tests can identify the causes and detect co-infections
you might also have
1. Blood tests
• Blood tests can confirm the diagnosis of HIV or later stages of
syphilis
2. Urine Samples
• Some STIs can be confirmed with a urine sample
3. Fluid samples
• If you have open genital sores, your doctor may test fluid and
samples (through swab) from the sores to diagnose the type
of infection
Screening
STI Screening
• Testing for a disease in someone who doesn’t have symptoms
• Most of the time, STI screening is not a routine part of health
care.
• Patient must submit themselves to be checked
SCREENING is recommended for:
1. EVERYONE
• The one STI screening test suggested for everyone ages 13 to 64
is a blood or saliva test for human immunodeficiency virus (HIV),
the virus that causes AIDS
• Experts recommended that people at high risk have an HIV test
every year
• If sexually active, make sure to be screened every year
2. Everyone born between 1945 and 1965
• There’s a high incidence of hepatic C in people born between
1945 and 1965.
• Since the disease often causes no symptoms until its advanced,
experts recommend that everyone in that age group should be
screened for hepatitis C.
3. Pregnant women
• All pregnant women will generally be screened for HIV, hepatitis
B, chlamydia, and syphilis at their first prenatal visit.
• Gonorrhea and hepatitis C screening tests are recommended at
least once during pregnancy for women at high risk of these
infections
4. Women aged 21 and older
• The Pap smear (Papanicolaou) test screens for changes in the
cells of the cervix, including inflammation, precancerous
changes, and cancer.
• Cervical cancer is often caused by certain strains of HPV.
• Experts recommend that women have a Pap test every three
years starting at age 21
o Regardless of if you’ve had sex or not
• After age 30, experts recommend women have an HPV test and
a Pap test every five years
• Or women over 30 could have a Pap test alone every three years
or an HPV test alone every three years.
5. Women under age 25 who are sexually active
• Experts recommend that all sexually active women under age
25 be tested for chlamydia infection
• The chlamydia test uses a sample of urine or vaginal fluid that
you can collect yourself
• Reinfection by an untreated or undertreated partner is
common, so you need the second test to confirm that the
infection is cured
• You can catch chlamydia multiples times, so get retested if
you have a new partner
• Screening for gonorrhea is also recommended in sexually
active women under age 25.
6. Men who have sex with men
• Compared with other groups, men who have sex with men
run a higher risk of acquiring STIs
• Many public health groups recommend annual or more
frequent STI screening for these men
• Regular tests for HIV, syphilis, chlamydia, and gonorrhea are
particularly important
• Evaluation for hepatitis B also may be recommended
7. People with HIV
• If you have HIV, it dramatically raises your risk of catching
other STIs. Experts recommend immediate testing for
syphilis, gonorrhea, chlamydia, and herpes after being
diagnosed with HIV
• They also recommended that people with HIV be screened
for hepatitis C.
• Women with HIV may develop aggressive cervical cancer,
so experts recommend they have a Pap test at the time of
the HIV diagnosis or within a year of becoming sexually
active if they are under 21 and have HIV
• Then, experts recommend repeating the Pap test every
year for three years
• After three negatives tests, women with HIV can get a Pap
test every three years
8. People who have a new partner
• Before having a vaginal or anal intercourse with new partners,
be sure you’ve both been tested for STIs
• However, routine testing for genital herpes isn’t
recommended unless you have symptoms
• It’s also possible to be infected with an STI yet still test
negative, particularly if you’ve recently been infected because
it is still developing in your body
STD TESTING: WHAT’S RIGHT FOR YOU?
• Sexually transmitted diseases are common, but the types of STD
testing you need may vary by your risk factors. Find out what’s
recommended for you.
• If you’re sexually active, especially with multiple partners, you’ve
probably heard the following advice many times: USE
PROTECTION AND GET TESTED.
• This is important because a person can have a sexually
transmitted disease without knowing it.
• In many cases, there aren’t any signs or symptoms. In fact, that’s
why many experts prefer the terms sexually transmitted
infections, because you CAN have an infection WITHOUT
disease SYMPTOMS
• But if you are sexually active, you should ask these questions to
yourself:
1. What TYPES OF STI TESTING do you NEED?
2. HOW OFTEN should you be screened?
The answers DEPEND on:
1. Your age
2. Your sexual behaviors and
3. Other risk factors
• DON’T ASSUME that you’re receiving STI testing every time you
have a gynecologic exam or Pap test
• If you think that you need STI testing, REQUEST it from your
doctor.
• Talk to your doctor about your concerns and what tests you’d
like or need
TESTING FOR SPECIFIC STIS
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See the GUIDELINES for STI testing for SPECIFIC Sexually transmitted
infections
Testing for Chlamydia and Gonorrhea
1. Chlamydia and Gonorrhea;
• National guidelines recommend that you get screened
ANUALLY if:
a. You’re a sexually active woman under age 25
b. You’re a woman older than 25 and at risk of STIs – such as
having sex with a new partner or multiple partners
c. You’re a man who has sex with men
d. You have HIV
e. You’ve been forced to have intercourse or engage in
sexual activity against your will
• Doctors screen people for chlamydia and gonorrhea by taking
samples from:
a. Urine test
b. Swab inside the penis in men, or cervix in women
• The sample is the analyzed in a lab. Screening is important,
because if you don’t have signs or symptoms, you may not
know that you have either infection
2. HIV, SYPHILIS, AND HEPATITIS
The Centers for Disease Control and Prevention encourages
a. HIV testing
• Yearly for high risk
• At least once, as a routine part of medical care
• Adolescent or adult between the ages of 13 and 64
b. Younger teens should be tested if they have a high risk of
an STI. The CDC advises yearly HIV testing if you’re at a high
risk of infection
✓ The CDC recommended hepatitis C screening for everyone
born between 1945 and 1965. The incidence of hepatitis C
is high in this age group, and the disease often has no
symptoms until it’s both advanced. Vaccines are available
for both hepatitis A and B if screening shows you haven’t
been exposed to these viruses
✓ National guidelines recommend that you request testing for
HIV, syphilis, and hepatitis if you:
a. Test positive for another STI, which puts you at greater risk
of other STIs
b. Have had more than one sexual partner (or if your partner
has had multiple partners) since your last test
c. Use intravenous (IV) drugs
d. Are a man who has sex with men
e. Are pregnant or planning on becoming pregnant
f. Have been forced to have intercourse or engage in sexual
activity against your will
g. Your doctor tests you for syphilis by taking either a blood
sample or a swab from any genital sores you might have.
The sample is to be examined in a lab. A blood sample is
taken to test for HIV and hepatitis.

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 SEXUALLY TRANSMITTED INFECTIONS (STIs) o Sore throat
1. Syphilis o Swollen lymph nodes
2. Gonorrhea • These s/s may disappear within a few weeks or repeatedly come
3. Chlamydia and go for as long a s a year
4. Trichomoniasis
Latent Syphilis:
5. Genital Warts
6. Genital Herpes • If you aren’t treated for syphilis, the disease
7. HIV & AIDS moves from the secondary stage to the hidden
1. Syphilis (latent) stage, when you have no symptoms.
• Syphilis is a bacterial infection usually spread by sexual contact • The latent stage can last for years
• The disease starts as a painless sore – genitals, rectum, or mouth • Signs and symptoms may never return, or the
• Spreads from person to person via: skin or mucous membrane disease may progress to the third (tertiary) stage
(contact with these sores) Other types of syphilis:
• After the initial infection, the syphilis bacteria can remain Tertiary Syphilis:
inactive in the body for decades before becoming active again. • About 15-30% of people infected with syphilis
• Early syphilis can be cured, sometime with a single shot who don’t get treatment will develop
(injection) of Penicillin – drug of choice for syphilis complications known as tertiary syphilis.
• Without treatment, syphilis can severely damage: the heart, • Most complicated stage
brain, other organs, and can be life-threating • Appears 3-15 years after the initial infection
• Can be passed from mothers to unborn children • Soft, rounded, tumor-like areas of
Symptoms: inflammation called “Gummas” may appear
• Develops in stages, and symptoms vary with each stage • In the late stage, the disease may damage:
• But the stages may overlap, and symptoms don’t always occur in o The brain
the same order o Nerves
o Eyes
• You may be infected with syphilis without noticing any
o Heart
symptoms for years.
o Blood vessels
o Liver
Stages of Syphilis: Primary > Secondary > Latent > Tertiary
o Bones and
Primary Syphilis:
o Joint
• Chancre – first sign of syphilis is a
• These problems may occur many years after the original,
small, flat painless ulcer/sore
untreated infection
• Appears 10-90 days after 1st contact
Neurosyphilis:
• Sore appears at the spot where the
• At any stage, syphilis can spread and, among
bacteria entered your body (some
other damage.
may develop 1 or several)
• May cause damage to the brain and nervous
• Chancre sore may appear on the genitals, rectum, tongue, or
system and the eye
lips. The disease can be present with the appearance of a single
chancre
Congenital Syphilis:
• While most people infected with syphilis develop only one
• Babies born to women who have syphilis
chancre, some people develop several of them
can become infected through the placenta
• The chancre usually develops about 3 weeks after exposure.
or during birth.
• Many people who have syphilis don’t notice the chancre because
• Most newborns with congenital syphilis have
it’s usually painless
no symptoms, although some experience a
• May be hidden within the vagina or rectum.
rash on the palms of their hands and soles of
• The chancre will heal on its own within 3-6 weeks. their feet
Secondary Syphilis:
• Later s/s may include:
• Follows 2-10 weeks after primary syphilis o Deafness
• Has many symptoms, including distinctive o Teeth deformities
rash o Saddle nose – where the bridge if the nose collapses
• Within a few weeks of the original chancre • However, babies born with syphilis can also be born too early
healing, you may experience a rash that (premature); may die in the womb before birth or can die after
begins on your trunk but eventually covers birth
your entire body – even the palms of your When to see a doctor?
hands and the soles of your feet. Call your doctor if you or your child experiences:
• Worst during 3-4 months after infection o Any unusual discharge
• Last 1-6 months o Sore or rash – particularly if it occurs in the groin area
• This rash is usually not itchy and may be Causes of Syphilis
accompanied by wartlike sores in your • Treponema pallidum = bacterium that
mouth or genital area causes syphilis
• Some people also experience: • Spread is through sexual contact with an
o Hair loss infected person
o Muscle aches • The bacteria enter the body through:
o Fever o Minor cuts
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 o Skin abrasion
o Mucous membranes
• Syphilis is contagious during its primary and secondary stages,
and sometimes in the early latent period
• Less commonly, syphilis may spread through; direct contact with
an active lesion, such as during kissing
• It can also be passed from mothers to their babies during
pregnancy or childbirth
• Syphilis CAN’T be spread superficially by using the same toilet,
bathtub, clothing or eating utensils, or from doorknobs,
swimming pools or hot tubs; SEXUAL CONTACT IS ONLY THE
REASON
• Once cured, syphilis doesn’t return on its own. However, you can
become reinfected if you have contact with someone’s syphilis
sore
Risk factors
You are at high risk if:
• Engage in unprotected sex
• Have sex with multiple partners
• Are a man who has sex with men (man-to-man sex)
• Are infected with HIV, the virus that causes AIDS
Complications
Without treatment:
• Syphilis can lead to damage throughout your body
• Syphilis also increases the risk of HIV infection and can cause
problems during pregnancy
With treatment:
• Treatment can help prevent future damage but can’t repair or
reverse damage that’s already occurred
1. “Gummas” = small bumps or tumors
• In the late stage of syphilis, bumps (gummas) can develop
on the skin, bones, liver, or any other organ
• Gummas usually disappear after treatment with antibiotics
2. Neurologic problems
• Syphilis can cause many nervous system problems,
including: Headache, stroke, meningitis, hearing loss
• Visual problems, including blindness
• Dementia
• Loss of pain and temperature sensations
• Sexual dysfunction in men
• Bladder incontinence
3. Cardiovascular problems
• Bulging and swelling of the aorta – your body’s major artery
– and of other blood vessels
• May also damage heart valves
4. HIV infection
• Adults with sexually transmitted syphilis or other genital
ulcers have an estimated 2x-5x increased risk of contracting
HIV
• A syphilis sore can bleed easily, providing an easy way for
HIV to enter the bloodstream during sexual activity
5. Pregnancy & Childbirth complications
• May pass syphilis to your unborn baby
• Congenital syphilis greatly increases the risk of miscarriage,
stillbirth or your newborn’s death within a few days after
birth
✓ THERE IS NO VACCINE FOR SYPHILIS
Prevention
To help prevent the spread of syphilis, follow these suggestions:
1. Abstain or be monogamous
• Abstain = the only certain way to avoid syphilis and
otherATIs is to avoid having sex
• Be mutually monogamous = the next best option is to have
mutually monogamous sex in which both partners have sex
only with each other and neither partner is infected
2. Use a latex condom
• Condoms can reduce your risk of contracting syphilis, but
only if the condom covers the syphilis sores
3. Avoid recreational drugs
• Misuse of alcohol or other drugs can inhibit your judgement
and lead to unsafe sexual practices
4. Partner notification and preventive measures
• Official, confidential partner notification can help limit the
spread of syphilis
• The practice also steers those at risk towards counseling
and the right treatment
• Since you can contract syphilis more than once, partner
notification reduces your risk of getting reinfected
5. Contact-tracing
• Aka “partner notification”
• Process of telling/notifying your sexual or injecting partners
about your STI diagnosis
• When your partner knows they might have been put at risk
of an STI as well, they can get tested quickly and if
necessary, treated immediately
• Partner notification is usually carried out by the individual
themselves with the support of a nurse and/or doctor in a
sexual health clinic or hospital setting.
• Positive life (Organization) = supports people diagnosed
with an STI (including HIV), to notify or tell partners with the
support of someone else (a peer) who has been through the
process of notifying partners (sexual or injecting)
themselves
• This peer-led partner notification is a way for anyone newly
diagnosed with an STI (including HIV) to take ownership of
a critical diagnosis moment
2. GONORRHEA
• aka “the clap” or “drip” bacterial infection (“tulo” in Bisaya)
• Common sexually transmitted disease (STD) infects both male
and female
• You can get gonorrhea by having sex with a person infected with
it
• Caused by the bacterium: Neisseria
gonorrhoeae – bacteria are most often
passed from one person to another during
sexual contact (oral, anal, vaginal
intercourse)
o Circular or oval shape with hair-like structures
• Most often affects the: urethra, rectum, throat, females=cervix
• Commonly spread during: vaginal, oral, anal sex
• But babies of infected mothers can be infected during childbirth
• In babies, gonorrhea most commonly affects the eyes
• Best way to prevent: abstain from sex, using a condom, be in a
mutually monogamous relationship
Symptoms:
• In many cases, gonorrhea infection causes no symptoms/
asymptomatic
• Symptoms, however, can affect many sites in your body, but
commonly appear in the genital tract
Male s/s: Female s/s:
• Painful urination • Increased vaginal
• Pus-like discharge from discharge
the tip of the penis = • Painful urination
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 infection (that’s why it’s • Vaginal bleeding between • People who both have HIV and gonorrhea are able to pass both
called “tulo”) periods, such as after diseases more readily to their partners
• Pain or swelling in one vaginal intercourse 5. Complications in babies
testicle • Abdominal or pelvic pain • Babies who contract gonorrhea from their mothers during birth
Gonorrhea: affecting other body parts: can develop blindness, sores on the scalp and infections
1. Rectum Prevention:
o Anal itching • Use a condom if you have sex
o Pus-like discharge from the rectum • Be monogamous; limit your number of sex partners
o Spots of bright red blood on toilet tissue • Be sure you and your partner are tested for STIs
o Having to strain during bowel movements • Don’t have sex with someone who appears to have a STI
2. Eyes (common to baby) • Consider regular gonorrhea screening
o Eye pain Screening:
o Sensitive to light • Annual Screening is recommended for sexually active women
o Pus-like discharge (one or both yes) <25 years old and for older women at high risk of infection
3. Throat • This includes women who have:
o Sore throat a. A new sex partner
o Swollen lymph nodes in the neck b. More than one sex partner
4. Joints c. A sex partner with other partners
o Septic arthritis = if 1 or < joints become infected by bacteria d. Or a sex partner who has a STI
o The affected joints might be: warm, red swollen, extremely • Regular screening is also recommended for men who have sex
painful (especially during movement) with men, as well as their partners
When to see a doctor? Diagnosis:
Make an appointment with your doctor if you notice: To determine whether you have gonorrhea, your doctor will analyze
1. Any troubling s/s, such as: a sample of cells.
o Burning sensation during urination Samples can be collected by:
o Pus-like discharge from your penis, vagina, or rectum 1. Urine Test
2. If your partner has been diagnosed with gonorrhea • This can help identify bacteria in your urethra
o You may not experience s/s that prompt you to seek 2. Swab of Affected Area
medical attention. But without treatment, you can reinfect • A swab of your throat, urethra, vagina, or rectum can collect
your partner even after he/she has been treated for bacteria that can be identified in a lab
gonorrhea • For women, home test kits are available for gonorrhea.
Risk Factors:
• They include vaginal swabs for self-testing that are sent to a
Sexually active
specified lab for testing
o Women younger than 25
• You can choose to be notified by email or text message
o Men who have sex with men (increased risk)
when your results are ready
Other factors:
• Having a new sex partner • You can view your results online or receive them by calling
a toll-free hotline
• Having a sex partner who has other partners
Testing for another STI:
• Having more than one sex partner
• Your doctor may recommend tests for other sexually
• Having gonorrhea or another STI
transmitted infections.
Complications:
1. Infertility in men • Gonorrhea increases your risk of these infections, particularly
Chlamydia, which often accompanies gonorrhea.
• Can cause a small, coiled tube in the rear portion of the testicles
• Testing for HIV also is recommended for anyone diagnosed with
where the sperm ducts are located (epididymis) to become
a STI
inflamed (epididymitis)
• Depending on our risk factors, tests for additional sexually
• Untreated epididymitis can lead to infertility
transmitted infections could be beneficial as well.
2. Infertility in women
Treatment:
• Can spread into the uterus and fallopian tubes, causing pelvic
1. Gonorrhea treatment in Adults
inflammatory disease (PID)
• Adults with gonorrhea are treated with antibiotics. Due to
• PID can result in:
emerging strains of drug-resistant Neisseria gonorrhoeae,
o Scarring of the tubes
the Centers for Disease Control and Prevention
o High risk of pregnancy complications
recommends that uncomplicated gonorrhea be treated
o Infertility PID requires immediate treatment
with the antibiotic:
• PID requires immediate treatment
✓ Ceftriaxone – given as an injection (drug of choice for
3. Infection that spreads to the joints and other areas of your body
gonorrhea) – with oral Azithromycin (Zithromax).
• The bacterium that causes gonorrhea can spread through the
✓ If you’re allergic to Cephalosporin antibiotics, such as
bloodstream and infect other parts of your body, including your
Ceftriaxone, you might be given:
joints
▪ Oral Gemifloxacin (Factive)
• Fever, rash, skin sores, joint pain, swelling, and stiffness are
▪ Injectable Gentamicin and Oral Azithromycin
possible results of gonorrhea spreading through bloodstream
2. Gonorrhea treatment for Partners
4. Increased risk for HIV/AIDS
• Your partner also should go through testing and treatment
• More susceptible to human immunodeficiency virus (HIV), the
for gonorrhea, even if he or she has no signs or symptoms
virus that leads to AIDS
7
 • Your partner receives the same treatment you do. Even if • Earlier, they were given the following names:
you’re being treated for gonorrhea, a partner who isn’t o Miyagawanella
treated can pass it to you again. o Halprowia
3. Gonorrhea treatment for Babies o Bedsonia
• Babies born to mothers with gonorrhea who develop the • Chlamydia trachomatis is a Gram-negative obligate intracellular
infection can be treated with antibiotics. bacterium
• Affects mainly the genitourinary system
DURING APPOINTMENT: • Nowadays, urogenital chlamydia is the most common cause of
Make a list of: non-gonococcal urethritis (up to 60%)
1. Your symptoms, if you have any, including any that may seem • Being hidden during a long period of time, chlamydia are able to
unrelated to the reason for which you scheduled the transform into so-called L-forms and to hibernate
appointment, and when they began. • This phenomenon contributes to long intracellular parasitism
2. All medications, vitamins, or other supplements you take, without conflicts with the host’s immune system
including doses. • In the process of cells’ division, chlamydia trachomatis are
3. Questions to ask your doctor transferred to
DURING APPOITMNET: daughter cells
For gonorrhea, questions to ask your doctor include: • Active reproduction
• What tests do I need? and so-called
• Should I be tested for other sexually transmitted infections? “awakening” of
• Should my partner be tested for gonorrhea? chlamydia from L-
• How long should I wait before resuming sexual activity? forms is possible only
(Answer: wait for results and if it’s negative you can) during the process of
• How can I prevent gonorrhea in the future? immunosuppression
• What gonorrhea complications should I be alert for? Ways of Infection
• Are there brochures or other printed material that I can • Infection with chlamydiosis is usually sexually transmitted
have? What websites do you recommend? • But while gonorrhea can be transmitted during sexual
• Will I need a follow-up visit? intercourse to 3 out of 4 people, only 1 out of 4 can be infected
*Don’t hesitate to ask other questions. with chlamydia
What to expect from your doctor? • Women are more susceptible to chlamydia
Questions your doctor is likely to ask you include: • The incubation period is from 2 weeks to 1 month
• Have your symptoms been continuous or occasional? • The main ways of infection are vaginal or anal sexual intercourse,
• How severe are your symptoms? household contacts (sauna, bath)
• Have you been exposed to sexually transmitted infections? • Children can become infected while passing through the birth
What can you do in the meantime? canal of a woman infected with chlamydiosis
• Abstain from sex until you see your doctor • A household way of transmission can occur from contaminated
• Alert your sex partners that you’re having signs and hands to eyes and genitals
symptoms so that they can arrange to see their doctors for • Chlamydia microorganisms remain infective on household items
testing o Days: up to 2 days
3. CHLAMYDIA TRACHOMATIS o Temperature: 19-20 degrees in wet conditions
• According to statistics, 100 million people become infected with Symptoms
chlamydia every year Early-stage Chlamydia trachomatis infections often cause few or
• At a conservative estimate, the number of people infected with asymptomatic. Even when signs and symptoms occur, they’re often
chlamydia around the globe is about 1 billion mild, making them easy to overlook
• The wide spread of chlamydial infection is associated primarily • Painful urination
with the asymptomatic course of the disease • Vaginal discharge in women
• Chlamydia (kluh-MID-e-uh) trachomatis (truh-KOH-muh-tis) • Discharge from the penis in men
• Common STI caused by bacteria • Painful sexual intercourse in women
• People with the disease may be asymptomatic • Bleeding between periods and after sex in women
• You might not know you have chlamydia because many people • Testicular pain in men
don’t have signs or symptoms: genital pain and discharge from • Chlamydia trachomatis = can also infect the rectum, either with
the vagina or penis no signs or symptoms or with rectal pain, discharge, or bleeding
• Chlamydia trachomatis affects mostly young women • Conjunctivitis Chlamydial eye infections = through contact with
• Can occur in both men and women and in all age groups infected body fluids
• It’s not difficult to treat, but if left untreated it can lead to more When to See a Doctor
serious health problems See your doctor if you have a / and if:
• Chlamydia, unlike many other microorganisms can damage both • Discharge from your vagina
the external and internal genital organs, the mucosa of the • Discharge from your penis or rectum
respiratory tract, the • Pain during urination
intima of vessels and • See your doctor if you learn your sexual partner has
heart, the synovial lining of chlamydia
joints, teeth, and the sense Your doctor will likely prescribe an antibiotic even if you have no
organs symptoms.
8
Causes
• The Chlamydia trachomatis bacterium is most commonly spread
through vaginal, oral, and anal sex
• It’s also possible for pregnant women to spread chlamydia to
their children during delivery, causing pneumonia or a serious
eye infection in the newborns
Factors That Increase Risk of Chlamydia trachomatis
• Being sexually active before age 25
• Having multiple sex partners
• Not using a condom consistently
• History of sexually transmitted infection
Complications
• Pelvic inflammatory disease (PID)
o Infection of the uterus and fallopian tubes that causes pelvic
pain and fever
o Severe infections might require hospitalization for
intravenous antibiotics
o PID can damage the fallopian tubes, ovaries, and uterus,
including the cervix—may make woman infertile
• Infection near the testicles (epididymitis)
o A chlamydia infection can inflame the coiled tube located
beside each testicle (epididymis)
o The infection can result in fever, scrotal pain, and swelling
• Prostate gland infection
o Rarely, the chlamydia organism can spread to a man’s
prostate gland
o Prostatitis can cause pain during or after sex, fever and chills,
painful urination, and lower back pain
• Infections in newborns
o Infection can pass from the vaginal canal to your child during
delivery, causing pneumonia or a serious eye infection
• Ectopic pregnancy
o This occurs when a fertilized egg implants and grows outside
of the uterus, usually in a fallopian tube
o The pregnancy needs to be removed to prevent life-
threatening complications, such as a burst tube
o A chlamydia infection increases this risk
• Infertility
o Chlamydia infections, even those that produce no signs or
symptoms can cause scarring and obstruction in the fallopian
tubes, which might make women infertile
• Reactive arthritis
o People who have Chlamydia trachomatis are at higher risk of
developing reactive arthritis, also known as Reiter’s
syndrome
o This condition typically affects the joints, eyes, and urethra—
the tube that carries urine from your bladder to outside of
your body
Prevention
The surest way to prevent chlamydia infection is to ABSTAIN from
sexual activities.
• Use condoms
o Use a male latex condom or a female polyurethane condom
during each sexual contact
o Condoms used properly during every sexual encounter
reduce but don’t eliminate the risk of infection
• Limit your number of sex partners
o Having multiple sex partners puts you at a high risk of
contracting chlamydia and other sexually transmitted
infections
o Get regular screenings. If you’re sexually active, particularly
if you have multiple partners, talk with your doctor about
how often you should be screened for chlamydia and other
sexually transmitted infections
o Avoid douching. Douching decreases the number of good
bacteria in the vagina, which can increase the risk of
infection.
• Get regular screenings
o If you’re sexually active, particularly if you have multiple
sexual partners, talk with your doctor about how often you
should be screened for chlamydia and other sexually
transmitted infections
Diagnosis
The Centers for Disease Control and Prevention recommends
chlamydia screening for:
• Sexually active women aged 25 or younger
o The rate of chlamydia infection is highest in this group, so a
yearly screening test is recommended
o Even if you’ve been tested in the past year, get tested when
you have a new sex partner
• Pregnant women
o You should be tested for chlamydia during your first
prenatal exam
o If you have a high risk of infection—from changing sex
partners or because your regular partner might be
infected—get tested again later in your pregnancy
• Women and men at high risk
o People who have multiple sex partners, who don’t always
use a condom or men who have sex with men should
conder frequent chlamydia screening
o Other markers of high risk are current infection with
another sexually transmitted infection and possible
exposure to an STI through an infected partner
Screening
Screening and diagnosis of chlamydia is relatively simple
• Urine test
o A sample of your urine is analyzed in the laboratory for
presence of this infection
• Swab
o For women, your doctor takes a swab of the discharge from
your cervix for culture or antigen testing for chlamydia
o This can be done during a routine Pap test
o Some women prefer to swab their vaginas themselves,
which has been shown to be as diagnostic as doctor-
obtained swabs
o For men, your doctor inserts a slim swab into the end of
your penis to get a sample from the urethra
o In some cases, your doctor will swab the anus
▪ Anal sex / men to men intercourse
o If you’ve been treated for an initial chlamydia infection, you
should be retested in about 3 months
Treatment
• Chlamydia trachomatis is treated with antibiotics
o You might receive a one-time dose, or you might need to
take the medication daily or multiple times a day for 5-10
days
• In most cases, the infection resolves within 1-2 weeks
o During that time, you should abstain from sex and wait for
the results to come out negative before you have sex again
o Your sexual partner or partners also need treatment even if
they have no signs or symptoms
o Otherwise, the infection can be passed back and forth
between sexual partners
• Having chlamydia or having been treated for it in the past
doesn’t prevent you from getting it again
9
Drugs and Antibiotics who have trichomoniasis might be at higher risk of delivering
• In accordance with the latest international standards (WHO their babies prematurely.
recommendations, European recommendations 2010 – • Men who have trichomoniasis typically have no symptoms.
European guideline for the management of Chlamydia • To prevent reinfection with the organism that causes
trachomatis infections), the most effective drug for urogenital trichomoniasis, both partners should be treated.
chlamydia is azithromycin (single dose) or doxycycline (7-day • The most common treatment for trichomoniasis involves taking
course) one megadose of metronidazole (Flagyl) or tinidazole
• Treatment of uncomplicated chlamydiosis includes (Tindamax).
o Azithromycin – for infections of the urogenital tract • You can reduce your risk of infection by using condoms correctly
caused by Chlamydia trachomatis (urethritis, Cervicitis) every time you have sex.
• For the treatment of uncomplicated urethritis / cervicitis, it is Symptoms:
prescribed in: • Many women and most men with trichomoniasis have no
o Single dose of 1000 mg (1 g) symptoms (asymptomatic), at least not at first.
o 100 mg twice a day for at least 7 days doxycycline Women Men (Trichomoniasis rarely
• Medications containing Azithromycin causes symptoms for men)
o Brand names: Zithromax, Azithromycin Dose Pack, Z-Pak, • An often-foul-smelling • Irritation inside the penis
Zmax vaginal discharge – which • Burning urination or after
• Medications containing Doxycycline might be white, gray, ejaculation
o Brand names: Vibramycin, Oracea, Adoxa, Monodox yellow, or green • Discharge from the penis
You are probably interested in the following question: • Genital redness, burning
“How soon can I have sex again?” and itching
• If you had a one-day course of azithromycin, you should • Pain with urination or
avoid sex at least a week after the treatment. Alternative sexual intercourse
drugs are other macrolides and fluroquinolones. When to See a Doctor:
• The safety profile allows pregnant women to use azithromycin • If you have a foul-smelling vaginal discharge
(B category by FDA). • If you have pain with urination/ sexual intercourse
• Other macrolides are not recommended for pregnancy (C- Cause
category) • Causative agent: Trichomonas vaginalis
• In case of chronic chlamydia (especially if it is complicated), • Trichomoniasis is caused by a one-celled
antibiotic therapy is longer and often combined (several protozoan, a type of tiny parasite that travels
antibiotics are used) between people during sexual intercourse.
• All partners who were in sexual contact with a patient must be • Incubation period: the incubation period
necessarily checked. between exposure and infection is unknown, but it’s thought to
• During the period of treatment, the sexual activity is not range from 4-28 days.
recommended. Alcoholic drinks are prohibited. It is also Risk Factors:
recommended to limit the use of dairy products. • Multiple sex partners
• After 6-9 weeks after the end of the treatment, the patient • History of other STI
should carry out PCR again (the results must be negative) • Previous episode of trichomoniasis
List of Chlamydia Infection Drug Medications Used to Treat • Sex without a condom
Chlamydia Infection (DAATEL) Complications:
1. Doxycycline Pregnant women who have trichomoniasis might:
2. Azithromycin • Deliver prematurely
3. Amoxicillin
• Have a baby with a low birth weight
4. Tetracycline
• Transmit the infection to the baby as he/she passes through the
5. Erythromycin
birth canal
6. Levofloxacin
Having trichomoniasis also appears to make it easier for women to
become infected with HIV, the virus that causes AIDS.
Chlamydia Symptoms
Prevention
Men Women
If your sexually active, you can take these steps to protect yourself
• Penile discharge • Vaginal discharge against getting or spreading trichomoniasis and other STDs:
• Burning/painful urination • Burning/painful urination • Use condoms
• Testicular swelling • Bleeding between periods • Get tested routinely for trichomoniasis and other STDs
• Pain during sexual • Get treated if you have trichomoniasis or other STDs
intercourse • Tell your sexual partners if you have trichomoniasis so they can
• Pain in lower belly get tested and treated
• Bleeding or discharge • Engage in monogamous relationship with one sexual partner
from the anus • Limit your number of sexual partners
4. TRICHOMONIASIS Diagnosis
• Trichomoniasis is a common sexually transmitted infection • Sample of vaginal fluid for women
caused by a parasite. • Urine for men
• In women, trichomoniasis can cause a foul-smelling vaginal o If the parasite can be seen under the microscope, no further
discharge, genital itching and painful urination. Pregnant women tests are needed
10
 o If this test isn’t conclusive, tests called rapid antigen tests • They can appear on the genitals, in the pubic area or in the anal
and nucleic acid amplification may be used canal
• In women, genital warts can grow inside the vagina
Treatment In women, genital warts can grow on the:
• For pregnant women • Vulva
o Swallow 1 megadose of either Metronidazole (Flagyl)/ • Walls of the vagina
Tindazole (Tindamax) • Area between the external genitals
o In some cases, your doctor might recommend a lower dose and the anus
of Metronidazole: 2x/day x 7 days • The anal canal
• Both you and your partner need treatment. And you need to • The cervix
avoid sexual intercourse until the infection is cured, which take In men, they can appear on the:
about a week • Pubic area
• Don’t drink alcohol for 24 hours after taking metronidazole or • Genitals
72 hours after taking tinidazole, because it can cause severe • Tip of the penis
nausea and vomiting. • Shaft of the penis
• Your doctor will likely want to retest you for trichomoniasis from • Scrotum
2 weeks to 3 months after treatment to be sure you haven’t been • Anal canal
reinfected Warts in the mouth
• Untreated, trichomoniasis can last for months to years • Especially who do or engage in oral sex
Preparing for Appointment:
• HPV mouth sore
Before the appointment, you might prepare a list that includes:
• A detailed description of your symptoms, including when they
started
• Sexually transmitted infectious you’ve had
• The number of sexual partners you’ve had during the past few • HPV in the tongue
years
What to expect from your doctor?
• For women:
o Pelvic exam
• Genital warts can also develop in the
o Take sample of vaginal fluids (for testing)
mouth or throat of a person who has had
• For men: will need to provide urine sample
oral sexual contact with an infected
Prognosis:
person
• Trichomoniasis is a very common STD that goes away with Signs and Symptoms:
proper 1. Small, flesh-colored, brown, or pink swelling in your genital area
Treatment: 2. A cauliflower-like shape caused by several warts close together
1. Both you and partner take medication as prescribed 3. Itching or discomfort in your genital area
2. Abstain from sex until infection clears up (about 1 week) 4. Bleeding with intercourse
3. Trichomoniasis rarely causes long-term problems, although an 5. Genital warts can be so small and flat as to be invisible
untreated infection makes you more susceptible to getting (or 6. Rarely, however, genital warts can multiply into large clusters,
spreading) HIV, the virus that causes AIDS in someone with a suppressed immune system
When to See a Doctor:
When to Call a Doctor?
• See a doctor if you or your partner develops bumps or warts in
• Unusual vaginal or penile discharge
the genital area
• Foul-smelling discharge Causes:
• Genital irritation or itching • HPV causes warts
• Vaginal redness, soreness or swelling • there are > 40 strains of HPV that affect the genital area
• Painful intercourse • Almost always spread through sexual contact
5. GENITAL WARTS
• Your warts don’t have to be visible for you to spread the
• Causative agent: Human Papilloma Virus infection to your sexual partner
(HPV) – the virus that causes genital warts at Risk Factors:
some point during their lives • Most people who are sexually active get infected with genital
• One of the most common types of STI HPV at some time
• Genital warts affect the moist tissues of the genital area Factors that can increase your risk of becoming infected include:
• They can look like small, flesh-colored bumps or have a • Having unprotected sex with multiple partners
cauliflower-like appearance • Having had another STI
• In many cases, the warts are too small to be visible • Having sex with a partner whose sexual history you don’t know
• Some strains of genital HPV can cause genital warts, while others • Becoming sexually active at a young age
can cause cancer • Having a compromised immune system (HIV or drugs from an
• Vaccine can help protect against certain strains of genital HPV = organ transplant)
HPV vaccine Complications:
Symptoms: 1. Cancer
• Genital warts are a common STI • Cervical cancer has been closely linked with genital HPV infection
11
• Certain types of HPV also are associated with cancers of the vulva,
anus, penis, and mouth and throat
• HPV infection doesn’t always lead to cancer, but its important for
women to have regular Pap tests, particularly those who’ve
been infected with higher risk types of HPV.
2. Problems during pregnancy
• Rarely during pregnancy, warts can enlarge, making it difficult to
urinate.
• Warts on the vaginal wall can inhibit the stretching of vaginal
tissues during childbirth
• Large warts on the vulva or in the vagina can bleed when
stretched during delivery
• Extremely rarely, a baby born to a mother with genital warts
develops warts in the throat
• The baby might need surgery to keep the airway from being
blocked
Prevention:
• Abstain from sex
• Monogamous relationship
• Limit number of sexual partners
• Be vaccinated to help prevent you from getting genital warts
• Using a condom every time you have sex is a good idea, but won’t
necessarily protect you from genital warts
HPV VACCINATION:
Three HPV vaccines have been approved by the Food and Drugs
Administration
1. Gardasil 9
o Approved for use in males and females
o 9-45 years old to protect against cervical cancer and genital
warts
CDC recommends:
• Routine HPV vaccination for girls and boys
• Ages 11 and 12
• Can be given as early as age 9
• It’s ideal for girls and boys to receive the vaccine before
they have sexual contact
• Side effects form the vaccine are usually mild:
o Soreness at the injection site
o Headaches
o Low-grade fever or flu-like symptoms
CDC now recommends that:
• all 11- and 12-year-old receive two doses of HPV vaccine at least
6 months apart, instead of the previously recommended 3-dose
schedule
• Younger adolescents ages 9-10 years old and teens 13-14 years
old also are able to receive vaccination on the updated 2-dose
schedule
• Research has shown that the 2-dose schedule is effective for
children under 15
• Teen and young adults who begin the vaccine series later, at ages
15-26 years old, should continue to receive 3-doses of the
vaccine
• Catch-up HPV vaccinations for all people through age 26 years
old who aren’t adequately vaccinated
Diagnosis:
Genital warts are often diagnosed by appearance. Sometimes a
biopsy might be necessary.
1. Pap test
• For women, it’s important to have regular pelvic exams and PAP
tests, which can help detect vaginal and cervical changes caused
by genital warts or the early signs of cervical cancer
• During a Pap test, your doctor uses a device called a “speculum”
to hold open your vagina and see the passage between your
vagina and your uterus (cervix)
• He/she will then use a long-handled tool to collect a small
sample of cells by swiping it form the cervix. The cells are
examined with a microscope for abnormalities
Pap Smear Procedure:
a. Doctor uses a vaginal speculum
to hold your vaginal walls apart
and to see the cervix. Speculum
is sterilized before entering the
vagina.
b. Next, a sample of cells from your
cervix is collected using a small
cone-shaped brush and a tiny
plastic spatula
c. Doctor rinses the brush and spatula in a liquid-filled vial and
sends the vial to a laboratory for testing
2. HPV test
• Only a few types of genital HPV have been linked to a cervical
cancer. A sample of cervical cells, taken during a Pap test, can be
testes for these cancer-causing HPV strains
• This test is generally reserved for women ages >=30years old. It
isn’t as useful for younger women because for them, HPV usually
goes away without treatment
Treatment:
1. Medications
Genital wart treatment that can be applied directly to your skin
(topical) include:
A. Imiquimod (Aldara, Zyclara)
• This cream appears to boost your immune system’s ability to
fight genital warts
• Avoid sexual contact while the cream is on your skin
• It might weaken condoms and diaphragms and irritate your
partner’s skin
• Possible side effect = skin redness
o Other side effects might include: blisters, body
aches/pains, cough, rashes, fatigue
B. Podophyllin and Podofilox (Condylox)
• Podophyllin is a plant-based resin that destroys genital wart
tissue
• Your doctor applies this solution
• Podofilox contains the same active compound, but you can
apply it at home
• Never apply podofilox internally, only topically
• Additionally, this medication isn’t recommended for use during
pregnancy
• Side effects: mild skin irritation, sores, pain
C. Trichloroacetic acid
• This chemical treatment burns off genital warts, and can be used
for internal warts
• Side effects: mild skin irritation, sores, pain
D. Sinecatechins (Vergen)
• Indication: treatment of external genital warts and warts in or
around the anal canal
• Side effects: reddening of the skin, itching, or burning, mild pain
Don’t try to treat genital warts with OTC wart removers. These
medications aren’t intended for use in the genital area
2. Surgery
• If your warts aren’t causing discomfort, you might not need
treatment. But if you have itching, burning and pain, or if you’re
12
 concerned about spreading the infection, your doctor can help
you clear an outbreak with medications or surgery
• However, warts often return after treatment. There is NO
treatment for the virus itself.
• Indications:
o Remove larger warts
o Warts that don’t respond to medications
o Pregnant clients
o Warts that your baby can be exposed to during delivery
Surgical Options Include:
A. Cryotherapy (freezing with liquid nitrogen)
• Freezing works by causing a blister to form around your wart.
• As your skin heals, the lesions slough off, allowing new skin to
appear. You might need to repeat the treatment.
• Main side effects: pain, swelling
B. Electrocautery
• Uses an electrical current to burn off warts
• Side effects: some pain, swelling after the procedure
C. Laser treatments
• Uses an intense beam of light, can be expensive and is usually
reserved for extensive and tough-to-treat warts
• Side effects: scarring and pain
D. Surgical excision
• Uses special tools to cut off warts
• Need local or general anesthesia for this treatment
• Side effects: pain
Nursing Interventions:
1. Advice patient to describe/state their symptoms to the doctor;
when and where it began; and note whether your sexual partner
has had similar symptoms
2. Advice patient to tell his sexual history, including all recent
exposures to possible sources of infection, particularly if you’ve
had unprotected sex or sex with a new partner
3. Inform your doctor of his medical information, including other
conditions you’re being treated for
4. Tell doctor all medication, vitamins, or other supplements you
take, including doses.
Your doctor is likely to ask you questions, including:
• How severe are your symptoms?
• Do you practice safe sex? Have you always done so?
• Has your partner been tested for sexually transmitted
infections?
• Have you had the HPV vaccine? When?
• Are you pregnant or planning to become pregnant?
6. GENITAL HERPES
The facts:
• Genital herpes (JEN I tell / HER pees) is a sexually transmitted
virus
• Genital herpes is common in both men and women in the US
• Most people who have genital herpes don’t know it. There are
often no symptoms
• If you have symptoms, the most common ones are painful
blisters and sores
• You can pass genital herpes to others without knowing it
• There is no cure for genital herpes, but there are treatments for
the symptoms
• Genital herpes does not usually cause serious health problems
Overview:
• Genital herpes is a common sexually transmitted infection
• Mode of transmission: sexual contact is the primary way that the
virus spreads
• After the initial infection, the virus lies dormant in your body and
can reactivate several times a year.
• Genital herpes can cause pain, itching and sores in your genital
area. But you may have no signs or symptoms of genital herpes.
• If infected, you can be contagious even if you have no visible
sores
• There’s no cure for genital herpes, but medications can ease
symptoms and reduce the risk of infecting others. Condoms also
can help prevent the spread of a genital herpes infection
• Causative agent: Herpex Simplex Virus (HSV)
• Causes: 2 types of Herpex Simplex virus infections
can cause genital herpes:
o HSV-1
a. The type that usually causes cold sores or fever blisters
around your mouth
b. Mode of transmission: skin-to-skin contact, though it
can be spread to your genital area during oral sex
c. Recurrences are much less frequent when they are
with HSV-2 infection
o HSV-2
a. Very common and highly contagious, whether or not
out have an open sore
b. Commonly causes genital herpes
c. Mode of transmission:
• Sexual contact
• Skin-to-skin contact
Causes:
• Because the virus dies quickly outside of the body, it’s
nearly impossible to get the infection through:
o Contact with toilets
o Towels/other objects used by an infected person
Symptoms:
• Most people infected with HSV don’t know they have it because
they are ASYMPTOMATIC/don’t have any signs or symptoms or
because their signs and symptoms are so mild
• When present, symptoms may begin about 2 – 12 days after
exposure to the virus
• During an INITIAL outbreak, you may have flu-like signs and
symptoms such as:
▪ Swollen lymph nodes in your groin
▪ Headache
▪ Muscle aches
▪ Fever
• Pain or itching
o You may experience pain and tenderness in your genital
area until the infection clears.
• Small red bumps or tiny white blisters
o These may appear a few days to a few weeks after infection
• Ulcers
o These may form when blisters rupture and ooze or bleed.
Ulcers may make it panful to urinate
• Scabs
o Skin will crust over and form scabs as ulcers heal
Differences in Symptoms Location
• Sores appear where the infection entered your body
• You can spread the infection by touching a sore and then
rubbing or scratching another area of your body, including your
eyes.
• Men and women can develop sores on the:
o Buttocks and thighs
o Anus
o Mouth
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 o Urethra (the tube that allows urine to drain from the • The virus is sexually transmitted more
bladder to the outside) easily from men to women than it is
Women can also develop sores WOMEN Genital herpes from women to men
in or on the: symptoms Have multiple • Each additional sexual partner raises
• Vaginal area/wall • Pain during urination sexual partners your risk of being exposed to the virus
• External genitals • Fatigue that cause genital herpes
• Cervix • Small blisters that break
open and cause painful COMPLICATIONS
sores 1. Other STI
• Fever o Having genital sores increases your risk of transmitting or
• Headache contracting other sexually transmitted infections, including
• Pain around genitals AIDS
• Itching 2. Newborn infection
• Babies are born to infected mothers can be exposed to the
Men can also develop sores in MEN genital herpes symptoms virus during the birthing process. This may result in brain
or on the: damage, blindness, or death for the newborn.
• Penis • Pain during urination 3. Bladder problems
• Scrotum • Fatigue • In some cases, the sores associated with genital herpes can
• Small blisters that break cause inflammation around the tube that delivers urine from
open and cause painful your bladder to the outside world (urethra).
sores • The swelling can close the urethra for several days, requiring
• Fever the insertion of a catheter to drain your bladder
• Headache 4. Meningitis
• Pain around genitals • In rare instances, HSV infection leads to inflammation of the
membranes and cerebrospinal fluid surrounding your brain
• Itching
and spinal cord
• Herpes in the mouth
• Rectal inflammation (Proctitis). Genital herpes can lead to
o Dried up does not mean it is healed
inflammation of the lining of the rectum, particularly in men
who have sex with men
PREVENTION
• The suggestions for preventing genital herpes are the same as
those for preventing other STI
1. Abstain from sexual activity
2. Limit sexual contact to only one person who is infection free
3. Use, or have your partner use, a latex condom during every
sexual contact
4. Avoid intercourse if either partner has an outbreak of
herpes in the genital area or anywhere else
PREGNANCY PRECAUTION
If you’re pregnant and know you have genital herpes, tell your doctor.
If you think you might have genital herpes, ask to be tested for it
1. Your doctor may recommend that you start taking herpes
antiviral medications late in the pregnancy to try to prevent an
Recurrences are common: outbreak around the time of delivery
• Genital herpes is different for each person 2. If you’re having an outbreak when you go into labor, your doctor
• The signs and symptoms may recur, off and on, for years will probably suggest a cesarean section to reduce the risk of
• Some people experience numerous episodes each year passing the virus to your baby
• For many people, however, the outbreaks are less frequent as DIAGNOSIS:
time passes Your doctor usually can diagnose genital herpes based on a Physical
• During a recurrence shortly before sores appear, you may feel: Exam and the results of certain laboratory tests
o Burning, tingling, and itching where the infection first 1. Viral culture
entered your body • This test involves taking a tissue sample or scraping of the sores
o Pain in your lower back, buttocks, and legs for examination in the laboratory
o However, recurrences are generally less painful than the 2. Polymerase Chain Reaction (PCR) test
original outbreak, and sores generally heal more quickly. • PCR is used to copy your DNA from a sample of your blood, tissue
When to see a doctor? from a sore or spinal fluid
• If you suspect you have genital herpes – or any other STI – see • The DNA can then be tested to establish the presence of HSV and
your doctor determine which type of HSV you have
Risk factors: HIGH RISK 3. Blood test
Are a woman • Women are more likely to have genital • This test analyzes a sample of your blood for the presence of HSV
herpes than are men antibodies to detect a past herpes infection
TREATMENT
There’s NO CURE for genital herpes
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Treatment with prescription antiviral medications may:
1. Help sores heal sooner during an initial outbreak
2. Lessen the severity and duration of symptoms in recurrent
outbreaks
3. Reduce the frequency of recurrence
4. Minimize the chance of transmitting the herpes virus to
another
Antiviral medications used for genital herpes include:
1. Acyclovir (Zovirax)
2. Valacyclovir (Valtrex)
• Your doctor may recommend that you take the medicine only
when you have symptoms of an outbreak or that you take a
certain medication daily, even when you have no signs of an
outbreak
• These medications are usually well-tolerated, with a few side
effects
COPING AND SUPPORT
• Finding out that you have genital herpes can cause
embarrassment, shame and anger, among other emotions
• You may be suspicious or resentful of your partner if you think
he or she “gave” you the infection. Or you might fear rejection
by your current partner or future partners.
• Here are healthy ways to cope with having genital herpes
1. Communicate with your partner
• Be open and honest about your feelings.
• Trust your partner and believe what he or she tells you.
• Don’t assign blame.
• Genital herpes can lie dormant in your body for years, so it’s
often difficult to determine when you became infected
2. Educate yourself
• Talk with your doctor or a counselor to learn how to live
with the condition and minimize your chances of infecting
others.
• Learn about your treatment options and how to manage
outbreaks
3. Join a support group
• Look for a group in your area or online so that you can talk
about your feelings and learn from others’ experiences
Preparing for Appointment:
• If you think you have genital herpes or other STI, make an
appointment to see your primary care doctor or gynecologist
• Before the appointment, encourage the patient to list answers
to the following question:
o What are your symptoms? When did they start?
o Do you have a new sexual partner or multiple partners?
o Have you ever been diagnosed with a sexually
transmitted infection?
o Do you regularly use condoms?
o What medications or supplements do you take regularly?
o What tests do I need?
o Should I be tested for other STIs?
o Should my partner be tested?
o Do I need to abstain from sexual activity during
treatment?
o How can I avoid infecting my partner?
• What to expect from your doctor:
o Your doctor is likely to ask you a number of questions,
such as:
a. Do you have pelvic pain?
b. Do you have pain while
urinating?
c. Do you have sores or unusual
discharge?
- Pimple: genital warts or caused HPV
- Vesicle: genital herpes or caused by HSV
PHILIPPINE DOH PROGRAMS ON STD/STI
HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
Objective:
• Reduce the transmission of HIV and STI among the Most At Risk
Population and General Population and mitigate its impact at the
individual, family and community level
Program activities
• With regard to the prevention and fight against stigma and
discrimination, the following are the strategies and
interventions:
o Availability of free voluntary HIV counseling and testing
service
o 100% condom use program (CUP) especially for
entertainment establishments
o Peer education and outreach
o Multi sectoral coordination through Philippine national
AIDS Council (PNAC)
o Empowerment of communities
o Community assemblies and forum to reduce stigma
o Augmentation of resources of social hygienic clinics; and
o Procured male condoms distributed as education
materials during outreach
Program Accomplishments
• As of the first quarter of 2011, the program has attained
particular targets for the three major final outputs: (1) health
policy and program development; (2) capability building of LGUs
and other stakeholders and (3) leveraging services for priority
health program
• For the health policy and program development, the Manual of
Procedures/Standards/Guidelines is already finalized and
disseminated. The ARV Resistance surveillance among People
Living with HIV (PLHIV) on treatment is being implemented
through the Research Institute for tropical Medicine (RITM).
Moreover, both the strategic Plan 2021 – 2016 for Prevention of
Mother to Child Transmission and the Strategic Plan 2012 – 2016
for Most at risk Young People and HIV prevention and treatment
are being drafted
• With regard to capability building, the Training Curriculum for
HIV counseling and testing is already revise. Twenty-five priority
LGUs provided support in strengthening local AIDS councils, as of
March 2011, there were already 17 treatment hubs nationwide
• Lastly, for the leveraging services, baseline laboratory testing is
being provided while male condoms are being distributed
through social hygiene clinics. A total of 1250 PLHIV were
provided with treatment and 4,000 STI were treated
Partner organizations/agencies:
The following organizations/agencies take part in achieving the goal
of the National HIV/STI prevention program:
• Department of Interior and Local Government (DILG)
• Philippine National AIDS Council (PNAC)
• Research Institute For Tropical Medicine (RITM)
• STI/AIDS Cooperative Central Laboratory (SCCL)
• World Health Organization (WHO)
• United States Agency For International Development (USAID)
• Pinoy Plus Association
• AIDS Society of the Philippines (ASP)
• Positive Action Foundation Philippines Inc (PAFPI)
• Action for Health Initiatives (ACHIEVES)
• Affiliation Against AIDS In Mindanao (ALAGAD-MINDANAO)
• AIDS Watch Council (AWAC)
• Family Planning Organization of the Philippines (FPOP)
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• Free Rehabilitation, Economic, Education, and Legal assistance
Volunteers Association, Inc (FREELAVA)
• Philippine NGO Council on Population, Health, and Welfare, Inc
(PNGOC)
• Leyte Family Development Organization (LEFADO)
• Remedios AIDS Foundation (RAF)
• Social Development research Institute (SDR)
• TLF Share Collectives, INC.
• Trade Union congress of the Philippines (TUCP) Katipunang
• Manggagawang Pilipino
• Health Action Information Network (HAIN)
• Hope Volunteer Foundation, Inc
• Kanlungan Center Foundation, Inc (KCFI)
• Kabataang Gabay sa Positibong Pamumuhay Inc (KGPP)
• Program Manager: Dr Jose Gerard B. Belimac
• Department of Health – National Center for Disease Prevention
And Control (DOH-NCDPC)
o If you want to learn more, they are available every
Wednesdays and Thursdays from 8AM to 12PM
o Provide education and orientation for STI, especially
first-time mothers

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