 Gonorrhea caused by N.

gonorrhoeae which is a gram-negative bacterium that

is transmitted primarily through sexual or in neonates because of contact during
birth
 Gonorrhea symptoms are not produced but without treatment persons may
develop PID.

 Symptoms in men: Penile discharge, Burning on micturition, Painful

swollen testicles, urethritis, epididymitis, arthritis
 Symptoms in women: Asymptomatic usually; however, urinary tract
infection, increased vaginal discharge, and itching may occur
 Gonorrhea assessment involves assessing for fever; for urethral, vaginal, and
rectal discharge and for signs of arthritis
 Gonorrhea diagnostic testing
 Male patient: Specimens are obtained from the urethra, anal canal, and
pharynx using gram stain for N. gonorrhea
 Female patient: Cultures are obtained from the endocervix, pharynx, and
anal canal
 Gonorrheal infection treatment
 Ceftriaxone (Rocephin) or cefixime [Suprax]
 Ciprofloxacin [Cipro] or ofloxacin [Floxin]) along with doxycycline

 Chlamydial infections & Gonorrhea are the leading causes of pelvic

inflammatory disease (PID)
 Chlamydia & Gonorrhea are the most common causes of endocervicitis
 Chlamydia causes C. trachomatisis a bacterium that requires attachment to the
host cell, invasion, intracellular growth, and replication
 Chlamydial infections of the cervix symptoms are not produced, but cervical
discharge, dyspareunia, dysuria, bleeding, conjunctivitis and perihepatitis may
occur
 Symptoms in men: Penile discharge, Burning on micturition, Painful
swollen testicles, arthritis
 Chlamydia is treated with doxycycline for 1 week or with a single dose of
azithromycin.
 Partners must also be treated.
 Pregnant women are cautioned not to take tetracycline because of
potential adverse effects on the fetus, erythromycin may be prescribed
 Cultures for chlamydia and other STDs are taken from patients who have been
sexually assaulted when they first seek medical attention (prophylactic treatment)
and repeated in 2 weeks.
 Annual screening for chlamydia is recommended for all sexually active women
20 - 25 years of age and older women with new sex partners or multiple partners
 Rescreening is required for women with chlamydial infections 3 - 4
months after treatment is completed
 Nursing Management:
1. Assist patients in assessing their own risk and bring about changes in
behaviour occur
2. Discourage patients from assuming that a partner is “safe” without open,
honest discussion
 Patient teaching:
1. Encourage abstinence, postponing the age of initial sexual exposure,
limiting the number of sexual partners, and use of condoms for barrier
protection
2. Inform patients that screening for Chlamydia and treating infection at an
early stage are important to decrease disease progression common to
women and to decrease the likelihood of infection in infants
 Pelvic inflammatory disease (PID) is an inflammatory condition of the pelvic
cavity that may begin with cervicitis and may involve the uterus (endometritis),
fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum, or pelvic
vascular system

 Narrowing & scarring of fallopian tubes may occur which increases the risk for
ectopic pregnancy (fertilized eggs become trapped in the tube), infertility,
recurrent pelvic pain, tubo-ovarian abscess, and recurrent disease.

 Pathophysiology of PID:
1.Organisms usually enter the body through the vagina, pass through the cervical
canal, colonize the endocervix, and move upward into the uterus

2.Under various conditions, the organisms may proceed to one or both fallopian
tubes and ovaries and into the pelvis

3.In bacterial infections that occur after childbirth or abortion, pathogens are
disseminated directly through the tissues that support the uterus by way of the
lymphatics and blood vessels

4.In pregnancy, the increased blood supply required by the placenta provides
more pathways for infection
 These post-partum and post-abortion infections tend to be unilateral
 5.Infections can cause perihepatic inflammation when the organism invades the
peritoneum

6.In gonorrheal infections, the gonococci pass through the cervical canal and into
the uterus, where the environment, especially during menstruation, allows
them to multiply rapidly and spread to the fallopian tubes and into the pelvis
 The infection is usually bilateral

7. One of the most common causes of salpingitis (inflammation of the

fallopian tube) is chlamydia, possibly accompanied by gonorrhoea

 Risk factors for PID:

1.Early age at first intercourse
2.Having multiple sexual partners
3.Having frequent intercourse
4.Having intercourse without condoms
5.Having sex with a partner with an STD
6.Having a history of STDs or previous pelvic infection

 Clinical Manifestations of PID

1.Vaginal discharge
2.Dyspareunia
3.Lower abdominal pelvic pain & Tenderness that occurs after menses.
 Pain may increase while voiding or with defecation.
4.Fever
5.General malaise
6.Anorexia
7.Nausea
8.Headache
9.Vomiting (possibly)
On pelvic examination for signs for PID
1. Intense tenderness may be noted on palpation of the uterus or movement of the
cervix (cervical motion tenderness)

Medical Management: Broad-spectrum antibiotic therapy is prescribed

 Intensive therapy: Bed rest, intravenous fluids, and intravenous antibiotic

therapy.
  If the patient has abdominal distention or ileus, nasogastric intubation
and suction are initiated.
Nursing Management of PID
 Maintained patient on bed rest placed in the semi-Fowler’s position to
facilitate dependent drainage
 Assess and record vital signs
 Assess characteristics and amount of vaginal discharge is necessary as a
guide to therapy
 Administer analgesic agents as prescribed for pain relief.
 Apply heat safely to the abdomen to provide some pain relief and
comfort’
 Handle perineal pads with gloves, discard the soiled pad and perform
meticulous hand hygiene to minimizes the transmission of infection to
others
Patient Teaching
 Inform patient about the need for precautions and encourage them to take
part in procedures to prevent infecting others and protecting herself from
reinfection
 Educate patient to use condoms if a partner is not well known or has had
other sexual partners recently.
 Explain how pelvic infections occur, how they can be controlled and
avoided, and their signs and symptoms.
 Inform patient of the signs and symptoms of ectopic pregnancy (pain,
abnormal bleeding, delayed menses, faintness, dizziness, and shoulder
pain) because they are prone to this complication
 SYPHILIS
 Syphilis is an acute and chronic infectious disease caused by the spirochete
Treponema pallidum.
 It is acquired through sexual contact or may be congenital in origin
Stages of Syphilis in the untreated person
1. Primary / Acute: Occurs 2 - 3 weeks after initial inoculation with the organism
 A painless lesion at the site of infection is called a chancre. Untreated,
these lesions usually resolve spontaneously within about 2 months but
doesn’t go away
 Usually treated with penicillin IM

2. Secondary / Latent: Occurs when the hematogenous spread of organisms from

the original chancre leads to generalized infection
 Rash occurs about 2 - 8 weeks after the chancre and involves the trunk nd
the extremities, including the palms of the hands and the soles of the feet
Generalized signs of infection
 Lymphadenopathy
 Arthritis
 Meningitis
 Hair loss
 Fever
 Malaise
 Weight loss
After the secondary stage, there is a period of latency, during which the infected
person has no signs or symptoms of syphilis BUT it maybe interrupted by a
recurrence of secondary syphilis

3. Teritary / Late Latent: Syphilis presents as a slowly progressive, inflammatory

disease with the potential to affect multiple organs
Signs & Symptoms of tertiary syphilis
 Aortitis & Neurosyphilis
 They are evidenced by dementia, psychosis, paresis, stroke, or meningitis

Assessment and Diagnostic Findings

 Diagnosis of syphilis: Identification of the spirochete obtained from the chancre
lesions of primary syphilis
 Serologic tests used in the diagnosis of secondary and tertiary syphilis:
1. Nontreponemal or reagin tests (Venereal Disease Research Laboratory)
{VDRL}
2. Rapid plasma reagin circle card test (RPR-CT)

 Treponemal tests: Are used to verify that the screening test did not represent a
false-positive result
1. Fluorescent treponemal antibody absorption test {FTA-ABS}
2. Microhemagglutination test {MHA-TP}
Medical Management
 Treatment of all stages of syphilis:
1. Penicillin G benzathine one dose intramuscularly is the medication of
choice for early syphilis or early latent or latent syphilis of less than 1 year’s
duration
2. Late latent or latent syphilis of unknown duration should receive three IM
injections of Peniciilin G benzathine at 1-week intervals and teach patient
to return to complete regimen

NB) a. Patients who are allergic to penicillin are usually treated with doxycycline
b. The patient treated with penicillin is monitored for 30 minutes after the
injection to observe for a possible allergic reaction
 If allergic reaction occurs administer antihistamine (Benadryl or
corticosteroid)
 Keep oxygen at hand incase of allergic reaction
c. Assess B/P + Pulse after administering antibiotic
Nursing Management Syphilis
 All cases of patients diagnosed with syphilis are reported to the local public
health department to ensure community follow-up
 Gloves are worn when having direct contact with lesions, and hands are washed
after gloves are removed
 Assure patient with primary + secondary syphilis that with proper treatment, skin
lesions and other sequelae of infection will improve, and serology eventually will
reflect cure
 The patient is instructed to refrain from sexual contact with previous or current
partners until they have been treated.