Care of Clients with

Sexually Transmitted Diseases (STDs)

Kennedy C. Bangan, RN, MSN
Faculty
Learning Objectives
• Assess clients for clinical manifestations
of sexually transmitted diseases.
• Discuss the etiology, risk factors and
basic pathophysiology of STDs.
• Develop plan of care for the prevention
of spread, management, follow-up care,
self-management education with STDs.
• Implement plan of care to restore,
maintain and promote health for clients
with STDs.
• Evaluate planned client outcomes utilized
for planning the care of client with STDs.
 Sexually Transmitted Disease (STD)
• Refers to any infection contracted primarily through sexual activities or
contact.
• A.k.a Sexually Transmitted Infection (STI)
Characteristics of STDs
• STDs can be transmitted by any sexual activity between opposite-sex or same-
sex partners.
• Having one, STD confers no immunity against future reinfection with that STD
or with any other STD (except, possibly for hepatitis B).
• Sexual partners of infected clients need to be assessed for treatment.
• STDs affect people from all socio-economic classes, cultures, ethnicities, and
age-groups.
• Women bear a disproportionate number of the effects of STDs.
• Frustration, anger, anxiety, fear, shame and guilt are common emotions
associated with an STD diagnosis.
• STDs frequently coexist in the same client.
Specific Risk Factors for Acquiring STDs

Other Substance High Risk Sexual Younger Age at

IV Drug Use
Abuse Activity Sexarche

Inner City Poor Poor

Poverty
Residence Nutrition Hygiene
 Genital
Herpes
Syphilis Trichomoniasis

Gonorrhea AIDS

Chlamydial Common Sexually

Transmitted
Infection
STDs Enteric
Infections
• Most common bacterial STD.
• Causative agent: Chlamydia
trachomatis
• Is transmitted by intimate sexual
contact.
• The infection does not cross the
placenta.
• The incubation period is 7 to 21 days.
• Known as “The Great Sterilizer”.
• Reiter’s syndrome is a serious
systemic complication that occurs
more commonly in men.
Clinical Manifestations
• Yellow, mucopurulent vaginal discharge
• Spotting at menstrual midcycle or with sexual
Females intercourse.
• Urethritis with dysuria
• Urinary frequency

• Urethritis with dysuria

Males • Clear to mucopurulent
discharge

Both • Proctitis
Sexes • Pharyngitis
Definitive Diagnostic Collaborative Management
Tissue • Doxycycline (Vibramycin)
Culture
• Azithromycin (Zithromax)
• All sexual partners within the last 60
Direct Fluorescent days should be examined and treated.
Antibody (DFA)
Microscopy • Infected clients should avoid all sexual
activity until both partners are cured
and they should use condoms
thereafter.
ELISA
• Aka Clap, Drip, White, Strain, & Dose
• Causative agent: Neisseria gonorrhoeae
• Incubation period: 3 to 8 days
• Local infections involves mucosal
surfaces of the cervix, urethra, and
rectum, vestibular gland, pharynx or
conjunctiva.
• Systemic infection involves bacteremia
with polyarthritis, dermatitis,
endocarditis and meningitis.
• Highest risk in teenagers & young adult.
• Infection through direct sexual contact.
• Infection in infant during vaginal
delivery.
 Clinical Manifestations
Females Males

• Heavy, yellow-green, • Purulent penile discharge

purulent vaginal • Dysuria
discharge • Urinary frequency
• Cervical erythema • Epididymitis & Prostitis
• Red, swollen, sore (most common
vulva complication)
• Abnormal menstrual
bleeding
• Dysuria and urinary
frequency
• Salpingitis (most
common complication)
Definitive Diagnostic Collaborative Management
• Cetriaxone (Rocephin)
• Cefixime (Suprax)
History
taking • Ciprofloxacin (Cipro)
• Ofloxacin (Floxin)
• All persons treated for Gonorrhea
Physical need to be treated concurrently for
Examination chlamydial infection.
• All sexual partners within the last 60
days before diagnosis should undergo
examination, culture and treatment.
Smear or
Culture • Emphasis on the client the importance
of taking the complete course of
prescribed medications.
• Aka Bad blood, Lues, Pox, & Syph
• Causative agent: Treponema pallidum
• Known co-factor for development of HIV
infection.
• Highest risk in adolescents, young adult,
& men to men sexual relationship.
• Infection through direct sexual contact.
• Infection can also be passed
transplacentally from an untreated
pregnant woman to her fetus (congenital
syphilis).
• Can progress to irreversible blindness,
mental illness, paralysis, heart disease
and death.
 Clinical Manifestations
• Genital chancre
Primary • Chancre develops in the genitalia, anus, or mouth.
• Chancre heals in 4 to 6 weeks.
Stage • Lymphadenopathy

• Develops in 6 to 8 weeks after infection.

• Generalized rash appears on the palms and soles.
Secondary • Gray, mucus patches in the mouth, Sore throat
• Condylomata lata
Stage • General flu-like symptoms
• Patchy hair loss from eyebrows and scalp.
• Disappear after 2 to 6 weeks.
 • Period after infection with syphilis when a client is
seroreactive but shows no other evidence of the disease.
• The disease is non-infectious except via transplacental
Latent Stage spread or blood transfusion.
• Occurs 1 to 2 years after the primary lesion and can last as
long as 50 years.

• 1 to 35 years after the primary infection, the untreated

client experiences irreversible complications such as
chronic bone and joint inflammation, cardiovascular
Tertiary Stage problems, granulomatous lesions (Gummas) on any part of
the body and ophthalmic, auditory and CNS problems.
• This stage may be terminal if untreated.
Definitive Diagnostic Collaborative Management
• Penicillin injection is the treatment of
choice for primary, secondary, and early
Dark Field latent stage of syphilis.
Late latent syphilis is treated with 3 weeks
Microscopy Penicillin injections
Neurosyphilis is treated with IV Pen-G
For non-pregnant client who are allergic to
penicillin, Doxycycline or Tetracycline may be
VDRL given.
• All people who have had sexual contact
with the client who has primary syphilis
must be identified and evaluated.
FTA-ABS • Clients with primary and secondary
Test syphilis should abstain from sexual
contact for at least 1 month after
treatment.
• A recurrent, systemic viral infection.
• Peak among adolescents and young adults.
• Causative agent: Herpes simplex virus (HSV) type 2
• HSV type 1 is mainly non-genital. HSV type 2 is sexually transmitted genital
infection.
• Can be transmitted while a lesion is present and for 10 days after a lesions has
healed.
• Newborn can be infected during vaginal delivery.
 Clinical Manifestations Definitive Diagnostic
• Burning sensation (Paresthesia)
• Vesicles with erythematous border, form
painful, shallow ulcers that then crust
and heal with a scar in 2 to 4 weeks.
• Potential complications are as follows: Viral Culture
Disseminated infections
Meningitis
Transverse myelitis
Women at risk for spontaneous abortion
HSV2 predispose women to carcinoma of Pap Smear
the cervix.
Collaborative Management
• Acute primary infection: Acyclovir (Zovirax) or Famciclovir for 7 to 10 days.
• Episodic recurrences: Acyclovir, Valacyclovir (Valtrex), or Famciclovir (Famvir)
for 5 days.
• Handwashing by heath care providers is critically important.
• Infected clients should have separate towels and other personal items and
avoid touching their eyes.
• Clients should use condoms during latent periods.
• Women should have annual pelvic examinations and Pap smear.
• Reduce pain of herpes lesions by:
Keeping the involved area clean and dry.
Wearing loose-fitting nonsynthetic undergarments.
Using sitz bath, cooling application.
Medications (Analgesic and ASA).
• A common, treatable, sexually transmitted disease (STD).
• Most people who have trichomoniasis do not have any symptoms.
• Aka Trich
• Causative agent: Trichomonas vaginalis
• Trich affects all genders.
• Can also infect the anus, mouth and hands.
• Vaginal-penile or vaginal-vaginal intercourse, anal, oral sex, or genital touching (skin-
to-skin contact without ejaculation).
 Clinical Manifestations Definitive Diagnostic
• Men:
Itching or irritation inside the penis;
Burning after peeing or ejaculating;
Discharge from the penis.
• Women: Physical
Itching, burning, redness or soreness of the Examination
genitals;
Discomfort when peeing;
A clear, white, yellowish, or greenish
vaginal discharge with a fishy smell.
Vaginal
Swab
Collaborative Management
• Metronidazole (Flagyl) or Tinidazole (Tindamax) as prescribed.
• It’s important to keep the following points in mind while undergoing
treatment:
A single medication dose cures up to 95% of infected women. Men and women may
need to take the medication for five to seven days.
Client and sexual partners must be treated for trich or will continue to pass the infection
back and forth.
Client shouldn’t have sex for one week after finishing the medication to give the drug
time to kill off the infection and for symptoms to clear up.
Instruct the client to see healthcare provider in three months to ensure you’re no longer
infected.
• Causative agent: Human papilloma virus (HPV)
• Usually transmitted by sexual contact.
• It is strongly associated with carcinoma of the genitals, including the cervix and penis.
• Incubation period: 1 to 2 months
• Clinical Manifestations:
Benign growth that occur in multiple, painless clusters.
Oral, pharyngeal, and laryngeal lesions can also occur.
Definitive Diagnostic Collaborative Management
• Chemical, mechanical and ablative
techniques are used for visible lesions.
• Topical treatment: Podophyllin resin in
compound tincture of Benzoin or
Pap Smear Trichloroacetic Acid (TCA).
• Cryotherapy of warts may be done.
• Carbon dioxide lasers, electrocautery,
and simple surgical excision can be
Colposcopy
done on extensive warts.
• Is a disorder caused by the human immunodeficiency virus (HIV).
• It is characterized by generalized dysfunction of the immune system.
• The syndrome is manifested clinically by opportunistic infection and unusual
neoplasms.
• Long incubation period, sometimes up to 10 years or more.
• Mode of transmission:
Sexual
Parenteral
Perinatal
 Persons Frequent Heterosexual
Male Babies born
Intravenous receiving exposure to contact with
homosexual to infected
drug abuser blood blood and high-risk
or bisexual mothers
transfusion body fluids individuals
 Diarrhea

Fungal Cytomegalovirus
Infection
Kaposi’s
Sarcoma
Weight
Pneumonia
loss
Definitive Diagnostic Collaborative Management
• Implement standard precaution.
ELISA • Promote respiratory function.
• Provide adequate nutritional support.
Western • Maintain fluid & electrolyte balance.
Blot • Promote comfort.
• Monitor for signs of infection.
CD4+
Best Practice!
p24
Antigen Proper handwashing when caring for clients with
HIV infection and AIDS
Nucleoside Reverse Anti-Infective Protease Inhibitors
Transcriptase Medications • Amprenavir it’s nephrotoxic
Inhibitors • Pentamidine used to treat • Indinavir causes
PCP. Nephrotoxic, hyperbilirubinemia, nephritis,
• Zidovudine, Ritovir, kidney stones
Hepatotoxic,
Abacavir can cause N/V, • Lopinavir & Ritonavir it’s
Immunosuppresive,
Diarrhea Hypotension, Hypoglycemia. hepatotoxic
• Didanosine, Stavudine, • Nelfinavir cause nausea,
• Metonidazole use to treat flatulence, diarrhea
Zalcitabine can cause cryptosporidiosis and
Neuropathy, Hepatotoxic, • Ritonavir hepatotoxic & increase
giardiasis.
Pancreatitis Triglycerides level
Antiviral Medications Antifungal infections
• Ganciclovir used to treat • Ketoconazole used to treat
CMV retinitis. Cause bone candidiasis & histoplasmosis.
marrow depression. It is hepatotoxic.
• Acyclovir used to treat • Fluconazole used to treat
Herpes simplex, herpes candidiasis. It is hepatotoxic.
zoster or varicella zoster. It • Amphotericin B used to treat
is Nephrotoxic. candidiasis and other fungal
infection. Nephrotoxic, can
• Foscavir used to treat CMV
cause Thrombophlebitis &
retinitis. It is Nephrotoxic. Bone marrow depression.