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COMMUNICABLE

DISEASES
*SEXUALLY
TRANSMITTED
DISEASES*
( GONORRHEA,
SYPHILIS & AIDS )

-SEGI COLLEGE KUALA LUMPUR-


GONORRHEA
DEFINITION
Gonorrhea is a sexually transmitted diseases (STD).
Gonorrhea is caused by Neisseria Gonorrheae, a
bacterium that can grow and multiply easily in the
warm, moist areas of the reproductive tract, including
the cervix (opening to the womb), uterus (womb), and
fallopian tubes (egg canals) in women, and in the
urethra (urine canal) in women and men. The
bacterium can also grow in the mouth, throat, eyes
and anus.
RISK FACTORS
Sexually active persons :
• Teenagers
• Young adults
• Africans Americans
SIGN AND SIMPTOMS
For men :
• Burning sensation when urinating
• White, yellow, or green discharge from penis
• Painful or swollen testicles
For women :
• painful or burning sensation when urinating
• Increased vaginal discharge
• Vaginal bleeding between period
CONT..
For both :
•Rectal infection like :
• Discharge
•Anal itching
•Soreness
•Bleeding
•Painful bowel movements
•Infections in throat :
•Sore throat
DIAGNOSTIC PROCEDURES
• Urine test for UFEME (urine for
examination & microscopic examination)
• Gram stain (sample from a urethra or a
cervix)

gram stain of
urethral
discharge
HOW DOES GONORRHEA
AFFECT A PREGNANT WOMAN
AND HER BABY?
Pregnant woman who has gonorrhea may give
the infections to her baby as the baby passes
through the birth canal during delivery. This
can cause :
• Blindness
• Joint infections
• Life threatening blood infections
TREATMENTS
Medication like antibiotics :
• fluoroquinolones
(eg : single-dose pills such as
ciprofloxacin)
• cephalosporins
• ceftriaxone
(single-dose injection)
CONT..
• amoxicillin
(orally)
• cefixime
(400mg orally)
• Spectinomycin
(2g by IM injection)
Oinment :
• Erythromycin Gonococcal
ophthalmia
(prevent blindness)
COMPLICATIONS
For women :
• Pelvic Inflammatory Diseases (PID)
• Infertility
• Ectopic pregnancy
• Perihepatitis
• Fitz-hugh-curtis syndrome (rare)
Gonococcal
cervicitis

Bartholin’s abscess
CONT..
For men :
• Epididymitis
• Infertility
• Prostatitis
• urethritis

Gonococcal urethritis
Disseminated
gonorrhea
(skin lesion)
SYPHILIS
SYPHILIS
DEFINITION

Is a sexually transmitted diseases (STD)


caused by the bacterium traponema
pallidum. It has often been called “the
great imitator” because so many of the
sign & symptoms are indistinguishable
from these of other disease.
PATHOPHYSIOLOGY
• Break in the skin or mucous membrane

• Vulnerable to invasion by the spirochete

• Enter the system and spread through the blood and lymphatic system

• Congenital syphilis is transfered to the fetus

• Through the placenta circulation


SIGN AND SYMPTOMS
Primary syphilis :
• Usually occurs 10 days to 3 month after exposure
• Sore on the penis (men)
• Sore around inside the vagina (women)
Secondary syphilis :
• Rash – redish brown occur anywhere on body
• Fever
• Swollen lymph glands
• Body aches
• Sore in mouth
• fatigue
CONT..
Tertiary syphilis :
• effect brain & spinal cord
• damage heart & other organs
Late syphilis :
• Jerky or uncoordinated muscle movement
 Paralysis
 Numbness
 Gradual blindness
 Dementia
DIAGNOSTIC TEST
• Dark ground examination
• DFA- TP (direct fluorescent antibody)
• FTA (fluorescent treponemal antibody absorption)
• S. VDRL (venereal disease research laboratary)
• TPHA (treponema pallidum haemagglutination assay test
• CXR (Chest X-ray)
• Lumbar puncture
• Serum FTA
TREATMENT
• Primary & secondary
1. Procaine penicillin G 600 000 units IM daily for
10 days.
2. Benzathine penicillin 2.4 million units IM weekly
for 2 weeks.
- If allergic to penicillin
1. Doxycycline 100mg oral TID for21 days
2. Tetracycline 500mg oral 6 hourly for 21 days
3. Erthromycin 500mg oral 6 hourly for 21 days
cont…
• Late stage
1. Benzathine penicillin 2.4 million units
IM weekly for 3 weeks
- If allergic to penicillin
1. Doxycycline 100mg for 30 days or
tetracycline.
NURSING
MANAGEMENT
 Administer IM injection of penicillin G as ordered.
 Discuss the importance of abstaining from sexual activity until
he and his partners are cured, and of using condoms to prevent
reinfection.
 Explain the need to return for follow up testing in 3 months and
again at 6 months.
 Notify sexual partners that they need to come to the clinic for
testing.
 Refer to a social worker for counseling about the effect of the
disease on their relationship.
 Teach the couple about the importance of treatment to the
health of their infant.
NURSING
DIAGNOSIS
&
NURSING
INTERVENTIONS
Risk for injury to the patient, his
partners & the infant r/t disease process
• Teach the importance of taking any
prescribed medication.
• Encourage referral of any sexual partners
for evaluation and necessary treatment.
• Teach abstinence from sexual contact until
client and partners are cured and
to use condoms to prevent
future infections.
CONT..
• Emphasize the importance of returning
for follow – up testing at 3 and 6 month.
Intervals for early syphilis and 6 and 12
month intervals for late latent syphilis.
• Provide information about
manifestations of reinfections.
Anxiety related to the effects of the infections
on the unborn child
• Emphasize that syphilis can be effectively
treated, preventing the serious
complications of the late-stage diseases.
• Teach the pregnant client that taking
medications as directed and returning each
month for follow-up testing will help ensure
the well-being if her baby.
Low self-esteem related to diseases
process
• Create an environment where the client feel
respected and safe to discuss questions and
concerns about the disease and its effect on
the client’s life.
• Provide privacy and confidentiality.
• Let client know that the nurse and other
healthcare providers care about them and
the succesful treatment of their diseases.
-AIDS-
WHAT IS HIV?
WHAT IS AIDS?
HIV (Human Immunodeficiency Virus) is
a virus that attacks the immune system,
the body’s natural defense system
AIDS (Acquired Immune Deficiency
Syndrome)
PATHOPHYSIOLOGY
Sexual transmission

Unprotected relations

Infected sexual secretions

Genital, oral, rectal mucous membranes

Infected person
Cont…

Blood or blood product

• Infected blood / blood transfusion


• Open wound
• Receive tatoo,piercings and scarification
procedure
Infected person
Cont…

Mother to child

Virus from mother to child

in utero, intrapartum or via

Absence of treatment

Infected baby
SYMPTOMS
Progresses in 3 stages :
Initial stage (Acute Retroviral Syndrome)
• Abdominal cramps, nausea or vomiting
• Diarrhea
• Fever
• Headache
• Skin rash
• Weight loss
Cont…
Chronic stage
• Confusion
• Dry cough
• Fatigue
• SOB
• Personality changes
• Odynophagia (pain during swallowing)
• Mouth sores
Late stage
DIAGNOSTIC
PROCEDURE
Testing positive for HIV infection
• Complete Blood Count (CBC)- to identify the number
and type of cell in blood
• A chemistry screen- measure the blood levels and
evaluate liver and kidney function
• Syphilis testing
• Screening for hepatitis A, hepatitis B and
hepatitis C
• Tuberculosis (TB) screening
TREATMENT
Antiretroviral Therapy :
Nucleoside reverse transcriptase inhibitors
- tenofovir, abacavir
Nonnucleoside reverse transcriptase inhibitors
(NNRTIs)
- nevirapine, etravirine
Protease inhibitors (PIs)
- tipranavir, indinavir
Fusion and entry inhibitors
- maraviroc, enfurvitide
Integrase inhibitors
- raltegravir (insentress)
Cont…

Antibiotics and prednisone


• for complication of pneumonia
Amphotericin B with flucytosine :
• for complication of meningitis
Clotrimazole
• for complication of oral candidiasis
WHY TREATMENT IS
FAILURE ??

• The virus that causes HIV has become


resistant. The medication no longer
effectively controls virus multiplication nor
protects immune system
• Didn’t take medication as prescribed
MANAGEMENT
• Medical history ;
Eg. Have you ever had symptoms that
might indicate illness ( fever, weight loss,
sob,or diarrhea? )
• Physical examination ;
Temperature
Weight
Eyes – cytomegalovirus (CMV) retinitis
Gynecologic
Cont…

Mouth – oral yeast infections (thrust),


mouth sores
Lymph nodes - lymphadenopathy
Abdomen – hepatomegaly, splenomegaly
Skin – Seborrheic dermatitis, Kaposi’s
sarcoma
COMPLICATION
 Bacterial Infection
– Bacterial pneumonia
– Mycobacterium avium complex(MAC)  including bone
marrow, liver, spleen
– Tuberculosis(TB)
– Salmonellosis  contaminated food and water
 Viral Infection
– Cytomegalovirus(CMV)  transmitted in body fluids
– Viral hepatitis  viral infection of the liver
– Herpes simple virus(HSV)
– Human papillovirus(HPV)
– Progressive multifocal leukoencephalopathy(PML)
 speech problem, weakness, loss of vision, numbness arm and leg
Cont…

Fungal Infection
– Candidiasis  thick white coating on the mucous membrane of mouth,
tongue,esophagus, vagina
– Cryptococcal meningitis  CNS infection
Parasitic Infection
– Pneumocytis carinni pneumonia(PCP)
– Toxoplasmosis  leads to encephalitis
Cancer
– Kaposi’s sarcoma  tumor of blood vessels (pink, red, purple lesions
on skin and mouth)
– Non-hodgkin’s lymphoma  painless swelling of the lymph
nodes in neck, armpit , groin
Cont…

Other
– Wasting syndrome  muscle wasting
– Neurological complication  confusion, changes in
behavior, depression, anxiety
NURSING DIAGNOSES
&
INTERVENTIONS
1) Ineffective coping

 Assess social support network and usual


methods of coping.
 Plan for consistent, uninterrupted time with
the client.
 Promote the interaction between the client,
significant other and family.
 Support positive coping behaviors, decision,
actions and achievement.
Cont…
2) Ineffective sexuality patterns

 Examine your feelings about sexuality, your role


in dealing with a client’s sexuality, the client’s
lifestyle and sexual preferences.
 Provide factual information about HIV infection
and its effects.
 Encourage discussion of fear and concers with
significant other.
 Establish a trusting ,therapeutic relationship
through the use of time ,active listening, caring,
and self disclosure. Maintain nonbreathing ,
nonjudgmental attitude toward the client.
HEALTH EDUCATION
FOR SEXUALLY
TRANSMITTED DISEASE

(STD)
Practice safe sex to prevent HIV. Always
use a condom during sexual activity, unless
in a relationship with one partner who does
not have HIV or other sex partners
• Reduce number of sex partners, preferably
to one partner
• Do regularly tested for HIV
Cont…

• Coping and support to patient and family


• HIV / AIDS clinics that may help :
Learn all about HIV / AIDS
Be proactive
Maintain a strong support system
• Keep all appointments and take medications
exactly as directed
Cont…

• Talk to sex partner about their sexual history


and find out whether has engaged in high-risk
behaviors
• Avoid alcohol and drugs, which can impair both
judgement and immune system.
• Tell sex partners about behavior and whether
has HIV-Positive
• Do not donate blood, plasma, semen, body
organs or body tissues
Cont…

• Avoid breast feeding their infant.


• Wear mask, glove, protective eyewear or shields,
gowns and apron to prevent exposure of the skin or
mucus membranes to bloodborne pathogens
• Do not share IV needles, syringes, cookers, cotton,
cocaine spoon or eyedroppers with others.
REFERENCES
• http://www.nursereview.org/2007/10/nursing-reference-hiv-aids.html
• http://www.mayoclinic.com/health/syphilis
• http://en.wikipedia.org/wiki/HIV
• http://www.webmd/a-to-z-guides
• http://en.wikipedia.org/wiki/Gonorrhea http://images.search.yahoo.com/search/images?
• http://www.jazas.org/aids.php
• Medical Surgical Text book (Lemone & Burke)

GROUP MEMBERS
• NOR SHILA • SITI NOOR
• NURUL NOOR SHAHERA
NADHIRAH • MAILANI
• NURUL • SHARIFAH
FAREHAH NOR’AIN
• JDV • NORHASIMAH
• SURAYA • NURUL IZZATI
Thank you
for your
attentions!!
!