SEXUALLY

TRANSMITTED
DISEASES
JASMIN P. EGARGUE
SEXUALLY TRANSMITTED INFECTION
― are diseases that are spread through sexual contact
with an infected partner.
― STIs may be spread among women having sex
with women or men having sex with men.
― STIs are becoming more difficult to treat because
the causative organisms are becoming more and
more resistant to antibiotics.
STI’ PREVENTION
 Abstinence or condom use provides the best protection
against STIs.
 Additional measures are voiding immediately after coitus.
 Washing the genitals well with soap and water
 Choosing sexual partners who are at low risk for infection
 Educating adolescents about safer sex practices, including the
need for condom use and the importance of health screening for
these disorders, is an important nursing responsibility.
Candidiasis

 Candidiasis is a vaginal infection spread by the fungus. Candida, an

organism that thrives on glycogen.

 Candidal infections are diagnosed by removing a sample of the discharge

from the vaginal wall and placing it on a glass slide; three or four drops of

a 20% potassium hydroxide (KOH) solution are then added, and the

mixture is protected by a coverslip. Under a microscope, typical fungal

hyphae indicate the presence of Candida organisms

ASSESSMENT
Symptoms:
 Vulvar and vaginal reddening
 Burning
 Itching
 Bleeding from hairline fissures
 The vagina sometimes shows white “patches” on the
walls.
 A thick, cream cheese–like discharge can usually be
observed
 There may be pain on coitus or on tampon insertion.
Therapeutic Management
 Therapy for candidal infections includes vaginal
suppositories or cream applications of antifungal
preparations such as miconazole (Monistat) or
clotrimazole (Lotrimin), once a day for 3 to 7 days.
 Oral fluconazole (Diflucan) can be administered as
a one-time oral dose.
 Teach women to insert these or antifungal
suppositories at bedtime so the drug does not drain
from the vagina immediately afterward.
 During the day, a girl may want to wear a sanitary pad to avoid
staining from vaginal discharge.
 Treatment should not be interrupted until it is complete, even
during a menstrual period.
 Be certain that adolescents know how to differentiate a candidal
infection from other infections or to consult a health care
provider for assistance and treatment if they are not sure.
 If a girl has frequent candidal infections, her urine should be
tested for glucose to rule out diabetes mellitus.
 If an adolescent is sexually active, treatment of the male partner
may be necessary to break a reinfection cycle.
Trichomoniasis
 Trichomonas vaginalis is a single-cell protozoan that is
spread by coitus. The incubation period is 4 to 20 days.
 The infection is diagnosed by microscopic examination
of a sample of the vaginal discharge after it is combined
with lactated Ringer’s or normal saline solution.
 Trichomonads typically appear as rounded, mobile
structures. Be aware that Trichomonas infections cause
such inflammatory changes in the cervix or vagina.
Assessment
 With a trichomonal infection, females notice vaginal irritation
and a frothy white or grayish-green vaginal discharge.
 The frothiness of the discharge is an important typical finding.
 The upper vagina is reddened and may have pinpoint petechiae.
Extreme vulvar itching is present.
 By contrast, males with the same infection rarely report any
symptoms.
 The infection is diagnosed by microscopic examination of a
sample of the vaginal discharge after it is combined with lactated
Ringer’s or normal saline solution.
Therapeutic Management
 Oral metronidazole (Flagyl) eradicates
trichomonal infections. Treatment with
Flagyl and use of condoms by sexual
partners help prevent recurrence of
Trichomonas in both parties.
 Advise patient not to drink alcoholic
beverages during the course of treatment.
Bacterial Vaginosis
 Bacterial vaginosis is the invasion of an organism such as
 Gardnerella vaginalis. This organism thrives in the vagina, a
body area with a reduced oxygen level. When the infection is
present vaginal discharge appears milk-white to gray and has
a fishlike odor. Pruritus can be intense.
 Microscopic examination of the discharge in normal saline
solution shows gram-negative rods adhering to vaginal
epithelial cells, which are termed clue cells
 The treatment is oral or vaginal metronidazole for
7 days; the woman’s sexual partners should also be
treated to prevent recurrence of the infection.
Chlamydia trachomatis Infection
 Symptoms include a heavy grayishwhite
discharge and vulvar itching.
 The incubation period is 1 to 5 weeks.
 Diagnosis is made by culture of the organism.
 Therapy is oral doxycycline or tetracycline for 7
days or azithromycin in a single dose.
 Long-term effects of chlamydial infections are
PID, possibly leading to subfertility.
 Human Papillomavirus
 The human papillomavirus (HPV) causes fibrous tissue
overgrowth
(sometime called genital warts) on the external vulva, vagina, or
cervix (condyloma acuminatum).
 At first, lesions appear as discrete papillary structures; they
then spread, enlarge, and coalesce to form large, cauliflower-
like lesions.
 Therapy for such lesions is aimed at dissolving the lesions and
also ending any secondary infection present.
 Small growths may be removed by applying podophyllin
(Podofin).
 Large lesions may be removed by laser therapy, cryocautery, or
knife excision. With cryocautery, edema at the site is evident
immediately; lesions become gangrenous, and sloughing occurs
in 7 days.
Therapeutic Management
 Small growths may be removed by applying
podophyllin (Podofin).
 Large lesions may be removed by laser therapy,
cryocautery, or knife excision. With cryocautery,
edema at the site is evident immediately; lesions
become gangrenous, and sloughing occurs in 7
days.
 Healing will be complete in 4 to 6 weeks with only slight
depigmentation at the site. Sitz baths and a lidocaine cream may
be soothing during the healing period.
 Women who have had one episode of infection should be
conscientious about having yearly Pap tests for the rest of their
lives.
 The vaccine, Gardasil, is recommended to be routinely

administered to early teenage girls in three doses.

 A second dose is 2 months after the first dose and the third
dose is 6 months after the first dose.
 Immunizing young teenage girls against HPV infection should
reduce not only the incidence of HPV infections in the future
but the rate of cervical cancer as well.
Herpes Genitalis (Herpes Simplex Type 2)
 Genital herpes is caused by herpesvirus hominis type 2 (also
called herpes simplex virus type 2, or HSV-2).
 This is one of four similar herpesviruses: cytomegalovirus,
Epstein-Barr,varicella-zoster, and herpes types 1 and 2.
 Unlike most other STIs, although the virus can be contained,
there is no known cure.
 The disease involves a lifelong process, therefore, and, although
it is not a precursor to cervical cancer, women with cervical
cancer tend to have more antibodies against herpes genitalis
than others or probably have been exposed to the virus more
than others.
 The virus is spread by skin-to-skin contact, entering through a
break in the skin or mucous membrane.
Assessment
 Herpes is diagnosed by culture of the lesion secretion
from its location on the vulva, vagina, cervix, or penis
or by isolation of HSV antibodies in serum.
 The incubation period is 3 to 14 days.
 On first contact, extensive primary lesions originate as a
group of pinpoint vesicles on an erythematous base.
 Within a few days, the vesicles ulcerate and become
moist, painful, draining, open lesions.
 An adolescent may have accompanying flulike
symptoms with increased temperature.
Therapeutic Management
 Acyclovir (Zovirax) is an example of an antiviral
that controls the virus by interfering with
deoxyribonucleic acid reproduction and decreasing
symptoms.
 Sitz baths three times a day may be helpful to
reduce discomfort.
 Condoms (male or female) help prevent the spread
of herpes among sexual partners.
Hepatitis B and Hepatitis C
 Both hepatitis B and hepatitis C can be spread by
semen as well as blood and therefore are
considered STIs.
 Hepatitis B can be spread by sexual intercourse,
adolescents who did not receive immunization
against this as an infant need immunization against
this updated.
Gonorrhea
 Gonorrhea is transmitted by Neisseria gonorrhoeae,
a grampositive diplococcus that thrives on columnar
transitional epithelium of the mucous membrane.
 Symptoms begin after a 2- to 7-day incubation
period.
 In males, they include urethritis (pain on urination
and frequency of urination) and a urethral discharge.
 Without treatment, the infection may spread to the
testes, scarring the tubules and causing permanent
sterility.
 Although symptoms of gonorrhea in females are not
as visible, there may be a slight yellowish vaginal
discharge.
 Bartholin’s glands may become inflamed and painful.
 If left untreated, the infection may spread to pelvic
organs, most notably the fallopian tubes (PID).
Assessment
A urine culture for the gonococcal bacillus, in
addition to vaginal and urethral cultures, should be
obtained from all children with vulvovaginitis or a
urethral discharge.
 In males, a first voiding may reveal gonococci if a
midstream urine specimen is inconclusive.
Therapeutic Management
 Oral cefixime (Suprax) or intramuscular ceftriaxone
(Rocephin) plus oral doxycycline (Vibramycin) for 7 days
is the current recommended therapy.
 Approximately 7 days after treatment, a client should return
for a follow-up culture to verify that the disease has been
completely eradicated (few adolescents take this
precaution).
 Adolescents are usually assessed for syphilis along with the
gonorrheal culture, although the dose of ceftriaxone and
doxycycline is also effective treatment for syphilis.
Syphilis
 Syphilis is a systemic disease caused by the
spirochete Treponema pallidum.
 It is transmitted by sexual contact with a person
who has an active spirochet containing lesion.
 After an incubation period of 10 to 90 days, a
typical lesion appears, usually on the genitalia
(penis or labia) or on the mouth, lips, or rectal area
from oral–genital or genital–anal contact.
 Swollen lymph nodes may be present but
these are unlikely to be noticed by the
affected person. A lesion in the vagina may
not be detected.
 Without treatment, a chancre lasts
approximately 6 weeks and then fades.
Assessment
 Syphilis is diagnosed by recognition of the various
symptoms
 of the three stages and by serologic serum tests,
usually the
 Venereal Disease Research Laboratory test
(VDRL), the automated reagin test (ART), the
rapid plasma reagin test (RPR), or the fluorescent
treponemal antibody–absorption test (FTA-ABS).
 Therapeutic Management
 Benzathine penicillin G, given intramuscularly in two sites,
is effective therapy. For the adolescent who is sensitive to
penicillin, either oral erythromycin or tetracycline can be
given for 10 to 15 days.
 After therapy,
 adolescents may experience a Jarisch-Herxheimer reaction
and is caused by the sudden
 destruction of spirochetes. The reaction lasts about 24 hours
and then fades.
 Adolescents, in particular, need accurate information about
syphilis to become aware of the symptoms and safer sex
practices.
Amenorrhea
 Amenorrhea (absence of menstruation) occurs with pregnancy because
of the suppression of follicle-stimulating hormone(FSH) by rising
estrogen levels.
 In a healthy woman who has menstruated previously, the absence of
menstruation strongly suggests that impregnation has occurred.
 Amenorrhea, however, also heralds the onset of menopause

or could result from delayed menstruation because of unrelated reasons,

such as uterine infection, worry (perhaps over becoming pregnant), a
chronic illness such as severe anemia, or stress.

 It occurs in athletes who train strenuously, especially in long-distance

runners whose percentage of body fat drops below a critical point..
Symptoms
 The main sign of amenorrhea is the absence of menstrual periods.
Depending on the cause of amenorrhea, you might experience other
signs or symptoms along with the absence of periods, such as:
 Milky nipple discharge
 Hair loss
 Headache
 Vision changes
 Excess facial hair
 Pelvic pain
 Acne
Dysmenorrhea
 Dysmenorrhea is the medical term for pain with 
menstruation. There are two types of dysmenorrhea:
"primary" and "secondary".
 Primary dysmenorrhea is common menstrual cramps that
are recurrent (come back) and are not due to other diseases.
 Pain usually begins 1 or 2 days before, or when menstrual
bleeding starts, and is felt in the lower abdomen, back, or
thighs. Pain can range from mild to severe, can typically last
12 to 72 hours, and can be accompanied by 
nausea-and-vomiting, fatigue, and even diarrhea.
 Secondary dysmenorrhea is pain that is caused by a
disorder in the woman's reproductive organs, such as 
endometriosis, adenomyosis, uterine fibroids, or infection.
Pain from secondary dysmenorrhea usually begins earlier in
the menstrual cycle and lasts longer than common menstrual
cramps. The pain is not typically accompanied by nausea,
vomiting, fatigue, or diarrhea.
 Treatment
 For best relief, you should take ibuprofen as soon as
bleeding or cramping starts. You may take aspirin or
another pain reliever such as acetaminophen.
 Place a heating pad or hot water bottle on your lower
back or abdomen.
 Rest when needed.
 Avoid foods that contain caffeine.
 Avoid smoking and drinking alcohol.
 Massage your lower back and abdomen.
 Women who exercise regularly often have less
menstrual pain. To help prevent cramps, make exercise
a part of your weekly routine.