Sexually

Transmitted
Disease
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 Syphilis
Syphilis is an acute and chronic
infectious disease caused by the
spirochete Treponema pallidum.

Acquired through sexual contact or

may be congenital in origin

The rates of primary and secondary

syphilis have increased 15%
between 2017 and 2018.
 Stages of Syphilis and its Signs and Symptoms
Primary Syphilis Secondary Syphilis

2-3 weeks after initial inoculation with -Occurs by hematogenous spread leading to

the organism. Painless lesions at the site generalized infection.

of infection called chancres Generalized signs of infection may include

lymphadenopathy arthritis, meningitis, hair
loss, fever, malaise, and weight loss
 Stages of Syphilis and its Signs and Symptoms

Te r t i a r y S y p h i l i s
-The final stage in the natural history of the disease.
-The most common manifestations at this level are aortitis and
neurosyphilis, as evidenced by dementia, psychosis, paresis,
stroke, or meningitis
 Pathophysiology of Syphilis

The classic primary syphilis presentation is a solitary non-

tender genital chancre in response to invasion by the T.
pallidum. However, patients can have multiple non-
genital chancres, such as digits, nipples, tonsils, and oral
mucosa. These lesions can occur at any site of direct
contact with the infected lesion and are accompanied by
tender or non-tender lymphadenopathy. Even without
treatment, these primary lesions will go away without
scarring. If untreated, primary syphilis can progress to
secondary syphilis, which has many clinical and
histopathological findings.
 Assessment and Diagnostic Findings
The conclusive diagnosis of syphilis can be made by direct identification of the spirochete obtained from the
chancre lesions of primary syphilis.
The serologic tests are summarized as follows:
Nontreponemal or reagin tests, such as the Venereal Treponemal tests, such as the fluorescent treponemal
Disease Research Laboratory (VDRL), are generally antibody absorption (FTA-ABS) test. These are used to
used for screening and diagnosis. verify that the screening test did not represent a false-
positive result
Medical Management Nursing Management
Gloves are worn when direct contact with lesions is likely, and hand
Penicillin G benzathine hygiene is performed after gloves are removed.
The nurse instructs the patient to:

-Complete the full course of therapy if multiple penicillin injections are

required.
-Refrain from sexual contact with previous or current partners until the
partners have been treated.
-Recognize that condoms significantly reduce the risk of transmission of
syphilis and other STIS.
-Be aware that having multiple sexual partners increases the risk of
acquiring syphilis and other STIs.
 Chlamydia trachomatis and Neisseria gonorrhoeae Infections

Coinfection with C. trachomatis often

occurs in patients infected with N.
gonorrhoeae. These are two infections that
you can get from having sex with another
person They are caused by bacteria that
are passed from your sexual partner to
you. It is common to have chlamydia and
gonorrhea at the same time
 Chlamydia trachomatis and Neisseria gonorrhoeae Infections
Symptoms

Chlamydia in women Chlamydia in men

Painful sexual intercourse (dyspareunia) Burning sensation during urination

Vaginal discharge
Burning sensation during urination
Pain in the lower abdomen
Inflammation of the cervix (cervicitis)
Bleeding between periods
Yellow or green discharge from the penis
Pain in the lower abdomen
Pain in the testicles
 Pathophysiology of Chlamydia

Chlamydia is unique among bacteria, having an infectious cycle and two developmental
forms. These include the infectious form called the elementary body (EB) and the
reticulate body (RB). Within the host cell, the EB will differentiate into the
metabolically active RB. The RB will then use host energy sources and amino acids to
replicate and form new EB, which can then infect additional cells. C. trachomatis
targets the squamocolumnar epithelial cells of the endocervix and upper genital tract in
women, and the conjunctiva, urethra, and rectum in both men and women.
 Pathophysiology of Gonorrhea
N. gonorrhoeae infection starts with the adhesion of gonococci to
epithelial cells, followed by local cellular invasion. Gonorrhea has
multiple surface proteins that facilitate adhesion. N. gonorrhoeae
utilize pili to initiate adhesion to epithelial cells. Hair-like
appendages, and pili cover the bacterial surface. Their ability to
lengthen and retract allows the bacteria to attach from a distance and
move closer to the epithelial cells, promoting cellular invasion. Pili
also provide motility and protection.
Assessment and Diagnostic Findings of Chlamydia and Gonorrhea

Gram stain and the direct fluorescent antibody test can be used in chlamydia.
NAATS (NAATs find the genetic material or DNA of gonorrhea germs) are
also available for C. trachomatis. In the female patient, samples are obtained
from the endocervix, anal canal, and pharynx. In the male patient, specimens
are obtained from the urethra, anal canal, and pharynx. Because N.
gonorrhoeae organisms are susceptible to environmental changes, specimens
for culture must be delivered to the laboratory immediately after they are
obtained.
 Medical Management of Chlamydia and Gonorrhea

CDC recommends a single 500 mg intramuscular dose of ceftriaxone for

uncomplicated gonorrhea.

Treatment for coinfection with Chlamydia trachomatis with oral doxycycline

(100 mg twice daily for 7 days) should be administered when chlamydial
infection has not been excluded.
 Nursing Management of Chlamydia and Gonorrhea
The target group for preventive patient education about gonorrhea and chlamydia is the
adolescent and young adult population

-Reinforcing the importance of abstinence,

-Limiting the number of sexual partners
-Using condoms for barrier protection.
-Young women and those who are pregnant should also be
instructed bout the importance of routine screening for
chlamydia.
 Human Papillomavirus (HPV)

A type of virus that can cause abnormal tissue

growth (for example, warts) and other changes to
cells. Infection for a long time with certain types
of human papillomavirus can cause cervical
cancer. It is the most common sexually
transmitted infection (STI). HPV vaccines can
prevent some of the health effects HPV causes.
 Pathophysiology

The productive life cycle of HPVs is linked to epithelial

differentiation. Papillomaviruses are thought to infect cells in the
basal layer of stratified epithelia and establish their genomes as
multicopy nuclear episomes. In these cells, viral DNA is replicated
along with cellular chromosomes.
 Signs and Symptoms
Other warts associated with HPV include common warts, plantar, and flat warts.
Common wart Flats wart Plantar Wart
 Diagnostic studies

The important methods to diagnose HPV infection are:

-Colposcopy and acetic acid test – magnified viewing of the cervix

and a vinegar solution will be applied to the area that turns them
white.
-Biopsy
-DNA test (PCR, Southern Blot Hybridization, In Situ
Hybridization)
-Pap smear
 Surgical Treatment

Surgically treating genital warts doesn't cure a human

papillomavirus (HPV) infection, however, and warts can
return after surgery if the immune system does not
eliminate the infection. Surgery may be used to treat
moderate to severe cervical dysplasia by removing
abnormal cells on the cervix
 Medical Management

Salicylic acid
Imiquimod (Aldara, Zyclara)
Podofilox (Condylox)
Trichloroacetic acid.
 Nursing Management

-Relieve anxiety and depression

-Enhance self-care
-Educate patient about HPV infection
-Educate patient about treatments for warts
-Educate patient about screening for cervical cancer
-Educate patient about safe sex practice
-Administer medications as prescribed
-Consult with a mental health professional if the patient is anxious
-Refer patient to STD clinic to ensure no other infection is present
 HIV & AIDS
Human immunodeficiency
virus (HIV)
It is spread by contact with certain
HIV (human immunodeficiency virus) is a
bodily fluids of a person with HIV, most
virus that attacks cells that help the body
commonly during unprotected sex
fight infection, making a person more
vulnerable to other infections and diseases. May also transmit through sharing
injection drug equipment.

If left untreated, it can lead to

Acquired immunodeficiency
syndrome (AIDS)
HIV/AIDS pathophysiology

Acquired immunodeficiency
syndrome (AIDS)
is caused by HIV or human
immunodeficiency virus. The
infection causes progressive
destruction of the cell-mediated
immune (CMI) system, primarily by
eliminating CD4+ T-helper
lymphocytes.
HIV/AIDS pathophysiology

Acquired immunodeficiency
syndrome (AIDS)

Decreased immunity leads to

opportunistic infections and certain
cancers. Opportunistic infections
are caused by organisms that do not Sample Opportunistic infections and diseases
cause infections in healthy
individuals. HIV also directly
• Pneumonia
damages certain organs like the
brain. • Salmonella septicemia
• Invasive cervical cancer
• Herpes simplex breakouts
 Signs and Symptoms of HIV & Stages
Stage 1: Acute HIV Infection
Within 2 to 4 weeks after infection with HIV, about two-thirds of people will have a flu-like symptoms.

• Fever
• Sore throat
• Chills
• Fatigue
• Rash
• Swollen lymph nodes
• Night sweats
• Mouth ulcers
• Muscle aches
 Signs and Symptoms of HIV & Stages
Stage 2: Clinical Latency

In this stage, the virus still multiplies, but at very low levels. People in this stage may be asymptomatic. This
stage is also called chronic HIV infection.
Without HIV treatment, people can stay in this stage for 10 or 15 years, but some
move through this stage faster.

Treatment with antivirals as prescribed can allow a person to live longer and
healthier, and reduce risks of transmission.
 Signs and Symptoms of HIV & Stages
Stage 3: Acquired Immunodeficiency Syndrome
If a person has HIV and did not receive HIV treatment, eventually the virus will weaken the body’s
immune system and progress to AIDS.

This is the late stage of HIV infection.

-Symptoms of AIDS can include:
-Rapid weight loss and muscle wasting
-Recurring fever or profuse night sweats
-Extreme fatigue
-Prolonged swelling of the lymph glands in the armpits, groin, or neck
-Diarrhea that lasts for more than a week
-Sores/Ulcers of the mouth, anus, or genitals
-Pneumonia
-Rashes: Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
-Memory loss, depression, and other neurological disorders
 AIDS
(Acquired Immunodeficiency Syndrome)
It is the name used to describe a number of potentially life-threatening infections and
illnesses that happen when your immune system has been severely damaged by the HIV
virus.

The HIV virus is the agent being transmitted, not AIDs.

HIV causes AIDs.
 Diagnostic Studies
Enzyme-linked immunosorbent assay (ELISA Test)
Used to detect HIV infection.
• If an ELISA test is positive, the Western blot test is usually administered to confirm the diagnosis.
• If an ELISA test is negative, but you think you may have HIV, you should be tested again in one to three months.
 Diagnostic Studies

Western Blot
This is a very sensitive blood test used to confirm a positive ELISA test result. It is used to detect antibodies.

Proteins are separated, through a gel,

transferred to a sheet. It is then reacted to
a patient's serum.

It is labeled, unbound antibody are

washed off, and then bound visualized
through a film.

Results may take several weeks

 Medical Management
The treatment for HIV is called antiretroviral therapy (ART). ART involves a combination ofHIV treatment regimen every day. It
does not cure, but allows a person to live longer and reduces risk of transmission.

Classes of anti-HIV drugs include:

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Inhibits replication of the HIV virus.

Efavirenz (Sustiva) (Oral, capsules or tablets)

Rilpivirine (Edurant) (Oral, tablets)
Doravirine (Pifeltro) (Oral tablet)
 Medical Management

Nucleoside or Nucleotide reverse transcriptase inhibitors (NRTIs)

Faulty versions of the building blocks that HIV needs to make copies of itself.

• Abacavir (Ziagen) (Oral route, tablet),

• Tenofovir disoproxil fumarate (Viread) (Oral, tablet)
• Emtricitabine (Emtriva) (Oral capsules)
• Lamivudine (Epivir) (Oral)
• Zidovudine (Retrovir) (Oral).
 Medical Management

Protease inhibitors (PIs)

Inactivate HIV protease, another protein that HIV needs to make copies of itself.

• atazanavir (Reyataz) (Oral powder)

• Darunavir (Prezista) (Oral suspension)
• Lopinavir/Ritonavir (Kaletra) (Oral, tablet or solution).
 Medical Management

Integrase inhibitors (II)

Disables a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells.

• Bictegravir sodium/Emtricitabine/Tenofovir alafenamide fumarate (Biktarvy, 3 drug combination, oral

single tablet),
• Raltegravir (Isentress) (Oral suspension),
• Dolutegravir (Tivicay) (Oral route)
• Cabotegravir (Vocabria). (Intramuscular route)
 Medical Management

Entry or fusion inhibitors

Block HIV's entry into CD4 T cells.

• Enfuvirtide (Fuzeon) (Subcutaneous)

• Maraviroc (Selzentry) (Oral route)
 Nursing Management
-Promote skin integrity: Avoid scratching, use nonabrasive non-drying soaps, and apply moisturizers
-Promote regular oral care
-Promote regular bowel patterns
-Prevent infection: Monitor for signs of infection and laboratory test results that indicate infection.
-Improve activity: Assist in planning daily routines that maintain activity
-Maintain thought processes: Encourage ongoing family and friend interaction
-Maintain airway clearance: Deep breathing, coughing, postural drainage, percussion, and vibration every 2
hours
-Relieve pain: Use soft cushions and foam pads; administer pain medications as prescribed
-Maintain nutritional status: Eat foods that are easy to swallow while avoiding rough, sticky, and spicy foods.
Avoid raw eggs, meat and seafood.
 Health Teachings
• Inform all sexual partners if the individual is HIV positive.
• Use a clean needle to inject drugs and dispose of it. It is imperative that one should do not share it with
anybody.
• Male circumcision reduces the likelihood of HIV infection. Discuss it with the primary care provider.
• Use a clean condom at all times when having sexual intercourse. Preferably use a condom that contains a
water-based lubricant, which is more protective.
• The HIV-positive female must be treated with priority during pregnancy.
• Use emtricitabine/tenofovir disoproxil to reduce the risk of a sexually transmitted HIV infection. It must be
taken every day, and the individual can still be involved in safe sex practices. It does not prevent other
sexually transmitted diseases like syphilis.
 Herpes
A common disease caused by Herpes Simplex Virus (HSV)

HSV-1 HSV-2

primarily transmitted Primarily sexually transmitted

through oral contact. and causes genital
Causes Oral Herpes. 2 categories Herpes.
 Pathophysiology

HSV is transmitted through

direct and close contact with a
HSV is transmitted
person who is actively through direct and close
shedding the virus or the contact with a person
secretions who is actively shedding
the virus or the secretions
 Pathophysiology

The virus travels through the

nerve axons to the either the
trigeminal, cervical,
lumbosacral, or autonomic
ganglia and persists for life,
and typically lies dormant.

Breakouts are a result of

reactivation and HSV migrates
back through the axons to the
mucosa.
Pathophysiology
 Herpes Signs and symptoms

Infected individuals are at many times asymptomatic, or only suffer mild

symptoms

• Tingling, itching, & burning sensation

• Sores/Ulcers (Oral or genital)
• Body malaise
• Fever
• Swollen lymph nodes
• Dysuria/Painful urination
• Eye infection (Herpes keratitis) Requires prompt treatment, as scarring and impaired vision
may result. (S&x light sensitivity, discharge and pain in eye)
Herpes Signs and symptoms
Cervical

Herpes keratitis
 Diagnostics/Labs
HSV-1 & HSV 2 are indistinguishable visually, and type testing is
needed to confirm suspicions.
• Polymerase chain reaction assay- Detects HSV in blood
• Western Blot
• Glycoprotein G tests
Swab locations include: Skin via unroofing vesicles, Cervix (Vaginal speculum), Urethra, or
fresh lesions (Avoid crusting & healing ones).
• Serologic testing ( Discouraged by CDC for acute)
Indicated for determining evidence of past infection and lesions are present.
 Pharmacological Treatment
Anti-Herpes viral agents
• Acyclovir - Mainstay and firstline suppressor (Antiviral activity and effective against all
known herpesviruses)
• Penciclovir(Topical therapy)- Inhibits HSV activity & replication.
• Famciclovir- Oral, Rapidly converts to active antiviral penciclovir, inhibit activity of HSV 1
& 2, through their DNA polymerase and prevents replication.
• Valacyclovir- Oral, Rapidly converts to Acliclovir, inhibits activity & synthesis of HSV 1 &
2,.

All Lessen the severity and frequency of outbreaks, as well as prevent transmission.

No current vaccines exist

 Nursing Management
Management of genital herpes is focused on preventing transmission, suppressing symptoms,
and health education on minimizing risk of sexual transmission.

• Provide Pain medications and antipyretics (e.g ibuprofen) to reduce fever.

• Maintain hydration
• Provide health education on prevention (E.g condoms, risks increase when sores are open,
Maintain cleanliness when sores are present, including clothing and kitchen utensils.)
• Provide health education on transmission (Herpes may spread with and without sores)
• Pt. must abstain from sexual activity during outbreaks
• Offer or refer to counseling (Pt may be at risk of psychological distress, self-image due to
oral/skin/genital sores & ulcers)
 A Case Study of Secondary Syphilis (Coleman, et al., 2017)

A 39-year old man presented to the emergency department reporting several weeks of
generalized weakness, headache, nausea, and migratory arthralgia (pain in a joint, pain
"spreads" to another).

The patient had exclusively intercourse with men, had participated in condomless anal
insertive and receptive intercourse, and had been in a monogamous relationship during
the past 6 months.
 Physical examination
Painful, ulcerated plaque on upper lip
Macular rash crater-like scarred painless lesions on the glans (Likely healing)
Hyperkeratotic Maculopapular palmar rash
Bilateral Subdamindubular (Salivary gland) lymphadenopathy/Swollen lymph nodes

No ocular, neurologic deficits, or cardiovascular abnormalities.

 Diagnosis
Positive reactive syphilis immunoglobulin G
enzyme immunoassay
Positive rapid plasma reagin (RPR) tests.
Thus, with clinical presentation & lab findings,
Secondary syphilis was the chosen diagnosis

Treatment
The Patient was treated with benzathine penicillin G 2.4 million units
intramuscularly

Patient was also advised to contact and discuss with the partner for
evaluation.
 References
Mathew Jr J, Sapra A. (2022) Herpes Simplex Type 2
Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK554427/
Azher TN, Yin X, Tajfirouz D, Huang AJH, Stuart PM. (2017) Herpes simplex keratitis: challenges in diagnosis and
clinical management.
https://doi.org/10.2147/OPTH.S80475
American International Medical University (2017) Herpes Simplex : Symptoms, Causes, Diagnosis and Management
Retrieved from: https://www.aimu.us/2017/10/30/herpes-simplex-symptoms-causes-diagnosis-and-management/
Coleman E., Fiahlo A., Brateanu A., (2017) Secondary syphilis
10.3949/ccjm.84a.1608
Groves M. J. (2016). Genital Herpes: A Review. American family physician, 93(11), 928–934.
Retrieved from: https://pubmed.ncbi.nlm.nih.gov/27281837/
Mahmood, T., & Yang, P. C. (2012). Western blot: technique, theory, and trouble shooting. North American journal of
medical sciences, 4(9), 429–434. https://doi.org/10.4103/1947-2714.100998
Snow, Michelle (2011) What you need to know about genital herpes
Rdoi: 10.1097/01.NURSE.0000398758.27016.98
 Reference cont.
Centers for Disease Control and Prevention (CDC). (2020q). Sexually transmitted disease surveillance, 2018 National profile. Retrieved on
3/18/2020 at: www.cdc.gov/std/stats 18/natoverview.htm

Centers for Disease Control and Prevention (CDC). (2020r). Sexually transmitted diseases (STDs). Retrieved on 8/4/2020 at:
www.cdc.gov/ std/treatment/default.htm

HIV Diagnosis. (n.d.). ucsfhealth.org. https://www.ucsfhealth.org/conditions/hiv/diagnosis

HIV Treatment: The Basics | NIH. (n.d.). https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-basics

Longworth, M. S., & Laimins, L. A. (2004). Pathogenesis of human papillomaviruses in differentiating epithelia. Microbiology and
molecular biology reviews : MMBR, 68(2), 362–372. https://doi.org/10.1128/MMBR.68.2.362-372.2004

Mandal, A., MD. (2019, May 29). AIDS Pathophysiology. News-Medical.net. https://www.news-medical.net/health/AIDS-
Pathophysiology.aspx

Mohseni M, Sung S, Takov V. Chlamydia. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537286/
Springer C, Salen P. Gonorrhea. [Updated 2022 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK558903/