Chapter 5

Sexually Transmitted
Infections
STIs

 Define

 Curable versus incurable

 Safer-sex practices

The problem of STIs has still not been tackled adequately

on a global scale, and until this is done, numbers
worldwide will continue to increase.

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Factors Placing Teenagers at Risk for STIs

 Females’ anatomy predisposing them to STIs (columnar

epithelial cells sensitive to invasion)
 Teenagers’ feelings of invincibility
 Unprotected intercourse
 Partnerships of limited duration
 Obstacles to using the health care system

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Manifestations of Common STIs #1

 Chlamydia: may be asymptomatic, dysuria, urinary

frequency, dyspareunia, cervical discharge,
endocervicitis, inflammations of the rectum and lining of
the eye, can infect throat
 Gonorrhea: may be asymptomatic, dysuria, urinary
frequency, vaginal discharge, dyspareunia,
endocervicitis, arthritis, PID, rectal infection
 Genital herpes: blister-like genital lesions, dysuria, fever,
headache, muscle aches, malaise

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Manifestations of Common STIs #2

 Syphilis: disease is divided into four stages:

o Primary: chancre on place of bacteria entrance
o Secondary: maculopapular rash, sore throat,
lymphadenopathy, flu-like symptoms
o Latent: no symptoms; can be infective first 1–2 years
of latency, some will go on to develop tertiary
infections
o Tertiary: tumors of the skin, bones, and liver, CNS
symptoms, CV symptoms; usually not reversible

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Manifestations of Common STIs #3

 Trichomoniasis: may be asymptomatic, dysuria, urinary

frequency, vaginal discharge, dyspareunia, irritation of
genital area
 Genital warts: wart-like lesions that are soft, moist, or
flesh colored and appear on the vulva and cervix and
inside; also surrounding the vagina and anus, sometimes
appear in cauliflower-like clusters, and are either raised
or flat, and small or large

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Open Discussion

 Client’s sexual habits

 Appropriate anticipatory guidance
 Methods to prevent recurrent STIs

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Most Common Causes of Vaginitis

 Candida: fungus
 Trichomonas: protozoan
 Gardnerella: bacterium

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Vulvovaginal Candidiasis

 Nursing management
o Teaching preventive measures
 Cotton underwear
 Avoidance of irritants
 Good body hygiene
 Avoidance of douching or super-absorbent tampons

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Question #1

Is the following statement true or false?

Trichomoniasis is one of the most common causes of
vaginal discharge.
a. True
b. False

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Answer to Question #1

b. False
Vulvovaginal candidiasis is one of the most common
causes of vaginal discharge.

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Bacterial Vaginosis

 Most prevalent cause of vaginal discharge

 50%–75% women asymptomatic
 Risk factors
o Multiple sex partners
o Douching
o Lack of vaginal lactobacilli

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Chlamydia #1

 Most common bacterial STI in the United States; majority

asymptomatic
 Cause: Chlamydia trachomatis (intracellular parasite)
 Therapeutic management
o Antibiotics (doxycycline, azithromycin)
o Combination regimen if gonorrhea also present
o Screening

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Chlamydia #2

 Nursing assessment
o Risk factors: adolescence, multiple sex partners, new
sex partner, sex without condom, oral contraceptive
use, pregnancy, history of another STI
o Manifestations: mucopurulent vaginal discharge,
urethritis, bartholinitis, endometritis, salpingitis,
dysfunctional uterine bleeding
o Urine testing or swab specimen culture,
immunofluorescence, EIA, or nucleic acid amplification

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Gonorrhea #1

 Second most commonly reported infection in the United

States
 Highly contagious and reportable to health departments
 Cause: aerobic gram-negative intracellular diplococcus
 Site of infection: columnar epithelium of endocervix
 Almost exclusively transmitted via sexual activity
 Therapeutic management: antibiotic therapy (dual
therapy)

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Gonorrhea #2

 Nursing assessment
o Risk factors: low socioeconomic status, urban living,
single status, inconsistent use of barrier
contraceptives, age <20 years, multiple sex partners
o Manifestations: most asymptomatic; abnormal vaginal
discharge, dysuria, cervicitis, abnormal vaginal
bleeding, Bartholin abscess, PID
o Neonatal conjunctivitis if woman gives birth

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Nursing Management: Chlamydia and
Gonorrhea

 Treatment strategies
 Referrals
 Preventive measures
 Education and counseling
 Sexual history
 Public education
 Safe sex practices

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Question #2

Which infection is characterized by a vaginal discharge

that has a stale fish odor?
a. Trichomoniasis
b. Bacterial vaginosis
c. Chlamydia
d. Gonorrhea

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Answer to Question #2

b. Bacterial vaginosis
Bacterial vaginosis is an infection in which the vaginal
discharge has a characteristic stale fish odor. There is no
odor associated with the vaginal discharge of
trichomoniasis, chlamydia, or gonorrhea.

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P-LI-SS-IT

 Four levels
 Determine interventions for women with STIs

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Genital Herpes Simplex #1

 Recurrent lifelong viral infection

 Transmission via contact with mucous membranes or
breaks in skin with visible or nonvisible lesions
 Kissing, sexual contact, and vaginal delivery
 Therapeutic management

○ No cure
○ Antiretroviral therapy to reduce or suppress
symptoms, shedding, and recurrent episodes

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Genital Herpes Simplex #2

 Nursing assessment
o Primary episode (most severe and prolonged):
multiple painful vesicular lesions, mucopurulent
discharge, superinfection with candida, fever, chills,
malaise, dysuria, headache, genital irritation, inguinal
tenderness, lymphadenopathy
o Recurrent infection (more localized and quicker
resolution): tingling, itching, pain, unilateral genital
lesions (more localized)
o Diagnosis confirmed via viral culture of fluid from
vesicle

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Question #3

Is the following statement true or false?

Recurrent infection episodes of herpes simplex virus are
usually less severe and prolonged than the initial episode.
a. True
b. False

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Answer to Question #3

a. True
The primary episode of herpes simplex is usually the
most severe, with recurrent episodes usually milder and
shorter in duration.

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Syphilis #1

 Curable bacterial infection caused by spirochete

Treponema pallidum
 Serious systemic disease
 Therapeutic management
o Benzathine penicillin G IM
o Doxycycline if allergic to penicillin
o Reevaluation with serologic testing

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Syphilis #2

 Nursing assessment
o Primary: chancre, painless bilateral adenopathy
o Secondary: flu-like symptoms, rash on trunk, palms,
and soles, alopecia, adenopathy
o Latency: absence of manifestations, positive serology
o Tertiary: life-threatening heart disease, neurologic
disease
o Tests: VDRL and RPR; FTA-ABS, TPPA, and TPHA

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Nursing Management of Herpes and
Syphilis
 Education (see Teaching Guidelines 5.3)
 Referral to support group
 Coping skills
 Options for treatment and rehabilitation

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Pelvic Inflammatory Disease #1

 Result of ascending polymicrobial infection of upper

female reproductive tract
 Frequently from untreated chlamydia or gonorrhea
 Complications
 Therapeutic management
o Empiric broad-spectrum antibiotics
o Oral fluids
o Bed rest
o Pain management

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Pelvic Inflammatory Disease #2
 Nursing assessment
o Risk factors
o Manifestations: lower abdominal tenderness, adnexal
tenderness, cervical motion tenderness, fever,
dysmenorrhea, dysuria, dyspareunia
o Diagnosis: endometrial biopsy, transvaginal
ultrasound, laparoscopic examination

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Pelvic Inflammatory Disease #3
 Nursing management
o Hydration
o Analgesics
o Education to prevent recurrence (see Teaching
Guidelines 5.4)
o Risk assessment
o Sexual counseling

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Human Papillomavirus #1

 Most common viral infection in the United States

 Genital warts or condylomata
 Nursing assessment
o Risk factors
o Manifestations: most asymptomatic; visible genital
warts
o Pap smears; HPV test

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Human Papillomavirus #2

 Therapeutic management: primary prevention via

vaccine and education; treatment of lesions and warts;
secondary prevention via education
 Nursing management
o Teaching about prevention
o Promotion of vaccines and screening tests
o Education about link between HPV and cervical cancer

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Hepatitis A and B

 Hepatitis A spreads via GI tract

 Hepatitis B via saliva, blood, semen, menstrual blood,
and vaginal secretions
 Therapeutic management: prevention through
immunization
 Nursing assessment: hepatitis A manifestations; hepatitis
B manifestations
 Nursing management: screening, vaccination

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Ectoparasitic Infections

 Scabies: intensely pruritic dermatitis with lesions

 Pubic lice: pruritus with lice or nits
 Treatment: permethrin cream or lindane shampoo;
decontamination of bedding and clothing; treatment of
family members and sexual partners
 Three-tiered approach: eradicate infestation, remove
nits, prevent spread or recurrence
 Education (see Teaching Guidelines 5.5)

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Human Immunodeficiency Virus #1

 Transmission
 AIDS due to HIV infection
 Fetal and neonatal effects
 HIV and adolescents increasing; most exposed via sexual
intercourse
 Manifestations: acute phase; asymptomatic with viral
replication, immunosuppression with opportunistic
infections, AIDS

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Human Immunodeficiency Virus #2

 Diagnosis
 Therapeutic management: ART (Antiretroviral therapy)
 Nursing management
o Education about drug therapy
o Compliance
o Prevention
o Care during pregnancy and childbirth
o Referrals

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Preventing STIs

 Education about safer sex practices

 Behavior modification
 Contraception

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Physiologic and Psychological Aspects

 Address psychosocial well-being upon diagnosis of any

STI
 Occurs
o Races
o Ethnicities
o Classes and social levels
o More frequently in women
 Client education on effective prevention methods

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Nursing Management #1

 Vulvovaginal candidiasis, focusing on avoidance of sex

and alcohol consumption
 Bacterial vaginosis, focusing on primary prevention and
education
 Chlamydia and gonorrhea, focusing on education and
counseling and treatment regimen
 Genital herpes simplex and syphilis, focusing on support,
assistance with coping, and education

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Nursing Management #2

 PID, focusing on drug therapy, hydration, pain relief,

education, and sexual counseling
 HPV, focusing on preventive education, vaccination, and
counseling
 Hepatitis A and B, focusing on screening and vaccines
 Scabies and lice, focusing on eradicating the infestation
and preventing spread and recurrence
 HIV, focusing on education, counseling, support, and
compliance with therapy

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