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A1 PASSERS TRAINING, RESEARCH, REVIEW & DEVELOPMENT COMPANY

2
nd
Floor Sommerset Bldg., Lopez Jaena St. Jaro, Iloilo City
Tel No.: (033) 320-2728; 09106547262
Email Address: a1nursingreviewic@yahoo.com.ph

OVERVIEW OF SEXUALLY TRANSMITTED DISEASES
Prepared by: ATTY. SALEX ALIBOGHA

STDs
- the most common causes of illness in the world with health, social and economic consequences.
MAJOR HEALTH PROBLEM
serious sequelae
facilitate transmission of HIV
Estimates (1995): 333 million new cases of curable STDs
STD Situation
More than 20 STDs
250 million new cases per year
among the top 5 leading causes of adult morbidity
Problems of Sexually Transmitted Disease
FACTORS
Demographic
Biological
Psychological
Sociocultural & Socioeconomic
STDs AFFECT SEXUALLY ACTIVE PERSONS
Causative Agents
Bacteria
Neisseria gonorrhea, Chlamydia trachomatis, Treponema pallidum
Virus
HIV, Hepa B Virus (HBV),Herpes Simplex Virus (HSV),Human Papilloma Virus (HPV)
Protozoa
Trichomonas vaginalis
Fungus
Candida albicans (Monilia)
Parasites
Phthirus pubis, Sarcoptes scabiei
MODES OF TRANSMISSION
sexual intercourse
blood and blood products
mother to infant
close contact
HISTORY TAKING
o The following points will facilitate the history taking process.
o Many patients are afraid of STDs and their effects.
o Many STD patients feel guilty and are embarrassed that others would know of their
condition.
o Many symptoms can be unpleasant. What patient want most is effective treatment.
o All patients need counseling and information about STD prevention and required
treatment.
o People have sex throughout their lives and may have, from time to time, new partners.
Therefore, STDs can occur at any age.
History taking for Male Patients
Discharge
Painful urination
Pain during intercourse
Ulcers
Lumps, swelling
Rash, itching
History Taking for Female Patients
Vaginal discharge
Itching
Pain, Soreness
Dysuria, Frequency Nocturia
Pain during intercourse
Ulcer
Lumps, swelling
Rash
Abdominal Pain
Backache
Joint pain
Menstruation
Pervious History
Cervical smear
Contraception
SYNDROMIC APPROACH MANAGEMENT
THE SYNDROMES:
GONORRHEA
Causative agent: Neisseria gonorrhea
direct staining of urethral or cervical secretions
fragile organism
Incubation period: 2-5 days post coitus
as early as 1 day
as late as 12 days
Gonorrhea in males
Main symptoms:
Urethral discharge
thick pus usually in the morning
Dysuria
pain/ burning on urination, sometimes with increasedfrequency
Dysuria in a young man always suggests STD until proven otherwise.
Cloudy or Bloodstained Urine
Anal discharge/ rectal pain
Sore throat
oral sex
often asymptomatic
Complications in Men:
Main symptoms:
1. Urethral discharge thick pus usually in the morning
2. Dysuria
pain/ burning on urination, sometimes with increased frequency
Dysuria in a young man always suggests STD until proven otherwise.
3. Cloudy or Bloodstained Urine
5. Anal discharge/ rectal pain
6. Sore throat
oral sex
often asymptomatic
Complications in Men:
Urethral stricture-scarring
Epididymitis
o unilateral pain or tenderness of scrotum
o infertility
o destruction of the testis
Prostatitis
Gonorrhea in Women
1. Vaginal discharge
o Cervix: pus, swelling, and reddening
o Yellowish, Purulent, usually odorless
2. Dysuria
o Gonococcal urethritis
o Same symptoms due to non-STD causes
3. Anal discharge and pain
4. Sore throat
o Oral sex
o Maybe asymptomatic
Signs of early infection in Women
1. Vaginal discharge
2. Dysuria
Complications in woman
1. Pelvic inflammatory disease (PID)
o Ectopic pregnancy
o Infertility
o Premature Birth
o Intra-uterine death
2. Endometritis
3. Salpingitis
4. Arthritis/ Reiters syndrome
Complications of Gonorrhea in women
o 50% of the women with gonorrhea are asymptomatic
o late treatment complications
infection of the Bartholins gland
PID
uterus, fallopian tubes
most serious complication
low abdominal pain and tenderness
discharges with dysuria
patient maybe very ill and febrile
Salphingitis
localized PID mainly in fallopian tubes
lower abdominal pain/ tenderness
fever/ ill
abnormal period
TOTAL BLOCK - INFERTILITY
PARTIAL BLOCK ECTOPIC PREGNANCY
Gonorrhea in pregnancy
same symptoms as in non-pregnant women
PID less common
risk of membrane infection
retarded growth of fetus
premature rupture of membrane with premature delivery
eye infection from pus in the cervix
Extragenital gonorrhea
1. Arthritis
often affects the knee
most common in young people
more common in females during pregnancy
joint destruction: urgent treatment
2. Rash-Septicemia/ Blood Infection
3. Eye Infection
Gonorrhea in Children
sexual abuse
swelling/redness of vulva with itchiness
Effects to the Newborn:
ophthalmia (less severe)
pneumonia
NON-GONOCOCCAL URETHRITIS(NGU)/NON-SPECIFIC URETHRITIS(NSU) AND CERVICITIS
discharges/ dysuria
no gonococci cultured
Most common causes:
Chlamydia trachomatis
Mycoplasma
Trichomonas
Genital herpes
CHLAMYDIA TRACHOMATIS
Incubation period: 1-12 days
Clinical manifestations in Males:
same symptoms as GC
watery/mucupurulent urethral discharge
dysuria/ frequency
epididymitis
arthritis/Reiters syndrome-are common
Clinical Manifestations in Female:
most are asymptomatic
initial signs and symptoms
o cervical inflammtion
o vaginal discharge
o dysuria
Complications in Males:
epididymitis
prostatitis-infertility
arthritis
Complications in Females:
pelvic inflammatory disease
endometritis
arthritis
TRICHOMONIASIS
caused by Trichomonas vaginalis
Modes of Transmission
o sexual contact- primary
o mother to newborn
*Ten times more common in women than in men.
Signs and Symptoms in Women( 25% with no symptoms)
vaginal discharge
profuse, frothy, greenish-yellow, malodorous
severe vaginal itching
vulva may be thickened or reddened
dysuria due to vulvar inflammation
dyspareunia
*These symptoms are worst during menstruation, pregnancy, in diabetics and post-menopausal
women.
Complications: Associated with pelvic Inflammatory disease
Trichomoniasis in Men:
largely asymptomatic
itching, dysuria, frequency
Laboratory Diagnosis:
fresh wet smear with NSS
culture
CANDIDIASIS OR MONILIASIS
caused by Candida albicans, a yeast organism most common in vagina
Factors leading to Infection:
Diabetics
oral contraceptives
oral antibiotics
anemia
person living with AIDS/HIV
poor anal, perianal hygiene
*Hot, humid weather and tight clothes favor infection.
Candidiasis in Women:
50% are asymptomatic
vaginal discha4rge- thick, curdy with an offensive odor; whitish, plaque on vaginal walls upon
speculum exam
irresistible itching in the vulva or anal region
dysuria or painful urination
painful sexual intercourse
Candidiasis in Men:
less common
itching especially in an un circumsized
Diagnosis:
o KOH- direct visualization
o Culture
Management:
good personal hygiene
Identify factors
Drug treatment
Diagnosis:
smooth, gray or white discharge
vaginal pH > 4.5
amine/ whiff test
clue cells
Complications
PID
PROM in pregnant women
CLINICAL FEATURES OF VAGINAL DISCHARGES
Vaginosis Trichomoniasis Candidiassis Gonorrhea Chlamydia
Odor Fishy Foul Varies varies varies
Amount Increased Profuse Varies varies Varies
Color Grey-white Yellow-green White White/Yellow Mucoid/White
Consistency Thin/Smooth Often frothy Thick,
clumpy
Varies Varies
Itch Rare Common Severe Unusual Unusual
Soreness Rare Common Common Dysuria Dysuria

GENITAL ULCER DISEASE
Genital Herpes
caused by Herpes Virus or Herpes simplex virus (Type I, Type II)
Incubation period: 4 days ( 2-14 days)
Laboratory tests are not readily available; thus diagnosis is usually done on clinical grounds
Signs and Symptoms:
Up to half of new infections are asymptomatic or cause mild symptom.
Pain and itching in the genital area are due to vesicular rash or blister. Blisters erode and form
shallow sores that merge top form large5r sores.
Affects the external genitalia(vulva or penis), the vagina, penis; causes dysuria and clear and
mucoid discharge
Clinical Course:
1. Initial Infection- accompanied by fever, headache and general malaise; painful, multiple,
bilateral lesion.
2. Resolution of the lesion (blister or sore) after 10-20 days.
3. Recurrence- usually unilateral lesions occurs( 2-6 times/ year); lasts for 3-7 days, less pain
and no systemic symptoms.
usually limited to the genitalia
episodes are less severe and shorter ranging from 8-12 days
can recur due to trigger factors like menstruation and sexual intercourse.
Treatment:
There are no known cure. The symptoms can be alleviated if treated as soon as possible
following the onset.
Wash with soap and water to avoid secondary bacterial infection.
SYPHILLIS
a chronic sexually transmitted disease caused by bacteria Treponema pallidum(spirochete)
Transmission:
sexual contact
blood transfusion
perinatal
Clinical Course:
Early Syphillis
Primary syphilis
first manifestation is a hard sore( chancre) at the site of the inoculation
the chancre is usually single, painless, firm to touch with slightly elevated edges
and often appears clearly punched out ( 3mm to 1cm)
found in the glans penis, prepuce and penile shaft in ,men.
Found in the vulva, especially the labia forechette or clitoris, vagina or in the
cervix
Associated with painless enlargement of regional lymph nodes
The chancre and the lymph nodes are highly infectious
Secondary syphilis ( systemnic) generalized rash
from 3-6 weeks or 1- 6 months after the appearance of the chancre
associated with fever, body malaise, etc.
condylomata lata may present with papules that have thickened and look warty.
Early latent syphilis
asymptomatic and detected serologically
Late Syphillis
Tertiary
cardiovascular syphilis- develops 10-30 years after the primary stage
neurosyphillis
gumma- is a typical destructive lesion which can affect any organ
Late latent syphilis
asymptomatic and detected by ,means of serologic testing.
PELVIC INFLAMMATORY DISEASE
clinical syndrome found in women, resulting from infection of the uterus, fallopian tubes,
ovaries, peritoneal structures and other surrounding structures.
Complication of ascending genital tract infection and is frequently associated with pre-existing
or concomitant gonococcal or chlamydial infection
Symptoms:
usually dull lower abdominal pain
typically but not invariably bilateral
if associated with gonorrhea, less than 3 days
chlamydia- milder and tolerated for longer period.
Menorrhagia or metrorrhagia- endometritis
Dysuria
Dyspareunia
Risk Factors:
sexual activity: increased with increased number of sex partners and number of coitus
age
contraceptive use
vaginal douching
latrogenic
post-partum infection

OTHER STDs
Pubic lice
Etiologic agent: Phthirus pubis
( like tiny crab or turtle)
Mode of transmission:
sexual intercourse
close physical contact
through clothing and bedding
Signs and Symptoms:
severe itchiness
elevated red and pink spots
Venereal Wart
Etiologic agent: Human papilloma virus
Clinical features:
small fingerlike growth with spiny projections
cauliflower appearance
bleed when impaired


COMPONENTS OF STD MANAGEMENT
refers to the treatment of patients with STD related syndromes and their sexual partmers
through early recognition, effective drug therapy, education on risk reduction and prevention of
further infection.
Aims of achieving a cure reducing and preventing risk taking behavior and insuring apprpriate
treatment of sexual partners
Nursing Management
Assessment
Subjective data:
o Exposure to STD contact , including HIV
o Prior STD History, treatment
o Sexual Orientation
o Relationship of onset of symptoms to last sexual intercourse
o Number of sexual partners in the past 2 months
o Women: LMP, vaginal discharge, vulva itching, dysuria, urinary urgency, abdominal
pain, rectal symptoms, sore throat
o Heterosexual Men, gay, bisexual men: urethral discharge, dysuria, genital lesion, skin
rash, itching, sore throat
o Gay: rectal symptoms such as pain, bleeding, discharge
o Objective data:
o inspection and palpation: integumentary system and reproductive system
o Examination of Women:: Skin, lower abdomen, inguinal area, hands, palms, forearms,
pubic hair, vagina, cervix, mouth, throat including tonsils, pregnancy test of women of
child bearing age.
o Examination of Men: inspection of pubic hair, penis, meatus, milking of the urethra,
palpation of scrutum
Nursing Interventions
1. Teach the importance of taking any prescribed oral medication
2. Encourage client to refer any sexual partners for evaluation any necessary treatment
3. Teach the client to abstain from sexual contact until client and partners are cured and to use
condoms to prevent future infections
4. Emphasize the importance of follow up testing
5. Provide information about signs and symptoms of infections
6. Create an environment where the client feels respected and safe to discuss questions and
concerns about the disease and its effect on the clients life
7. Provide privacy and confidentiality
8. Let the client know that the nurse and other health care provider care about the client and the
successful treatment of the disease
9. Allow the client to express specific fears and feeling about the disease process
10. Refer sexual partners for evaluation and treatment
THE 4 Cs:
Counseling and Education
listen to the patient
Summarize
tame emotions
eliminate hasty judgment
never interrupt
inspire openness
generate conclusions
*Confidentiality should be emphasized in the counseling session.
EDUCATION
There are common mistaken beliefs on protecting oneself from STD/HIV infection that need to be
corrected through education. Some of them are:
physical appearance will show if the person is free from infection
married women are safe
young people are likely to be free from infection
taking medication before or after sex
urinating, washing, or douching after sex prevents STDs
only high risked groups like commercial sex workers or gay men will get infected
COMPLIANCE TO MEDICATION
to make sure patience have understood information about medication and treatment, ask them
to repeat the instructions you have given them
CONTACT TRACING (PARTNERNOTIFICATION)
tracing of all sexual partners of a patient treated for STD
all individuals involved should be treated
STD patient
source of the STD
second degree sexual contact those who may have been infected by the
patients, usually the regular partners
information relevant to encourage partner treatment
WAYS OF PARTNER NOTIFICATION
patient or self referral
health provider referral
Principles to consider:
confidentiality
voluntary
treatment should be available to all partners
observe human rights and dignity of the patient
support services
* When partners are traced, treat them for the same STD regardless of whether they show
symptoms or not
Safer Sex and Condoms