Sexually Transmitted Infections Overview

Sexually Transmitted Infections (STIs)

• Twenty-five organisms and syndromes are classified as STIs, including AIDS and Hepatitis B.
• Twenty million new cases of STIs occur annually in the U.S.
• Twenty-five percent of individuals will contract an STI during their lifetime.
• Increased STI incidence is attributed to a younger population, greater sexual freedom, development of antibiotic-resistant strains, and decreasing barrier contraceptive use. Drug use is also a contributing factor to the incidence increase.
• Risk factors for STIs include single individuals, non-white individuals, adolescents, women, low socio-economic status, lack of medical care, multiple partners, and drug use. Bisexual men and individuals with other STIs are also at higher risk.

Learning Outcomes

• Describe the spread and control of sexually transmitted infections (STIs).
• Identify risk factors and develop patient education plans for STIs.
• Analyze the physiological and psychological aspects of sexually transmitted diseases (STDs).
• Describe the nursing management needed for women with STIs.
• Describe the needs and considerations for women with intellectual and developmental disabilities (IDDs) and their sexual health, including the critical need for education, as these individuals may face increased risks due to their circumstances.

Consequences of STIs for Women

• Men are more likely to transmit STIs to women than vice-versa.
• Women with STIs often experience less noticeable symptoms compared to men, delaying diagnosis and treatment.
• STIs in women can cause: scarring of fallopian tubes, pelvic inflammatory disease (PID), ectopic pregnancy, infertility, preterm labor, ruptured membranes (ROM), spontaneous abortion, and certain cancers.
• Infants born to mothers with STIs may experience Group B strep infection, premature delivery, brain damage, pneumonia, and death.

Bacterial STIs

• Chlamydia is the most common bacterial STI in the U.S.
  • Caused by Chlamydia trachomatis.
  • Complications: pelvic inflammatory disease (PID), ectopic pregnancy, infertility; can lead to premature birth and infant conjunctivitis and low birth weight.
  • Symptoms: up to 50% of women are asymptomatic; thin or mucopurulent discharge; friable cervix.
  • Treatment: single dose of 1 gram azithromycin; doxycycline for 7 days. All sexual partners must also be treated.
  • Patient education: encourage abstinence; all sexual partners require treatment.
• Gonorrhea:
  • Causative agent: Neisseria gonorrhoeae.
  • Risk factors: vaginal, oral, or anal sex.
  • Signs and Symptoms: 80% asymptomatic in women; purulent green to yellow vaginal discharge, dysuria, urinary frequency, swollen cervix.
  • Complications: Premature rupture of membranes (PROM), preterm delivery, chorioamnionitis, postpartum endometritis, intrauterine growth restriction (IUGR), ophthalmia neonatorum (eye infections).
  • Treatment: Ceftriaxone 500 mg IM and azithromycin 1 gram orally. Coexisting Chlamydia should also be treated. All sexual partners require treatment.
  • Patient education: encourage abstinence; all sexual partners require treatment.

Syphilis

• Causative agent: Treponema pallidum.
• Increased incidence particularly among gay and bisexual men.
• Diagnosis: prenatal screens (VDRL or RPR blood tests) are critical for pregnant women; testing is recommended during the first prenatal visit and again in the third trimester.
• Stages:
  • Primary: painless chancre (sore) persists for a few weeks then disappears; may present with slight fever, weight loss, malaise.
  • Secondary: skin eruptions (condylomata lata), rash on palms and soles of feet; enlarged and non-tender lymph nodes; symptoms last six weeks to six months.
  • Tertiary: occurs two to 30 years later; possible neurosyphilis, damage to internal organs.
• Treatment: penicillin G IM in a single dose.
• Patient education: partners must be treated; critical for pregnant women to have early diagnosis. The incubation period is 10-90 days.

Viral STIs

• HPV (Human Papillomavirus)
  • Causative agents: certain HPV strains associated with cervical dysplasia (cancer).
  • Risk factors: oral, vaginal, or anal sex.
  • Signs and symptoms: often asymptomatic; soft, gray, or pink cauliflower-like lesions in the genital area; painful intercourse, itching.
  • Treatment: depends on severity of infection; various clinical approaches may be used.
  • Patient education: encouraged for both men and women; vaccine available in 3 doses over 6 months for prevention. Women with HPV require frequent pap tests for cervical dysplasia.
• Genital Herpes Simplex
  • Causative agent: Herpes simplex virus-2 (HSV-2) or HSV-1.
  • Incidence: 1 person in 6 adults between ages 14-49 is infected; recurrent, life-long viral infection.
  • Risk Factors: transmitted by oral, vaginal, or anal sex; skin-to-skin contact is possible.
  • Primary episode: blisters, ulcers that may occur hours to 20 days after initial exposure followed by painful, open sores.
  • Subsequent outbreaks: episodes triggered by stress, menses, ovulation, pregnancy, strenuous sexual activity. Immune-compromised individuals are at increased risk.
  • Complications: spontaneous abortion, low birth weight (LBW); Transmission to neonate must be considered.
  • Treatment: no cure; medical treatment of symptoms.
  • Patient education: no cure; prevent transmission, sitz baths, loose-fitting clothing and cotton underwear recommended during active outbreaks. C-section delivery recommended for pregnant women experiencing active outbreaks.

HIV/AIDS

• Causative Agent: Retrovirus that attacks and destroys T Lymphocytes.
• Risk Factors: IV drug use, multiple sexual partners, history of other STIs & blood transfusions; bisexuality.
• Signs and Symptoms: fatigue, flu-like symptoms, weight loss, lymphadenopathy, rash, and a decrease in CD4 counts.
• Treatment: Antiviral therapy to suppress viral replication.
• Implications in pregnancy: vertical transmission possible; c-section delivery at 38 weeks, infant bathed before immunizations, avoid breastfeeding. Retrovir (Zidovudine) to infants at birth.

Pelvic Inflammatory Disease

• Definition: an inflammatory disorder of the female genital tract. STIs are a causative agent.
• Risk Factors for women: ages 15-24, multiple sexual partners, early age of sexual activity, recent IUD insertion, and frequent douching. Low socioeconomic status and lack of medical care can also increase risk.
• Signs and symptoms: bilateral sharp cramping pain in the lower abdominal quadrants; fever greater than 101 degrees Fahrenheit; mucopurulent cervical or vaginal discharge; irregular bleeding; cervical tenderness during intercourse; malaise, nausea, and possible vomiting.
• Treatment: outpatient - ceftriaxone 500 mg IM one time. Inpatient - IV fluids, antibiotics, and pain medication.
• Patient education: the consequences can include infertility; partners must be treated; sexual activity should be avoided until complete treatment.

Vaginal Infections

• Bacterial Vaginosis:

  • Incidence: 15-20% of pregnant women.
  • Causative Agent: overgrowth of normal anaerobic bacteria.
  • Risk Factors: frequent sexual intercourse, trauma from douching, cigarette smoking, new/multiple partners, and in pregnancy Vitamin D deficiency or higher dietary fat intake. Low socioeconomic status & lack of medical care may increase risk.
  • Signs and symptoms: vaginal discharge (thin and gray), fishy odor, and burning/itching.
  • Treatment: usually metronidazole (Flagyl). Different dosage for pregnancy.
  • Patient education: it is not an STI, caused by decrease in normal vaginal flora, may lead to preterm labor, premature rupture of membranes (PROM), chorioamnionitis, pelvic inflammatory disease. Do not use douches/harsh soaps, abstain from intercourse until complete treatment. Avoid alcohol.

• Vulvovaginal Candidiasis:

  • Causative Agent: Candida albicans
  • Risk Factors: glycosuria and diabetes mellitus, use of oral contraceptives, certain antibiotics, and pregnancy.
  • Signs and symptoms: non-malodorous but thick white vaginal discharge, severe itching, painful urination (dysuria), painful intercourse (dyspareunia), swollen labia.
  • Treatment: OTC Monistat, Fluconazole (Diflucan).
  • Patient education: no cure.

• Trichomoniasis:

  • Causative agent: Trichomonas vaginalis, a motile protozoan
  • Risk factors: sexual activity
  • Signs and symptoms: often asymptomatic; yellow-green, frothy, odorous discharge, vulvar itching, dysuria or dyspareunia.
  • Treatment: antibiotics as prescribed.
  • Complications: preterm delivery, postpartum infection, elevated risk of HIV transmission.
  • Patient education: must treat partner and abstain from intercourse until both are cured.

Risk Reduction Measures

• Know your partner.
• Decrease the number of partners.
• Test with new partners.
• Have low-risk sex; use condoms.
• Avoid sharing body fluids.
• Vaccination against Hep B, A, and HPV.

IDD and STIs

• It is incorrect to assume that people with intellectual and developmental disabilities are not sexually active; it's important to provide comprehensive education related to sexual health for individuals with IDD to prevent STIs and other health problems. These individuals often have increased risk factors including poverty, unemployment, sexual abuse, lack of sexual health knowledge, unsafe sexual behavior and poor nutritional health, which increase STI risk.

This quiz covers key information about sexually transmitted infections (STIs), including their prevalence, risk factors, and societal impacts. Understand how demographic trends and behaviors contribute to STI transmission and learn effective patient education strategies. Explore both physiological and psychological aspects of STIs to promote better health outcomes.