STI Student Notes PDF

SEXUALLY TRANSMITTED INFECTIONS Professor Marissa Ferrentino, MSN RN STUDENT LEARNING OUTCOMES Describe assessment techniques related to STI’s. Explain primary interventions related to prevention of STI’s. Distinguish treatment modalities and nursing interventions for selected STI’s. Examine a teach...

SEXUALLY TRANSMITTED INFECTIONS Professor Marissa Ferrentino, MSN RN STUDENT LEARNING OUTCOMES Describe assessment techniques related to STI’s. Explain primary interventions related to prevention of STI’s. Distinguish treatment modalities and nursing interventions for selected STI’s. Examine a teaching plan for client’s with STI’s. STI DEFINITION Sexually transmitted infections (STI) are infectious diseases that are spread through sexual contact with the penis, vagina, anus, mouth, or sexual fluids of an infected person. STIS Bacterial Gonorrhea, syphilis, chlamydial Viral Genital herpes, genital warts, human immunodeficiency virus infection, hepatitis B and C, Molluscum Parasitic/Protozoan Infection Trichomoniasis All cases of gonorrhea, syphilis and chlamydial infections must be reported RISK FACTORS FOR STIS High Risk Behaviors - alcohol/drug use - More than 1 sexual partner Medical History - Having 1 STI places you at higher risk for another - Unvaccinated High-Risk Populations - Under 25 yrs of age - Ethnicity - Transgender persons - Victims of sexual assault - Women ASSESSMENT Most STI are asymptomatic – once symptoms appear complications may occur - Dysuria, urethral discharge, frequency - Anorectal pain, pruritus - Epididymis (red, swollen scrotum) - Cervicitis (mucopurulent drainage, bleeding, pain with intercourse) Complications: infertility, PID DIAGNOSIS Thorough history and physical exam Sexual history - number of partners, types of partners, type of birth control, use of condoms, history of STI, use of drugs, risk of violence Urine tests Cultures CHLAMYDIA Most common reportable STI - Often poorly managed, inaccurately diagnosed or undiagnosed until complications - Diagnosis through NAAT urine test, testing for other STIs - Regular screening in high-risk populations - Treatment: - Azithromycin or Doxycycline - No sexual activity for 7 days after treatment - Expedited partner therapy GONORRHEA Caused by Neisseria gonorrhea Spread through sexual fluids Diagnosis: NAAT test, testing for others, culture Men more likely to have symptoms than women Treatment: IM ceftriaxone with oral Azithromycin **must get 2 antibiotics** Complications: disseminated gonococcal infection, neonatal gonococcal conjunctivitis TRICHOMONIASIS Parasitic infection Transmitted through sexual fluids Cervix may have strawberry appearance Inflammation and irritation can put these patients at higher risk for HIV NAAT testing, cultures Treatment: metronidazole (Flagyl) or tinidazole (Tindamax) GENITAL HERPES Life-long incurable infection - HSV 1 or HSV 2 (1 is more common with oral lesions, 2 with genital) - Spread through contact with infected person - Viral reactivation occurs when virus goes back to initial site of infection (stress, sunburn, illness, fatigue) - Greatest risk of transmission when lesions are present - Asymptomatic viral shedding - Diagnosis: culture of lesions GENITAL HERPES CONT. GENITAL HERPES CONT. Clinical Manifestations: Prodromal stage: before lesions appear, burning, itching, tingling at site Vesicular stage: blisters appear Ulcerative stage: lesions rupture and form ulcerations Final stage: crusting and epithelization occurs - May have flu-like symptoms with first episode - Recurrent episodes usually shorter and lesions heal faster GENITAL HERPES CONT. Treatment: Anti-virals - acyclovir, famciclovir, valacicolvir - Inhibit herpetic viral replications - IV acyclovir for severe life-threatening infections Good hygiene, loose-fitting clothes Keep eruptions clean and dry Complications: blindness, encephalitis, meningitis - C-Section is needed if mother has active lesions at time of birth GENITAL WARTS Caused by HPV - Low risk causes warts on skin - High risk causes it on genitals and can lead to cancers - Skin-to-skin contact, non-penetrating sexual activity - Diagnosis: visualization, biopsy - Asymptomatic, discrete growths. - Grow to be larger – 1 to 10 genital warts GENITAL WARTS CONT. HPV vaccines 3 vaccines available – Quadrivalent (Gardasil) 2 or 3 IM doses over 6 month period Does not treat active HPV Wart removal Chemically or ablation Cryotherapy Laser GENITAL WARTS CONT. 80-90% trichloroacetic acid (TCA), Bichloroacetic acid (BCA) Physician’s office for 3-6 treatments Not washed off after treatment Podofilox liquid and gel prescriptions (Condylox and Condylox gel) At home Applies for 3 consecutive days, followed by no treatment for 4 days Imiquimod cream (Aldara): immune response modifier Applied at bedtime Three times a week up to 16 weeks SYPHILIS Bacterial STI - Direct contact with a syphilitic ulcer (chancre) - Can be transmitted to fetus - Can cause irreversible damage to skin, bone and liver - Can cause heart problems and neuro problems (if invades corresponding areas) SYPHILIS Stages Primary: highly infectious - Development of chancre Secondary: highly infectious, a few weeks after chancre heals - Maculopapular rash on hands/feet, flu-like symptoms Latent: lasts throughout life-late stage - Asymptomatic Late: Noninfectious - Organ damage: personality changes, heart valve issues, gummas (destructive lesions) SYPHILIS RASH SYPHILIS Diagnosed by blood test - Venereal Disease Research Laboratory (VDRL) and Rapid Plasma Reagin (RPR): screen for antibodies - Confirmed by fluorescent treponemal antibody absorption (FTAAbs) test - HIV testing Treatment: Penicillin G benzathine - Cannot reverse damage - All sexual contacts from 90 days should be treated - Follow-up testing every 6 months up to 2 years STI NURSING MANAGEMENT Health Promotion - Safer sex practices - Limiting sexual contacts - Addressing drug and alcohol use - Teaching special populations - Education about signs and symptoms - Proper condom use STI NURSING MANAGEMENT Screening programs Voluntary prenatal, HIV clinics, gonorrhea, chlamydia Education and research Educational programs for high risk populations HPV Vaccines STI NURSING MANAGEMENT Acute Care Psychologic Support - embarrassment, guilt - Encourage patient to voice feelings - Referrals to professional counseling - Educate about diagnosis - Online or local support groups STI NURSING MANAGEMENT - Follow up - Hygiene Measures - Hand washing - No scratching at sites - Sexual Activity - Ambulatory Care SEXUAL DYSFUNCTION STUDENT LEARNING OUTCOMES Describe sexual dysfunction disorders Explain sexual disorders Distinguish treatment modalities and the role of the nurse in the care of the client with sexual disorders Examine the application of the nursing process in the planning and delivery of care to the patient with sexual dysfunction ERECTILE DYSFUNCTION Inability to attain or maintain an erect penis that allows satisfactory sexual activity. Interfere with a man’s Self esteem, confidence, relationships Can occur at any age More than 10 million men in the US Can be physiologic or psychologic in nature - diabetes, heart disease, alcohol, drugs, trauma ERECTILE DYSFUNCTION Clinical Manifestations Inability to attain or maintain an erection May occur occasionally with a gradual onset or a sudden onset ERECTILE DYSFUNCTION Diagnosis: - sexual, health and psychosocial history. - International Index of Erectile Dysfunction (IIEF) - Screening tool that asks 5 areas of male sexual function - Rule out physiologic issues: glucose, A1C, lipid profile, hormone levels, CBC, thyroid - Vascular studies to assess blood flow ERECTILE DYSFUNCTIONTREATMENTS Collaborative Care Oral drug therapy- Erectogenic Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra, Staxyn), avanafil (Stendra) Smooth muscle relaxation and increased arterial inflow Taken 1 hour before sexual activity Do not take with nitrates-mostly sildenafil*** Watch for blurred vision, sudden hearing loss and an erection lasting longer than 4 hours Vacuum Erection device ERECTILE DYSFUNCTION Collaborative care Intraurethral devices and Intracavernosal injections Vasoactive drugs Alprostadil (Caverject, Edex) Insertion of a medication pellet into the urethra or by injection Papaverine, phentolamine and alprostadil (Trimix) Injected into the penis Enhance blood flow into the penile arteries Side effects: Headache, dyspepsia, flushing and nasal congestion Rare side effects: blurred or blue-green visual disturbances, sudden hearing loss and erection lasting more than 4 hours Penile implants Sexual counseling PRACTICE QUESTION The nurse understands that which of the following are correct about syphilis? Select all that apply. a. A chancre is a common symptom in late syphilis. b. Neurosphyilis invades the CNS and may occur at any stage of syphilis. c. The most infectious stages of syphilis are the primary and secondary stages. d. Latent infections are detected primarily by visual inspection. e. Penicillin G is the preferred treatment for all stages of syphilis. PRACTICE QUESTION Which statement is correct when providing discharge instructions to a patient with genital herpes? a. Genital herpes is an infection that is always symptomatic. b. Genital herpes is a mildly contagious infection. c. Genital herpes is an infection that can be cured by antivirals. d. Genital herpes can be transmitted without displaying any symptoms. PRACTICE QUESTION The nurse recognizes that which statements are true of gonorrhea? Select all that apply. a. Gonorrhea is caused by N. Gonorrhoeae. b. Concurrent infection with chlamydia is common so testing for both is recommended. c. It is best to collect the urine late in the day when urine is diluted. d. A hallmark symptoms in male patients in purulent urethral discharge. e. The NAAT is effective in the detection of a urethral infection with gonorrhea. PRACTICE QUESTION The nurse recognizes that which patient is at the great risk for an STI? a. A 21-year old female who attends college. b. A 60 year old male married for 30 years. c. A 35 year old pregnant female. d. A 13 year old male who has not engaged in sexual activity. PRACTICE QUESTION A patient is complaining of an inability to achieve an erection. The nurse realizes this may be related to a personal medical history of which condition? a. Crohns disease b. Hepatitis C c. Migraines d. Diabetes REFERENCES Lewis, Dirksen, Heitkemper and Bucher. 2020. Medical-Surgical Nursing. 11th edition. Elsevier: Missouri