SEXUALLY TRANSMITTED INFECTIONS  Instruct the client in the importance of

 Also known as venereal diseases rescreening because reinfection can occur as

 Diverse group of infections spread through the client nears term.
sexual activity with an infected person  Ensure that the sexual partner is treated.
RISK FACTORS e. Complications
1. Having unprotected sex.  Sterility
2. Having sexual contact with multiple partners.  Premature and stillbirths
3. Having a history of STIs.  Infant pneumonia and eye infections leading to
4. Anyone forced to have sexual intercourse or sexual blindness
activity
5. Misuse of alcohol or use of recreational drugs.
6. Injecting drugs. B. GONORRHEA
7. Being young. a. Description and Pathophysiology
 Gonorrhea is an infection caused by Neisseria
A. CHLAMYDIA
gonorrhoeae, which causes inflammation
a. Description and Pathophysiology
of the mucous membranes of the genital and
 Most common and fast-spreading bacterial
urinary tracts.
STD
 Transmission of the organism is by sexual
 Sexually transmitted pathogen associated with
intercourse
an increased risk for premature birth, stillbirth,
 Infection may be transmitted to the newborn’s
neonatal conjunctivitis, and newborn
eyes during delivery, causing blindness
chlamydial pneumonia
(ophthalmia neonatorum- develops 2 to 5 days
 Can cause salpingitis, pelvic abscesses, ectopic
after birth)
pregnancy, chronic pelvic pain, and infertility
 Incubation period: 2-3 weeks for males;  Incubation period: 2 to 10 days
usually no symptoms (female) b. Assessment
 Causative agent: Chlamydia
trachomatis,invades the reproductive  Usually asymptomatic
structures causing tissue irritation. If untreated,  Whitish or yellowish vaginal/penile discharge
it can cause sterility in infected women; can  Urinary frequency
transmit to infants during birth; and can spread  Painful urination
to eyes by autoinoculation (self-transmission  lower abdominal pain
to other area of the body.  Painful bowel elimination with purulent rectal
b. Assessment discharge (anal infection)
 Usually asymptomatic  Sore throat (pharynx infection)
 Bleeding between periods or after coitus c. Diagnostic Procedures
 Mucoid or purulent cervical discharge  Gram staining
 Dysuria and pelvic pain  Culture of cervical and urethral smear
(confirmatory)
c. Diagnostic Procedure: culture for Chlamydia d. Management
trachomatis
Medical Management
d. Management
Medications -antibiotic therapy
Medical Management Drug of Choice: Doycycline and azithromycin
 Medications- antibiotic therapy Nursing Management
 Drug of choice: Doxycycline and azithromycin
 Obtain a vaginal culture during the initial
Nursing Management prenatal examination to screen for gonorrhea;
the culture may be repeated during the third
 Screen the client to determine whether she is trimester in high-risk clients.
high risk; a vaginal culture is indicated for all
pregnant clients if the client is in a high-risk  Instruct the client that treatment of her partner
group or if infants from previous pregnancies is necessary if infection is present.
have developed neonatal conjunctivitis or
pneumonia.
  Administer crede’s prophylaxis after birth (as to repeat the test at 36 weeks’ gestation
part of NB care) because the disease may be acquired after the
initial visit (for Pregnant women)
 Administer antibiotics as prescribed
C. SYPHILIS
 Instruct the client that treatment of her partner
a. Description and Pathophysiology
is necessary if infection is present and for
 Syphilis is a chronic infectious disease caused
follow-up
by the organism Treponema pallidum.
 Transmission is by physical contact with e. Complications:
syphilitic lesions, which usually are found on 1. Severe damage to nervous system and other organs
the skin, mucous membranes of the mouth, or (after many years)
genitals, and through placental transmission 2. Heart disease
(after 5th month of gestation) 3. Brain damage and severe illness or death (newborn)
 The infection may cause abortion or premature
labor and is passed to the fetus after the fourth D. HERPES INFECTION
month of pregnancy as congenital syphilis. a. Description and Pathophysiology
 Incubation period: 10 days to 3 months,  Increases the risk for cervical cancer
average: 21 days  Transmission: direct contact with oral or
b. Assessment (per stage) genital secretions from an infected person
during active stage, sexual contact during
Primary Stage (Most infectious stage) periods of asymptomatic viral shedding, or
 Appearance of ulcerative, painless lesions autoinoculation
(chancre) produced by spirochetes at point of  It can also be transmitted during delivery
entry into the body (mother- child transmission)
 Caused by herpes simplex virus type 2, known
Secondary Stage (Highly infectious stage) as genital herpes
 Appearance of lesions about 6 weeks to 6  The virus remains dormant in the ganglia of
months after primary stage; located anywhere nerves causing recurring of symptoms
on the skin and mucous membranes
 Generalized lymphadenopathy b. Assessment
1. Single or multiple vesicles (may rupture in 1 to 3
Tertiary Stage (Entrance of spirochetes into
days)
internal organs, causing permanent damage)
2. Painful and reddened ulcers
 Symptoms occur 10 to 30 years after untreated 3. Swelling of inguinal lymph nodes
primary lesion Invasion of central nervous 4. Flu- like symptoms
system, causing meningitis, ataxia, general 5. Headache
paresis, and progressive mental deterioration
 Deleterious effects on aortic valve and aorta c. Management
Medical Management
c. Diagnostic Procedure 1. Medications- antiviral medications (acyclovir,
1. Rapid Plasma Reagin (RPR) - screening test valacyclovir)
2. Venereal Disease Research Laboratory (VDRL) Nursing Management
3. Fluorescent Treponema Antibody Absorption Test 1. Administer medications as prescribed
(FTA- ABS) - confirmatory test 2. Instruct the client that treatment of her partner is
Note: Follow up exam: 3,6, 12 months after initial necessary if infection is present
treatment
d. Complications: Cervical Cancer
d. Management
Medical Management
1. Medications - antibiotic therapy E. VENERAL WARTS
Drug of choice: Pen G
a. Description and Pathophysiology
Nursing Management
 Also called as condylomas
 Obtain a serum test (Venereal Disease
 Causative Agent: human papilloma virus
Research Laboratory or rapid plasma reagin)
(HPV)
for syphilis on the first prenatal visit; prepare
  Transmission:  Transmitted via sexual contact \
i. genital- genital,  Associated with premature labor and birth
ii. genital- anal, b. Assessment
iii. genital- oral;  Client complains of “fishy odor” to vaginal
iv. autoinoculation secretions
b. Assessment  increased odor after intercourse.
 Single or cluster, painless soft fleshy growth c. Diagnostic Procedure
(genitalia, cervix, vagina, perineum, anus,  Microscopic examination of vaginal secretions
throat, mouth) identifies the infection.
c. Management d. Management
Medical/Surgical Management Medical Management
1. Medications- Podofilox cream 1. Medications - anti protozoal
2. Surgery- Metronidazole (Flagyl)
• excision, Nursing Management
• cauterization, 1. Sexual partner may need to be treated.
• cryosurgery 2. Administer medications as ordered
Nursing Management
1. Administer medications as ordered H. Vaginal candidiasis
2. Assist for surgery a. Description and Pathophysiology
3. Encourage annual Pap (Papanicolaou) smear.  Candida albicans is the most common
4. Sexual contact should be avoided until lesions  causative organism.
are healed (condoms reduce transmission).  Predisposing factors
o use of antibiotics,
o diabetes mellitus,
F. TRICHOMONIASIS o obesity.
 diagnosed by : identifying spores of Candida
a. Description an Pathophysiology
albicans.
 Trichomoniasis is caused by Trichomonas b. Assessment
vaginalis and is transmitted via sexual contact.
 Infection is associated with premature rupture  Vulvar and vaginal pruritus
of the membranes and postpartum  White, lumpy, cottage cheese–like discharge
endometritis. from vagina
 Transmission: contact with web objects c. Management
(towels, wash clothes, douching equipment) Medical Management
 Incubation period: 4-20 days, ave: 7 days 1. Medications -antifungal vaginal preparation such as
b. Assessment miconazole (Monistat)
1. Yellowish to greenish, frothy, mucopurulent, C2. Nursing Management
copious, malodorous vaginal discharge 1. Sitz bath to relieve extensive irritation and swelling
2. Inflammation and itching of vulva, vagina, or both 2. Sexual partner may need to be treated
may occur
3. Painful urination
4. Clear penile discharge
c. Diagnostic Procedures
1. Microscopic slide of discharge-
2. Culture test
Note: A normal saline wet smear of vaginal secretions
indicates the presence of protozoa.
d. Management
- antibiotics (metronidazole)

G. BACTERIAL VAGINOSIS

a. Description and Pathophysiology

 Caused by Haemophilus vaginalis
(Gardnerella vaginalis)
 HUMAN IMMUNODEFICIENCY VIRUS (HIV)  CD T- cell <200 mm3
AND ACQUIRED IMMUNODEFICIENCY  Development of more severe opportunistic
SYNDROME (AIDS) infection or cancer (Pneumonia and
Kaposi’s Sarcoma)
A. Definition and Pathophysiology
 Skin lesions that occur primarily in individuals
 HIV is transmitted through blood; blood with a compromised immune system
products; and other bodily fluids, such as
Assessment
urine, semen, and vaginal secretions; the virus
is also transmitted through exposure to  Kaposi’s sarcoma is a slow-growing tumor
infected secretions during birth and through that appears as raised, oblong, purplish,
breast milk. reddish brown lesions; may be tender or
nontender.
 HIV is the causative agent of AIDS.
 Organ involvement includes the lymph nodes,
 AIDS is a viral disease caused by human
airways or lungs, or any part of the
immunodeficiency virus (HIV), which
gastrointestinal tract from the mouth to anus
destroys T cells, thereby increasing
susceptibility to infection and malignancy
C. Diagnostic Procedures
 The syndrome is manifested clinically by
opportunistic infection and unusual 1. ELISA (enzyme-linked immunosorbent
neoplasms. assay) - screening test
 The disease has a long incubation period, 2. Western Blot and IFA (immunofluorescence
sometimes 10 years or longer. assay) - confirmatory test
 Manifestations may not appear until late in the 3. CD 4 T- cells monitoring
infection
 Causative agent: HIV 1, HIV 2, RNA D. Management
Retrovirus
Medical Management
B. Assessment (per stage) 1. Medications- Anti retroviral
a. Non-nucleoside reverse transcriptase inhibitors
1. Primary Infection (6 weeks to 6 months) (NNRTIs) turn off a protein needed by HIV to make
 Fever copies of itself. Examples include efavirenz (Sustiva),
 Headache rilpivirine (Edurant) and doravirine (Pifeltro).
 Muscle aches and joint pain b. Nucleoside or nucleotide reverse transcriptase
 Rash inhibitors (NRTIs) are faulty versions of the building
 Sore throat and painful mouth sores blocks that HIV needs to make copies of itself.
 Swollen lymph glands, mainly on the neck Examples include abacavir (Ziagen), tenofovir
 Diarrhea (Viread), emtricitabine (Emtriva), lamivudine (Epivir)
 Weight loss and zidovudine (Retrovir). Combination drugs also are
 Cough available, such as emtricitabine/tenofovir (Truvada)
 Night sweats and emtricitabine/tenofovir alafenamide (Descovy).
c. Protease inhibitors (PIs) inactivate HIV protease,
2. Clinical latent infection (Chronic HIV)/ another protein that HIV needs to make copies of
Asymptomatic Stage itself. Examples include atazanavir (Reyataz),
darunavir (Prezista) and lopinavir/ritonavir (Kaletra).
 In this stage of infection, HIV is still present in d. Integrase inhibitors work by disabling a protein
the body and in white blood cells. However, called integrase, which HIV uses to insert its genetic
many people may not have any symptoms or material into CD4 T cells. Examples include
infections during this time. bictegravir sodium/emtricitabine/tenofovir alafenamide
 CD4 T-cell count >500 mm3 fumar (Biktarvy), raltegravir (Isentress) and
Symptomatic HIV dolutegravir (Tivicay).
e. Entry or fusion inhibitors block HIV's entry into
 CD4 T- Cells between 200-499 mm3 CD4 T cells. Examples include enfuvirtide (Fuzeon)
 Unexplained or persistent diarrhea and fever and maraviroc (Selzentry).
 Presence of Opportunistic infections (TB, oral
Candidiasis)
Progression to AIDS
Nursing Management
1. Provide respiratory support.
2. Administer oxygen and respiratory treatments
as prescribed.
3. Provide psychosocial support as needed.
4. Maintain fluid and electrolyte balance.
5. Monitor for signs of infection.
6. Prevent the spread of infection.
7. Initiate standard and other necessary
precautions.
8. Provide comfort as necessary.
9. Provide meticulous skin care.

HEALTH INSTRUCTIONS TO CLIENTS TO

PREVENT STI’S
1. Abstain.
2. Stay with one uninfected partner.
3. Wait and test.
4. Get vaccinated.
5. Use condoms and dental dams consistently and
correctly.
6. Don't drink alcohol excessively or use drugs.
7. Communicate.
8. Consider male circumcision
9. Consider pre- exposure prophylaxis (PrEP).