Chapter 20

ARE OF CLIENTS
WTHSEXUALLY
SrDs)
TRANSNMITTED DISEASES
oduction
Seualy transmitted diseases (STDs) have great impact in all
sn's life. STDs can negatively infiuence a person's self - dimensions of
undy afect a person's enire life and his family. concept and may

Society, oftentimes associate STDS with promiscuity or socially

ooeotable behaviors. This makes most persons afilicted with STDS hesitate to
immediate treatment. And most oiten, the disease is already in its advance
2e when the individual finally decides to consult health care workers.

Therefore, nurses need to educate high risk individuals on prevention of

FDs. Furthermore, nurses need to be alert to indicators of STDS, since prognosis
abe influenced by earty diagnosis and treatment Covert physiologic symptoms
afraquently be identified by analyzing psychosocial and sexual behavior of
óiduals.
Nursing care plans need to address a person's total needs, because the
tre body is frequently adversely affected by STDS which may range from curable
èmydia, Gonohrea, to life - kong Herpes genitalis or syphilis, and life
aening disorders, especialy HIV and AIDS.
aming Outcomes
he end lof this Chapter, the leamer should be able to:
ASsess clients for clinical manitestations of sexually transmitted diseass.
DIScuSs the etiology, risk factors and basic pathophysiology of sexually
transmitted diseases. management, follow -
Qevelop plan of care for the prevention of spread,
for clients with sexualy
care, self - management education
transmitted diseasses. maintain and promote health for clients
restore,
Implement
With
plan of care to
sexauallytransmitted diseases.
5. outcomes utilized for planning the cane of clients
Evaluate planned client
Wüh sexaually transmitted diseases.
599
 Sexually transmithed disease (STD) refers to ayinfecion contracted
Also known as STI
through sexal
ctvites or
contct.
(sexaly -
infection).
1. STD's
STD'S
can
have the
following
be
characteristics:
transmitted by any sexual activity between opposite-
same - sex partners (not only vaginal-penile sex but als0 oral
yanst
2. sex).
Having one, STD confers noimmunity against future reinftecion with
other STD (except, possibly for hepatitis R)
or with any need to be as88e8sedfor
of infected clients
3. Sexual partners
afect people from all
s0cio-economic
treatment.
classes, cuftures,
4. STD's
5. age -grOups.
Women bear adisproportionate number of the efiects of ST'S.
6. Frustration, anger, anviety,
fear, shame and guiit are
et hicest
common
associated with an STD diagnosis.
same client. ernt
7. STD'S frequenty coexist in the
The following are specific risk factors for acquiring STD's:
Intravenous (l) drug use.
Other substance abuse.
High risk sexual activity (use of prostitutes, multiple or casual sexual partvers
sex with IV drug users and infected people, unprotecked sex,
for money or drugs). exchanging
Younger age (children and adolescents).
Younger ageat sexarche (the beginning of sexual acivity).
Inner city residence.
/ Poverty
Poor nutrition
Poor hygiene
Common STD'S
1. Chlamydial infection
2. Gonorrhea
3. Syphilis
4. Genital herpes
5. Tichomoniasis
6.7. Acquired
Sexually Immunodeficiency Syndrome
transmitted enteric (AIDS)e.g.
infecions Shigellosis, salmonelts
amebiais, and giardiasis (men who have sex with men are at highest
these infecions).
1. Chlamydial Infection
Most common bacterial STD. nonmotie gam
Causative organism is Chlamydia trachomatis, a vagi
negative bacterium.
C.
Contact-
trachomatis is transmited penetat
by intimate sexual anal thobith
V intercourse
The
with an infected man, oral-anal contact, orthrouoh
pnoumoni
infecion does not cross th but passage andI
placenta conjunctivitis
Canal o an infected mother can cause
in a nevwbom.
600
 incubation perioddis 7to 21 days.
Chlanydialinfecion is known as he oreat sterilizer and the most
pelvicintammatory disease (PID) and tubal
/inportantCAUse of
/ May cause salpingitis, Inferility and ectopic pregnancy ininfertility.
women;
pdioymitisand steriityin men.
/Reltor's syndrome is a sorlos sytemlc complicaion that
occurs more
commonlyin men. The diseas consistsof urethritis, polyarthritis and
conjunctivitis.
manlfestations Incude: (may be
poriod)
asymptomatic for an extended
Fomales
Yellow, mucopurulent vaginal discharge.
Sootting st menstual midcje or with sexual intercourse. Urethitis
with dysuria (painful or difficult urination).
Urethritis with dysuria (painful or difficult urination).
. Uinary frequency.
B. Males
Urethritiss with dysuria
Clear to mucopurulent discharge
C In both sexes (due to rectal and orogenital contaact)
Proctitis (ractal infammation)
Pharyngitis
Chlamydial and gonorheal infections often coexist.
Definitive diagnosis is done through tissue culture of cellular material from
the urethra, endocervit or rectum. Oher tests incude DFA (direct
fuorescent antibody microsScopy), and EUISA (enzyme - linked
immunosorbent assay).
Medical INursing Management
Doxycycline (Vibramycin) gven orally for 7 days (reatment of
choice for chlamydial infection)or Azithromycin (Zithromax), one
dose.
All sexual partners within the last 60 days should be examined and
treated.
Infected clients shoud avoid all sexual activity until both partners are
Cured and they should use condoms thereafter.

Gonorhea
Also known as "clap," white, ""drip,""strain," and dose."
\ocal infecion involves mucosal surfaces of the cervix, urethra and
Gm; vestibular glands; pharynx or conjunciva.
Systemic infecion (disseminated gonococcal infecion) involves
baceremia andwith polyarthritis, dermatitis, endocarditis and meningits.
Teenager
Most
20 toe S
cases
24 years.
young adults are at highest risk.
oCcur In people ages 15 to 29 years, highest rate in those age
caused by the gram- negative diplococCus Nelsseria gonorhoeae.
almost aways transmitted by direct sexual contact because the
ausative norganism
necüon does not survive long outside the body.
infants ocCurs during vaginal birth, an infecion of
medical
personne through broken skin.
601
 The incubeion period is 3 to 8 days.
Cllnlcal manetaions incude (mayl be
A. Fomales
asymptomatic)
Heavy, yellow-groen, purulent vaginal
Cervical erythema
Red, wollon, sore ulva
Abnomal menstrual bleeding
discharge.
Dysuria and urinary frequency
The most common complicaton of
Botgonoea
salpingitis, which can progress to PID.
can produce Infertilty secondary
to h PID nd
B. Males
thefallopian tubes. scaring and
Purulent penile discharge
Dysuria
Urinary frequency
Complicatons
prostatitis.
of gonohea in males
incude
Both men and women may have
orogenital contact or procitis from analconjuncivitis or oplpharyngt
didymlstls
Diagnosis of gonorhea can be contact made
examination,
exudates fromidentficaion
ofthe through history,
infected areas. gon0COcCus on a smear, or cr thy d
Culture with selecive culture media
Medical I Nursing Management remains the comerstone of diaoro
Single intramuscular (IM) dose of
single oral dose of Cefixime Cefuriaxone (Rocephine)
(Suprax),
Ofloxacin (Floxin).
Note: Penicillin was the
Ciproñoxacin (Cpr
resistant organism. treatment of choica before the advert
Allpersons treated for
chlamydial infecion. gononhea need to be treated concurrenty
For cliets with
Ceftriaxone, disseminated gonococcal infecion, the treatmen
given IM or V every
hours after improvement begins, 24 hours and continued
Ciproflaxacin, followed by Catana
given orally for a full week.
All sexual partners within
undergo examination, culturetheandlast 60 days before diagnosiss
treatment
Emphasize to the cient receiving treatment for gononh
importance oftaking the complete COurse of prescribed medicabin
B. Syphills
Also called "bad blood,
The causative oganismues,""pox,
is the spirochete Treponema Palidum.
and "sypn.
Soxual When

transmission o T. pallidum OCcurs onlySyphi

Mucocutaneous lesions of primary and socondarywin mena
present.
Adolescents,
greatest risk. young adults and men who have SOx

602
 sa known cofactor for development of HIN
padm enters he body hroug h direct infectiorn.
seaual contact
aso be passed transplacentaly from an untreated
The infecion
fetus during any stage of the
disease (congenital pregnat
WOmnto her
Syphilis can progress to
paralysis, heart disease and death.irreversible blindness, mental syphilis).
ilness,
Cnical manifestations:
Primary Stage
Cenial chanre. A chancre is an oval ulcer
horder that does not bleed readily and is with a raised fim
Itdevelops in he genitalia, anus or mouth. painless unless infeced.
weeks. Chancre heals in 4 to 6
,
Lymphadenopatüly. The nodes are painless, fin and discrete.
b Secondary Stage
Develops in 6 to 8 weeks after infection.
.Generalized rash (maculopapular and nonpruritic rash); appears
on the palms of the hands and soles of the feet. The
rash is
infectious.
Generalized, nontender, discrete lymphadenopathy
Gray, mucous patches in the mouth, accompanied by sore
throat.
Condylomata lata. These are broad- based, flat papules, which
develop on the labia or anus, or at the comers of the mouth.
General flu- like manifestations (nausea, anorexia, constipation,
headache, muscle, joint and bone pain, chronic fever).
Patchy hair loss from eyebrows and scalp.
(Secondary stage manifestations usually disappear after 2 to 6
weeks).
GLatent Stage
Latent syphilis is the period after infecion with T. pallidum when a
client is seroreactive (with a positive blood test) but shows no
other evidence of disease.
During this stage, the disease is noninfectious except via
uansplacental spread or blood transfusion. It is not transmited
by sexual contact during this phase.
s Stage occurs 1 to 2 years after the primary lesion and can
L

last as long as 50 years.

TertiaryetoStage
35 years after the primary infecion, the untreated client
such as chronic bone and
joexperiences
ireversible complications
int inflammation, cardiovascular problerns, granulomatous
ophthalmic,
of the body and
lesions
auditory
(gummas)
and
on any part
central nervous system problems.
This stage may be terninal if untreated. DFA
secondary stage is by
Diagnosis
(Gark - fiekd
in the primary
microscopy)
Stage and

603
 as follows:
Other tests are
VDRL ABS tests (Fluorescent treponemal
FTA
absorption) Management
Medical and Nusing is the treatmont of
injection
o Penicillin
dose, for primary,
secondary and earty latent cholce: ghven 1
> Late latent syphilis
is treated with 3 syphilis.
weekly
A
injections.
Neurosyphilis is treated with V aquo
pericd
penicillinG.
For nonpregnant clients who are allergic
doxycycline or tetracycline may be given.
to Crystal
All people who have had seaual Contact with the c
has primary syphilis must be identified and
peni c ,
ciert who
evaluated.
Clients with primary or secondary syphilis should:
from sexual contact for att least 1 month atber absta
"Adequate treatmetis curative but reinfecction is treatment,
possible.
4. Genital Herpes
A recument, systemic viral infection.
Peak incidence is among adolescents and young adults.
Caused by hepes simplex vinus (HSV) type 2, closely related to HSy
type 1.
HSV type 1 is mainly nongenital. The infection occurs above the wae
often on the lips or nose. HSV type 2 infecion occurs primarily below
the waist as a sexualy transmitted genital infection.
HSV organism is present in the exudates of the lesion. Herpes can be
transmitted while a lesion is present and for 10 days after a lesion
has healed.
Transmission is by direct contact with the exudates during the sexa
activity, but it is possible by fomites such as towels used by an infecisd
person.
V Newborns can be infected during vaginal delivery when acive 9
lesions are present. Caesarean secion prevents this transmisson.
Clinical manifestations of genital herpes usually occur 3t0
after contact These are as follows:
Buming sensation (paresthesia) that
Vesicles with erythematous border, form painful, shalow ulcers
then crust and heal wih a scar in 2 to 4 disseminatsod
eeks.
Potential complicaions of HSV infecions are as follows: at nisttr
infecions, meningitis, transverse myelitis. Women to are carcinonaa
spontaneous
the cervix. aborion. HSV type 2 predispOSes WOmen
Diagnosis is confimed by viral
viral culture, Pap SMear.
 edical/NurngManngement
achronic dRse whout a cure. Acyclovir
herpes ks primary infection is
Cental
rocommended treatment for acute days. Episodic
orally for 7 to 10
The or Famcclovir, taken Valscyclovt Valtrex), or
Zovirax) testod with Agyclovir,
rOcurences are
takenforr5 days.
Femcickovir (Famvir) care providers is critically important. personal items
Hancdwashing by healnhave separate towels and other
should
Infoctedclients their eyes. periods. The possible isk of
avoid touchingg during latent
and should use condoms lesions are not present. smear.
Clients even when
transmission exists annual pevic examinations
and Pap
shoukd have lesionsby:
Women herpes dry.
Reducepainof involvedarea cleanandundergaments.
the nonsynthetic medications
4 Keeping loose-fitting applications and analgesic,
Wearing
Using siz bath, coolingg
3 suchasaspinin.
negative bacillus
caused by gram
Chanchroid contagious infection imegular and
multiple painful,
ahighly ducreyi.
sHoemophilus produce
ymphadenopathy.
or pustules in clients with
papules inguinal infection
/The initial ulcers with tender and syphilis
deepgenitalhigh rate of HIV infection, HSV
tested for HIV
There is a
/chancroid. also be before
chanchroid should corntactwithin
10 days
Clents with sexual treated.
/nfecionandsyphilis.
client hashad examinedand Cefriaxone givenIMin
whomthe Azithromycin orErythromycin may be
should be
/Peoplewithmanifestations
onsetof is oral
Ciprofloxacin or
Recommendedtherapy
the
alternatively,
dose;
asingle
givenorally. Acuminata)
(Condylomata vins (HP). including the
ntal Warts papilloma
human sexualcontact. genitals,
the
Caused transmited
by by with carcinoma of
Usually associsted the vuva,
STongly follows: painless clusters on glans
S meatus or
cervox and penis. as
manfestations are in multiple, area, urethral
Clinical growth thatoccur anorectal
engn penineum, occur. ofvagina
exDOsure. aso
(examination
vagina, cervix,
months after
laryngeal
lesionscan
colposcopy
penis 1to 2 and and magnifyinglens).
Oral, pharyngeal, Snmear,containing
through Pap scope
Diagnosis is with a
nd cervical tissues
 Medical and Nursing Managoment
" Thee s no cure for oenital warts.
Chemical, mechanical and ablatie techniques are
lesions. used tor
Topical treatrment: Podophyllin resin in compound
or Trichkoroacetic acid (TCA).
vubk
inchure di Berzalh
Cryotherapy of warts may be done.
Carbon dioxide lasers, elecirocautery and
can be done on extensive warts. simple surgical
7. Acquired Immunodeficiency Syndrome (AIDS)
Is a disorder caused by the human
It is
Transmission of the
1. Sexual exposure todisease is by:
immunodeficiency
characterized by generalized d,tuncion of the virus (HIV),
immune system.
2. genital secretions of an infected
3.
Parenteral exposure to infected blood and tissue. person
Perinatal exposure o an infant to infecled
through birth or matermal secretions
The syndrome is breastfeeding.
unusual neoplasms.manifested clinically by opportunistic infecion a
The disease has long
more. incubation period, someämes up to 10 yoars or
The diagnostic tests for HV
1. Enzyme - and AlIDS are as follows:
linked immunosorbent assay (ELSA). It detemines the
response of antibodies to the HIV virus.
2. Westem blot. It
3. p24 antigen. confims the presence of HIV antibodies.
TWo or more positive
infection. results are diagnostic for HIN
4. CDt. It is
used to assess immune
progression. status, risk for disease
High risk groups for AlDS are
Male as
follows:
homosexuals
Intravenous drug
or
bisexuals.
abusers.
Persons
receivingg blood transfusions, e.g., hemophiliacs,
clients. surgia
Frequent exposure to blood and body
Heterosexual
Babies bom tocontact with high - risk fluids.
infected mothers. individuals.
The clinical
manifestations
Malaise, weight loss of AIDS are as follows:
Lymphadenopathy for at least 3 months
Leukopenia
Diarhea
Fatigue
Night sweats
Presence of opportunisticinfections
Pneumocystic carini pneumonia.
Kaposi's sarcoma
606
 Fungalinfections
Candioiasis
cytomegalovirus

claborative management for clionts with AIDS indude the followwng:

Implement:standard precaution.
Promoterespiratory funcion.
Provideadequate nutritional support
Maintainfluid and electrolyte balance,
Promotecomfort
infecion.
Monitorfor signsof
Proper handwashing when caing for clients with
Best Practice: AIDS.
HNintectionand
AIDS
ledications for HIV and Inhibitors
iNucleoside Reverse Transcriptase
Ziagen (Abacavir), Videx (Didanosine), Epivir (Lamivudine),
Ritrovir, AZT (Zidovudine)
i. Can cause nausea, vomiting, diahea
b. Didanosine, Stavudine, Zalcitabine (HIVID)
L Can cause neuropathy, hepatotoxicity and pancreatitis.
2 Antiviral Medications
a Cytovene (Ganciciovir). Is used to treat cytomegalovius retinitis. It
causes bone marrow depression.
b. Zovirax (Acyclovir). Is used to treat hepes simplex, herpes Zoster
or varicella zoster. It is nephrotoic.
C Foscavir (Foscanet). It is used to treat cytomegalovirus retinitis. It
is nephrotoxic.
Antiinfective Medications
a. Pentam 300 (Pentamidine). Is used to treat pneumocystis carinü
pneumonia. is nephrotoxic, hepatotoxic and
Immunosuppressive. It may cause hypotension and hypoglycemia.
D. Flagyl (Metronidazole), Is used to treat cryptosporidiosis and
giardiasis. Avoid alcohol during treatment to prevent disuffiram
like manífestations.
Antifungal Medications
a. Nizoral (Ketoconazole). Is used to treat candidiasis,
or histoplasmosis. It is hepatotoxic and may
coccidioidomycosis
use photosensitivity. Avoid alcohol during treatment to prevent
iver damage.
b. Difucan (Fluconazole). Is used to treat candidiasis. It is
". hepato toxic.
Fungizone (Amphotericin B). Is used to treat candidiasis and other
fungal infecions. It is nephrotoxic, can cause thrombophlebiis
and bone marrow depression.

607
5. Proease inhibitors
a. Agenerase (Amprenavir). It is nephrotoxic.
b. Crùdvan (Indinavir). It causes hypertbilirubinemia,
kidney stones.
c. Kaletra (Lopinavir and Ritonavin). It is hepatotoxjc nephritis nd
d. Viracept(Nelfinavi). It can ause nausea, flaulence
e. Norvir (Ritonavi). It is hepatotoxic and
increasesand diarhea
levels.
tigyceita