Study Notes for Sexually Transmitted Diseases

 Sexually transmitted diseases (STDs) are infectious diseases transmitted most

commonly through sexual contact.

 Types of STD infections include bacterial (gonorrhea, chlamydia, syphilis) and viral
(genital herpes, genital warts).

 Most infections start as lesions on the genitalia and other sexually exposed mucous
membranes. Wide dissemination to other body areas can then occur.

 A latent, or subclinical, phase is present with all STDs. This can lead to a long-term
persistent infection and transmission of disease from asymptomatic (but infected) person
to another contact.

 Different STDs can coexist within one person.

GONORRHEA
 Gonorrhea is the second most frequently reported STD in United States.

 It is caused by Neisseria gonorrhoeae, a gram-negative diplococcus.

 Gonorrhea is spread by direct physical contact with an infected host, usually during
sexual activity (vaginal, oral, or anal).

 The initial site of gonorrhea infection in men is usually the urethra.

 Symptoms of urethritis consist of dysuria and profuse, purulent urethral discharge

developing 2 to 5 days after infection.

 Women with gonorrhea are often asymptomatic or have minor symptoms that are often
overlooked. A few women may complain of vaginal discharge, dysuria, or frequency of
urination.

 Complications of gonorrhea in men are prostatitis, urethral strictures, and sterility from
orchitis or epididymitis.

 Because women with gonorrhea who are asymptomatic seldom seek treatment,
complications are more common and include pelvic inflammatory disease (PID),
Bartholin’s abscess, ectopic pregnancy, and infertility.

 Typical clinical manifestations of gonorrhea, combined with a positive finding in a

Gram-stained smear of the purulent discharge from the penis, gives an almost certain
diagnosis in men. A culture must be performed to confirm the diagnosis in women.
  The most common treatment for gonorrhea is a single IM dose of ceftriaxone (Rocephin).
Patients with coexisting syphilis are likely to be cured by same drugs used for gonorrhea.

 All sexual contacts of patients with gonorrhea must be evaluated and treated to prevent
reinfection after resumption of sexual relations.

SYPHILIS
 The cause of syphilis is Treponema pallidum, a spirochete which enters the body through
very small breaks in skin or mucous membranes.

 In addition to sexual contact, syphilis may be spread through contact with infectious
lesions and sharing of needles among IV drug users.

 If syphilis is not treated, specific stages are characteristic of disease progression.

 In the primary stage, chancres appear. During this time, draining of microorganisms into
lymph nodes causes regional lymphadenopathy. Genital ulcers may also be present.

 Without treatment, syphilis progresses to a secondary (systemic) stage. Manifestations

include flu-like symptoms of fever, sore throat, headaches, fatigue, and generalized
adenopathy.

 The third stage is most severe stage. Manifestations include gummas, aneurysms, heart
valve insufficiency, and heart failure, and general paresis.

 Syphilis is commonly diagnosed by a serologic test. Benzathine penicillin G (Bicillin) or

aqueous procaine penicillin G remains the treatment for all stages of syphilis.

CHLAMYDIAL INFECTIONS
 Chlamydial infections are the most commonly reported STD in the United States.

 They are caused by Chlamydia trachomatis, a gram-negative bacterium that is

transmitted during vaginal, anal, or oral sex.

 Chlamydial infections are associated with gonococcal infections, which makes clinical
differentiation difficult. In men, urethritis, epididymitis, and proctitis may occur in both
diseases. In women, bartholinitis, cervicitis, and salpingitis (inflammation of the fallopian
tube) can occur in both diseases. Therefore, both Chlamydia and gonorrhea are usually
treated concurrently even without diagnostic evidence.

 Complications from chlamydial infections in men result in epididymitis with possible

infertility and reactive arthritis.

 Complications from chlamydial infections in women may result in PID, which can lead to
chronic pelvic pain and infertility.
  DNA amplification tests are the most sensitive diagnostic methods available to detect
chlamydial infections.

 Chlamydial infections respond to treatment with doxycycline (Vibramycin) or

azithromycin (Zithromax).

GENITAL HERPES
 Genital herpes is caused by herpes simplex virus type 2 (HSV-2).

 The virus enters through mucous membranes or breaks in skin during contact with
infected person.

 In general, HSV type 1 (HSV-1) causes infection above waist, involving gingivae,
dermis, upper respiratory tract, and CNS.

 HSV type 2 (HSV-2) most frequently infects the genital tract and perineum (locations
below waist).

 In a primary episode of genital herpes the patient may complain of burning or tingling at
the site of inoculation. Multiple small, vesicular lesions may appear on penis, scrotum,
vulva, perineum, perianal region, vagina, or cervix.

 Recurrent genital herpes occurs in 50% to 80% of individuals during the year following
the primary episode. Stress, fatigue, sunburn, and menses are noted triggers. Symptoms
of recurrent episodes are less severe, and lesions usually heal within 8 to 12 days.

 The diagnosis of genital herpes is confirmed through isolation of the virus from active
lesions by means of tissue culture.

 Three antiviral agents are available for treatment: acyclovir (Zovirax), valacyclovir
(Valtrex), and famciclovir (Famvir). These drugs inhibit herpetic viral replication and are
prescribed for primary and recurrent infections.

GENITAL WARTS
 Genital warts are caused by the human papillomavirus (HPV). There are over 100 types
of papillomaviruses, and about 40 of these affect the genital tract.

 Most individuals who have HPV infection do not know they are infected because
symptoms are often not present.

 Some HPV types appear to be harmless and self-limiting, whereas others are linked to
cervical and vulvar cancer in women and anorectal and squamous cell carcinoma of the
penis in men.

 Genital warts are discrete single or multiple papillary growths that are white to gray and
pink-flesh colored. They may grow and coalesce to form large, cauliflower-like masses.
  In men, warts may occur on the penis and scrotum, around the anus, or in the urethra. In
women, warts may be located on the vulva, vagina, or cervix and in the perianal area.

 Diagnosis of genital warts can be made on the basis of gross appearance of lesions.

 Genital warts are difficult to treat and often require multiple office visits with a variety of
treatments.

 Treatment consists of chemical or ablative (removal with laser or electocautery) methods.

Because treatment does not destroy the virus, recurrences and reinfection are possible,
and careful long-term follow-up is advised.

 A vaccine is now available to prevent precancerous genital lesions and genital warts due
to human HPV (types 6, 11, 16, and 18).

NURSING MANAGEMENT
 Nurses should be prepared to discuss decreasing exposure to STDs with all patients, not
only those who are perceived to be at risk.

 “Safe” sex practices include abstinence, monogamy with the uninfected partner,
avoidance of certain high-risk sexual practices, and use of condoms and other barriers to
limit contact with potentially infectious body fluids or lesions.

 Nurses can actively encourage communities to provide better education about STDs for
their citizens. Teenagers have a high incidence of infection and should be a prime target
for such educational programs.

 An STD may be met with many emotions, such as shame, guilt, anger, and a desire for
vengeance. The nurse should provide counseling and try to help patient verbalize feelings
related to the STD.