Learning Objectives:

1. Discuss common health problems among adolescents

2. Identify different diagnostic tests and tools
3. Explain the clinical manifestations and nursing intervention for these health problems

Learning Outcomes:
1. Perform nursing care to adolescent clients with health problems
2. Utilize the nursing process in the delivery of care
DISORDERS OF SKELETAL STRUCTURE

Spinal disorders in children may include kyphosis (an outward

curvature of the spine) or lordosis (an inward curving of the spine) but
scoliosis (a sideways curve) is the most commonly seen disorder.

Functional (Postural) Scoliosis

Scoliosis is a lateral (sideways) curvature of the spine. It may involve
all or only a portion of the spinal column. It may be functional (a curve
caused by a secondary problem) or structural (a primary deformity).

Functional scoliosis occurs as a compensatory mechanism in children

who have unequal leg lengths, in children with ocular refractive errors
that cause them constantly to tilt their head sideways, or children with
accompanying neuromuscular disorders such as cerebral palsy

The pelvic tilt caused by unequal leg length or muscle strength results in
a spinal deviation because this is necessary for the child to stand
upright. The curve that occurs in functional scoliosis tends to be a C-
shaped curve, whereas that in structural scoliosis tends to be S-shaped
(composed of two separate curves).
Structural Scoliosis
Structural scoliosis is idiopathic, permanent curvature of the spine accompanied by damage to the
vertebrae. The spine assumes a primary lateral curvature. To allow the child to hold the head level, a
compensatory second curve develops, giving the spine an S-shaped appearance. The primary curve is
often a right thoracic convexity. As the original curve becomes severe, rotation and angulation of vertebrae
occur. The thoracic rib cage rotates to become very protuberant on the convex curve. Vertebral growth may
halt because of extreme pressure changes.
Assessment
1. All children older than 10 years of age should be assessed for scoliosis at all health assessment visits
• condition develops insidiously and is prominent before it is noticed
2. A scoliometer (a type of protractor), can be used to document the extent of a spinal curve.
• a reading greater than 7 degrees equals a 20-degree scoliotic curve detected by radiography
Therapeutic Management

1. if the spinal curve is less than 20 degrees, no therapy is required except for close observation until
the child reaches about 18 years of age.
2. If the curve is greater than 20 degrees, treatment may consist of a conservative, nonsurgical
approach using a body brace or traction, or it may include surgery or a combination of both surgical
and nonsurgical measures.
3. Curves greater than 40 degrees require surgery with spinal fusion
Bracing. If the spinal curve is greater than 20 degrees but less than 40 degrees and the child is still
skeletally immature, bracing, one of the oldest forms of correction, is still a prime intervention

Charleston Bending
Brace

The brace is worn for 23 hours per day to be removed only for showering or participation in a
structured athletic program.
At night, the child may wear a Charleston Bending Brace that confines the spine to an
overcorrected position.
Nursing Diagnosis: Situational low self-esteem related to obviousness of the brace used for scoliosis
correction
Outcome Evaluation: Child states positive aspects of self; participates in activities; establishes
friendships with peers.

1. Encourage children to voice what it feels like to have to wear a brace of this size constantly.
A scoliosis brace typically is worn until the child’s spinal growth stops (at about 141⁄2 years of
age in girls, 161⁄2 years in boys), as demonstrated by spinal radiographs.
2. Help them to concentrate on things they can do, such as having a friend over or going to the
movies, rather than those things they cannot do because of the brace (play a contact sport)

Halo Traction.
Halo traction is typically used for children who have such
severe scoliosis they experience respiratory involvement,
cervical instability, a high thoracic deformity, or decreased
vital capacity from severe spinal curvature and rotation.
Halo traction is prescribed for about 3 months’ time.
Surgical Intervention: Spinal Instrumentation.
Surgical correction usually is necessary if the spinal
curvature is greater than 40 degrees. Instruments, such
as rods, screws, and wires, are placed next to the spinal
column to provide firm reduction of the curvature; the
spine is then fused in the corrected position.
Bone from the iliac crests may be used to strengthen
 BONE TUMORS

Tumors derived from connective tissue, such as bone and cartilage, muscle, blood vessels, or lymphoid
tissue, are called sarcomas. They are the second most frequently occurring neoplasms in adolescents
(only lymphomas occur more frequently).

• Bone tumors may arise during adolescence because of rapid bone growth is occurring at this time.
Because girls have a puberty growth spurt earlier than boys, bone tumors tend to occur slightly earlier
in girls than in boys (13 compared with 14 or 15 years of age).
• The two most frequently occurring types are osteogenic sarcoma and Ewing’s sarcoma
Osteogenic Sarcoma
An osteogenic sarcoma is a malignant tumor of
long bone involving rapidly growing bone tissue
(mesenchymal-matrix forming cells). It tends to
occur more commonly in boys than in girls.
The most common sites of occurrence are the
1. distal femur (40% to 50%),
2. proximal tibia (20%),
3. proximal humerus (10% to 15%).
Metastasis occurs early because of the
extensive vascular system in bones .

• Metastasis to the lungs is the most

common site. 25% of adolescents have
lung metastasis already by the time of
initial diagnosis.
• S/S with lung metastasis are chronic
cough, dyspnea, chest pain, and leg
pain (if the tumor originates in the leg).
Other common sites of metastasis are
brain and other bone tissue.
 Assessment
1. Pain and swelling are the most common presenting
symptoms.
2. The pain increases with activity and weight bearing and may
cause the child to limp. It is common for a child to have a dull
aching pain for several months before diagnosis.
3. Palpation at the site of disease often reveals tenderness,
swelling, warmth, and erythema
DIAGNOSIS. An x-ray fi lm may include a sunburst pattern
of the affected bone. An accompanying chest x-ray
exam should be performed to check for metastasis. A MRI
of the entire bone should be performed to evaluate the
extent of the tumor.
Therapeutic Management
The primary treatment goal is total eradication of the tumor
• Chemotherapy to shrink the tumor before surgery. Parents may be very concerned with this delay. They
need an explanation that, with bone tumor, this is an accepted and helpful intervention before surgery.
.
Nursing Diagnosis: Risk for injury related to surgery and bone prosthesis
Outcome Evaluation: Extremity distal to surgical incision remains warm to touch; capillary filling is less than
5 seconds; adolescent reports no tingling or numbness in distal extremity.

1. Always position and handle the leg carefully to prevent further disruption.
2. Assess frequently for signs that the neurologic and circulatory systems are intact
• distal to the surgery (toes are warm and pink
• Capillary filling is less than 5 seconds; adolescent reports no numbness or tingling).
3. Administer analgesic
Adolescents who had pain in the leg before surgery may continue to feel this pain even after the
involved bone segment has been removed. This is known as phantom pain, and it occurs because
nerve tracts continue to report pain for a time after the pain has been relieved.
Ewing’s Sarcoma

Ewing’s sarcoma is the second most common type of bone tumor in children and young adults. Ewing’s
sarcoma is a highly malignant bone tumor with a histologic appearance that is different from that of
osteosarcoma. Ewing’s sarcoma tumors can occur anywhere in the body but is typically found in bones
other than the long bones of the arms and legs. The most common sites are the pelvis, the arms and
legs, and the ribs
ASSESSMENT.
Similar to those of osteosarcoma.
1. Pain or tenderness and swelling at the site of the tumor are
the usual presenting symptoms. The bone pain or swelling
may be attributed to a sports injury and caregivers may
delay seeking care.
Radiographs reveal an unusual “onion-skin” reaction
(overlapping fine lines disclosed on the x-ray film) surrounding
the invading tumor cells.
Therapeutic Management
1. surgery to remove the primary tumor,.
2. Chemotherapy - drugs often used are vincristine, cyclophosphamide, doxorubicin,
3. Irradiation of the entire involved bone may be scheduled.
About 50% of children survive for at least 5 years; older children have a better survival rate than younger
children.
 Accidents- Trauma in Injury
Accidents, such as those involving motor vehicles, falls, burns, and water immersions, cause more deaths
in the 1- to 4-year age group than the next six most prevalent causes combined. In the 15- to 24-year age
group, they cause half of the deaths of the age group.
Accidents become fatal when lung, heart, or brain function becomes inadequate. These three body systems,
therefore, must be evaluated first (Airway, Breathing, Circulation and Disability, or an ABCD evaluation).
Important Assessments on Initial Examination of an Injured Child

Body System Assessment

Respiratory System Quality of respirations

Rate of respirations
Sound of obstruction (wheezing, stridor, retractions, coughing?)
Color (cyanotic?)
Oxygen hunger (restlessness, inability to lie flat?)
Cardiovascular system Color (pallor from hemorrhage or cardiovascular collapse?)
Gross bleeding
Pulse rate (increases with hemorrhage)
Blood pressure (decreases with hemorrhage)
Feeling of apprehension from altered vascular pressure

Nervous system Level of consciousness (child answers questions coherently, infant attunes to parent’s voice?)
Pupils (equal and reacting to light?)
Bumps or bruises on head or spinal column
Loss of motion or sensory function in a body part
HEAD TRAUMA
Children receive head injuries when they are involved in multiple- trauma
accidents, such as automobile crashes. Falls from swing sets, porches, and
bunk beds also cause many head injuries. Other children are injured by being
struck on the head by an object, such as a baseball, rock, or hockey puck, or by
falling from a bicycle.
Head injuries are always potentially serious not only because they can cause an immediate threat to
the life of the child, but also because several complications may follow.
Immediate Assessment
1. neurologic assessment as soon as they are seen and again at frequent intervals to detect signs
and symptoms of increased intracranial pressure (ICP). Increasing pressure puts stress on the
respiratory, cardiac, and temperature centers, causing dysfunction in these areas.
• With increased pressure, the pupils become slow or unable to react immediately.
• Level of consciousness and motor ability decrease, pulse and respiratory rates decrease,
and temperature and pulse pressure increase.

2. Assess vital signs to detect these changes and observe children’s pupils to be certain that they
are equal and react to light.
3. Assess children’s level of consciousness and motor function.
4. Stabilize the neck with a brace until cervical trauma has been ruled out.
Immediate Management
After a head injury, brain edema is likely because fluid rushes into the inflamed and bruised area.
1. Both central venous and central arterial lines may be inserted.
• ICP monitoring may be initiated
• A computed tomography (CT) scan or magnetic resonance imaging (MRI) will be ordered to
determine areas of edema or bleeding.
• An attempt may be made to decrease brain edema by intravenous (IV) administration of a hypertonic
solution, such as mannitol. This will increase intravascular pressure and shift the edema fluid back
into the blood vessels.
• Steroids such as dexamethasone may be added to decrease inflammation and edema.
• Keeping the head elevated is also effective in reducing ICP.

Nursing Diagnosis: Risk for excess fluid volume related to administration of hypertonic solution
Outcome Evaluation: The child’s respiratory rate remains between 16 to 24 breaths/minute; specific
gravity of urine is between 1.003 and 1.030; pulse remains between 60 to 100 beats per minute; blood
pressure remains consistent for age group; lungs are clear to auscultation.
1. assess vital signs frequently to be certain that the fluid load being pulled into the intravascular
system does not overtax it. This fluid must be excreted by the kidneys to keep the vascular system
from becoming overloaded.
2. Keep accurate intake and output records to ensure that the kidneys are functioning
3. test the specific gravity of urine to detect the development of pituitary compression and resultant
overproduction or underproduction of antidiuretic hormone from the posterior pituitary.
Nursing Diagnosis: Risk for delayed growth and development related to late sequelae of head injury
Outcome Evaluation: Child shows no evidence of any alteration in thought processes, seizure activity,
or memory at follow-up visits. Cognitive and physical development are appropriate for age.
1. Offer information on the child’s progress as it becomes available to you.
2. Urge parents to help care for the child to increase their sense of control.
3. During the acute phase of illness, ensure that parents are informed about the dangers of
increased ICP. If they ask about the possibility that personality changes or seizures will develop
later in life, their questions should be answered truthfully.

Skull Fracture
A skull fracture is a crack in the bone of the skull .
Recognizing skull fractures in children is important,
because associated cerebral injury often occurs under the
fracture.
• Many skull fractures are simple linear types, most
often involving the parietal bones.
In some children, the skull does not fracture, but the
suture lines separate. This occurs more commonly in the
lambdoid suture line; a coronal suture separation is rare
and, if present, indicates severe trauma
Assessment
If the base of the skull is fractured, a child usually exhibits
1. orbital ecchymosis ( Racoon’s eyes) or postauricular ecchymosis ( Battle Sign)
2. Rhinorrhea or otorrhea (clear fluid draining from the nose or ear, respectively) may be present.
This is escaping cerebrospinal fluid (CSF)—a serious finding, because it means that the child’s
central nervous system is open to infection. Test the fluid discharge with a glucose reagent strip if
there is doubt about the source of the drainage. CSF will test positive for glucose, whereas the
clear, watery drainage from an upper respiratory tract infection will not.
3. shock, investigate for bleeding points other than the head injury. Skull fractures are confirmed
by skull radiography. If a skull fracture is linear with no underlying pathology, no treatment
except observation and prescription of an analgesic is necessary.
4. In about 3 weeks, a repeat radiograph will be needed to confirm that healing has taken place.
Parents can be reassured that a second radiograph this soon is not harmful but necessary. If a
fracture is depressed (a bone fragment is pressing inward) or compounded (bone is broken into
pieces), surgery will be necessary to remove or repair broken fragments.
Therapeutic Management
1. If CSF is draining from the nose, a child will be admitted to the hospital for observation.
2. Keep the child in a semi- Fowler’s position so that fluid drains out, not inward, to reduce the
possibility of introducing infection.
3. Make certain that children do not attempt to hold their nose or pack their nostrils with something to
halt the drainage. Because coughing and sneezing may allow air to enter the meningeal space,
coughing may be suppressed by medication.
4. If the drainage is excoriating to the upper lip, coat the space with petrolatum.
5. prophylactic antibiotic to reduce the risk for meningitis.
6. If the drainage does not stop within a few days, surgery will be necessary to repair the fracture and
reduce the danger of meningitis. Air that enters intracranial spaces usually is absorbed rapidly.
7. If radiographs at 72 hours still show air in the cerebral spaces, it implies that a skull defect
remains, and surgery may be indicated to close the defect.
Concussion
Concussion is the temporary and immediate
impairment of neurologic function caused by a hard,
jarring shock. It may occur on the side of the skull that
was struck (a coup injury) or on the opposite side of the
brain (a contrecoup injury)
As the brain recoils from the force of the blow and
strikes the posterior surface of the skull, this second
injury occurs. Children have at least a transient loss of
consciousness at the time of the injury. They may vomit
and may show irritability after regaining consciousness.
They typically have no memory (amnesia) of the events
leading up to the injury or of the injury itself.

Contusion
A brain contusion occurs when there is tearing or laceration of
brain tissue The symptoms are the same type as for concussion
but more severe. In addition, there are specific symptoms related
to the lacerated brain area such as a focal seizure, eye deviation,
or loss of speech. Surgery may be necessary to halt bleeding. The
child’s prognosis depends on the extent of the injury and
effectiveness of therapy.
Coma
Coma (unconsciousness from which a child cannot be roused) or
stupor (grogginess from which a child can be roused) may be
present in children after severe head trauma.

Coma and stupor are both symptoms of underlying disorders;

a history of the injury must be obtained so that treatment can be
directed specifically toward the cause.
Assessment
1. Obtain a history to determine the circumstances immediately before the time the child became
comatose.
2. Assess children in coma carefully and completely, so that the cause of the decreased
consciousness can quickly be determined.
3. Undress the child completely so that all body parts can be inspected.
4. Count respirations and pulse and measure blood pressure to establish baseline values, because
changes in these values often provide good clues regarding the cause of coma.
• A child with increased ICP, for example, will show decreased pulse and respiratory rates and
increased blood pressure.
• Diabetes, in contrast, leads to increased respirations.
• Hemorrhage leads to an increased pulse rate and decreased blood pressure.
• Drug ingestion may lead to either increased or decreased measurements, depending on the drug
ingested.
Therapeutic Management
If children are unconscious for longer than a transient period, they usually are admitted to an observation
unit for further assessment.
• place a child who is comatose on the side to reduce the risk of aspiration.
• Oral suctioning - to remove mucus from the mouth and pharynx .
• If a child has acute signs of respiratory difficulty, endotracheal intubation may be necessary to ensure
respiratory function.
• An IV route is established so that, when specific measures such as blood replacement, electrolyte
replacement, or fluid replacement are needed, a route for immediate administration will be available.
• complete blood count, electrolyte determination, toxicology tests, and cross-matching. If the cause of
the coma is unknown,
• a lumbar puncture and EEG may be done. Skull radiography, CT scan, or MRI may be done.

A child’s prognosis after coma depends on the initial cause of the coma. If the increased
ICP can be relieved before any permanent brain damage results, the effects of the coma
will be transient.
Glasgow Coma Scale A.M. P.M. A.M.
Assessment Reaction Score 8 10 12 2 4 6 8 10 12 2 4 6 8
Eye Opening Spontaneously 4 X X X X X X
Response
To speech 3 X X
To pain 2 X X X
No response 1
Motor Response Obeys verbal command 6 X X X X X X
Localizes pain 5 X X
Flexion withdrawal 4 X X
Flexion 3 X
Extension 2
No response 1
Verbal Response
Oriented x3 5 X X X X X X
Conversation confused 4 X X
Inappropriate speech 3 X
Incomprehensible sounds 2 X X
No response 1
FIGURE 52.5 Glasgow Coma Scale scoring for a child. A score of 3 to 8 denotes severe trauma; 9 to 12, moderate trauma;
13 to 15, slight trauma. Notice the gradual improvement from coma in this example
Nursing Diagnosis: Risk for imbalanced nutrition, less than body requirements, related to inability to
take in oral food or fluid
Outcome Evaluation: Child’s skin turgor is normal; weight remains within acceptable percentile; hourly
urine output remains greater than 1 mL/kg.
1. nutrition is maintained by nasogastric (NG) or gastrostomy tube feedings, IV fluid administration, or
total parenteral nutrition. (to prevent aspiration)
2. IV fluid is only a short-term answer, beause adequate protein and fat cannot be supplied solely by
this route.
3. NG or gastrostomy feedings can supply total nutrient needs. Always aspirate NG or gastrostomy
tubes for stomach contents before giving a feeding to check tube placement and assess gastric
residual amounts.
4. Return any amount of stomach residue aspirated, because if this is discarded each time, a child will
lose a large amount of stomach acid, possibly leading to alkalosis

5. Check whether the amount of the feeding should be reduced by the amount of fluid remaining in
the stomach before feeding the full amount of prescribed formula.
6. Give mouth care at least twice daily with clear water and a padded tongue blade.
7. Coat lips with petrolatum to prevent drying and cracking.
8. Close the eyes to prevent drying and corneal ulceration. Artificial tears (methylcellulose) may be
prescribed to keep eyes from drying until the child regains consciousness.
AMENORRHEA
Amenorrhea refers to the absence of menses.
1. Primary amenorrhea is when no menses occur by the age of 17.
2. Secondary amenorrhea implies that menses have been established, but have ceased for a minimum
of 3 months.
• corpus luteum cyst, lactation, menopause (premature or normal)
• hypothyroidism or hyperthyroidism, chemotherapy, polycystic ovarian syndrome (PCOS),
diabetes mellitus, stress, excessive exercise, weight loss, and

Pregnancy must always be considered as a cause of secondary amenorrhea, even if the patient denies
sexual contact.

SIGNS AND SYMPTOMS. In primary amenorrhea, the patient may exhibit abnormalities in body habitus,
suggestive of delayed puberty. The Tanner stages of sexual characteristic development may show
delays. In cases of secondary amenorrhea, signs and symptoms of pregnancy include mastalgia (breast
tenderness); breast enlargement; nausea and possibly vomiting, especially in the early morning;
gastrointestinal upset; and urinary frequency. On examination, the uterus may be enlarged and
Chadwick’s sign (blue or violaceous cervix) may be present, a probable sign of pregnancy that becomes
evident about the fourth week of gestation.
DIAGNOSIS. In
the absence of menses, a number of laboratory tests and other diagnostic tests are
often necessary in the diagnostic evaluation of amenorrhea.
diagnostic tools Determining Reason for Amenorrhea
• Genetic testing may be required to determine disorders such as Turner’s syndrome.
• Pelvic ultrasound or transvaginal (ultrasound wand in the vaginal canal) is used to test for
pregnancy, ovarian cysts, and other gynecological abnormalities. Patients normally are required to
drink four 8-ounce glasses of water 1 hour before a pelvic ultrasound to elevate the bladder in order
to view the pelvic organs.
Labs: Tests for Amenorrhea
• Urine pregnancy test (urinary HCG): these tests are widely available over-the-counter
• Serum pregnancy test (qualitative or quantitative tests show positive pregnancy and approximate
duration of pregnancy, respectively). Considered more accurate than urine pregnancy tests and identify
pregnancy earlier.
• Thyroid stimulating hormone (TSH) is a general test for hypothyroidism and hyperthyroidism.
• Prolactin level: elevated in hyperprolactinemia, which may be seen with hypothyroidism or with a benign
pituitary adenoma. Prolactin is a hormone produced in the pituitary gland and is associated with
breastfeeding.
• Levels of follicle stimulating hormone (FSH) may be low in PCOS.
• Levels of luteinizing hormone (LH) may be elevated in PCOS.
• Testosterone levels may be high in PCOS, in addition to dehydroepiandrosterone (DHEA) levels.
NURSING CARE.

The nurse must realize that some adolescent girls are unaware that pregnancy is possible with just
genital contact. Often pregnant adolescents may be in a state of denial.
The nurse should evaluate the patient with amenorrhea for signs and symptoms of pregnancy first,
including weight gain, unprotected coitus, fatigue, nausea and vomiting, and mastalgia (tender breasts). A
urinary human chorionic gonadotropin (hCG) test may be run and may turn positive within days after a
missed menses.

In cases of possibly false-negative urine pregnancy tests, it is necessary to administer the serum HCG
test to determine pregnancy status.

The nurse can also assist the patient in constructing a calendar depicting her abnormal menstrual
pattern. Young girls often need to be educated about variations in menstrual cycles, and why it is
essential that they keep track of their cycle days, intervals, and duration.
 SEXUALLY TRANSMITTED INFECTIONS
Sexually transmitted infections (STIs) are diseases that are
spread through sexual contact with an infected partner.
1. Trichomoniasis
2. Human immunodeficiency virus (HIV) infection
If these diseases are discovered in young children,
the possibility of sexual abuse has to be considered
(STIs may be spread among women having sex with
women or men having sex with men.
Chlamydia trachomatis Infection

• Chlamydia trachomatis infections have become the most common bacterial cause of STI in the United
States .Symptoms include
1. a heavy, grayish white discharge and vulvar itching.
2. The incubation period is 1 to 5 weeks.
• Diagnosis is made by culture of the organism.
• Therapy is oral doxycycline or tetracycline for 7 days or azithromycin in a single dose. Because it has
become so common, most public health departments require that cases now be reported. Long-term
effects of chlamydial infections are PID, possibly leading to subfertility. Because there is a strong
association between gonorrhea and Chlamydia, if a chlamydial infection is documented, women are
usually tested for gonorrhea as well.
Human Papillomavirus
The human papillomavirus (HPV) causes fibrous tissue overgrowth
(sometime called genital warts) on the external vulva, vagina, or cervix
(condyloma acuminatum).

• At first, lesions appear as discrete papillary structures; they then

spread, enlarge, and coalesce to form large, cauliflower-like lesions.
The infection may be present in as many as 10% to 30% of women
and is most common in women who have multiple sexual partners
• Therapy for such lesions is aimed at dissolving the lesions and also
ending any secondary infection present.
• Small growths may be removed by applying podophyllin (Podofin).
• Large lesions may be removed by laser therapy, cryocautery, or knife
excision. With cryocautery, edema at the site is evident immediately;
lesions become gangrenous, and sloughing occurs in 7 days.
• Healing will be complete in 4 to 6 weeks with only slight
depigmentationat the site.
• Sitz baths and a lidocaine cream may be soothing during the healing
period. Children (both male and female) with HPV infections should
be further investigated for sexual abuse
Herpes Genitalis (Herpes Simplex Type 2)
• Genital herpes is caused by herpesvirus hominis type 2
(also called herpes simplex virus type 2, or HSV-2).
This is one of four similar herpes viruses:
1. cytomegalovirus
2. Epstein-Barr
3. varicella-zoster
4. herpes types 1 and 2.).
• Unlike most other STIs, although the virus can be
contained, there is no known cure.
The virus is spread by skin-to-skin contact, entering
through a break in the skin or mucous membrane. In the
newborn, the virus can be systemic or even fatal
Assessment
• Herpes is diagnosed by culture of the lesion secretion from its location on the vulva, vagina, cervix,
or penis or by isolation of HSV antibodies in serum.
• The incubation period is 3 to 14 days.
• Extensive primary lesions originate as a group of pinpoint vesicles on an erythematous base.
• Within a few days, the vesicles ulcerate and become moist, painful, draining, open lesions. An
adolescent may have accompanying flulike symptoms with increased temperature
• vaginal lesions may cause a profuse discharge.
• Pain is intense on contact with clothing or acidic urine.
• After the primary stage that lasts approximately 1 week, lesions heal but the virus lingers in a
latent form, affecting the sensory nerve ganglia.
• The condition will flare up and become an active infection during illness, just prior to menstruation,
fever, overexposure to sunlight, or stress.
Therapeutic Management
• Acyclovir (Zovirax) is an example of an antiviral that controls the virus by interfering with
deoxyribonucleic acid reproduction and decreasing symptoms. The drug is available as a topical
ointment.
• be certain to protect yourself with a finger cot or glove so that you do not contract the virus or
absorb the drug.
• Sitz baths three times a day may be helpful to reduce discomfort.
• An emollient (A&D Ointment) can also reduce discomfort, but its moisture tends to prolong the active
period of the lesions.
• Topical imiquimod (Aldara) or Foscarnet (Foscavir) may be prescribed for resistant lesions.
• Condoms (male or female) help prevent the spread of herpes among sexual partners. Valacyclovir
(Valtrex) may be prescribed as a preventive measure to help limit the disease spread. Because of
the possible association with cervical cancer, any female with genital herpes
Gonorrhea
• Gonorrhea is transmitted by Neisseria gonorrhoeae, a
grampositive diplococcus that thrives on columnar transitional
epithelium of the mucous membrane.
• Symptoms begin after a 2- to 7-day incubation period.
• In males, urethritis (pain on urination and frequency of
urination) and a urethral discharge.
• Without treatment, the infection may spread to the testes,
scarring the tubules and causing permanent sterility.
• (Although symptoms of gonorrhea in females are not as
visible,
• a slight yellowish vaginal discharge.
• Bartholin’s glands may become inflamed and painful.
• If left untreated, the infection may spread to pelvic
organs, most notably the fallopian tubes (PID).
• Tubal scarring can result in permanent sterility.
• In both males and females, untreated gonorrhea can
lead to arthritis or heart disease from systemic
Assessment
A urine culture for the gonococcal bacillus, in addition to vaginal and
urethral cultures, should be obtained from all children with vulvovaginitis
or a urethral discharge. In males, a first voiding may reveal gonococci if
a midstream urine specimen is inconclusive.

Therapeutic Management
Although gonorrhea has traditionally been treated with amoxicillin and
probenecid, the incidence of penicillinase producing strains has made this
traditional therapy ineffective.
• oral cefixime (Suprax) or intramuscular ceftriaxone (Rocephin) plus oral
doxycycline
• (Vibramycin) for 7 days is the current recommended therapy. This
treatment regimen is effective for both gonorrhea and Chlamydia.
• Sexual partners should receive the same treatment.
Approximately 24 hours after treatment, gonorrhea is no longer infectious. Approximately 7 days
after treatment, a client should return for a follow-up culture to verify that the disease has been
completely eradicated (few adolescents take this precaution).
Trichomoniasis
Trichomonas vaginalis is a single-cell protozoan that is spread by coitus and affects between 3% and
13% of adult men and women in the United States (Sutton et al., 2007). The incubation period is 4 to
20 days.

Assessment
1. vaginal irritation and a frothy white or grayish-green vaginal discharge.
• The frothiness of the discharge is an important typical finding.
The upper vagina is reddened and may have pinpoint petechiae.
• Extreme vulvar itching is present. (males with the same infection rarely report any
symptoms).
2. The infection is diagnosed by microscopic examination of a sample of the vaginal discharge after
it is combined with lactated Ringer’s or normal saline solution.

Therapeutic Management
1. Oral metronidazole (Flagyl) eradicates trichomonal infections.
2. Treatment with Flagyl and use of condoms by sexual partners help prevent recurrence of
Trichomonas in both parties.
3. Because the drug interacts with alcohol to cause acute nausea and vomiting, advise
women not to drink alcoholic beverages during the course of treatment.
Hepatitis B and Hepatitis C
Both hepatitis B and hepatitis C can be spread by semen as well as blood and therefore are
considered STIs.
Because hepatitis B can be spread by sexual intercourse, adolescents who did not receive
immunization against this as an infant need immunization against this updated.
Syphilis

Syphilis is a systemic disease caused by the spirochete

Treponema pallidum. It is transmitted by sexual contact with a
person who has an active spirochete-containing lesion,
• Like gonorrhea and Chlamydia, it must be reported to
public health departments.
• After an incubation period of 10 to 90 days, a typical lesion
appears, usually on the genitalia (penis or labia) or on the
mouth, lips, or rectal area from oral–genital or genital–anal
contact. The lesion (termed a chancre) is a deep ulcer and
is usually painless despite its size. Swollen lymph nodes
may be present but these are unlikely to be noticed by the
affected person. A lesion in the vagina may not be detected.
Without treatment, a chancre lasts approximately 6 weeks
and then fades.
The final stage of syphilis - is a destructive neurologic
disease that involves major body organs such as the
heart and the nervous system.
Typical symptoms are
1. blindness
2. paralysis
3. severe, crippling neurologic deformities
4. mental confusion
5. slurred speech and lack of coordination.
This final stage must be identified before the disease
becomes fatal.

Assessment
Syphilis is diagnosed by recognition of the various
symptoms of the three stages and by serologic serum
tests,
1. Venereal Disease Research Laboratory test (VDRL),
2. automated reagin test (ART)
3. the rapid plasma reagin test (RPR)
4. fluorescent treponemal antibody–absorption test
(FTA-ABS).
Therapeutic Management
Benzathine penicillin G, given intramuscularly in two sites, is
effective therapy.
For the adolescent who is sensitive to penicillin, either oral
erythromycin or tetracycline can be given
for 10 to 15 days. Sexual partners are treated in the same way
as the person with the active infection
Human Immunodeficiency Virus (HIV)
HIV is carried by semen as well as other body fluids, so infection with this virus is considered an STI.
Invasion of the virus is discussed with other immune disorders in

AIDS is the end stage of acquired immunodeficiency caused by infection with the RNA human
immunodeficiency retrovirus HIV (McFarland, 2008). The virus has at least two divisions,
HIV-1 and HIV-2,