Sexually Transmitted Disease (STD)
Sexually Transmitted Disease (STD)
Protozoa
Syphilis Trichomoniasis
Gonorrhea
Chancroid
Viral
AIDS
HSV
Warts
Is a systemic and highly infectious STD that usually begins with mucous membrane
and quickly becomes systemic
Treponema pallidum
– spirochete
Treponema pallidum
Has no other host but man
Believed that mo will pass thru mucosa w/o
a visible crack
Does not withstand drying
Has been found alive in a glass for ½ hour
after a glass was rinsed by cold water
Can not be grown in vitro
MOT:
Direct Contact- infectious exudates from obvious
or concealed moist early lesions of skin and mucous
membrane, body fluids and secretions
Blood Transfusion
Transplacental Transfer syphilis
neonatorum
Indirect Contact
Entry of MO
STAGES OF SYPHILIS:
PRIMARY SYPHILIS
SECONDARY SYPHILIS
TERTIARY SYPHILIS
Pathogenesis
Microorganism penetrates skin/mucosa
Extragenital area –
lips, tongue, tonsil, finger, nipple
2. Description of primary lesion
(hard chancre)
Chancre begins at
the site of
inoculation
Appears like a
pimple if it is on skin
Chancre
Inguinal lymphadenopathy
Fever
COURSE:
Lesion heals within
4 – 6 weeks without treatment
(chancre in men)
Basilar meningitis
SKIN
Anogenital are
Mouth
Axilla
Toe webs
Soles of feet
Palms of hands
Initially:
bilaterally symmetric
pink
non pruritic
round macules
B. SECONDARY SYPHILIS
SKIN
Non pruritic round macule that
appears b/w rolls of fat and
Transforms into
papular
follicular
pustular lesions
CONDYLOMATA LATA
CONDYLOMATA LATA
B. SECONDARY SYPHILIS
HAIR
“Moth – eaten scalp”
– alopecia beginning on the occipital area
Loss of eyelashes, beard and lateral 1/3 of the
eyebrows.
temporary
MUCOUS MEMBRANE
mucous patches of the mouth, throat and cervix
Yellow to white in color and covered with exudates, which
when removed reveals a soft glistening appearance.
LYMPHATIC SYSTEM
generalized non-tender lymphadonapathy w/ occasional splenomegal
Secondary syphilis: moth-eaten alopecia, which affects the scalp, eyebrows, eyelashes,
and beard. (Courtesy of Stacy Smith, M.D.)
Secondary syphilis: alopecia of the eyebrows. This patient presented to the
dermatologist with the sole complaint of loss of eyebrow hair.
B. SECONDARY SYPHILIS
COURSE: lesions slowly fade away, but may
recur during the latent phase
OCCURRENCE:
May begin as early as 1 year after the
initial infection.
Typically occurs after a latent period of 5 –
20 years
Systemic infection
C. TERTIARY SYPHILIS
LESIONS:
Cardiovascular syphilis Arteritis of the aorta—vessel necrosis– dilatation of the ao
Syphilitic Aortitis aortic regurgitation—CHF
Arteritis Multiple small infarcts—direct damage to neural cells in SC and cerebral cortex
Neurosyphilis/CNS
paresis., personality
Meningeal syphilis changes, slurred speech,
tremors, resembles CVA
Meningovascular syphilis
Granulomas
connective tissue in
the form of small
grainy particles along
with masses of tiny
blood vessels that
forms over wound
DIAGNOSIS:
3.Gross Appearance of the Lesion
2. Dark Field Microscopy of Exudate
- from skin scrapings/test not readily available
- confirms the diagnosis of syphilis in primary and
secondary
3. Serology
-VDRL slide test
-Rapid Plasma Reagin
( RPR)
4. Fluorescent Treponemal Antibody
Absorption test
TREATMENT:
1. Penicillin
2.4 mu or more
(benzathine penicillin G)- IM
2-4 mu/week x 3 weeks
****allergy to penicillin – tetracycline and doxycycline
2. Screen and treat all sexual partners
(CONTACT TRACING)
If client tests positive, provide counseling in privacy.
Teach about disease and treatment.
Provide emotional support.
UNIVERSAL PRECAUTION
Keep lesion dry and dispose drainage properly
Abstain from sexual contact atleast 1 month after the
treatment
Encourage pt to undergo VDRL after 3, 6, 12, 24
months
-Aka Jack, Clap, Gleet, Dose, Strai, Drips, Morning
drop
-GONOCOCCAL INFECTION OF THE GENITOURINARY TRACT
- INVOLVES THE MUCOSAL LINING OF GUT,RECTUM, PHARYNX
DIAGNOSTICS:
Gram’s Staining, Nucleic Acid Probe Test, Direct
Fluorescent Antibody
Pathogenesis
Infection
Penetration of the mucosa and elicits an acute inflammatory response consisting of leukocytes
Edema of the gland ducts or plugs of debris obstructs drainage to form abscess
Infection can spread to mucosal surfaces like fallopian tube, endometrium, peritoneal cavity of
women
Sterility
GONOCOCCAL INFECTIONS IN FEMALES:
3.Cervicitis
4.Vaginitis
5.Anorectal Gonorrhea
6.Pharyngeal Gonorrhea
1. Cervicitis
With yellow or green mucopurulent discharge
Dysuria, Urinary frequency, (1st) Cervical
erythema, red swollen vulva, abN menses,
Early s/sx of pelvic infxn (fever, N/V, abd’s
pain/tenderness)
Primarily affects the cervical os
Complication of PID:
Endometritis
Salpingitis
Tubal infertility
GONOCOCCAL INFECTIONS IN FEMALES:
2. Vaginitis
Occurs commonly in prepubertal and
postmenopausal women
Abundant purulent discharge
Red and edematous vaginal mucosa
GONOCOCCAL INFECTIONS IN FEMALES:
3. Anorectal Gonorrhea
Anorectal pain or pruritus
Tenesmus
Rectal bleeding
Purulent rectal discharge
4. Pharyngeal Gonorrhea
Fellatio
Cervical Lymphadenopathy
Tonsillar enlargement, possibly exudates
Complications:
Salphingitis--- PID--- infertility
(scarring and occlusion of the FT)
GONOCOCCAL INFECTIONS IN MALES:
1.Acute Urethritis
- most common manifestation
- Inflammation can cause stricture that prevents
passage of Urine
2. Urethral Discharge
Discharge is mucoid and scant initially but
becomes profuse and purulent within two
days
Complications:
rectal infection (homosexuals),
epidymitis, and prostatitis(pelvic pain and fever)
Diagnostic
1. Gram’s staining
2. Nucleic Acid Probe Test
3. Direct Fluorescent Antibody Test
Serology (VDRL)
– should be drawn at time of initial treatment
and at monthly intervals.
NURSING CONSIDERATIONS:
If client tests positive, provide counseling in
private.
Teach about prevention and control.
Provide emotional support.
Case finding
Contact tracing
Safe sex(abstinence, condom, monogamous relationship)
Crede’s prophylaxis
ULCUS MOLLE, SOFT CHANCRE, SOFT
SORE
TRANSMISSION:
Direct sexual contact with discharges from
open lesions
INCUBATION PERIOD: 4 to 7 days
PERIOD OF COMMUNICABILITY:
After 2 to 3 days:
papules evolve into pustules
which spontaneously ruptures
and forms a sharply circumscribed ulcer that is not
indurated, ulcers are painful and bleed easily
APPEARANCE:
ulcers are painful and bleed easily
APPEARANCE:
Other signs: Inguinal adenitis and suppuration
DIAGNOSIS:
1. PE
2. Rule out genital herpes, primary syphilis
3. Smear and Culture
4. Biopsy and darkfield examination
TREATMENT:
3.Ceftriaxone 250 mg IM x 1 dose
4.Azithromycin 1 gm PO x 1 dose
5.Erythromycin 500 mg PO x 7 days
6.Ciprofloxacin 500 mg PO BID x 3 days
NURSING MANAGEMENT:
Practice Standard Precaution
Check for drug allergy
Instruct patient to abstain from sexual
contact until healing is complete
Wash genitalia with soap and water
Viral
AIDS
HSV
Warts
AIDS
AIDS
Acquired Immunodeficiency Syndrome/
Acquired Immune-Deficiency Syndrome
TRANSMISSION:
6. Homosexual and Heterosexual Contact
7. By blood and Blood Products
8. Infected Mothers to Infants
AIDS
HIV
(dendritic cells in the mucosa of the genital tract)
Systemic infection
Antibodies(cytotoxic t-cells)
Specific for HIV infected cells
When HIV infection takes place, Anti-HIV bodies are produced but they do not appear
immediately
WINDOW EFFECT
In some cases, antibodies to HIV become detectable 4-6 weeks after infection
Once the virus enters the T4, it inserts its genetic materials into the T4’s nucleus taking
over the cell to replicate itself
Virus mutates rapidly making it difficult for the body to “recognize” the invaders
STAGES OF AIDS
Acute HIV Syndrome
Clinical Latency
Symptomatic disease
AIDS
STAGES OF AIDS
Acute HIV Syndrome
( 3 - 6 weeks after Primary Infection)
General:
MINOR :
fever pharyngitis
LAD headache
arthralgias myalgias
lethargy malaise
anorexia weight loss
nausea vomiting
diarrhea
AIDS
STAGES OF AIDS
Acute HIV Syndrome
Neurologic:
meningitis encephalitis
peripheral neuropathy myelopathy
Dermatologic:
erythematous maculopapular rash
mucocutaneous ulceration
AIDS
MAJOR:
Weight loss: 10% of body weight
Chronic diarrhea for more than a month
Prolonged fever for 1 month
AIDS:
Adult: 2 major and 1 minor
Pedia: 2 major and 2 minor
AIDS
STAGES OF AIDS
Clinical Latency
may last up to 10 years
Progressive decline of CD4+ T – Cells
Immunodeficiency
AIDS
STAGES OF AIDS
Symptomatic Disease
Respiratory:
Acute Bronchitis, Sinusitis, PCP
Cardiovascular:
HIV – associated cardiomyopathy
GIT:
Thrush, Oral hairy leukoplakia, aphthous ulcers
GUT:
HIV – associated nephropathy
Neurological:
Kaposi’s sarcoma, AIDS Dementia Complex
AIDS
STAGES OF AIDS
Symptomatic Disease
Pulmonary Opportunistic infections
1. PCP
2. Histoplasmosis
3. TB
GIT
1. Mycobacterium avium
2. CMV
3. Hepatitis B, C, D
4. HIV-wasting syndrome
AIDS
STAGES OF AIDS
Symptomatic Disease
GIT
5. Oral Candidiasis
6. Oral hairy leukoplakia
AIDS
STAGES OF AIDS
Symptomatic Disease
Gynecologic
A. Vaginal Candidiasis
CNS
AIDS Dementia syndrome
- progressive cognitive and motor
function deterioration
AIDS
STAGES OF AIDS
Symptomatic Disease
Kaposi’s Sarcoma
- vascular malignancy
- red to purple, palpable, non-blanching,
painless
lesion
- usually on face, penis, scrotum
Treatment: Chemotherapy
AIDS
DIAGNOSTIC PROCEDURE:
4.ELISA
-Serological test for antibodies against HIV; reactive test
-Standard screening test but less reliable in early stage
-Results usually appear after 22-27 days
2. Western Blot
-Confirmatory dxtic test
-More accurate than ELISA
-If ELISA 2x (+); western blot is recommended
-Done during late stage/ can detect lower levels of antibodies
3. PCR test- for viral nucleic acid sequences to assess levels of viremia
4. CD4-T-cell- less than 200 cells/mm3
AIDS
TREATMENT:
3.No cure. Counseling after positive
diagnosis.
2. Medications:
A. Nucleoside Analogue Reverse transcriptase Inhibitor
- slows disease process by inhibiting reverse
transcriptase enzyme
Zidovudine (AZT)
Didanosine
Zalcitabine
Stavudine
Lamivudine
AIDS
2. Medications:
B. Non-nucleoside reverse transcriptase inhibitor
Delavirdine
Nevirapine
Efavirenz
C. Protease inhibitor
- prevents assembly of viral particles
Ritonavir
Saquinavir
Indinavir
Nelfinavir
AIDS
NURSING CONSIDERATIONS:
3.Wear gloves, wash hands whenever handling blood or
body fluids. (PPE)
4.Follow universal precautions.
5.Teach preventive measures.
A. Latex condom use
B. No needle sharing
AIDS
NURSING CONSIDERATIONS:
4. Teach about disease process.
Malaise Myalgia
Pain itching
Relieve vulvar pain- keep the area clean and dry; wear
lose fitting non-synthetic undergarments; sitz bath;
cooling applications and analgesic meds
Acyclovir
- to reduce healing time
- (not recommended during pregnancy)
NURSING CONSIDERATIONS:
•Teach patients to use warm compresses or take sitz bath
several times a day.
•Use a drying agent, such as povidone iodine solution.
•Increase fluid intake.
•Avoid all sexual contact during the active phase.
•Those with Herpetic Whitlow
– instruct not to share towels or eating utensils.
- Abstain from direct patient care.
DIGITAL HERPES SIMPLEX
The herpes simplex virus infection on the finger is known as herpetic whitlow. Grouped, fluid-filled or pus-filled,
blisters are typical and usually itch and/or are painful.
WARTS – VERRUCA VULGARIS
(VENEREAL WARTS)
GENITAL WARTS
Condyloma acuminatum
cauliflower shaped lesions that appear on moist skin surfaces such
as the vagina and anus
CAUSATIVE AGENT:
Human Papilloma Virus (HPV)
TRANSMISSION:
Direct contact , Sexually transmitted
INCUBATION PERIOD:
3 to 4 months average, Ranges from 1 month
to 2 years
PERIOD OF COMMUNICABILITY:
S/Sx
No symptoms
Itchiness occurs with anogenital warts
DIAGNOSTIC EXAM:
NURSING CONSIDERATIONS:
Trichomoniasis
Trichomoniasis
A PROTOZOAL INFECTION CAUSING VULVOVAGINITIS
CAUSATIVE AGENT:
Trichomonas vaginalis
– inhabits the lower genital tract of females (moist
environments) and at the urethra and prostate of males
Trichomoniasis
TRANSMISSION:
By contact with vaginal and urethral
discharges of infected persons during sexual
intercourse.
Possibly by direct contact with contaminated
articles such as wet towels and swimsuits,
washcloths and douching equipment.
INCUBATION PERIOD:
5 to 28 Days
Trichomoniasis
PERIOD OF COMMUNICABILITY: