Sexually transmitted infections Part III

Sexually Transmitted
Infections
By: Maria Carmela L. Domocmat, RN, MSN
Nurse Instructor
Northern Luzon Adventist College

1. Diseases Characterized by 3. Diseases Characterized by
Ulcerations Vaginal Discharge
Chancroid Bacterial Vaginosis
Trichomoniasis
Genital HSV Infections
Vulvovaginal Candidiasis
Granuloma Inguinale
(Donovanosis) 4. Human Papillomavirus (HPV)
Infection
Lymphogranuloma Venereum
Genital Warts
Syphilis
5. Ectoparasitic Infections
2. Diseases Characterized by Scabies
Urethritis or Cervicitis Pediculosis Pubis
Chlamydial Infections 6. Hepatitis A, B, C
Gonococcal Infections 7. Sexually transmitted enteric
infections
Proctitis, Proctocolitis, and
Enteritis

Overview
Maria Carmela L. Domocmat, RN, MSN

Chlamydial infections
Gonorrhea


Chlamydia
one of the most common STD's
Known as the silent STD
Known as the “great sterilizer”
Most important cause of PID and tubal infertility
(ectopic pregnancy)


bacterial infection caused by pathogen
Chlamydia trachomatis
Non-motile gram negative bacteria

Incubation Period of Chlamydia
7-21 days


mainly passed through sexual activity:
Intimate sexual contact
vaginal or anal sex with an infected partner
oral sex (less common)
sharing sex toys
touching parts of the body with fingers (for
example, chlamydia often occurs in the eyes)
do not cross placenta but vaginal delivery from
infected mother can cause conjunctivitis and
pneumonia in newborn

Mode of transmission (MOT)

NOT from simple kissing, sharing baths,
towels, cups, or from toilet seats.

Mode of transmission (MOT)

people can infect other when they have
symptoms & some times when they do
not, the partner is infected in
approximately 33% of the sexual contacts
with an infected partner

Infectivity

70% of women and 50% of men who
have chlamydia – asymptomatic
– that’s why usually goes untreated.

Signs and Symptoms of Chlamydia

Chlamydia Symptoms in Women:
Yellow, mucopurulent vaginal discharge
Urethritis with dysuria (pain or a burning on
urination)
Menorrhagia (bleeding between periods)
Dyspareunia (pain during sex) or bleeding
after sex
low abdominal pain sometimes with nausea


Chlamydial cervicitis

Chlamydia Symptoms in Men:
Clear to mucopurulent (white/cloudy, watery)
discharge from penis
Urethritis with dysuria
testicular pain and/or swelling
Swollen and tender testicles


Chlamydia - Symptoms

Both gender
Proctitis (inflammation of the rectum)
Pharyngitis


culture swab of the cervical mucus
Tissue culture from urethra, endocervix,
rectum
Rapid nonculture detection test on
urogenital secretions

Dx tests

culture swab or swab test of the cervical
mucus
can be done in conjunction with a Pap test.
about 90% accurate.
Tissue culture from urethra, endocervix,
rectum
expensive, technically difficult
Rapid nonculture detection test on urogenital
secretions
More convenient
Less expensive
Quicker

Dx tests

a swab test collecting fluid from the
penis or vagina.
Swab test is obtained by briefly placing a swab
in the opening of the urethra at the tip of the
penis; this causes brief discomfort and a
burning sensation
NAATS
To detect C. trachomatis antigen
Most sensitive test in endocervical and urethral
specimens
men - simple urine test

Dx tests

Direct fluorescent antibody
(DFA)microscopy
ELISA
Nucleic acid amplification test
Monoclonal antigen-antibody tests

Should also be tested for gonorrhea

Dx tests

Recommended Regimens
Zithromax® (azithromycin) 1 g orally in a
single dose
OR
Doxycycline (Vibramyicin) 100 mg 2-3 times a
day for 7 days

Treatment of Chlamydia

Alternative Regimens
Erythromycin base 500 mg orally four times a day for 7
days
OR
Erythromycin ethylsuccinate 800 mg orally four times
a day for 7 days
OR
Levofloxacin 500 mg orally once daily for 7 days
OR
Ofloxacin 300 mg orally twice a day for 7 days

Treatment

Examine and treat - all sexual partners within
the last 60 days
Treating gonorrhea is advocated for patients
being treated for chlamydia, and vice versa (50%
have both infections together)
Instruct about the greater risk of infection with
multiple sexual partners
Avoid all sexual activity until both partners are
cured
Should use condom thereafter

Mgmt

Recommended Regimens
Azithromycin 1 g orally in a single dose
Amoxicillin 500 mg orally three times a day for 7 days

Alternative Regimens
Erythromycin base 500 mg orally four times a day for 7
days
Erythromycin base 250 mg orally four times a day for
14 days
Erythromycin ethylsuccinate 800 mg orally four times a
day for 7 days
Erythromycin ethylsuccinate 400 mg orally four times a
day for 14 days

Treatment during Pregnancy

In women, chlamydia can cause pelvic
inflammatory disease (PID), which can
lead to:
Salpingitis, subsequent scarring and occlusion
(blocked) fallopian tubes which can result in
reduced fertility or ectopic pregnancy
infertility
long-term pelvic pain
early miscarriage or premature birth

Complications

In men, chlamydia can lead to:
inflammation of testicles
infected prostate
urethral stricture, may extend to epididymis
which may result in reduced fertility or sterility
Reiter's syndrome (polyarthritis -inflammation
of the joints)
Urethritis
Conjunctivitis

Complications

If Untreated:
both sexes
sterility
fetus/newborns
Pneumonia
Conjunctivitis
Ear infection
Death

Complications

A chlamydial etiology should be
considered for all infants aged ≤30 days
who have conjunctivitis, especially if the
mother has a history of untreated
chlamydia infection.

Ophthalmia Neonatorum Caused
by C. trachomatis

tissue culture and nonculture tests (e.g., direct
fluorescence antibody [DFA] tests, EIA, and NAAT)
Sensitive and specific methods

Specimens for culture isolation and nonculture tests should
be obtained from the everted eyelid using a dacron-tipped
swab or the swab specified by the manufacturer’s test kit,
and they must contain conjunctival cells, not exudate
alone.
Specific diagnosis of C. trachomatis infection confirms the
need for treatment not only for the neonate, but also for
the mother and her sex partner(s).
Ocular specimens from infants being evaluated for
chlamydial conjunctivitis also should be tested for N.
gonorrhoeae.

Dx tests: Ophthalmia Neonatorum

Neonatal chlamydial conjunctivitis,
showing a blood-stained discharge from
the infant's closed, swollen eyes.


Recommended Regimen
Erythromycin base or ethylsuccinate 50
mg/kg/day orally divided into 4 doses daily for
14 days

Treatment: Ophthalmia
Neonatorum

Characteristic signs of chlamydial
pneumonia in infants include
1) a repetitive staccato cough with
tachypnea
a type of cough that erupts in short, sudden
bursts.
2) hyperinflation and bilateral diffuse
infiltrates on a chest radiograph.

s/s:
Infant Pneumonia Caused by C.
trachomatis

In addition, peripheral eosinophilia (≥400
cells/mm3) occurs frequently.
Wheezing is rare,
and infants are typically afebrile.
Because clinical presentations differ, initial
treatment and diagnostic tests should include C.
trachomatis for all infants aged 1–3 months who
are suspected of having pneumonia (especially
those whose mothers have untreated chlamydial
infection).

s/s:
trachomatis

Specimens for chlamydial testing should
be collected from the nasopharynx.
Tissue culture
definitive standard for chlamydial pneumonia.
Nonculture tests (e.g., EIA, DFA, and
NAAT)
lower sensitivity and specificity

Dx tests: Infant Pneumonia
Caused by C. trachomatis

Recommended Regimen
Erythromycin base
or ethylsuccinate 50 mg/kg/day orally
divided into 4 doses daily for 14 days

trachomatis

Once chlamydia has been successfully
treated, it won't come back unless a new
infection is picked up.


is a highly contagious sexually
transmitted STD bacterial infection
sometimes referred to as the clap.
The nickname of the clap refers to a treatment
that used to clear the blockage in the urethra
from gonorrhea pus, where the penis would be
'clapped' on both sides simultaneously.
This gonorrhea treatment is rarely used today,
however the nomenclature remains.

Gonorrhea

AKA:
Clap
White
Drips
Strain
Dose

Gonorrhea

spreads through semen or vaginal fluids during
unprotected sexual contact, heterosexual or
homosexual, with an infected partner:
vaginal or anal sex with an infected partner
oral sex (less common)
sharing sex toys
touching parts of the body with fingers (for example,
touching the private parts and then the eyes)
any very close physical contact
the bacteria can be passed from hand to hand (very rare
isolated cases)
Infants
from a mother to her infant – vaginal birth
Infection of medical personnel through broken skin

MOT

You can NOT catch it from simple kissing,
sharing baths, towels, cups, or from toilet
seats.


Neisseria gonorrhoeae
a bacterium that can grow and multiply easily in
the warm, moist areas of the reproductive tract,
including the cervix (opening to the womb), uterus
(womb), and fallopian tubes (egg canals) in
women, and in the urethra (urine canal) in women
and men.
can also grow in the mouth, throat, eyes, and
anus.
Incubation Period
1-14 days

Cause


contact with the penis, vagina, mouth, or
anus.
Ejaculation does not have to occur for
gonorrhea to be transmitted or acquired.
Gonorrhea can also be spread from mother to
baby during delivery.

People who have had gonorrhea and received
treatment may get infected again if they
have sexual contact with a person infected
with gonorrhea.

MOT

Some – asymptomatic
Dysuria and urinary frequency
white, yellow, or green discharge from the
penis
painful or swollen testicles

S/S: Men

Symptoms often mild
most women asymptomatic
Even when a woman has symptoms, they can
be so non-specific as to be mistaken for a
bladder or vaginal infection.
Dysuria and urinary frequency
Heavy, yellow-green vaginal discharge
Metrorrhagia
Cervical erythema
Red, swollen, sore vulva

S/S: women

may also infect the rectum, throat, eyes,
blood, skin, & joints.
Conjunctivitis
Pharyngitis


Endocervical gonorrhea

Hx
PE
Identify gonococcus on smear or culture
of exudate from infected areas
Gram stain of a sample from a urethra
Culture from nongenital specimens

Dx tests

ciprofloxacine
(Cipro® XR), IM, 500
mg a single dose
ceftriaxone
(Rocephin) a single
dose, IM
ofloxacin (floxin)
cefixime (Suprax)
Levaquin® 500 mg a
single dose
Tequin® 400 mg a
single dose

Treatment


Antibiotics can successfully cure gonorrhea in
adolescents and adults.
However, drug-resistant strains of
gonorrhea are increasing in many areas of
the world, including the United States, and
successful treatment of gonorrhea is
becoming more difficult.
CDC now recommends dual therapy (i.e.
using two drugs) for the treatment of
gonorrhea. Persons with gonorrhea should be
tested for other STDs.

Treatment

Emphasize – COMPLETE the course of
antibiotic
Although medication will stop the infection, it
will not repair any permanent damage done
by the disease.
People who have had gonorrhea and have
been treated can get the disease again if
they have sexual contact with persons
infected with gonorrhea.
If a person’s symptoms continue even after
receiving treatment, he or she should return
to a doctor to be reevaluated.

Treatment

Quinolone antibiotic
Should not be used in MSM or in quinolone-
resistant geographic area
Or infections acquired abroad


Warn pregnant client – danger of infecting
infant during delivery


In women, it can cause:
Salpingitis – can progress to PID
life-threatening complications such as ectopic
pregnancy (outside the womb)
blocked fallopian tubes (the tubes which carry
the egg from the ovaries to the womb), which
can result in reduced fertility or infertility
long-term pelvic pain

Complications


In men, it can lead to:
epididymitis
prostatitis
painful inflammation of the testicles, which
may result in reduced fertility or sterility

Complications


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