1
Q
How are sexually transmitted infections (STIs) transmitted?
A
- through sexual contact and/or
- parenteral exposure by infected blood, fecal-oral, intrauterine to fetus or perinatal from mother to neonate.
2
Q
How is an STI transmitted when it is through sexual contact?
A
From one person to another person through intimate contact such as oral, vaginal, or anal intercourse.
3
Q
Why are untreated STIs so concerning?
A
Untreated STIs can lead to:
- infertility of both men and women due to scarring
- ectopic pregnancy
- newborn complications
- fetal death
- maternal death
- increased risk of cancer
- systemic complications of heart and brain
- chronic pain
- pelvic inflammatory disease
4
Q
What is the best way to prevent STIs?
(besides sexual abstinence)
A
Condoms!
5
Q
How often should sexually active clients get screened for STIs?
A
Annually
6
Q
What is basic teaching about condom use?
A
- use latex or polyurethane condoms because they are stronger
- use a new condom for every sexual encounter
- if it breaks, replace immediately
- discard condoms that look brittle or discolored
- only use water based lubricants
- handle condoms with care so they don’t get damaged by nails or a sharp object
7
Q
How should a condom be put on?
A
- put on before any genital contact
- hold condom by tip and unroll it onto penis
- leave space at tip to collect semen
8
Q
How should a condom be taken off?
A
After ejaculation, withdraw erect penis carefully while holding condom at the base to prevent condom from slipping off.
9
Q
Are STIs reportable conditions?
A
Yes!
Many STIs need to be reported to the local health department.
10
Q
What information will be reported to the local health department for a client with an STI?
A
- name
- age
- contact information
- type of STI
- date of diagnosis
- any treatment given
All this information will be kept confidential.
11
Q
With an STI, what will the local department do with information that has been mandatory reported by the nurse?
A
The health department will use the confidential information to anonymously notify any sexual partners and connect them with testing and treatment.
12
Q
Can minors (less than 18 years old) give their own consent for treatment of STIs?
A
Yes!
Individuals less than 18 years old can get treatment for STIs without telling a parent or guardian.
13
Q
Which STIs usually require mandatory reporting in every U.S. state or Canadian province?
A
- chlamydia
- gonorrhea
- syphilis
- HIV/AIDS
- genital herpes
- hepatitis B and C
14
Q
Why is having more than one sexual partner a risk factor for STIs?
A
Because with multiple partners it raises a person’s exposure to infected people.
15
Q
Why are women more easily infected with STIs over men?
A
The vaginal canal is very vascular and has a large surface area where infections can occur (as compared to men).
16
Q
In general, what groups are a higher risk of getting infected with an STI?
A
- LGBTQ
- Black
- Native Hawaiian/Other Pacific Islanders
- Mexican
- Incarcerated
- Sex workers
- Men having sex with men
- Younger age: 15 - 24 years old
These groups are most vulnerable to STIs where teaching is extremely important.
17
Q
Why is there a healthcare disparity among certain groups that are a higher risk of STIs?
A
There is no one cause of why there is a higher risk of STIs (and a healthcare disparity), but it is believed to be from several causes:
- discrimination
- stigma of seeing a healthcare provider
- lack of awareness and action on the nurse’s part
- lack of available education on how to prevent
- lack of access to available healthcare resources
18
Q
What age group is there the highest risk of getting infected with an STI?
A
15 - 24 years old
19
Q
Why is it important to encourage barrier methods (condoms) of contraceptives to women who are post-menopausal?
A
Post-menopausal women are not able to get pregnant, but they are still susceptible to STIs, so barrier contraceptives should still be used.
20
Q
Why is men having sex with men a higher risk factor for STIs (compared to men having sex with women)?
A
- Anal sex is more common between men and this type of sex can cause tearing of the rectum making infections more common
- men are more likely to have sex with multiple and anonymous partners
- men are more likely to engage in risk-taking behavior and not use condoms
21
Q
Why is IV drug use a risk factor for STIs?
A
Because STIs can be transmitted through blood and some IV drug needles may not be clean.
The most common would be HIV and hepatitis B and C.
22
Q
Why is engaging in anal, vaginal or oral sex without a condom a risk factor for STIs?
A
Because STIs are transmitted through body fluids and/or lesions and with no protection this increases a person’s risk.
23
Q
Why is having sex while under the influence of drugs or alcohol a risk factor for STIs?
A
- Drugs and alcohol impairs judgment and increases the risk of not using any type of contraception.
- Drugs may also be traded for sex.
24
Q
What type of environment should a nurse provide to a client that needs to discuss sexualilty or sex-related topics?
A
Provide a safe, non-judgmental and private environment so the client can feel comfortable discussing these topics.
Many clients may feel shame, fear, guilt or embarrassment.
25
What is the **nurse's role** when talking about sexuality or sex-related topics with a patient?
* encourage expression of feelings
* provide information and resources such as support groups
* teach about diagnosis and treatment
* be non-judgmental and provide privacy
26
Are STIs mostly **preventable**?
**Yes!**
## Footnote
With **safer sex practices** most STIs can be prevented.
27
Name **5 Safer Sex Practices** to prevent STIs.
1. use a condom
2. wear gloves for finger or hand contact with vagina or rectum
3. practice mutual monogamy (only have 1 sexual partner)
4. decrease the number of sexual partners
5. practice abstinence (no sex at all)
28
Can clients by **asymptomatic** when they are infected with an STI?
**Yes**
## Footnote
Many clients are asymptomatic. That is why annual STI testing for sexually active clients is important.
29
Why is **infertility** a complication of untreated STIs?
Untreated STIs can cause **inflammation and scarring** in the reproductive tract making pregnancy almost impossible.
30
Can STIs be **transmitted** from a pregnant woman to their child during birth?
**Yes!**
This is called a congenital STI.
| *Congenital means present at birth.*
## Footnote
*Image is of a child that has contracted syphilis.*
31
Why is **death of a fetus** a complication of untreated STIs?
The fetus can **acquire the infection** and is unable to fight off the infection.
32
Why is **genital cancer** a complication of untreated STIs?
Persistent infections can lead to **abnormal cell growth** over time.
33
What is an **incubation period** in regards to infections?
The time **between exposure** to the infectious disease and **the start of symptoms**.
34
# Describe:
Genital herpes
A common viral disease that causes genital lesions caused by **herpes simplex virus** (HSV).
35
In regards to genital herpes, what is the **difference** between HSV-1 and HSV-2?
## Footnote
*HSV stands for herpes simplex virus*
* HSV-1 are mostly non-genital lesions such as cold sores that are on the mouth.
* HSV-2 are mostly genital lesions.
## Footnote
Both HSV-1 and HSV-2 can cause either oral or genital lesions.
36
Can a client be **cured** of genital herpes?
**No!**
## Footnote
The client cannot ever get rid of the infection.
37
Can a client with genital herpes **infect** another person even if lesions are not currently present?
**Yes!**
## Footnote
*Genital herpes can be transmitted even if lesions are not present.*
*This occurs through viral shedding.*
38
What is the **incubation period** of genital herpes?
2 to 20 days with the average being **one week**.
39
Do clients with genital herpes have **symptoms**?
Some do, but many clients **do not get any symptoms** and do not know they have an infection.
40
# Signs and Symptoms:
Genital Herpes
* itching or tingling sensation in the genital area
* vesicles (blisters)
* pain, fever, swelling
* swollen inguinal lymph nodes
41
What can **cause** an outbreak of genital herpes?
* stress
* fever
* poor nutrition
* menses
* sexual activity
42
How **long** does it take for lesions to heal after an outbreak of genital herpes?
2 to 6 weeks
43
# Diagnostic Tests:
Genital herpes
* swab culture
* polymerase chain reaction assays of the lesions
44
# Treatment:
Genital Herpes
Antiviral medications:
* acyclo**VIR**
* famciclo**VIR**
* valacyclo**VIR**
45
# Teaching:
Genital Herpes
* abstain from sexual activity while lesions are present (more likely to infect others)
* Encourage consistent use of condoms
* side effects of anti-viral medications
46
# Describe:
Syphilis
An STI transmitted through sexual or blood exposure or close body contact such as touching or kissing where there are open lesions.
| (Bacteria is *T. pallidum*)
## Footnote
*Can become systemic and lead to death if untreated.*
47
How many **stages** are there with syphilis?
**4 stages:**
* primary
* secondary
* early latent
* tertiary
48
# Signs and Symptoms:
What is the **first sign** that a client might have syphilis?
An ulcer called a **chancre** on the genitals or face that occurs at about 3 weeks after being infected.
## Footnote
*This occurs in the first stage of syphilis called the primary stage.*
49
# Describe:
Neurosyphilis
A **severe** type of syphilis that can occur at any time where the patient experiences:
* meningitis
* vision or hearing loss
* brain or spinal cord dysfunction
50
What are the **signs and symptoms** of the second stage of syphilis?
How **long** does it last?
**Systemic symptoms** that are similar to flu-like symptoms:
* malaise
* low-grade fever
* headache
* muscle aches
* sore throat
* rash on body
* enlarged inguinal lymph nodes
This stage lasts from ***4-12 weeks*** which is when the rash subsides without treatment.
51
What are the **signs and symptoms** of 3rd stage (early latent) of syphilis?
How **long** does it last?
**No symptoms**, but the client is still infected.
This stage can last **1 year or up to their entire life**.
52
What are the **signs and symptoms** of the 4th stage (late or tertiary) of syphilis?
**Severe** symptoms:
* heart failure and neuro symptoms
* lesions on skin, bones and internal organs
53
What **PPE** should the nurse wear if touching any lesions, sores, ulcers, or broken skin that may be infectious?
Always wear **gloves**!
54
# Diagnostic Tests:
Syphilis
* microscopic test for *T. pallidum* bacteria
* blood tests for antibody-antigen
55
# Medication:
Syphilis
Penicillin
## Footnote
*Assess for any penicillin allergies.*
56
# Teaching:
Syphilis
* have all sexual partners tested and treated
* disease will be reported to local health department (but kept confidential)
* importance of taking all the antibiotics until cured
* encourage use of condoms to prevent reinfection
* abstinence if lesions are present
57
# Describe:
Genital warts
An **STI** that is caused by certain types of HPV.
58
Which most common **virus** can cause many types of genital cancer?
Human papillomavirus
| (**HPV**)
59
# Signs and Symptoms:
Genital warts
* small, papillary growths that are white or resemble the color of the patient's skin
* located externally or internally (including the cervix)
60
# Diagnostic Tests:
Genital warts
by visual exam
61
# Treatment:
Genital warts
**Removal** of warts through freezing, topical ointments or surgical removal.
## Footnote
*No therapy eliminates HPV infection so recurrence of warts is very likely.*
62
What **teaching** should be done if a client with genital warts is receiving a topical ointment to remove the warts?
Topical ointments may cause:
* pain, bleeding and discharge as warts slough off
* keep area clean and dry and look for signs of further infection
* never use over-the-counter wart removal treatments for genital warts
63
What **diagnostic test** should be done if genital warts start to bleed, appears infected or persists?
A **biopsy** to check for cancer.
64
# Teaching:
Genital warts
* prevent with getting HPV vaccination
* have all sexual partners tested and treated
* disease will be reported to local health department (but kept confidential)
* importance of removal of warts
* encourage use of condoms to prevent reinfection
* abstinence if warts are present
65
What **diagnostic tests** should a woman get to test for cervical cancer and HPV infection?
* **Papanicolaou smear** ("Pap test") to test for cervical cancer
* **HPV test** to test for infection
66
# Describe:
Chlamydia
An **STI** that is caused by a bacteria.
67
What is the **incubation period** for Chlamydia?
**1 - 3 weeks**, but the bacteria may be in the genital tract for months with no symptoms.
68
# Signs and Symptoms:
Chlamydia
* vaginal or penile discharge
* dysuria
* pelvic pain
* irregular bleeding (with women)
## Footnote
*Many women have NO symptoms.*
69
# Diagnostic Test:
Chlamydia
swab of cells
70
# Medication:
Chlamydia
**Antibiotics:**
azithro**MYCIN** or doxy**CYCLINE**
71
# Teaching:
Chlamydia
* have all sexual partners tested and treated
* disease will be reported to local health department (but kept confidential)
* importance of taking all antibiotics until cured
* encourage use of condoms to prevent reinfection
* abstinence with active infection
72
What are the main **complications** of untreated chlamydia and gonorrhea?
In women:
* Pelvic inflammatory disease
* infertility
* ectopic pregnancy
* newborn complications
In men:
* epididymitis
* prostatitis
* infertility
73
# Describe:
Gonorrhea
An **STI** that is caused by a bacteria.
74
What is the **incubation period** of gonorrhea?
about **1 week**
75
# Signs and Symptoms:
Gonorrhea
* penile or vaginal discharge
* dysuria
* anal itching
* painful bowel movement
* lesions in the oral cavity or lips
## Footnote
If systemic, can get fever and body aches.
*Many women have NO symptoms.*
76
# Diagnostic Tests:
Gonorrhea
culture swab
77
# Medications:
Gonorrhea
Antibiotics:
* **CEFT**riazone and azithro**MYCIN** or
* doxy**CYCLINE**
78
# Teaching:
Gonorrhea
* have all sexual partners tested and treated
* disease will be reported to local health department (but kept confidential)
* importance of taking all antibiotics until cured
* encourage use of condoms to prevent reinfection
* abstinence with active infection
79
What is a **big complication** of untreated gonorrhea?
Pelvic inflammatory disease
| (PID)
80
# Describe:
Pelvic Inflammatory Disease
| (PID)
**Inflammation** in the fallopian tubes, ovaries and uterus most commonly caused by the STIs chlamydia and gonorrhea.
## Footnote
*Inflammation can get into the peritoneal cavity.*
81
What are the **main complications** of untreated PID?
* infertility
* abscess
* ectopic pregnancy
* perihepatitis
* sepsis and death
82
# Signs and Symptoms:
Pelvic Inflammatory Disease
* lower abdominal pain or pelvic pain
* irregular vaginal bleeding
* dysuria
* abnormal vaginal discharge
* dyspareunia (painful sex)
* malaise, fever, chills
* inflamed cervix
83
# Diagnostic Tests:
Pelvic Inflammatory Disease
Diagnosis is based on health history, physical assessment and cultures/labs, but usually not imaging tests.
84
# Treatment:
Pelvic Inflammatory Disease
* antibiotics
* surgery if abscess or peritoneal complications
* pain medication
85
# Teaching:
Pelvic Inflammatory Disease
* if infection is present have all sexual partners tested and treated
* if there is an infection, disease will be reported to local health department (but kept confidential)
* importance of taking all antibiotics until infection is gone
* encourage use of condoms to prevent reinfection
* abstinence with active infection
86
Where should a client be **referred** to if pelvic inflammatory disease has caused infertility and they wish to become pregnant?
An infertility clinic.
87
If a client has one STI, **should they get tested** for other STIs?
**Absolutely!** Having one STI puts a client at risk of other STIs.
## Footnote
*Test for: gonorrhea, syphilis, chlamydia, hepatitis B and C, HIV, HSV and HPV*
88
If a client is diagnosed with an STI or PID, should they also get a **pregnancy test**?
**Yes!** This is to prevent pregnancy related complications.
89
# Nursing considerations:
Administration of **antibiotics**
* take full course of antibiotics to prevent reinfection
* drink plenty of water to prevent kidney damage
* do not take any antacids as this will prevent absorption of antibiotics
90
As nurses, can we assume that **older clients** don't really have sex?
**No!**
Many older clients still have sex and may need teaching about how to prevent STIs.
## Footnote
*Approximately 40% of people 65 - 80 years old are having sex.*
91
As nurses, can we assume that a **heterosexual or homosexual couple** only has sex with their one partner?
**No!**
Some clients may be having sex with other people, so assessing, teaching and treatment about preventing STIs and pregnancy may still be needed.
92
What is **expedited partner therapy**?
| (EPT)
EPT is treating sexual partners of patients diagnosed with an STI (usually chlamydia or gonorrhea) by **providing prescriptions or medications to the patient, which they can take to their partner(s)** without the partner(s) having to be examined by a health care provider.
## Footnote
*Research has shown that it is an effective way to decrease rates of STIs, especially chlamydia and gonorrhea*.
Nursing Reproductive Health
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