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5 most common Sexually Transmitted Infection

Submitted by:

Leodel T. Barrio
RLE Group 4 BSN 2A Submitted to:

Jane P. Daniel, RN
RLE Preceptor

Gonorrhea
Gonorrhea (Colloquially known as the Clap) is transmitted by Neisseria gonorrheae, a gram-positive diplococcus that thrives on columnar transitional epithelium of the mucous membrane. The infection is transmitted from one person to another through vaginal, oral, or anal sex. You are more likely to develop this infection if you:

Have multiple sexual partners Have a partner with a past history of any sexually transmitted infection Do not use a condom during sex Abuse alcohol or illegal substances

Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for men who have sex with men is higher. Women have a 6080% risk of getting the infection from a single act of vaginal intercourse with an infected man. A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum. Gonorrhea cannot be spread by toilets or bathrooms.

Signs and Symptoms


Symptoms of gonorrhea usually appear 2 - 5 days after infection, however, in men, symptoms may take up to a month to appear. Some people do not have symptoms. They may be completely unaware that they have caught the infection, and therefore do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person. Symptoms in men include:

Burning and pain while urinating (Urethritis) Increased urinary frequency or urgency Discharge from the penis (white, yellow, or green in color) Red or swollen opening of penis (urethra) Tender or swollen testicles Sore throat (gonococcal pharyngitis)

Symptoms in women can be very mild or nonspecific, and may be mistaken for another type of infection. They include:

Vaginal discharge Burning and pain while urinating Increased urination Sore throat Painful sexual intercourse Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area) Fever (if the infection spreads to the fallopian tubes and stomach area)

If the infection spreads to the bloodstream, fever, rash, and arthritis-like symptoms may occur.

Assessment
A urine culture for gonococcal bacillus, in addition to vaginal and urethral cultures, should be done on all children with vulvovaginitis or urethral discharge. In males, a first voiding may reveal gonococci if a midstream is inconclusive.

Therapeutic Management
As of 2010 one intramuscular injection of ceftriaxone plus oral doxycycline for 7 days appears to be one of the few effective antibiotics. In 2011, there were reports of gonorrhea which had antibiotic resistance to multiple agents, specifically to both cefixime and ceftriaxone. Approximately 24 hours after treatment, the 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. All sexual contacts of the person with gonorrhea should be contacted and tested. This helps prevent further spread of the disease. In some places you may be able to take counseling information and medicines to your sexual partner yourself. In other places, the health department will contact your partner. There is no significant immunity following the infection and a person may become repeatedly infected

Prevention
Not having sexual intercourse (abstinence) is the only absolute method of preventing gonorrhea. A monogamous sexual relationship with an individual known to be free of any STD can reduce risk. Monogamous means you and your partner do not have sex with any other persons. You can greatly lower your risk of catching an STD by using a condom every time you have sex. Condoms are available for both men and women, but are most commonly worn by the man. A condom must be used properly every time. To further prevent the spread of infection, treatment of all sexual partners is important.

References: 1. Pilliterri, A. ;(2009)Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family 6th Edition 8, chap 46, 1384-5 2. Shrestha RK, Englund K. Infectious disease. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2010:section 8. 3. Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. 4. National Center for Biotechnology Information, U.S. National Library of Medicine 5. National Institute of Allergy and Infectious Diseases; National Institutes of Health, Department of Health and Human Services (2001-07-20). "Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention". Hyatt Dulles Airport, Herndon, Virginia. pp14 6. Deguchi T, Nakane K, Yasuda M, Maeda S (September 2010). "Emergence and spread of drug resistant Neisseria gonorrhoeae". J. Urol. 184 (3): 8518; q

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. Syphilis is believed to have infected 12 million people worldwide in 1999, with greater than 90 percent of cases in the developing world. After decreasing dramatically since the widespread availability of penicillin in 1940s, rates of infection have increased since the turn of the millennium in many countries, often in combination with human immunodeficiency virus (HIV). This has been attributed partly to unsafe sexual practices among men who have sex with men, increased promiscuity, prostitution and decreasing use of barrier protection.

Signs and Symptoms


Following an incubation period of 10 to 90 days, a typical lesion appears, generally on the genitalia or on the mouth, lips, or rectal area from oral-genital or anal genital contact. The lesion (termed a Chancre) is a deep ulcer and generally painless despite its size. Lymphadenopathy may be present but is unlikely to be noticed by the affected individual. A lesion in the vagina may not be evident. Without treatment, a chancre lasts approximately 6 weeks and then fades. Approxiamtely 2 to 4 weeks after the chancre disappears, a generalized macular copper-colored rash appears. Unlike many other rashes, it affects the soles and the palms. A serologic test for syphilis yields a positive result at this time. There may be secondary symptoms of generalized illness such as low-grade fever and adenopathy. With or without treatment, this stage of syphilis will also fade. The next stage is a latency period that may last from only a few years to several decades. The only indication of the disease is the serologic test, which continues to yield a positive result. 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 blindness; paralysis; severe, crippling neurologic deformities; mental confusion; slurred speech; and lack of coordination. This third stage should be identified before it becomes fatal.

Congenital syphilis may occur during pregnancy or during birth. Two-thirds of syphilitic infants are born without symptoms. Common symptoms that then develop over the first couple years of life include: hepatosplenomegaly (70%), rash (70%), fever (40%), neurosyphylis (20%), and pneumonitis (20%). If untreated, late congenital syphilis may occur

in 40%, including: saddle nose deformation, Higoumenakis sign, saber shin, or Clutton's joints among others.

Assessment
Syphilis is diagnosed by the recognition of the various symptoms of the three stages and by serologic serum tests, usually VDRL (Venereal Disease Research Laboratory), ART (automated reagin test), RPR (rapid plasma reagin test), or FTA-ABS (fluorescent treponemal antibody absorption test).

Therapeutic Management
The therapy arrests the disease at whatever stage it has reached. Benzanthine penicillin G given intramuscularly in two sites is effective therapy. For the adolescent sensitive to penicillin, either oral erythromycin or tetracycline can be given for 10 to 15 days. As with gonorrhea, sexual partners are treated in the same way as the person with the active infection. Several hours after getting treatment for the early stages of syphilis, people may experience Jarish-Herxheimer reaction. This is caused by an immune reaction to the breakdown products of the infection. Symptoms and signs of this reaction include:

Chills Fever General feeling of being ill (malaise) Headache Joint aches Muscle aches Nausea Rash

These symptoms usually disappear within 24 hours. Follow-up blood tests must be done at 3, 6, 12, and 24 months to ensure that the infection is gone. Avoid sexual contact when the chancre is present, and use condoms until two follow-up tests have indicated that the infection has been cured.

All sexual partners of the person with syphilis should also be treated. Syphilis is extremely contagious in the primary and secondary stages.

Because syphilis can be treated so easily, one would think it would be easy to eradicate. In reality, however, because the primary chancre is painless, many individuals are either unaware of it, thereby transmitting the disease to unsuspecting partners.

Prevention
The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected. Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.

References: Pilliterri, A. ;(2009)Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family 6th Edition 8 chap 46, 1385 2. Centers for Disease Control and Prevention (CDC). Recommendations and Reports: Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11). 3. Gao, L; Zhang, L, Jin, Q (2009 Sep). "Meta-analysis: prevalence of HIV infection and syphilis among MSM in China". Sexually transmitted infections 85 (5): 3548. 4. Karp, G; Schlaeffer, F, Jotkowitz, A, Riesenberg, K (2009 Jan). "Syphilis and HIV co-infection". European journal of internal medicine 20 (1): 913
1.

AIDS
Acquired immunodeficiency syndrome (AIDS) is an acquired immunodeficiency caused by the RNA cytopathic human immunodeficiency virus HIV. It is contracted through blood and body secretions. The virus acts by attacking the lymphoreticular system, in particular CD4 bearing helper T lymphocytes. The virus enters and replicates lymphocytes and, in the process, destroys them. There is no defense against the virus remaining in the body for life. This results in loss of CD4 lymphocytes and the ability to initiate a B-lymphocyte response. The final result is that the immune response and the ability to screen and remove malignant cells from the body are lost. Because B cels or humoral immune function, which initiates the production of antibodies, is affected, antibody formation will be decreased. When monocytes and macrophages become affected as well, the person with HIV infection is unable to resist normal infection and is susceptible to opportunistic infections.

Transmission HIV has been found in saliva, tears, nervous system tissue and spinal fluid, blood, semen (including pre-seminal fluid, which is the liquid that comes out before ejaculation), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk have been shown to transmit infection to others. The virus can be spread (transmitted):

Through sexual contact -- including oral, vaginal, and anal sex Through blood -- via blood transfusions (now extremely rare in the U.S.) or needle sharing From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk

Other methods of spreading the virus are rare and include accidental needle injury, artificial insemination with infected donated semen, and organ transplantation with infected organs. HIV infection is NOT spread by:

Casual contact such as hugging Mosquitoes Participation in sports Touching items that were touched by a person infected with the virus

People at highest risk for getting HIV include:


Injection drug users who share needles Infants born to mothers with HIV who didn't receive HIV therapy during pregnancy People engaging in unprotected sex, especially with people who have other high-risk behaviors, are HIV-positive, or have AIDS People who received blood transfusions or clotting products between 1977 and 1985 (before screening for the virus became standard practice) Sexual partners of those who participate in high-risk activities (such as injection drug use or anal sex)

Signs and Symptoms


AIDS begins with HIV infection. People who are infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops. Acute HIV infection progresses over time (usually a few weeks to months) to asymptomatic HIV infection (no symptoms) and then to early symptomatic HIV infection. Later, it progresses to AIDS (advanced HIV infection with CD4 T-cell count below 200 cells/mm3 ). Almost all people infected with HIV, if they are not treated, will develop AIDS. There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors, and many seem to have a genetic difference that prevents the virus from significantly damaging their immune system. The symptoms of AIDS are mainly the result of infections that do not normally develop in people with a healthy immune system. These are called opportunistic infections. People with AIDS have had their immune system damaged by HIV and are very susceptible to these opportunistic infections. Common symptoms are:

Chills Fever Sweats (particularly at night) Swollen lymph glands Weakness Weight loss

Assessment
HIV has a long incubation period of about 10 years in adults. Children who receive the virus through placental transmission are usually HIV positive by 6 months, developing clinical signs by 3 years of age. Children who receive the virus from another source usually convert to being HIV positive by 2 to 6 weeks, or at least by 6 months. During this preconversion time, the child may have poor resistance to infections such as fever , swollen lymph nodes, respiratory tract infections and thrush. Tests for detection of the HIV antigen termed p24 for PCR (polymerase chain reaction) tests; those for the antibody are termed ELISA and Western Blot confirmation. CD4 counts are used to document the disease status and predict disease progression.

Therapeutic Management
There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life for those who have already developed symptoms. Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. This is measured by the viral load (how much free virus is found in the blood). Preventing the virus from replicating can improve T-cell counts and help the immune system recover from the HIV infection.

Prevention
1. Safer sex practices, such as latex condoms, are highly effective in preventing HIV transmission. HOWEVER, there is a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV. 2. Do not use illicit drugs and do not share needles or syringes. 3. Avoid contact with another person's blood. You may need to wear protective clothing, masks, and goggles when caring for people who are injured. 4. Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. Infected people should tell any sexual partner about their HIV-positive status. They should not exchange body fluids during

sexual activity, and should use preventive measures (such as condoms) to reduce the rate of transmission. 5. HIV-positive women who wish to become pregnant should seek counseling about the risk to their unborn child, and methods to help prevent their baby from becoming infected. The use of certain medications dramatically reduces the chances that the baby will become infected during pregnancy.

References: 1. Pilliterri, A. ;(2009)Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family 6th Edition 8, chap 41, 1211-13 2. Del Rio C, Curran JW. Epidemiology and prevention of acquired immunodeficiency syndrome and human immunodeficiency virus infection. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 118. 3. Piot P. Human immunodeficiency virus infection and acquired immunodeficiency syndrome: A global overview. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadlelphia, Pa: Saunders Elsevier; 2007:chap 407. 4. National Center for Biotechnology Information, U.S. National Library of Medicine.

Chlamydia
Chlamydia is the most common curable sexually transmitted disease, and it is caused by Chlamydia trachomatis. Hundreds of thousands of new cases are reported every year, but that probably represents less than half of all infections. This is because half of all chlamydia cases in men, and three quarters of chlamydia cases in women, have no symptoms. Sexually active individuals and individuals with multiple partners are at highest risk.

Signs and Symptoms


The primary infection site for chlamydia in men is the urethra, the tube inside the penis that carries urine and sperm. Infection of the urethra is known as urethritis. Chlamydia symptoms in men may include:

burning pain on urination discharge from the opening of the penis (the urethra) pain in the testicles pain in, or discharge from, the rectum

For Women: The primary infection site for chlamydia in women is the cervix, the opening that connects the vagina to the uterus, or womb. Infection of the cervix is known as cervicitis. Chlamydia Symptoms in women may include:

Vaginal irritation Heavy grayish-white discharge Painful sexual intercourse Pain in, or discharge from, the rectum Nondescript pain in the lower abdomen Severe pelvic pain from an infection that has ascended from the cervix into the upper reproductive tract.

Assessment
Diagnosis is made by culture of the organism. If an individual engages in anal sexual contact, samples from the rectum may also be needed. The sample is sent for a fluorescent or monoclonal antibody test, DNA probe test, or cell culture. Some of these tests may also be performed on urine samples.

Therapeutic Management
Therapy is oral doxycycline or tetracycline for 7 days. Chlamydia infection in a mother may cause eye infection or pneumonia in the newborn. During pregnancy, the infection is treated with erythromycin, since tetracycline is teratogenic.

Prevention
All sexually active women up through age 25 should be screened yearly for chlamydia. All women with new sexual partners or multiple partners should also be screened. A mutually monogamous sexual relationship with an uninfected partner is one way to avoid this infection. The proper use of condoms during intercourse usually prevents infection.

References: 1. Pilliterri, A. ;(2009)Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family 6th Edition 8, chap 46, 1381 2. Stamm WE, Batteiger BE. Chlamydiatrachomatis (trachoma, perinatal infections, lymphogranuloma venereum, and other genital infections). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 180 3. Boskey E. ; Chlamydia: An Overview In: Sexually Transmitted Diseases (STDs) Guide 2011. 4. http://std.about.com/od/bacterialstds/a/chlamydiaoverv.htm 5. National Center for Biotechnology Information, U.S. National Library of Medicine.

Herpes Genitalis
Genital Herpes is caused by the herpes virus hominis type 2 (HSV-2). This is one of four similar herpes viruses: cytomegalovirus, Epstein-Barr, Varicella-zoster, and herpes type 1 and type 2. Unlike most other STDs, there is no known cure. The disease involves a lifelong process and may be a precursor to cervical cancer. The virus, spred by skin-to-skin contact, enters a break in the skin or mucous membrane.

Signs and Symptoms


The incubation period is 3 days to 2 weeks after exposure. Symptomatic HSV presents with multiple small vesicles on an erythematous base. The vesicles are painful and eventually rupture, leaving an open lesion or ulcer. Many people with genital herpes never have sores, or they have very mild symptoms that go unnoticed or are mistaken for insect bites or another skin condition. If signs and symptoms do occur during the first outbreak, they can be quite severe. This first outbreak usually happens within 2 days to 2 weeks of being infected. General symptoms include: Fever Headache Malaise Anorexia Pain Lymphadenopathy Edema

Genital symptoms include the appearance of small, painful blisters filled with clear or straw-colored fluid usually found:

In women: on the outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks In men: on the penis, scrotum, around the anus, on the thighs or buttocks In both sexes: on the tongue, mouth, eyes, gums, lips, fingers, and other parts of the body

Assessment
Herpes is diagnosed by a culture of the lesion secretion from its location on the vulva, vagina, cervix, or penis or by isolation of HSV antibodies in serum. A test called PCR performed on fluid from a blister shows small amounts of DNA. It is the most accurate test to tell whether the herpes virus is present in the blister. Blood tests check for antibody levels to the herpes virus. These blood tests can identify whether someone has ever been infected with the herpes virus, even between outbreaks. It may be positive even if they've never had an outbreak.

Therapeutic Management
Acyclovir (Zovirax) controls the virus by interfering with DNA reproduction and decresing symptoms. The drug is available as a topical ointment. If applying this to a client, protect yourself with a finger cot or glove so thet you do not contract the virus or absorb the drug. Sitz baths three times a day and applying a soothing substance such as cornstarch to reduce discomfort may be helful, but its moisture tends to prolong the active period of the lesions. Because of the association with cervical cancer, any female with genital herpes should have a yearly pap test for the rest of her life.

Prevention
Condoms will help prevent the spread of herpes among sexual partners. People with herpes may have difficulty establishing sexual relationships for fear of infecting a partner. Because herpes is communicated only by direct contact, infected indviduals need to inform their partner when they have any active lesions and take extra precautions to decrease the danger of spreading the virus.

References: 1. Pilliterri, A. ;(2009)Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family 6th Edition 8, chap 46, 1381,1384 2. Schiffer JT, Corey L. Herpes simplex virus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 136. 3. Bavis MP, Smith DY, Siomos MZ. Genital Herpes: Diagnosis, treatment, and counseling in the adolescent patient. In: The Journal for Nurse practitioners Volume 5, Issue 6, June 2009. Pp 415-420.