7.4 Introduction to Sexually Transmitted Infections and Drugs to Treat Them

Sexually transmitted infections (STIs) are a major public health concern. These infections, caused by bacteria, viruses, or parasites, spread through sexual contact and can lead to serious health complications if left untreated.

Understanding STIs is crucial for nurses. From recognizing symptoms to administering treatments, nurses play a vital role in patient care. This knowledge helps prevent transmission, promote early detection, and ensure effective management of STIs.

Overview of Sexually Transmitted Infections (STIs)

Mechanisms of common STIs

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• Bacterial STIs invade and multiply within host cells causing inflammation and tissue damage (Chlamydia, Gonorrhea, Syphilis)
  • Transmitted through sexual contact or from mother to child during childbirth
• Viral STIs invade host cells and hijack cellular machinery for replication leading to cell damage and immune response (HPV, HSV, HIV)
  • Transmitted through sexual contact, blood, or from mother to child during pregnancy or childbirth
• Parasitic STIs attach to and feed on host cells causing inflammation and irritation (Trichomoniasis)
  • Transmitted through sexual contact

Key symptoms of prevalent STIs

• Chlamydia often asymptomatic but can cause abnormal vaginal or penile discharge, burning during urination, and pelvic pain in women
• Gonorrhea frequently asymptomatic but may present with thick, cloudy, or bloody discharge from the penis or vagina, pain or burning during urination, and pelvic pain in women
• Syphilis progresses through stages:
  1. Primary: Painless sore (chancre) at the site of infection
  2. Secondary: Skin rash, fever, swollen lymph nodes
  3. Latent and tertiary: Damage to internal organs, neurological problems
• HPV causes genital warts and abnormal cell changes on the cervix (precancerous or cancerous)
• HSV presents with painful, fluid-filled blisters or sores on or around the genitals, rectum, or mouth and flu-like symptoms (fever, body aches, swollen lymph nodes)
• HIV initially causes flu-like symptoms within a few weeks of infection followed by a prolonged asymptomatic period and eventually weakens the immune system leading to opportunistic infections and cancers
• Trichomoniasis characterized by foul-smelling vaginal discharge, genital itching or irritation, and pain during urination or sexual intercourse
• Some individuals may be asymptomatic carriers, capable of transmitting STIs without showing symptoms

Diagnostic approaches for STIs

• Physical examination inspects genital area for sores, warts, or discharge and palpates lymph nodes for swelling
• Laboratory tests include:
  1. Bacterial culture for Chlamydia and Gonorrhea
  2. Nucleic Acid Amplification Tests (NAATs) for bacterial and viral STIs
  3. Blood tests for Syphilis and HIV
  4. Pap smear for HPV
• Screening involves routine testing for high-risk individuals and prenatal screening for pregnant women

Prevention strategies for STIs

• Education promotes safe sex practices and encourages open communication between partners
• Barrier methods include consistent and correct use of condoms and dental dams for oral-genital or oral-anal contact
• Vaccination prevents cervical cancer and genital warts (HPV vaccine) and sexual transmission of Hepatitis B
• Regular testing allows for early detection and treatment of STIs
• Monogamy or abstinence reduces the number of sexual partners or abstains from sexual activity altogether
• Sexual health education programs in schools and communities play a crucial role in prevention

Public Health Measures

• Contact tracing helps identify and notify potentially infected individuals
• Antibiotic stewardship programs promote responsible use of antibiotics to prevent resistance
• Comprehensive sexual health education in schools and communities
• Promotion of safe sex practices through public health campaigns
• Immune response research to develop new vaccines and treatments

Main drug classes for STIs

• Antibiotics treat bacterial STIs (Chlamydia, Gonorrhea, Syphilis) and include Azithromycin, Ceftriaxone, Doxycycline, and Penicillin G
• Antivirals manage viral STIs (HIV, HSV) and include Acyclovir, Valacyclovir, and Antiretroviral therapy (ART) for HIV
• Antiparasitics treat parasitic STIs (Trichomoniasis) and include Metronidazole

Benefits vs risks of STI treatments

• Antibiotics effectively treat bacterial STIs, prevent complications and transmission but may cause allergic reactions, gastrointestinal side effects, and contribute to antibiotic resistance
• Antivirals reduce severity and frequency of HSV outbreaks and prevent HIV progression but can cause side effects (nausea, headache, dizziness) and interact with other drugs
• Antiparasitics effectively treat Trichomoniasis and prevent transmission but may cause gastrointestinal side effects and interact with alcohol (Metronidazole)

Nursing considerations for STI medications

• Assess for allergies and contraindications before administering medication
• Educate patients on proper dosing, duration, and potential side effects
• Monitor for adverse reactions and effectiveness of treatment
• Encourage adherence to the prescribed treatment regimen
• Maintain patient confidentiality and provide a non-judgmental environment
• Emphasize the importance of partner notification and treatment

Patient education for STI therapies

• Provide clear, written instructions on how to take the prescribed medication
• Discuss the importance of completing the full course of treatment, even if symptoms improve
• Advise on common side effects and when to seek medical attention
• Encourage the use of barrier methods during treatment to prevent transmission
• Stress the importance of follow-up testing to ensure the effectiveness of treatment
• Offer resources for emotional support and counseling services
• Educate on preventive measures to reduce the risk of future STIs
• Emphasize the importance of regular screening and early detection of STIs