STIs are those that are spread through

sexual contact with an infected

partner
 Trichomoniasis is an infection caused by a single-cell protozoan (round
mobile structure) spread by coitus.
 Etiology: trichomona Vaginitis
Signs and symptoms:
 A woman notices a yellow-gray, frothy, odorous vaginal discharge.
 Vaginal irritation, redness and pinpoint petechiae
 Extreme vaginal itching
 Dyspareunia
 Increased vaginal pH
 Males-- asymptomatic
DIAGNOSTIC TEST:
 Scrapping of vaginal discharge with drops of Ringer’s Solution
 The infection is diagnosed by examination of vaginal secretions on a wet
slide that has been treated with potassium hydroxide (KOH) or by a vaginal
culture.
Treatment:
It is important that trichomoniasis infections be identified and treated
because they may be asssociated with preterm labor, premature rupture of
membranes, and post-cesarean infection.
•The drug of choice is single-dose oral metronidazole (Flagyl) 2gm given
to both woman and sex partner
Metronidazole was once thought to be teratogenic, but the CDC now
confirms it is safe in either early or late pregnancy. This should not be
taken with alcohol– causes acute nausea and vomiting
•Topical– providone iodine or vinegar douche only to reduce symptoms
until metronidazole can be used

NURSING INTERVENTIONS:
1.Advise client to abstain from coitus; male sex partner may use condom
2.Advise woman to use tampons to absurd discharges and increase comfort
3.Emphasize importance of perineal hygiene
 Moniliasis may affect skin, mucous membranes as
in GIT, mouth, vagina, anus, fingernails, and body
folds– groins, neck, axillae
Common in:
 Obese people, perspires profusely
 DM
 pregnancy
 using oral contraceptive pills
 pseudopregnancy state
 antibiotic and steroids users.
Etiology: Candida Albicans
Signs and symptoms:
Cheesy, white non-odorous vaginal discharge
Vaginal and vulvar itching
Red, beefy appearance of affected areas dyspareunia
Causes thrush in newborn
DIAGNOSTIC TEST:
•Scrappingof vaginal discharge with 3-4 gtts of 20% (KOH) potassium hydroxide
TREATMENT:
•4-6 months. Apply Gentium Violet 1% for relief of pruritus (stains underware
permanently)
•Nystatin (mycostatin) drug of choice– DOC
•Male partner to be treated as well
NURSING CARE:
1.Antibiotic by mouth should be stopped
2.Rule out DM and treat properly
3.Weight reduction for obese people
4.Avoid coitus during infection or use condom during treatment period
 Herpes genitalis spreads by skin to skin contact and virus
enters thru a break in the skin or mucous membranes. It is
highly contagious.
Incubation period: 3-14 days
Etiology: Herpes Virus Horminis II
 HVH-2-- genital virus (not airborne– not by fomites)
 HVH-1-- non-genital forms- oral skin but it is possible for
each virus to cross infects
Signs and symptoms:
 Vesicular lesion on cervix, vagina, vulva, penis
 Systemic symptoms as headache, malaise, low grade fever
 Dysuria
 Pain intense upon contact with clothing
DIAGNOSTIC TEST:
History and clinical evaluation
Isolation of virus in tissue culture (most accurate)
Scrapping for pap smear or Tzanck smear
TREATMENT:
•Analgesics for pain– aspirin
•Acyclovir (Zovirax) do not cure only alleviate symptoms and reduce spread of
virus

Nursing Care:
1.Abstinences- condoms and spermicide less effective
when to abstain: -presence of lesions
- last 4-6 weeks of pregnancy if partner has HIV1
2. Keep lesion clear and dry
3. Culture virus during pregnancy to safeguard fetus- 50% of newborn may be
infected during delivery
 Syphilis is a systemic disease caused by the spirochete
Treponema pallidum.
 It is currently increasing in frequency.
Transmission: Sexual contact/ congenital– moves thru
skin and mucous membrane and into the bloodstream
and destroy tissues in an organ in the body
 Early in pregnancy (before week 18), the placenta
appears to provide some protection against the disease.
After this time, however, the spirochete crosses the
placenta freely and may be responsible for spontaneous
miscarriage, preterm labor, stillbirth, or congenital
anomalies in the newborn
STAGES:
I. Incubation period
characteristics:
1. 10-90 days– average 21 days
2. No s/s or lesion
3. Presence of etiology agent- blood is infective
II. Primary (early) Syphilis– most infectious stage– lasting 1-6 weeks
Characteristics:
1. Chancre or primary sore painless ulcer appears 1st in site of entry of the
organism (genitalia, anorectal, lips, oral cavity, fingers)
2. Chancre erodes and heals 4-6 weeks leaves a scar or none at all
3. Inguinal lymph nodes enlarges
4. Presence of indolent, painless ulcerations in any part of the body suspect
III. Secondary syphilis
Characteristics:
1. Follows onset on chancre—9- 90 days
2. Influenza like symptom and rashes ulcerations; Condylomata– moist papules
on cell site– highly infectious
3. General patchy hair loss on scalp
4. Acute iritis
5. Hoarseness, chronic sore throat
IV. Late syphilis
Characteristics:
1. 10-30 days
2. Granuloma– lesions on skin, bones, liver, CVS (heart, and CNS(brain))
DIAGNOSTIC TEST:
Serologic test. All pregnant women are screened for syphilis at a first prenatal visit
by a VDRL, ART, or FTA-ABS antibody reaction test. Those who have
multiple sexual partners are tested again about week 36 of pregnancy. In
some institutions, women are screened again for congenital syphilis by a
cord blood sample.
• Non- treponemal or Reagin test- detect antibiotic like substance
• Treponemal test- measure specific antibiotics to TP
Treatment:
•One injection of benzathine penicillin G is the DOC (drug of choice) for the
treaatment of syphilis during pregnancy.
After therapy, a woman may experience a sudden episode of hypotension,
fever, tachycardia, and muscle aches. This is called Jarisch-Herxheimer reaction
and is caused by the sudden destruction of spirochetes. This reaction lasts for 24
hours then fades

Nursing care:
1.Isolation of infected materials
2.Case follow-up
3.Advise patient to refrain fro sexual contact with untreated previous partner
 Gonorrhea is an STI caused by the gram-
negative coccus Neisseria gonorrhoeae.
Transmission: sexual/ direct contact with
discharge
 Gonorrhea is associated with spontaneous

miscarriage, preterm birth, and endometris in

the postpartum period
 It is also a major cause of pelvic inflammatory

disease (PID) and infertility.

Signs and symptoms:
Woman:
1. Heavy green- purulent discharges, abnormal uterine bleeding; abnormal menses
2.Urinary frequency, pain and burning sensation
3. Ascending infection (PID)
Men:
1.Purulent dischargefollowing paiful urination, urethrititis, prostatitis, epididymitis
(pain-burning)
2.Pelvic pain and fever
A yellow-green vaginal discharge may be present, or a woman may be asumptomatic.
Her male partner usually has severe symptoms of pain on urination and a purulent
yellow penile discharge.
Despite safer sex practices and effective therapy, this disease still spreads at an epidemic
rate in young adults.
Pharyngeal gonorrhea:
1.Sore throat; maybe asymptomatic
Anorectal gonorrhea:
1.anal-rectal burning, itching, and bleeding mucopurulent discharge, painful defacation
Adult gonococcal conjuctivitis
1.Transmitted to eyes by fingers
Diagnostics:
•Diagnosis of Gonorrhea is made by culture of the organism from the vagina, rectum, or
urethra.
•Direct flourescent antibody test
Treatment:
•Tetracycline, Amoxicillin with probenecid and penicillin with prebenecid
Although Gonorrhea has traditionally been treated with amoxicillin and probenecid, the
incidence of penicillinase-producing strains has made this traditional therapy ineffective.
Therefore, oral cefixime (Suprax) or IM ceftriaxone (Rocephin) is the current
recommended therapy.
Goal of care:
1.Eradicate organism
2.Educate patient about this condition
Sexual partners also should be treated to prevent reinfection. Because most people who
contract gonorrhea also have a chlamydial infection, nonpregnant women should receive
doxycycline therapy at the same time. If a woman is pregnant, she should receive
amoxicillin or azithromycin.
Fetal outcome: Opthalmia Neonatorum– Crede’s prophylaxis- used after delivery
(Terramycin Opthalmic ointment for both eyes)
It is important that gonorrhea be identified and treated during pregnancy because if the
infectionis present at the time of birth, it can cause a severe eye infection that can lead to
blindness in the newborn.
Nursing Care: Careful handwashing
 Infection with the human immunodeficiency virus(HIV), the
organism responsible for acquired immunodeficiency syndrome
(AIDS), is the most serious of the STIs because it can be fatal to both
mother and child.
 The virus is contracted through sexual intercourse, by exposure to
infected blood, by vertical transmission across the placenta to the
fetus at birth, or by breast milk to the newborn.
 HIV has become the leading cause of death in women 25 to 44 years
of age. 1-2% of every 1,000 women giving birth are HIV positive.
Pregnancy does not appear to accelerate the progression of the
disease.
 The disorder is caused by a retrovirus that infects and disables T
lymphocytes. Without T lymphocytes, the body cannot fight
infection through either T-cell or B-cell activity
Risk factors include:
•Multiple sexual partners of the individual or sexual partner
•Bisexual partners
•Intravenous drug use by the individual or sexual partner
•Blood transfusions (rare)
Assessment:
Unlike other STIs, HIV infection rarely begins with the reproductive tract irritation.
Instead, early symptoms are more subtle and often difficult to differentiate from
those of other diseases or even from the symptoms of early pregnancy(ex fatigue,
anemia, diarrhea, weight loss)
Without therapy, HIV infection may progress through the following stages:
•The initial invasion of the virus, which may be accompanied by mild, flulike
symptoms
•Seroconversion, in which a woman converts from having no HIV antibodies in her
blood serum (HIV serum negative) to having HIV antibodies against HIV (HIV
serum Positive). Happens 6 months to 1 year after exposure
•An asymptomatic period, appears to be disease-free except for symptoms such as
weight loss and fatigue (a wasting syndrome), although the virus could be
replicating by this time. Period varies: average of 3-11 years
•A symptomatic period, woman develops opportunistic infections and possibly
malignancies( ex toxoplasmosis, oral and vaginal candidiasis, GI illness, Herpes
simplex,and HIV-associated dementia). At this point , the CD4 count is usually
below 200 cells/mm3.
DIAGNOSTIC TEST:
Testing for HIV infection is done by an ELISA antibody reaction; for
confirmation, a Western blot analysis is required.
Rx:
•Zidovudine(ZVD) administered to woman beginning with the 14th week of
pregnancy and the newborn receives the drug for 6 weeks after birth, the risk of
perinatal transmission can be reduced to only 8-10%
•Nevirapine, a newer antiretroval drug, may reduce the incidence even more.
Goal of therapy:
•To maintain the CD4 cell count at greater than 500 cell/mm3 by administering
1 or more protease inhibitors such as ritonavir (Norvir) or indinavir(Crixivan),
(in addition to ZVD), in conjunction with a nucleoside reverse transcriptase
inhibitor drug(NRTI)
nd develop aids in the first year of life.
Nursing care:
1.Issues of safer sex practices, testing of sexual contacts, continuation or
termination of the pregnancy and treatment during pregnancy must be addressed.
2.Women infected with HIV are usually advised not to become pregnant until
more is learned about how to prevent transmission to a fetus.
•HIV infection is associated with low birth weight and preterm birth.
•20-50% of infants born to untreated HIV- positive women will contract the virus
a
