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Sexually Transmitted Infections (STIs) | 마이메르시 MyMerci
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Sexually Transmitted Infections (STIs)

NCLEX Review Guide: Sexually Transmitted Infections (STIs)

Common STIs and Clinical Manifestations

Bacterial STIs

  • Chlamydia trachomatis: Often asymptomatic, may cause urethritis, cervicitis, and pelvic inflammatory disease (PID) in women. Leading cause of preventable blindness and infertility worldwide.
  • Neisseria gonorrhoeae: Causes purulent urethral discharge in men, may be asymptomatic in women, can lead to PID and disseminated gonococcal infection.
  • Treponema pallidum (Syphilis): Primary stage presents with painless chancre, secondary stage shows rash on palms/soles, tertiary stage affects cardiovascular and neurological systems.

Memory Aid: Syphilis Stages

"Can't See Terrible Lesions" - Chancre (Primary), Skin rash (Secondary), Tertiary complications, Latent period

Key Points

  • Chlamydia and gonorrhea often co-occur and are treated simultaneously
  • Syphilis requires specific treponemal testing for confirmation

Viral STIs

  • Herpes Simplex Virus (HSV-1, HSV-2): Causes painful vesicular lesions, recurrent episodes are typically less severe than initial outbreak. Increased transmission risk during active lesions.
  • Human Papillomavirus (HPV): High-risk types (16, 18) associated with cervical cancer, low-risk types (6, 11) cause genital warts.
  • Hepatitis B: Can cause chronic infection leading to cirrhosis and hepatocellular carcinoma, transmitted through sexual contact and blood.

Clinical Scenario

A 22-year-old female presents with painful genital ulcers and flu-like symptoms. She reports this is her first episode. What is the priority nursing intervention?

Answer: Administer antiviral therapy (acyclovir) within 72 hours of symptom onset and provide pain management education.

Diagnostic Testing and Treatment

Laboratory Diagnostics

  1. Nucleic Acid Amplification Tests (NAATs): Gold standard for chlamydia and gonorrhea detection from urine or swab specimens
  2. Rapid Plasma Reagin (RPR): Screening test for syphilis, requires confirmatory treponemal testing
  3. Type-specific serology: HSV-1 and HSV-2 antibody testing, IgM indicates recent infection
  4. Pap smear and HPV testing: Cervical cancer screening, co-testing recommended for women ≥30 years

Treatment Comparison

STIFirst-line TreatmentAlternative
ChlamydiaAzithromycin 1g PO x1Doxycycline 100mg BID x7 days
GonorrheaCeftriaxone 500mg IM x1Cefixime 800mg PO x1
Primary SyphilisBenzathine PCN G 2.4 million units IM x1Doxycycline 100mg BID x14 days
HSV (initial)Acyclovir 400mg TID x7-10 daysValacyclovir 1g BID x7-10 days

Nursing Interventions and Patient Education

Priority Nursing Actions

  • Partner notification and treatment: All sexual partners within 60 days must be evaluated and treated to prevent reinfection.
  • Medication adherence counseling: Emphasize completing entire antibiotic course even if symptoms resolve early.
  • Safe sex education: Consistent condom use reduces transmission risk but doesn't eliminate it completely for all STIs.
  • Follow-up testing: Test-of-cure required for gonorrhea treatment, annual screening recommended for high-risk populations.

Memory Aid: STI Education

"SAFER" - Screen regularly, Abstain or be monogamous, Follow treatment plans, Educate partners, Return for follow-up

Complications and Prevention

  • Pelvic Inflammatory Disease (PID): Serious complication of untreated chlamydia/gonorrhea leading to infertility, ectopic pregnancy, and chronic pelvic pain.
  • Pregnancy considerations: Screen all pregnant women for STIs, treat immediately to prevent vertical transmission and adverse outcomes.
  • HPV vaccination: Gardasil-9 recommended for males and females ages 9-26, can prevent up to 90% of cervical cancers.

Key Points

  • Many STIs are asymptomatic, especially in women
  • Dual therapy often required due to co-infections
  • Partner treatment essential to prevent reinfection
  • Regular screening crucial for sexually active individuals

Commonly Confused Points

HSV-1 vs HSV-2

CharacteristicHSV-1HSV-2
Primary siteOral (can cause genital)Genital (can cause oral)
Recurrence rateLess frequent genital recurrenceMore frequent genital recurrence
TransmissionOral contact, sharing utensilsSexual contact

Primary vs Secondary Syphilis

StageLesionLocationPain
PrimaryChancre (ulcer)Site of infectionPainless
SecondaryMaculopapular rashPalms and solesNon-painful

Study Tips and Quick Checks

High-Yield Facts

  • Chlamydia = silent infection, leading cause of PID
  • Gonorrhea = purulent discharge, antibiotic resistance concerns
  • Syphilis = "great imitator," affects multiple systems
  • HSV = recurrent, viral shedding occurs without symptoms
  • HPV = cancer risk, vaccine preventable

Common Pitfalls

  • Don't assume symptoms indicate presence - many STIs are asymptomatic
  • Remember to treat partners even if they're asymptomatic
  • Penicillin allergy requires alternative antibiotics for syphilis
  • Pregnant patients need immediate treatment to prevent complications

Self-Assessment Checklist

  • ☐ Can identify key symptoms of major bacterial and viral STIs
  • ☐ Understand appropriate diagnostic tests for each STI
  • ☐ Know first-line treatments and alternatives
  • ☐ Recognize complications of untreated STIs
  • ☐ Can educate patients on prevention and safe practices

Remember: STI management requires a non-judgmental approach, comprehensive education, and thorough follow-up. Your knowledge and compassionate care can prevent serious complications and improve patient outcomes. You've got this!

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