Medical Sexually Transmitted Disease | CHAPTER-14 | Medical and Surgical Nursing

Medical Sexually Transmitted Disease – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.

Medical Sexually Transmitted Disease

Definition of Sexually Transmitted Disease (STD):

Sexually transmitted diseases may be defined as infections acquired during heterosexual or homosexual intercourse with an infected partner

Or,

STDs are the diseases which are predominantly transmitted by/ 1 by/ through sexual (or intimate) contact from an infected partner.

Or,

The sexually transmitted diseases (STD) are a group of communicable disease that are transmitted predominantly by sexual contact and caused by wide range of bacterial, viral, protozoal, and fungal agents and ectoparasites.

(Ref by-K. Park/27/330+ D. C. Dutta’s Gynae/5/142)

Name of Sexually Transmitted Diseases (STDs):

(Ref: D. C. Dutta’s Gynae/5/142)

Classification of Sexually Transmitted Disease (STDs):

According to causative agent:

(*) Indicate common STD disease)

(Ref by K. Park/224/331)

Risk Factors of STDs (Sexually Transmitted Disease):

Anyone who is sexually active risks exposure to a sexually transmitted infection to some degree, Factors that may increase that risk include:

1. Having unprotected sex. Vaginal or anal penetration by an infected partner who isn’t wearing a latex condom significantly increases the risk of getting an STI. Improper or inconsistent use of condoms can also increase your risk.

2. Having sexual contact with multiple partners. The more people you have sexual contact with, the greater your risk. This is true for concurrent partners as well as monogamous consecutive relationships.

3. Having a history of STIs. Having one STI makes it much easier for another STI to take hold

4. Anyone forced to have sexual intercourse or sexual activity. Dealing with rape or assault can be difficult, but it’s important to be seen as soon as possible. Screening, treatment and emotional support can be offered

5. Abusing alcohol or using recreational drugs. Substance abuse can inhibit your judgment, making you more willing to participate in risky behaviors.

6. Injecting drugs. Needle sharing spreads many serious infections, including HIV, hepatitis B and hepatitis C.

7. Being young. Half of STIs occur in people between the ages of 15 and 24.

8. Men who request prescriptions for drugs to treat erectile dysfunction. Men who ask their doctors for prescriptions for certain drugs such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) – have higher rates of STIs, Be sure you are up to date on safe sex practices if you ask your doctor for one of these medications.

Mode or Route of Transmission of STDs.

1. Unprotected sexual intercourse (vaginal, anal or oral)

2. Trans-placental, eg. Mother to child

• During pregnancy: HIV, syphilis
• During delivery: Gonorrhea, Chlamydia, and HIV
• After birth: HIV, (through breast feeding)

3. Transfusion of infected blood and blood products

4. Sharing of needle and syringe for intravenous drug infusion.

Preventive Measures of STD/AIDS:

A. Health and sex education:

• Motivation of sexual behavior (Avoidance of multiple sexual partners)
• Use of condom
• Avoidance of sharing of needles and syringes by intravenous drug users.
• All mass media channels should be involved in educating the people on STDs, their nature, mode of transmission and prevention.

B. Prevention of blood borne STDs transmission:

• Exclude the high risk donors from donating blood, body organs, sperms and other tissues.
• All blood should be screened before transmission.
• Strict sterilization practices should be ensured in hospitals and clinics,
• Disposable syringes and needles should be used,

C. Control of prostitution:

• For this programmed active support of social workers and law enforcing agencies is needed.
• Rehabilitation of prostitutes

D. Social welfare measures:

• Provision of recreation facilities in the community
• Provision of decent living conditions
• Marriage counseling
• Prohibiting the sale of pornographic books and blue films

E. Abiding by the law of religion

Control of STDs:

The control of STDs may be considered under the following principle.

a) Initial planning:

• Problem detection
• Establishing priorities: Priority groups on the basis of: Age, sex, area, occupation etc.
• Setting objects.
• Considering strategies

b) Intervention strategies:

• Case detection:

✔ Screening: High priority is given, pregnant women, Blood donors, Army, Police, truck drivers, CSWs or (prostitutes) and other risk group.

✔ Contract tracing: Technique, by which the sexual partners of diagnosed patients are identified, located, investigated and treated.

✔ Cluster testing: Here the patients are asked to name other persons of either sex who move in the same socio sexual environment

• Case holding and treatment: Adequate treatment of patients and their contacts is the mainstay of STD control.
• Epidemiological treatment: Administration of full therapeutic dose of treatment to persons recently exposed to STD while awaiting the results of laboratory tests followed by contact treatment according to that laboratory result.
• Personal prophylaxis:

✔ Contraceptive, eg, condoms, Diaphragms.

✔ The exposed parts should be washed with soap and water as soon as possible

✔ vaccines, eg, hepatitis B vaccine

• Health and sex education:

✔ Motivation of sexual behavior (Avoidance of multiple sexual partners)19721

✔ Education among: younger generation, vulnerable groups, Couple preparing for marriage, Community leaders, General public.

c) Supportive components:

• STD clinic
• Laboratory services
• Primary health care
• Information system
• Legislation
• Social welfare measures

✔ Rehabilitation of prostitutes

✔ Marriage counseling

✔ Provision of recreation facilities in the country

✔ Prohibiting the sale of sexually stimulating literature, pornographic books and photographs.

manage a case of sexual transmitted disease (STD)

A. Syndromic treatment:

• For vaginal discharge in all cases: Treat for vaginitis (Trichomoniasis and BV plus candidiasis)
• If the risk assessment is positive and or discharge from the cervix is detected: Treat for cervicitis (Gonorrhea and chlamydial infection)
• Syndromic treatment for urethral discharge includes both gonorrhea and chlamida.
• Therapy for uncomplicated gonorrhea:

✔ Ciprofloxacin, 500 mg orally, as a single dose (for 7 days. Or

✔ Ceftriaxone, 125 mg by intramuscular injection, as a single dose. Or

✔ Cefixime, 400mg orally, as a single dose.

B. Therapy for Chlamydia:

• Doxycycline, 100 mg orally, twice daily for 7 days. Or
• Azithromycin, 1 gm orally, as a single dose.

C. Recommended regimen for chlamydial infection during pregnancy:

• Erythromycin, 500 mg orally, 4 times a days for 7 days. Or
• Amoxycillin, 500 mg orally, three times a day for 7 days.

[Patients should be advised to return if symptoms persist 7 days after start of therapy]

Social and Behavioral Factors Involved in the Spread of STDs:

➤ Prostitution: The prostitute acts as a reservoir of infection. The prostituant (male component of prostitution) is equally important.

➤ Broken homes: Children of broken families are frustrated and go to prostitutes.1

➤ Sexual disharmony.

➤ Easy money: Prostitution provides an occupation for earning easy money.manl

➤ Emotional immaturity of teenagers.

➤ Social disruption.

➤ International behavioral pattern: Freedom from supervision, equal right for both sexes, relaxation of moral and cultural values, live together.

➤ Social stigma: Shy to go to VD clinic, not disclosing the source of contact, going to quacks for treatment, dropping out drugs before treatment is complete.

➤ Greater sexual encounter: More female employment, more co-educational schooling.

➤ Alcoholism: as it may encourage prostitution.

➤ Homosexuality.

➤ Easy to get contraceptive.

➤ Availability of photograph blue film pornography etc.

➤ Economic factors: Rapid economic development, greater prosperity and affluence.

➤ Absence of healthy recreation facilities.

➤ Frequent partner change.

➤ Having more partners.

➤ Sex with casual partners

Complication of STD:

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