Sexually Transmitted

Infections
By Marisol Jane T. Jomaya, RN, USRN, MAN
CLINICAL NURSE INSTRUCTOR
FACTS:
More than 1 million people acquire STI every
day (WHO, 2018)
No updated data on number of STIs in
Philippines except for HIV.
Social stigma associated with STIs are barriers
to prevention and control (Vista, 2018)
Philippines as fastest growing HIV epidemic in
western Pacific with 174% increase in cases
(Epidemiology bureau, DOH, 2018)
FACTS:
 Philippines enacted Reproductive Health Law (RA
10354)  in December 2012
 The RH law mandates active participation of youth
organizations in sexual and reproductive health
programs (Official Gazette of Republic of
Philippines, 2013).
 Restrictive parts of Philippine norms are rooted in
conservative beliefs and values espoused mainly
by the Catholic hierarchy and the so-called “pro-
life” movement.
FACTS:
 Infections that can be transmitted through sexual
activity
 May be caused by a bacteria, virus, fungus, or
other organism
 Some are curable, some are not
 Left untreated, STIs can cause pain, sickness,
infertility, birth defects, and sometimes, death
 STIs are very common.
 You can have more than one STI at a time, and
you can get the same STI more than once.
 Factors contributing to
high rates of STIs
Main reason: multiple sexual partners and
unprotected sex--especially prevalent
behavior in adolescence and early adulthood
Use of oral contraceptive
Limited access to health care
Practitioners do not ask questions about
patients’ sexual behaviors
Asymptomatic infected clients
Difficulty talking to partner
Size comparison of STI pathogens

Protozoa, lice, scabies mites:

Easily visible under light microscop

Yeast: clearly visible under

light microscope

Bacteria: barely visible under

light microscope

Viruses: not visible under light

microscope
Bacterial infections

Chlamydia
Gonorrhea
Syphilis
CHLAMYDIA
Chlamydia

• Caused by: bacterium Chlamydia trachomatis

that infects the urogenital system
Chlamydia

• Transmission: primarily penile-vaginal, oral-

genital, oral-anal, or genital-anal contact; can
also be spread by fingers from one body site to
another.
• Symptoms:
• In majority of cases, none! 
• if present:
• Women: mild irritation or itching, burning urination, slight 
vaginal discharge
• Men: urethral discharge, burning urination
Chlamydia

Consequences if left untreated:

 Women: pelvic inflammatory disease (PID)
 Bacterial infection spreads from cervix up into uterine lining,
fallopian tubes, and possibly ovaries.
 Symptoms of PID include disrupted menstruation, chronic
pelvic pain, lower back pain, fever, nausea, vomiting, and
headache.
 Even after treatment, scar tissue from PID can block
fallopian tubes and cause infertility or ectopic pregnancy
(very dangerous)
Chlamydia
Chlamydia
Consequences if left untreated:
 Men: epididymitis (infection of the epididymis) or
urethritis (infection of the urethral tube)
 Symptoms of epididymitis: heaviness in testes; small, hard,
painful swelling in testes; inflamed scrotum
 Symptoms of urethritis: penile discharge, burning urination
Chlamydia Untreated

• Trachoma:
• a chronic, contagious form of
conjunctivitis caused by
chlamydia infection.
• World’s leading cause
of preventable blindness.
Consequences for babies
born to infected mothers:
• Babies of infected mothers can
also develop pneumonia
caused by chlamydia infection
• Chlamydia infection can lead
to premature delivery
Chlamydia

Treatment:
7-day treatment of doxycycline, or one dose
of azithromycin
All exposed sexual partners should be
treated
GONORRHEA

Anyone who is
sexually active
can get
gonorrhea.
GONORRHEA
Gonorrhea

• Caused by: bacterium Neisseria gonorrhoeae

• Prevalence: ~700,000 new cases a yr. in US
• Transmission: penile-vaginal, oral-genital, oral-
anal, or genital-anal contact
Gonorrhea

• Symptoms:
• Male early symptoms:
• foul-smelling, cloudy penile discharge,
• burning urination
• symptoms may clear up, but does not
necessarily mean bacteria are gone
• Female early symptoms:
• usually go undetected
• inflamed cervix, mild discharge
• burning urination
Gonorrhea

Consequences if left untreated:

Men: prostate abcesses, painful BMs, difficult
urination, possible sterility due to scar tissue in
epididymis after epididymitis
Women: PID (often more severe than w/chlamydia infection),
ectopic pregnancy, severe pelvic pain due to
scar-tissue adhesions across pelvis
Gonorrhea

Both sexes: can enter

bloodstream and spread
throughout body in ~2% of
cases, causing fever, loss
of appetite, arthritic pain,
can invade heart, liver,
CNS infections
Can cause blindness in
infants (due to conjunctivitis)
Gonorrhea

Treatment:
Dual therapy of two antibiotic regimens
CDC recommends a single dose ceftriaxone
250mg IM + 1g Azithromycin PO
(uncomplicated gonococcal infections);
cefexime 400 mg PO single dose as
alternative
Although medication will stop the infection,
it will not repair any permanent damage
done by the disease.
Gonorrhea

Treatment:
Often, chlamydia infections accompany
gonorrhea infection - - dual therapy will treat
both infections
Resistant bacteria require special treatment
All exposed sexual partners should be
treated
SYPHILIS
SYPHILIS
Syphilis
Caused by: bacterium
Treponema pallidium
Transmission: penile-
vaginal, oral-genital, oral-
anal, or genital-anal
contact
SCREENING:
VDRL test (Venereal Disease
Research Laboratory)
Syphilis
Syphilis - Manifestations

Primary syphilis: Single, painless sore (chancre)

 Women: on inner vaginal walls or cervix, sometimes on labia
 Men: glans of penis, penile shaft, or scrotum
 Can also occur on lips or tongue (infected orally) or in
rectum/anus (infected through
anal intercourse)

Glans of penis labia anus

Syphilis

• Secondary syphilis:
skin rash, often on palms,
soles of feet
• Severity can vary from barely
noticable to severe
• 90% of patients with non-itchy
rash
• Person may feel flu-like
symptoms
• If not treated, symptoms will
subside, but disease is not
eliminated
Syphilis

• Latent syphilis: no symptoms; no longer

contagious after 1-2 year of latent stage
(except pregnant woman to fetus--at all
stages)
• During latency, the patient is asymptomatic
with no signs on clinical examination. Therefore,
continued syphilis infection will only be found
by positive treponemal  antibody tests.
Syphilis

• Tertiary syphilis:
• May develop 20-40 years
after initial infection in up to
1/3 of untreated cases.
• Severe symptoms
anywhere--such as heart
failure, blindness, paralysis,
liver damage, mental
disturbance, death
Syphilis

• Treatment:
• Primary, secondary, or latent syphilis (< 1yr) early
cases treated with benzathine penicillin G IM or
other antibiotics (Doxycycline, tetracycline,
azithromycin, ceftriaxone)
• All exposed sexual partners should be treated
• Treated patients need blood tests at 3-month
intervals to make sure they are free of
bacterium
• To prevent birth defects, death to fetus, it is
recommended that all pregnant women are
tested for syphilis at first prenatal visit
Syphilis

• EVEN IF TERTIARY INFECTION IS CLEARED,

ANY NEURO/ORGAN DAMAGE MAY BE
IRREVERSIBLE.
Viral infections

Herpes Simplex Virus (HSV)

Human papillomavirus (HPV)
a.k.a. genital warts
Human immunodeficiency virus
(HIV)
HERPES SIMPLEX VIRUS (HSV)
HERPES SIMPLEX VIRUS (HSV 2)
Herpes

• Caused by: Herpes simplex virus (HSV)

• Two sexually transmitted types: HSV-1 and HSV-2
• HSV-1 is usually oral herpes (cold sores), but can infect
genitals; HSV-2 usually causes genital lesions, but can
also infect the mouth
Herpes

• Transmission:
• Genital herpes: penile-vaginal, oral-genital,
oral-anal, or genital-anal contact
• Oral herpes: through kissing, or oral-genital
contact
• Herpes sores are highly contagious--need to
avoid contact between lesions and someone
else’s body
• Can still transmit herpes even if no lesions are
present
Herpes
• COURSE OF DISEASE:
• INCUBATION PERIOD: 2-7 days
• INFECTIOUS PERIOD: persons with primary herpetic lesions
for about 7-12 days
• RECURRENT EPISODES: occur in 60-80% of patients whose
primary infection was symptomatic.
• RECURRENT EPISODES are milder and of shorter duration
than initial outbreak.
Herpes

• How to reduce risk of transmission:

• Herpes virus cannot pass through latex condoms
• During an outbreak (for most people, ~3 times/yr),
best to avoid sexual contact with the lesion area-
-condoms should not be relied on when lesions
are present

IS THERE A LINK BETWEEN HSV1 and HSV2?

Oral herpes caused by HSV-1 can be spread from
the mouth to the genitals through oral sex. This is
why some cases of genital herpes are caused by
HSV-1.
Herpes

• How to reduce risk of transmission:

• Between outbreaks--safest strategy is to use
condoms, oral dams, etc. since there can
sometimes be asymptomatic viral shedding
• Condoms aren’t 100% effective at preventing transmission,
since they don’t cover entire genital area, but they reduce
risk significantly
• Medications are available that reduce the amount
of asymptomatic viral shedding that occurs
between outbreaks--can significantly reduce risk of
transmission
Herpes
• Recurrence:
• After lesions heal, virus retreats up nerve fibers and stays
dormant in nerve cells in the spinal column
• Flare-ups occur when virus moves back down along
fibers to genitals or lips
• Triggered by wide variety of factors, such as: stress,
anxiety, depression, acidic food, UV light, fever, poor
nutrition, fatigue
• Symptoms during recurrent attacks tend to be milder
than primary episode, heal more quickly
Herpes

• Prodromal symptoms:
• Symptoms that warn of an impending herpes outbreak
• Burning, throbbing, or tingling at sites of infection
• Sometimes includes pain in legs, thighs, groin, or
buttocks
• Viral shedding is more common during prodromal
symptoms than beforehand--best to avoid contact
w/infected area from first sign of prodromal
symptoms until sores have healed
Herpes
Other complications:
Women:
Increased incidence of cervical cancer--women
with herpes should get Pap smears every 6-12
months
Newborn baby can be infected by passage
through birth canal--can cause severe damage or
death
C-section recommended for women w/active
symptomatic disease
Both sexes:
Ocular herpes infection can occur if virus is
transferred from a sore to the eye
Must be treated quickly to avoid eye damage
Herpes

• Treatment:
• Reduce frequency of outbreaks
• Treat symptoms of outbreaks and speed
healing
• Two types of therapies
• Suppressive therapy: medication taken daily to
prevent recurrent outbreaks; also reduces
asymptomatic viral shedding between outbreaks
• Episodic treatment: medication taken to treat
outbreaks when they occur
Herpes
• Treatment:
• Antiviral drugs--
reduce viral shedding
and the duration and
severity of outbreaks
• Acyclovir (trade
name Zovirax)
• Valacyclovir (trade
name Valtrex)
• Famiclovir (trade
name Famvir)