Learning objectives/outcomes

• At the end of this unit the student nurse should be

able to:
• Define the related concepts
• Discuss the causes/etiology
• Outline the clinical manifestations.
• Describe the types/classification/stages.
• Discuss Nursing assessment
• Recognise the possible complications.
1
 Learning outcomes continue
• Outline the Nursing diagnosis.
• Discuss the health education.
• Explain the Nursing management

2
 Testing of pre-existing knowledge
What is HIV stand for?
• H-Human
• I-immuno deficiency
• V-virus
What does Aids stand for?
• A-acquired
• I-immune
• D-Deficiency
• S-syndrome
3
 Testing of knowledge continues
What does STIs stand for?
Answer- Sexual transmitted infections
What does SRIs stand for ?
Answer-Sexual reproductive infections

4
 Course of lesson
Do you think that there is a linkage between STIs and
HIV ?
Answer-Treatment of STIs is an important
component of HIV prevention and care management.
Interaction of HIV and STIs is bi-directional.
Presence of STIs could increase vulnerability to HIV
infection.
clinical presentation of various types of STIs is
influenced by co-infection with HIV.
5
 Course of lesson
HIV and STIs continue
• In HIV positive patient syphilis can have
atypical presentation and can rapidly progress
to neuro syphillis.
• Co-infection with genital ulcers.
• Both specific and non-specific treponemal
serology tests for syphilis can be non-reactive
in presence of infection with HIV.

6
 Course of lesson
HIV and STIs continue
• Recurrent / persistent genital ulcers caused by
herpes simplex are common in patients with
HIV.
• Increase number of HPV(Human papilloma
virus) and cervical cancer mostly occurs in the
presence of HIV.
• STIs can be a marker of unprotected sex.

7
 Course of lesson
Definitions of concepts
What does syndromes mean?
• Is a group of symptoms a patient complains
about and they are clinical signs that you
observe during examination.
What does syndromic management mean?
• Treatment of all the common causes of those
symptoms.
8
 Course of lesson
Definitions of concepts continue
• BV-bacteria Vaginosis
• Candindas -fungal infection caused by steroids,
antibiotics therapy, pregnancy.
• Vulvitis -inflammation of vulva
• PID-Pelvic inflammatory diseases
• LAP-lower abdominal pain
• Vaginatis -infection and inflammation of vagina.
9
 Course of lesson
STIS syndromes
• What are the most common STIs syndromes?
• Genital ulcer diseases(GUD)
• Ureteral discharges(UD)
• Vaginal discharges(VD)
• Pelvic inflammatory diseases(PID)

10
 Vaginal discharge syndromes(VD)
Definition - abnormal vaginal
discharges( offensive, muco-purulent.
caused by: Cervicitis, BV, PID/LAP, vaginitis,
vulvitis.
Normal vs abnormal vaginal discharges
• Common for women to experience VD.
• This known as physiologic discharge.
VD occurs during:
11
 Course of lesson
Normal vs abnormal vaginal discharges continue
• Physiological changes during menstruation.
• Pregnancy Sexual arousal and lactation.
• During use of hormonal medications e.g
contraceptions.
• Reason for abnormal VD: due infection/ patho-
gical condition(s).

12
 Course of lesson

Aetiology
1.Vaginal infections-. Gardnerrela vaginalis and
retained foreign body.

T. Vaginals and BV are the most common causes of VD .

• TV is a common cause of STI related VDS in Namibia,
accounting for 14.5 %.
• BV is not any STI –accounting for 65% of VDS in
Namibia.

13
 Course of lesson
• BV not an STI-caused by depletion/absence of
normal vaginal flora/lactobacilli
• Having new or multiple sexual partners
• Douching
• Overuse of antibiotics
• Any women can get BV even she do not have
sex before.

14
 Course of lesson
Candidiasis.-not a sexual transmitted infection.
Occurs in patients with the following conditions:
• Pregnancy
• immunosuppressive
• use of antibiotics
• Oral contraceptives
2.Uterine infection: PID

15
 Course of lesson
3.Cervical infections: Gonnococcal cervicitis
chlamydial cervicitis, ulceration of cervix e.g
genital Herpes , chancroid, carcinoma.

16
 Course of lesson
Clinical manifestations
Depend on the causative agents
Trichomoniasis
• increased yellow-green discharges
• Profuse and frothy
• Underclothing stains
• Bad odour and vulva itching

17
 Course of lesson
Bacteria vaginosis
• Malodorous/fish smell
• Continuously moist
• Few vaginal discharges
• Grey-white vaginal discharges

18
 Course of lesson
Candida
• Vulva and vaginal itching sometimes burning
• Vulva reddish and inflamed
• Odourless, cheese like white discharge
• Skin irritated/scratched

19
 Course of lesson
Clinical manifestations continue
Cervicitis
• Frequently asymptomatic
• Vaginal discharge
• Dyspareunia
• Bleeding
• Inflamed cervix and induced bleeding of
cervical mucosa can lead to PID.
20
 Course of lesson
Nursing assessment
• Obtain history of menstruation,
contraceptions, sexual activities(no of partners
,new partners)STDs history, symptoms in
sexual partner.
• Assess level of pain, fever, hypotension,
increase pulse indicating hypervolemia

21
 Course of lesson
Nursing assessment continue
• Assess patient feeling about having STI
• Do full examination: abdominal and speculum
examination.
• Check for rebound ,guarding and cervical
motion tenderness and mass.
• Any abnormal appearance of cervix refer to
Gynaecologist.
22
 Course of lesson
Nursing diagnosis
• Deficient fluid volume related to fever and
decrease oral intake
• Risk for infection related to STIs/SRis.
• Acute pain related to pelvic inflammation
infection.

23
 VDS continues
Diagnostic evaluation
1.Vaginal smear = BV + Candida,
2.Pap smear = Carcinoma
3.Vaginal swab(PCR) to identify the following
organisms/agents:
• Chlamydia trachomatis (CT)
• Trichomonas Vaginalis(TV)
• M.gentalium

24
 Course of lesson
4. Swab - if ulcer present (GUD)
less common causes:
Etiologic agent(s) Associated disease
• Chlamydia Trachomatis =Lymphogranuloma venereum(LGV)
• Klebsiela granulomatis =Granulomma inguinale(GI) or
Donovanosis
Common causes:
Etiologic agent(s) Associated disease
• Haemophillus ducreyi Chancroid
• Herpes simplex-2 Genital herpes

25
 Course of lesson
Management
Cervicitis
• Metronidazole 2g po stat or
• 4oomg po Bd x7days
• Clotrimazole vaginal pessary 500mg stat
• Clotrimazole vaginal cream locally BD x7days

26
 Course of lesson
• Management continues
PID
• Cefixime 400mg po stat or Cefriaxone 250mg
imi stat
• Azytromycine 1g po stat
• Flagyl 2g po stat or 400mg po BD x 7days

27
 Course of lesson
Complications
• PID
• Premature rupture of membrane
• Pre-term labour
• Infertility
• Chronic pelvic pain

28
 Course of lesson
Health education

29
 Course of lesson
Activity/home work
Form up 5 groups
• Draw up a nursing care plan of a patient with
STI
• Devise an health education topic for a patient
with STI
• Discuss the nursing assessment

30
 Couse of lesson
Evaluation
• Define the concept syndrome.
• Outline the causes of BV.
• Discuss the health education to give to a
patient with VD.
• Explain the clinical manifestations of
Trichomonas vaginitis.

31
 References
• Sandra,M.N.(2010)Lippincott:Manual of
Nursing practice.(9th Ed)Lippincott:New york.
• Brunner,L,S.,& Suddaarth,(1992).The textbook
of Adult Nursing:London ,Chapman Hall.
• Mogothlane,S.motschedish
C. ,Mokgadi,M.,Joyce ,M.,& Young,A.
(2014)Juta ‘s complete text book of medical
Surgical Nursing.Cape Town:Lebone Publisher.

32
 References continues
• Ministry of health and social services
(2009).Guidelines for sexual transmitted
infections using syndromic approach.
Directorate of special programmes: Windhoek.

33
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Foamy discharges of trichomoniasis

35
PID

36
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cervicitis

38
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Cervicitis

40
Cervicitis

41
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Genital herpes

52
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Trichomoniasis

58
Trichomoniasis

59
vulvatis

60
Vulvovaginatis

61
HSV

62
HVS

63
HVS 1

64
HSV

65
HSV-2

66
Chancroid

67
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Chancroid

69
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Syphillis

71
Syphillis

72
Syphillis

73
Syphillis

74
syphillis

75
syphillis

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syphillis

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LGV

81
LGV

82
LGV

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LGV

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