Bacterial

Protozoa

Syphilis Trichomoniasis
Gonorrhea
Chancroid
Viral

AIDS
HSV
Warts
 Is a systemic and highly infectious STD that usually begins with mucous membrane
and quickly becomes systemic

a.k.a LUES VENERA

 
CAUSATIVE AGENT:

Treponema pallidum
– spirochete
Treponema pallidum
 Has no other host but man
 Believed that mo will pass thru mucosa w/o
a visible crack
 Does not withstand drying
 Has been found alive in a glass for ½ hour
after a glass was rinsed by cold water
 Can not be grown in vitro
 MOT:
 
Direct Contact- infectious exudates from obvious
or concealed moist early lesions of skin and mucous
membrane, body fluids and secretions
Blood Transfusion
Transplacental Transfer syphilis
neonatorum
Indirect Contact

Health Professionals developed primary lesions on hands

after examination of infectious lesions
INCUBATION PERIOD:
2 to 6 weeks
 
POC:
Variable and Indefinite
 
SUSCEPTIBILITY:
Universal
No natural immunity
 
OCCURRENCE:
Widespread
Primarily involving young persons
between 15 – 34 yrs
More prevalent in urban than rural areas
M>F
High prevalence among male homosexuals
Pathogenesis

Entry of MO

Organism multiplies and locally disseminate systematically through

the blood stream

STAGES OF SYPHILIS:
 PRIMARY SYPHILIS
 SECONDARY SYPHILIS
 TERTIARY SYPHILIS
Pathogenesis
Microorganism penetrates skin/mucosa

Multiplies in subcutaneous tissue at the site of entry

Proliferation of immune cells (lymphocytes /antibodies)

Inflammatory response leading to ulceration or wearing away of

tissue
STAGES:
 
PRIMARY SYPHILIS
 
1. Sites of Primary Lesions
 
Anogenital region

Extragenital area –
lips, tongue, tonsil, finger, nipple
2. Description of primary lesion
(hard chancre)

Chancre begins at
the site of
inoculation

Appears like a
pimple if it is on skin

 Begins as a single painless papule that

rapidly becomes eroded and usually
becomes indurated with a characteristic
cartilaginous consistency on palpation of
the edge and base of the ulcer.
 PRIMARY SYPHILIS

 Chancre
Inguinal lymphadenopathy

Lesions become multiple

painful vesicles, which later
ulcerate

Fever

COURSE:
Lesion heals within
4 – 6 weeks without treatment
(chancre in men)

It doesn’t mean that it is cured!!!

B. SECONDARY SYPHILIS
 
OCCURRENCE:
Approximately 6 – 7 weeks after primary lesions
appear.
Development of mucocutaneous lesions and
generalized lymphadenopathy
GENERAL S/ SXS:
Fever
Malaise
Sore Throat Nausea
Weight Loss Constipation
Anorexia Headache, muscle and joint pain
fever
Skin
Hair
Lymphatic system
Mucous membrane
Pathogenesis
Microorganism migrates into the lymphatics

To blood stream throughout the body

Lesions/Lymphadenopathy/microorganism can be found anywhere in

the body
”GREAT IMITATOR”

Basilar meningitis

CN deficits, AGN, hepatitis and synovitis

B. SECONDARY SYPHILIS

SKIN
Anogenital are
Mouth
Axilla
Toe webs
Soles of feet
Palms of hands

Initially:
bilaterally symmetric
pink
non pruritic
round macules
B. SECONDARY SYPHILIS

SKIN
Non pruritic round macule that
appears b/w rolls of fat and

Transforms into

papular

follicular

pustular lesions

-become enlarged and eroded

-produces broad, moist, pink or gray – white, highly
infectious lesions called CONDYLOMATA LATA
-develop in warm, moist body areas common in
labia, anus, corners of the mouth
B. SECONDARY SYPHILIS

CONDYLOMATA LATA

This 45-year-old house maid suffered from multiple

moist grayish papules on the vulva
for a month.

Dark field microscopy showed spirochetes consistent

with Treponema pallidum and her syphilis serology
(VDRL) was reactive with a titer of 1:256.

She was treated with benzathine penicillin 2.4 million

units intramuscularly in each buttocks.

All cutaneous lesions had resolved 3 weeks later when

she returned for reevaluation.

multiple confluent moist

grayish-white papules
B. SECONDARY SYPHILIS

CONDYLOMATA LATA
B. SECONDARY SYPHILIS
HAIR
“Moth – eaten scalp”
– alopecia beginning on the occipital area
Loss of eyelashes, beard and lateral 1/3 of the
eyebrows.
temporary

MUCOUS MEMBRANE
 mucous patches of the mouth, throat and cervix
Yellow to white in color and covered with exudates, which
when removed reveals a soft glistening appearance.

LYMPHATIC SYSTEM
 generalized non-tender lymphadonapathy w/ occasional splenomegal
Secondary syphilis: moth-eaten alopecia, which affects the scalp, eyebrows, eyelashes,
and beard. (Courtesy of Stacy Smith, M.D.)
Secondary syphilis: alopecia of the eyebrows. This patient presented to the
dermatologist with the sole complaint of loss of eyebrow hair.
B. SECONDARY SYPHILIS
COURSE: lesions slowly fade away, but may
recur during the latent phase

LATENT SYPHILIS- no clinical s/sx but with

reactive serological test

- 2/3 are asymptomatic until death

-immune system controls infection
- Patients who were remained untreated/
destructive but non-infectious

OCCURRENCE:
 May begin as early as 1 year after the
initial infection.
 Typically occurs after a latent period of 5 –
20 years
 Systemic infection
C. TERTIARY SYPHILIS
 
LESIONS:
 Cardiovascular syphilis Arteritis of the aorta—vessel necrosis– dilatation of the ao
Syphilitic Aortitis aortic regurgitation—CHF

Arteritis Multiple small infarcts—direct damage to neural cells in SC and cerebral cortex

 
Neurosyphilis/CNS
paresis., personality
Meningeal syphilis changes, slurred speech,
tremors, resembles CVA
Meningovascular syphilis

Tabes dorsalis- dorsal root ganglia,

demyelination of posterior columns
- ataxic, loss of position sense, vibratory, deep
pain, temperature, sensation, impotence, loss of
bladder or bowel function.
 C. TERTIARY SYPHILIS

“Benign” tertiary syphilis

Gummas or indolent ulcers of

the skin and mucous
membranes

Periostitis of the tibia, clavicle,

skull and other bones

Gummas of the liver

Induration and atrophy of the

base of the tongue
osteochondritis of femur and tibia
 C. TERTIARY SYPHILIS

“Benign” tertiary syphilis

Granulomas
connective tissue in
the form of small
grainy particles along
with masses of tiny
blood vessels that
forms over wound
DIAGNOSIS:
 
3.Gross Appearance of the Lesion
2. Dark Field Microscopy of Exudate
- from skin scrapings/test not readily available
- confirms the diagnosis of syphilis in primary and
secondary
3. Serology
-VDRL slide test
-Rapid Plasma Reagin
( RPR)
4. Fluorescent Treponemal Antibody
Absorption test
TREATMENT:
 
1. Penicillin
2.4 mu or more
(benzathine penicillin G)- IM
2-4 mu/week x 3 weeks
****allergy to penicillin – tetracycline and doxycycline
2. Screen and treat all sexual partners
 (CONTACT TRACING)
 If client tests positive, provide counseling in privacy.
 Teach about disease and treatment.
 Provide emotional support.
 UNIVERSAL PRECAUTION
 Keep lesion dry and dispose drainage properly
 Abstain from sexual contact atleast 1 month after the
treatment
 Encourage pt to undergo VDRL after 3, 6, 12, 24
months
-Aka Jack, Clap, Gleet, Dose, Strai, Drips, Morning
drop
 
-GONOCOCCAL INFECTION OF THE GENITOURINARY TRACT
- INVOLVES THE MUCOSAL LINING OF GUT,RECTUM, PHARYNX

Causative agent: Neisseria gonorrhoeae

-Highly contagious
-Gram (-) found in pairs
-Fragile and doesn’t survive
long outside the body
-Killed by drying, UV,
ordinary disinfectant
OCCURRENCE:
•Common worldwide
•M=F
•practically all ages
•Common among promiscuous male,
homosexuals, younger adult groups.
MOT:
Primarily by sexual intercourse
Rarely by indirect contact of genital secretions with
other mucous membranes
Direct contact with vaginal secretions (opthalmic
neonatorum)

INCUBATION PERIOD: 2 – 7 Days, sometimes longer

 
POC:
•Months if untreated, especially in untreated aymptomatic
Female
•Specific therapy usually ends communicability within hours
except from infections with penicillin – resistant strain
INCIDENCE IS INCREASING DUE TO:
 
Short Incubation Period
High promotion of asymptomatic carriers
Development of strains resistant to Penicillin and
Tetracyclines
Changing sexual habits
Revised morals standards

DIAGNOSTICS:
Gram’s Staining, Nucleic Acid Probe Test, Direct
Fluorescent Antibody
Pathogenesis
Infection

Gonococci become adherent to the urethral epithelium

Penetration of the mucosa and elicits an acute inflammatory response consisting of leukocytes

Edema of the gland ducts or plugs of debris obstructs drainage to form abscess

Infection can spread to mucosal surfaces like fallopian tube, endometrium, peritoneal cavity of
women

Scarring from abscess/ tubal involvement

Stricture/narrowing of fallopian tube

Decreased ovarian egg flow

Sterility
 GONOCOCCAL INFECTIONS IN FEMALES:
3.Cervicitis
4.Vaginitis
5.Anorectal Gonorrhea
6.Pharyngeal Gonorrhea

1. Cervicitis
With yellow or green mucopurulent discharge
Dysuria, Urinary frequency, (1st) Cervical
erythema, red swollen vulva, abN menses,
Early s/sx of pelvic infxn (fever, N/V, abd’s
pain/tenderness)
Primarily affects the cervical os

Complication of PID:
 Endometritis
 Salpingitis
 Tubal infertility
GONOCOCCAL INFECTIONS IN FEMALES:
 
2. Vaginitis
 Occurs commonly in prepubertal and
postmenopausal women
 Abundant purulent discharge
 Red and edematous vaginal mucosa
 GONOCOCCAL INFECTIONS IN FEMALES:

3. Anorectal Gonorrhea
Anorectal pain or pruritus
Tenesmus
Rectal bleeding
Purulent rectal discharge
 
4. Pharyngeal Gonorrhea
Fellatio
Cervical Lymphadenopathy
Tonsillar enlargement, possibly exudates 

Complications:
Salphingitis--- PID--- infertility
(scarring and occlusion of the FT)
 GONOCOCCAL INFECTIONS IN MALES:

1.Acute Urethritis
- most common manifestation
- Inflammation can cause stricture that prevents
passage of Urine
2. Urethral Discharge
Discharge is mucoid and scant initially but
becomes profuse and purulent within two
days

3. Dysuria with urinary

frequency and urgency

Complications:
rectal infection (homosexuals),
epidymitis, and prostatitis(pelvic pain and fever)
 Diagnostic
1. Gram’s staining
2. Nucleic Acid Probe Test
3. Direct Fluorescent Antibody Test

* males- gram stain (culture smear)

* females- pap smear, specimen taken from
cervix/anal canal
TREATMENT:
2.Ceftriaxone 250 mg IM(SD) plus
Doxycycline 100 mg BIDX 7 Days
2. Quinolones
3. Spectinomycin x 7 days
FOLLOW UP:
Cultures
– 14 days after completion of treatment

Serology (VDRL)
– should be drawn at time of initial treatment
and at monthly intervals.
NURSING CONSIDERATIONS:
 
If client tests positive, provide counseling in
private.
Teach about prevention and control.
Provide emotional support.
Case finding
Contact tracing
Safe sex(abstinence, condom, monogamous relationship)
Crede’s prophylaxis
ULCUS MOLLE, SOFT CHANCRE, SOFT
SORE

CAUSATIVE AGENT: Haemophilus ducreyi

TRANSMISSION:
Direct sexual contact with discharges from
open lesions
 
INCUBATION PERIOD: 4 to 7 days
PERIOD OF COMMUNICABILITY:

As long as the infectious agent persists in the

original lesion or discharging regional lymph nodes
usually until healed
 
OCCURRENCE:

Common in tropical and subtropical regions,

especially in seaports.
APPEARANCE:
 
Initial Lesion:
Papular with surrounding Erythema, pustules
produce multiple painful, irregular and deep
genital ulcers

After 2 to 3 days:
papules evolve into pustules
which spontaneously ruptures
and forms a sharply circumscribed ulcer that is not
indurated, ulcers are painful and bleed easily
APPEARANCE:
ulcers are painful and bleed easily
APPEARANCE:
Other signs: Inguinal adenitis and suppuration
DIAGNOSIS:

1. PE
2. Rule out genital herpes, primary syphilis
3. Smear and Culture
4. Biopsy and darkfield examination
TREATMENT:
 
3.Ceftriaxone 250 mg IM x 1 dose
4.Azithromycin 1 gm PO x 1 dose
5.Erythromycin 500 mg PO x 7 days
6.Ciprofloxacin 500 mg PO BID x 3 days
NURSING MANAGEMENT:
Practice Standard Precaution
Check for drug allergy
Instruct patient to abstain from sexual
contact until healing is complete
Wash genitalia with soap and water
Viral
AIDS
HSV
Warts
AIDS
 AIDS
Acquired Immunodeficiency Syndrome/
Acquired Immune-Deficiency Syndrome

- is a human disease characterized by progressive destruction of

the body's immune system.
 
AGENT:
Human Immunodeficiency Virus -1 and -2
(HIV -1 and HIV – 2)
- “slow virus” long incubation period (7-12 yrs)
 AIDS
•Originated from Eastern Africa thru precursor virus
of a chimpanzee
•Not hereditary or inborn
•Affects CD4+ T = Lymphocytes decreasing the
body’s immune response(increase susceptibility to
infection)
•Antibodies develop in 2 weeks to 6 months
•May remain asymptomatic for several years 
 AIDS
OCCURRENCE: Worldwide (Pandemic)

TRANSMISSION:
 
6. Homosexual and Heterosexual Contact
7. By blood and Blood Products
8. Infected Mothers to Infants
 

 
 AIDS
HIV
(dendritic cells in the mucosa of the genital tract)

Transported to the lymph nodes

HIV infects lymphocytes

Systemic infection

Body’s immune response

Antibodies(cytotoxic t-cells)
Specific for HIV infected cells

Viremia level decreased to a “plateau level”

When HIV infection takes place, Anti-HIV bodies are produced but they do not appear
immediately

WINDOW EFFECT
In some cases, antibodies to HIV become detectable 4-6 weeks after infection

HIV in circulation, it invades several types of cells (lymphocytes, macrophages, langehans

cell
 AIDS
HIV attacks immune system, microorganism attaches to CHON molecule called CD4 which
is found in the surface of T- cells

Once the virus enters the T4, it inserts its genetic materials into the T4’s nucleus taking
over the cell to replicate itself

T4 cell dies after being used by HIV for replication

Virus mutates rapidly making it difficult for the body to “recognize” the invaders

Reverse transcriptase which copy information for virus to replicate

HALLMARK: progressive decreased in CD4 T cells

 AIDS

STAGES OF AIDS
 
Acute HIV Syndrome
Clinical Latency
Symptomatic disease
 AIDS
STAGES OF AIDS
 
Acute HIV Syndrome
( 3 - 6 weeks after Primary Infection)
 
General:
MINOR :
fever pharyngitis
LAD headache
arthralgias myalgias
lethargy malaise
anorexia weight loss
nausea vomiting
diarrhea
 AIDS
STAGES OF AIDS
 
Acute HIV Syndrome

Neurologic:
meningitis encephalitis
peripheral neuropathy myelopathy

Dermatologic:
erythematous maculopapular rash
mucocutaneous ulceration
 AIDS
MAJOR:
Weight loss: 10% of body weight
Chronic diarrhea for more than a month
Prolonged fever for 1 month

AIDS:
Adult: 2 major and 1 minor
Pedia: 2 major and 2 minor
 AIDS
STAGES OF AIDS
 
Clinical Latency
may last up to 10 years
 
Progressive decline of CD4+ T – Cells

Immunodeficiency
 
 AIDS
STAGES OF AIDS
 
Symptomatic Disease
 
Respiratory:
Acute Bronchitis, Sinusitis, PCP
Cardiovascular:
HIV – associated cardiomyopathy
GIT:
Thrush, Oral hairy leukoplakia, aphthous ulcers
GUT:
HIV – associated nephropathy
Neurological:
Kaposi’s sarcoma, AIDS Dementia Complex
 AIDS
STAGES OF AIDS
 
Symptomatic Disease
 
Pulmonary Opportunistic infections

1. PCP
2. Histoplasmosis
3. TB

GIT
1. Mycobacterium avium
2. CMV
3. Hepatitis B, C, D
4. HIV-wasting syndrome
 AIDS
STAGES OF AIDS
 
Symptomatic Disease
 GIT

5. Oral Candidiasis
6. Oral hairy leukoplakia
 AIDS
STAGES OF AIDS
 
Symptomatic Disease
 
Gynecologic
A. Vaginal Candidiasis

CNS
AIDS Dementia syndrome
- progressive cognitive and motor
function deterioration
 AIDS
STAGES OF AIDS
 
Symptomatic Disease
 
Kaposi’s Sarcoma
- vascular malignancy
- red to purple, palpable, non-blanching,
painless
lesion
- usually on face, penis, scrotum

Treatment: Chemotherapy
 AIDS
DIAGNOSTIC PROCEDURE:
 
4.ELISA
-Serological test for antibodies against HIV; reactive test
-Standard screening test but less reliable in early stage
-Results usually appear after 22-27 days
2. Western Blot
-Confirmatory dxtic test
-More accurate than ELISA
-If ELISA 2x (+); western blot is recommended
-Done during late stage/ can detect lower levels of antibodies
3. PCR test- for viral nucleic acid sequences to assess levels of viremia
4. CD4-T-cell- less than 200 cells/mm3
 AIDS
TREATMENT:
 
3.No cure. Counseling after positive
diagnosis.
2. Medications:
A. Nucleoside Analogue Reverse transcriptase Inhibitor
- slows disease process by inhibiting reverse
transcriptase enzyme
Zidovudine (AZT)
Didanosine
Zalcitabine
Stavudine
Lamivudine
 AIDS
2. Medications:
B. Non-nucleoside reverse transcriptase inhibitor
Delavirdine
Nevirapine
Efavirenz

C. Protease inhibitor
- prevents assembly of viral particles
Ritonavir
Saquinavir
Indinavir
Nelfinavir
 AIDS
NURSING CONSIDERATIONS:
 
3.Wear gloves, wash hands whenever handling blood or
body fluids. (PPE)
4.Follow universal precautions.
5.Teach preventive measures.
A. Latex condom use
B. No needle sharing
 AIDS
NURSING CONSIDERATIONS:
 
4. Teach about disease process.

5. Provide emotional support.

6. Screen sexual partners.

7. Blood spills should be cleaned immediately using

common household disinfectant (bleach)

8. Label blood specimens with “AIDS precaution”

AGENT: Herpes Simplex Virus (HSV)
*occurs primarily below waist STD
 
TRANSMISSION:
  Type 2 Virus – Sexual Contact
* Can spread by touching an unaffected part of the body after
touching herpes lesion
 
INCUBATION PERIOD: 2 – 12 Days
 
POC:
Patients with primary genital lesions are infective for
about 7 – 12 days; with recurrent disease for 4 days to a week.
MANIFESTATIONS:
 
Fever Headache

Malaise Myalgia

Pain itching

Dysuria inguinal LAD

Vaginal and urethral discharge

 Lesions:
widely spaced bilateral
vesiculopustular or painful
erythematous ulcers.
Diagnostics:
2. Viral culture

3. Direct immunofluorescence staining

of vesicular exudates
4. Pap smear
TREATMENT: symptomatic and supportive
** chronic disease w/o cure; prevent/ lessen occurrences and
giving palliative

Relieve vulvar pain- keep the area clean and dry; wear
lose fitting non-synthetic undergarments; sitz bath;
cooling applications and analgesic meds
Acyclovir
- to reduce healing time
- (not recommended during pregnancy)
 
NURSING CONSIDERATIONS:
 
•Teach patients to use warm compresses or take sitz bath
several times a day.
•Use a drying agent, such as povidone iodine solution.
•Increase fluid intake.
•Avoid all sexual contact during the active phase.
•Those with Herpetic Whitlow
– instruct not to share towels or eating utensils.
- Abstain from direct patient care.
 
 DIGITAL HERPES SIMPLEX
The herpes simplex virus infection on the finger is known as herpetic whitlow. Grouped, fluid-filled or pus-filled,
blisters are typical and usually itch and/or are painful.
WARTS – VERRUCA VULGARIS
(VENEREAL WARTS)

GENITAL WARTS

- Benign growth that typically occur in multiple, painless,

clusters on the vagina, vulva, cervix, perineum, anorectal
area, urethral meatus/ glans penis

Condyloma acuminatum
 
cauliflower shaped lesions that appear on moist skin surfaces such
as the vagina and anus
CAUSATIVE AGENT:
Human Papilloma Virus (HPV)
 
TRANSMISSION:
 
Direct contact , Sexually transmitted
 
INCUBATION PERIOD:
3 to 4 months average, Ranges from 1 month
to 2 years
PERIOD OF COMMUNICABILITY:

Unknown, but probably as long as visible lesions persists

S/Sx
No symptoms
Itchiness occurs with anogenital warts
 
DIAGNOSTIC EXAM:

•Pap Smear and Visualization,

•Hybrid Capture Assay
•Application of 5% acetic acid
TREATMENT:

3.Cryosurgery – with liquid nitrogen

4.Electrocautery- burning
5.Laser-small warts
6.Fluorouracil- antineoplastic
7.Acid solution ( Podophyllin cream)
8.Trichloroacetic acid
9.Screen sexual partners

NURSING CONSIDERATIONS:

3.If client tests positive, provide counseling in privacy.

4.Teach about disease.
5.Provide emotional support.
 Protozoa

Trichomoniasis
 Trichomoniasis
A PROTOZOAL INFECTION CAUSING VULVOVAGINITIS

CAUSATIVE AGENT:

Trichomonas vaginalis
– inhabits the lower genital tract of females (moist
environments) and at the urethra and prostate of males
 Trichomoniasis
TRANSMISSION:
By contact with vaginal and urethral
discharges of infected persons during sexual
intercourse.
Possibly by direct contact with contaminated
articles such as wet towels and swimsuits,
washcloths and douching equipment.
 
INCUBATION PERIOD:
5 to 28 Days
 Trichomoniasis

PERIOD OF COMMUNICABILITY:

For the duration of the infection

 
SUSCEPTIBILITY/ RESISTANCE:
General but clinical disease is mainly on females.
 
Trichomoniasis
Trichomoniasis
 Trichomoniasis
DIAGNOSTICS:
 
3.Microscopy of wet mounts of secretions

5.Direct immunofluorescent antibody

staining
 Trichomoniasis
TREATMENT:

3.Metronidazole (Flagyl) 2 grams

once daily

5.Treat sexual partner.

 Trichomoniasis
NURSING CONSIDERATIONS:
 
3.Teach to avoid intercourse after treatment until both
partners are cured.
4.Teach to avoid alcohol while taking metronidazole
(acts like Antabuse and alcohol).
5.Provide counseling in privacy.
6.Teach about disease.
7.Teach to practice scrupulous cleanliness.