Sexually Transmitted Diseases (STDs)

1 Continuing Education (CEU) course for healthcare professionals. View the course online at for accreditation/approval information, course availability and other details, and to take the test for CE credit. The information provided in this course is to be used for educational purposes only. It is not intended as a substitute for professional healthcare. Contact Hours: 9 Sexually Transmitted Diseases : What Nurses Need to Know STD/STI Prevention and Treatment COPYRIGHT 2019, WILD IRIS MEDICAL EDUCATION, INC. ALL RIGHTS RESERVED. BY Leslie R. Crane, EdD, MSN, RN; Michael Jay Katz, MD, PhD LEARNING OUTCOME AND OBJECTIVES: Upon completion of this course, you will be better prepared to care for patients with Sexually Transmitted Diseases /infections ( stds /STIs). Specific learning objectives include: Identify recent trends in stds /STIs.

2 Describe the clinical settings in which patients may present with stds /STIs. Discuss the organisms that cause stds /STIs and their modes of transmission. Explain the general diagnostic process and presenting symptoms of stds /STIs. Summarize diagnostic methods, treatment options, and prevention measures for specific infections. Describe public health principles and strategies for preventing the spread of stds /STIs. Discuss specific measures for treating victims of sexual assault. Explain emotional and psychological issues affecting patients and their sexual partners. INTRODUCTION Ironically, sexual activity, a source of human enjoyment for many, is linked to some of the most feared Diseases of humankind. To combat spread of these infections, many cultures have regulated or restricted sexual practices.

3 Scientific study has revealed the causes of Sexually Transmitted Diseases / Sexually Transmitted infections ( stds /STIs), the conditions in which they thrive, effective treatments, and means for Sexually Transmitted Diseases 2 2019 WILD IRIS MEDICAL EDUCATION, INC. preventing their spread. Such knowledge is vital to the health and well-being of people everywhere, particularly for providers of healthcare. During sexual contact, skin and mucous membranes are rubbed together. These surfaces are warm and moist, and they often have small cuts, fissures, or abrasions. This makes sexual contact an ideal mode for passing certain microorganisms from person to person. Since sexual activity, both consensual and nonconsensual, is common, Sexually Transmitted Diseases and infections are widespread. stds /STIs are common reasons for patients to visit healthcare practitioners offices, clinics, urgent care centers, and emergency departments.

4 stds /STIs tend to coexist with one another. Behavior that puts a person at risk for one STD/STI may predispose them to having more than one infection (Bia o-W jcicka et al., 2017). People simultaneously have two or more stds /STIs more often than would be predicted by chance. Genital warts (condyloma acuminata), for instance, often occur with genital herpes infections, and chlamydial infections are frequently found with gonorrhea. Direct, individual medical treatment for all sexual partners is a key factor in the attempt to slow the spread of stds /STIs. As a rule, bacterial infections can be cured by a visit to the doctor s office or clinic when treated with antibiotics. But more is needed than the treatment of individual patients and their partners to slow the spread of stds . The control of stds /STIs must have both an individual and a societal focus.

5 For individual patients, the medical goal is to protect the patient s health and to ensure their future ability to have children, if they wish. For society, the medical goal is to protect uninfected people by: Making sufficient care available to treat infected individuals quickly, effectively, and affordably Encouraging the notification and examination of potentially infected sexual partners, including expedited partner therapy (Nanhoe et al., 2018) Teaching people that barrier methods of protection ( , condoms), while not 100% effective, are important safeguards during sexual contact The microorganisms that spread through sexual contact can cause disease at a variety of locations in the body. This course will focus on those Sexually Transmitted infections that cause most of their clinical problems locally, in the genital and lower urinary tracts.

6 The genital stds /STIs include, for example, chlamydial, syphilitic, and gonorrheal infections. In contrast, other stds /STIs cause most of their clinical problems systemically or at a distance from where the microorganisms first entered the body. HIV/AIDS, for instance, disables the immune system and causes clinical problems throughout the body. Hepatitis B can be spread by sexual intercourse and causes primarily liver Diseases . Sexually Transmitted Diseases 3 2019 WILD IRIS MEDICAL EDUCATION, INC. TERMINOLOGY The terms stds and STIs are usually used interchangeably or are in equal usage by healthcare personnel and in healthcare literature. This course groups both Sexually Transmitted infections and their Diseases into one category called stds /STIs. The term venereal disease (VD) is more commonly used to refer to historical discussions of stds /STIs or may be used more commonly in other countries (Merriam-Webster, 2018).

7 SCOPE OF THE PROBLEM Statistics on stds /STIs are particularly concerning because cases are increasing despite educational efforts and readily available condoms. There is also a growing misconception that stds /STIs cannot be spread by oral and anal routes of administration. However, statistics only partially represent the actual occurrence and subsequent impacts of stds /STIs, as many cases go unreported or undiagnosed. Cases that are undiagnosed will go untreated until they are discovered and adverse effects begin to show. Recent Trends in STD/STI Cases Any discussion of the current state of affairs of stds /STIs in the United States must consider recent trends, with data showing that the most common stds /STIs are rapidly being spread. Chlamydia has been the most commonly reported STD/STI in the United States for the past several years, and the occurrence of chlamydia and the next two most common stds /STIs (gonorrhea and syphilis) has increased phenomenally in recent years (CDC, 2018a).

8 According to the Centers for Disease Control and Prevention, a steep (31%) combined increase of chlamydia, gonorrhea, and syphilis was observed from 2013 to 2017. Together, there were million newly diagnosed cases of these three Diseases in 2017 alone, up from million reported cases in 2013. Chlamydia was the most commonly reported STD/STI in the United States in 2017, with an occurrence of million cases. In the same 5-year period, gonorrhea showed a 67% increase, with 555,608 new cases reported to the CDC in 2017, up from 333,004 in 2013. Syphilis showed a 76% increase, with 30,644 newly diagnosed cases reported in 2017, up from 17,375 in 2013. Although not the most common STD/STI, gonorrhea is of particular concern because recent strains are resistant to many antibiotic classifications.

9 Gonorrhea s ability to develop resistance to treatments such as extended-range cephalosporins raises worries that the infection could become untreatable. It is thus more important than ever to develop new antibiotics to treat the Sexually Transmitted Diseases 4 2019 WILD IRIS MEDICAL EDUCATION, INC. infection effectively. Other emerging stds /STIs, although currently low in occurrence, are of similar concern due to resistance to antibiotics (Blank & Daskalakis, 2018; Singh et al., 2018; Taylor et al., 2018). MULTI-DRUG RESISTANT AND EXTENSIVELY DRUG-RESISTANT A developing problem in the area of infection control is that certain strains of stds /STIs are becoming resistant to the antibiotics that have been traditionally used to treat them. Multi-drug resistant (MDR) refers to organisms that are no longer affected by specific antibiotics to which they were previously sensitive.

10 Extensively drug-resistant (XDR) means nonsusceptibility to at least one antibiotic in all but two or fewer antimicrobial categories. Pan-drug resistant denotes nonsusceptibility to all antimicrobial drugs (Basak et al., 2016). The above terms usually refer to tuberculosis or methicillin-resistant Staphylococcus aureus (MRSA), but resistant STIs are becoming an ever-increasing problem, particularly gonorrhea. Resistant infections are taken very seriously by those in healthcare, and experts from the National Coalition of STD Directors have called for a radical increase in funding to research incidences of drug-resistant stds /STIs and promote prophylaxis. Emerging stds /STIs There are several infections that are emerging as stds /STIs because the routes of transmission are sometimes sexual. Because the usual and expected routes are by food, vector, or droplet, rather than sexual, this poses a significant epidemiologic challenge for healthcare workers to anticipate, identify, and contain these infections when they are Transmitted Sexually .