This ppt includes 5 sexually transmitted infection

1. Sexually transmitted infections
Presenter:Noor Hasmee
Msc nursing 1st year
CON,ILBS

2. Outline
● Introduction of STI
● Review of male and female reproductive system
● Causes
● Epidemiology
● Etiology
● Pathophysiology
● Clinical features
● Diagnostic evaluation
● Clinical vignette
● Research
● Management
● Nursing management

3. Introduction
The term “sexually transmitted infection” (STI) refers
to a pathogen that causes infection through sexual
contact, whereas the term “sexually transmitted
disease” (STD) refers to a recognizable disease state
that has developed from an infection.

5. Review of anatomy
and physiology

7. Female reproductive tract

8. Causes of STI
BACTERIAL PARASITE
VIRAL
● SYPHILIS
● GONORRHEA
● CHLAMYDIA
● HIV
● HSV
● HPV
● CMV
● EBV
● VARICILLA
ZOSTER VIRUS
● HEPATITIS B
● ZIKA
● TRICHOMONAS
VAGINALIS

9. Sexual Health Questions to Ask All Patients

10. Partners
Could you tell me about your current relationships (e.g., no partner, one partner, multiple
partners)?
In the past 3 months, have you had sex with someone you didn’t know or had just met?
Have you ever been forced or coerced to have sex/sexual activity against your will as a
child or an adult?* If yes, does that experience affect your current sex life or sexual
relationships? (Probe: In what ways?) If yes, does that make seeing a health care provider
or having a physical exam difficult or uncomfortable?
Are you having any difficulties with your sexual relationships?
Do you or your partners have problems with sexual functioning?
practices In the past 3 months, what types of sex have you had? Anal? Vaginal? Oral? (Also, ask
whether they give or receive each type of sexual activity.)
Have you or any of your partners used alcohol or drugs when you had sex?
Have you ever exchanged sex for drugs or money?
Past History of
STI (s)
Have you ever had a sexually transmitted infection (or disease)? If yes, which STI(s)?
Where on your body were the infections? When did you have it? Were your partners tested
and treated too?
Have you ever been tested for HIV? If yes, how long ago was that test? What was the
result?

11. protection When do you use this protection? With which partners?
Have you been vaccinated against HPV? Hepatitis A? Hepatitis B?
Pregnancy
Do you have any desire to have (more) children? If yes, how many children would you like to
have? When would you like to have a child?
What are you and your partners doing to prevent pregnancy until that time? If no, are you doing
anything to prevent pregnancy?
How important is it to you to prevent pregnancy? Would you like to talk about birth control
options?

12. Epidemiology
STIs have a profound impact on sexual and
reproductive health worldwide.
More than 1 million STIs are acquired every day.
In 2020, WHO estimated 374 million new
infections with one of four STIs: chlamydia (129
million), gonorrhoea (82 million), syphilis (7.1
million) and trichomoniasis (156 million). More
than 490 million people were estimated to be
living with genital HSV (herpes) infection in 2016,

13. CONTD…
and an estimated 300 million women have an HPV infection,
the primary cause of cervical cancer. An estimated 296 million
people are living with chronic hepatitis B globally. Both HPV and
hepatitis B infections are preventable with vaccination.

14. Case report
Syphilis on the face in primary care: a rare sign of an increasingly common
problem
A 32-year-old man who has sex with men presented to primary care with a 2-week
history of a lesion on the tongue. He was otherwise well and reported no other
symptoms. He had no past medical history and was taking no regular medication. He
was a smoker and used cocaine occasionally. He had previously been treated for genital
herpes and had his last sexual health screen 6 months before. He was prescribed
chlorhexidine mouthwash and oral flucloxacillin, and was urgently referred to oral
medicine where the tongue lesion was biopsied. Routine blood tests including
vitamin B12 and folate, and thyroid function tests, later came back as normal.

15. Contd….
Referral was also made to dermatology where a lesion on the right cheek was
biopsied. Dermatology then referred the man to our genitourinary medicine clinic
where examination revealed three lesions: a 2 cm non-tender, indurated ulcer
on the posterior third of the tongue that had been biopsied (Figure 1), a 1
cm superficial ulcer on the right cheek that had been biopsied (Figure 2),
and a 1 cm superficial crusted ulcer on the left ala nasa (Figure 3). The
patient had no genital symptoms and declined genital examination.

16. Contd…

18. Syphilis

19. • Syphilis is a systemic bacterial
infection caused by the spirochete
Treponema pallidum.
• Treponema genus is a spiral-shaped
bacteria with a rich outer
phospholipid membrane that belongs
to the spirochetal order.
• It has a slow metabolizing rate as it
takes an average of 30 hours to
multiply. T. pallidum is the only agent
that causes venereal disease.
• The only host for the organisms
are humans, and there is no animal
reservoir.

20. Epidemiology
● According to the Center for Disease Contol and Prevention (CDC) statistics, there
were 88,042 reported new diagnoses of syphilis in 2016.
● Out of all syphilis cases, 27,814 were primary and secondary syphilis. In 2016,
most syphilis cases occurred among gay, bisexual, and other men who have sex
with men.
● Men aged 20 to 29 years have the highest rates of primary and secondary
syphilis.
● From 2008 to 2012, rates of congenital syphilis declined but increased by 38% in
2012.
● During 2016, 628 cases of congenital syphilis were reported with rates 8.0-times
and 3.9-times higher among infants born to black and Hispanic
mothers compared to white mothers.

21. Etiology
The only host for the organisms are humans, and there is no animal
reservoir.
Syphilis is considered a sexually transmitted disease, as most cases of
syphilis are transmitted through vaginal, anogenital, and orogenital
contact.
The infection can rarely be acquired via nonsexual contact, such as
skin-to-skin contact or via blood transfer (blood transfusion or needle
sharing).
Vertical transmission occurs transplacentally, resulting in congenital
syphilis.

22. Stages of syphilis

24. Neurosyphilis

27. Clinical features
● Non-tender genital chancre
● Multiple non-genital chancres, such as digits, nipples, tonsils, oral
mucosa.
● The clinical manifestations of secondary syphilis result from hematogenous
dissemination of the infection and are protean: condyloma lata
(papulosquamous eruption), hands and feet lesions, macular rash,
diffuse lymphadenopathy, headache, myalgia, arthralgia, pharyngitis,
hepatosplenomegaly, alopecia, and malaise
● The incubation period is about 20 to 90 days.
● The organism does invade the CNS early, but symptoms appear late.

28. Chancre

29. Non genital Chancre

30. condyloma lata

31. Rubbery lymph nodes

32. Rash

33. Alopecia

34. Diagnostic evaluation
● History and physical examination
● The serological tests are classified as non-treponemal and
treponemal.
● The VDRL and RPR tests are only positive after the development of the
primary chancre.
● Dark-field microscopy.
● Cerebrospinal (CSF) examination.
● Chest x-ray
● CT scan
● Echocardiogram

35. Treatment
● Primary, secondary, or early latent syphilis is treated with a single dose of intramuscular
(IM) penicillin G benzathine 2.4 million units.
● Alternative therapies include doxycycline 100 mg orally (PO) twice daily for 14 days or
ceftriaxone 1 to 2 gm IM or intravenously (IV) daily for 10 to 14 days or tetracycline
100 mg PO 4 times for 14 days.
● Late latent syphilis is treated with IM penicillin G benzathine 2.4 million units once
weekly for 3 weeks. Alternative therapies include doxycycline 100 mg PO twice daily for
28 days or tetracycline 100 mg PO four times daily for 28 days.

36. Contd…
● Tertiary syphilis is treated with IM penicillin G benzathine 2.4 million units
once weekly for 3 weeks.
● Neurosyphilis is treated IV penicillin G aqueous 18-24 million units daily for
10 to 14 days.
● Patients with a high titer of secondary syphilis can develop Jarisch-Herxheimer
reaction, which is an immune-mediated self-limited reaction that occurs within 2
to 24 hours of treatment and is characterized by high fever, headache, myalgias,
rash.
● Patients need to be followed post-treatment at 3, 6, 9, 12, and 24 months with
serial non-treponemal tests.

37. WHO guidelines
 Benzathine penicillin administered intramuscularly is the treatment of
choice
 Procaine penicillin is the 2nd choice and administered for 10 to 14 days
intramuscularly
 If penicillin cannot be used, doxycycline, azithromycin or ceftriaxone are
other options
 Doxycycline is preferred as it is cheap and easy to administer. But it is not
recommended in children or pregnant women
 Azithromycin does not cross the placenta and hence the infant has to be
treated after delivery

38. Complications
● Meningitis
● Stroke
● Cranial nerve palsies during early neurosyphilis or tabes dorsalis,
● Dementia, general paresis during late neurosyphilis.
● Cardiovascular syphilis is also a result of tertiary syphilis and can manifest
as aortitis, aortic regurgitation, carotid ostial stenosis, or granulomatosis
lesions (gummas) in various body organs.

39. Gumma

40. Gumma

41. Case vignette Contd…
Syphilis serology later demonstrated a positive syphilis antibody test and a positive Treponema
pallidum particle agglutination (TPPA) assay with a titre of >1:5120. Rapid plasma reagin (RPR) was
also positive with a titre of 1:16. Treponema pallidum PCR sampled from one of the lesions was later
confirmed positive. Histology from right cheek and tongue biopsies supported a diagnosis of syphilis.
A complete STI screen including a rapid HIV test was otherwise negative.
The man was treated for primary syphilis with a single dose of benzathine penicillin (2.4 million
units, intramuscularly). He was advised to abstain from sex until repeat serology confirmed adequate
syphilis treatment. A health advisor discussed partner notification and sexual risk reduction. He had had
three male partners in the previous 3 months who were contacted for screening.
Four weeks later, he returned for review and repeat syphilis serology. All three lesions had improved

45. Discussion
‘He who knows syphilis knows medicine’
Sir William Osler referred to syphilis as ‘the great imitator’ due to its variety of
multisystem presentations and ability to mimic other diseases.
Facial sores
In this case, there was a primary chancre of syphilis on the tongue and satellite
facial lesions. Cases of lesions on the face in primary syphilis are rare.

46. Unusual clinical manifestation and challenging
serological interpretation of syphilis: insights from a
case report
Aim of the work is to describe the difficulties encountered during the diagnostic
evaluation of atypical skin manifestations and of the serology for syphilis of an
HIV-infected patient who had contracted it several times
Case presentation: In 2020, a 52-year old HIV-positive bisexual male patient was
admitted to our department with a 4-month history of moderately itchy cutaneous
lesions localized at his neck, trunk and arms. In 2013, the patient presented with a
classic syphilitic roseola of the trunk and a secondary syphilis was diagnosed,
with increased levels of rapid plasma reagin (RPR), Treponema pallidum hemagglutination
assay (TPHA), anti-Treponema pallidum IgM and IgG Index. A second episode occurred in
2018, as a primary syphilis with multiple ulcerative lesions of the penis, and
increased levels of RPR, IgG and IgM. In 2019, a further episode of secondary syphilis
was treated with Doxycycline

47. In 2020, erythematous and papular lesions with vesicular components
and urticarial erythema multiforme (EM)-like lesions were present at
the neck, trunk and arms. Serological tests and Nucleic Acid Amplification
Test (NAAT) for Treponema Pallidum were performed, as well as a cutaneous
biopsy with histological and immunohistochemical evaluation of one lesion. NAAT
was negative for T. pallidum. Serological test results were discordant with a
new syphilis infection, showing only increased levels of RPR and anti-
Treponema IgG. The cutaneous biopsy revealed a non specific histological
pattern, while the immunohistochemical evaluation with anti-spirochetal
antibodies was mandatory for the diagnosis of recent syphilis, showing clusters
of rod-shaped elements, some of which with spiral form, focally present at the
epidermis and adnexal structures.

48. CONTD…
Conclusions: Nowadays, syphilis may present with atypical
clinical and serological features. Physicians should be aware of
these possible alterations and consider syphilis even in case of
uncommon clinical aspect and unclear serological tests.
Cutaneous biopsy and immunohistochemical exam may be
mandatory for the diagnosis.

49. Gonorrhea

50. ● Neisseria gonorrhoeae, an obligate human
pathogen, is a sexually transmitted disease that
causes consequential worldwide morbidity both
in resource-abundant and resource-limited
nations, and its diagnosis and treatment
require costly expenditures annually.
● Like other sexually transmitted infections
(STIs), gonorrhea disproportionately impacts
young adult populations.

51. Epidemiology
● A major public health concern, N. gonorrhoeae, is currently the second most
common cause of bacterial sexually transmitted infections worldwide. The
World Health Organization (WHO) estimates that 106 million new gonorrhea cases
are documented among adults annually worldwide; many more infections go
unreported. With more than 500,000 cases noted annually in the United States, N.
gonorrhoeae is the second most commonly reported sexually transmitted disease in
the United States.
● Gonorrhea infection has a slight male prevalence secondary to the increased
likelihood that males will manifest urogenital symptoms and also due to increased
diagnoses among men who have sex with men.Over the last decade, the incidence
of gonorrheal STIs has increased as a result of the rising number of antibiotic-
resistant strains

52. Pathophysiology

53. Clinical Manifestations
The most common clinical manifestations of gonococcal disease in
males include penile purulent discharge, dysuria, and testicular
discomfort. Male urogenital gonococcal complications include
orchitis, epididymitis, penile lymphangitis, penile edema, and post-
infectious urethral strictures.

54. History and physical
● In females, N. gonorrhoeae most commonly infects the cervix, resulting in cervicitis.
When female patients with gonococcal urogenital infections have symptoms, they may
complain of vaginal discharge, dysuria, or pelvic pain.
● Gonorrheal infection of the Bartholin’s glands adjacent to the vaginal introitus manifests
as labial soft tissue swelling, abscess formation, and pain.

55. Diagnostic evaluation
● Diagnostic laboratory assays are essential to confirm the clinical suspicion of
gonorrhea.
● Laboratory confirmation of N. gonorrhoeae infection's diagnosis is made by
direct detection of the gonococcal pathogen in urogenital, anorectal,
pharyngeal, or conjunctival swab specimens or first-catch urine
● Confirmation of the clinical suspicion of gonorrhea is established by detection
of N. gonorrhoeae or its genetic signature in genital or extragenital samples by
light microscopy of stained smears, culture, or NAAT

56. Treatment
● Worldwide N. gonorrhoeae STI treatment for urogenital infections in males and
females most commonly consists of dual therapy with a single intramuscular
or intravenous dose of 500 mg of ceftriaxone in conjunction with doxycycline
100 mg orally twice a day for 7 days.
● In patients 150 kg or more, 1 g of ceftriaxone should be given.
● For complicated gonococcal infections including pelvic inflammatory disease
(PID), epididymitis, and proctitis, dual therapy with a single intramuscular or
intravenous dose of 500 mg of ceftriaxone is paired with oral doxycycline
100 mg BID for seven days, rather than a single 1 g dose of azithromycin,
because of doxycycline’s effectiveness against C. trachomatis and documented
efficacy in treating epididymitis and proctitis.

57. Contd…
● In patients with a documented life-threatening allergy to
cephalosporins or B-lactam allergy, aztreonam
monotherapy can be utilized to treat N.
gonorrhoeae infections.
● Aztreonam 1g administered intravenously treats urogenital
gonorrhea and may have efficacy for pharyngeal and rectal
gonococcal infection as well when utilizing a 2g dose.

58. Complications
● Female and male infertility.
● Complications specific to males include epididymitis, prostatitis, and proctitis.
● Immune-mediated, systemic complications following gonorrhea infection can
result in the triad of reactive arthritis, urethritis, and conjunctivitis.
● Gonorrheal infection can complicate obstetrical delivery by infecting
newborns via eye contact with genital secretions during the puerperal period
and can result in gonococcal conjunctivitis that can progress onto blindness.
Gonorrheal infection increases the risk of sexual transmission of HIV-AIDS.

59. Gonorrhoeal infection can cause Fitz-Hugh-Curtis syndrome, liver
capsule inflammation with resultant intra-abdominal adhesions

60. Research

61. Prevalence and factors associated with gonorrhea infection
with respect to anatomic distributions among men who have
sex with men
Introduction
Gonorrhea (GC) infection caused by Neisseria gonorrhoeae has been steadily increasing
in Thailand over the last decade. Men who have sex with men (MSM) are at high risk for
gonorrhea infection
Materials and methods
In this study, we determined the prevalence of and risk factors associated with gonococcal
infections by three anatomical sites among MSM. We have conducted a cross-sectional
analysis of a sexually transmitted disease (STD), gonorrhea among MSM attending two
STD clinics in Khon Kaen, Thailand. We included 358 MSM over 18 years of age.

62. Contd…
Data were collected using self-administered questionnaire. In each participant, an
oropharyngeal, anorectal, and endourethral swab were tested with culture and nucleic
acid amplification test (NAAT). However, 267 urine samples were tested by both methods.
Factors associated with gonorrhea infections were assessed using univariate and
multivariate logistic regression.
Results
One hundred and ninety-five out of 358 (54.47%) MSM tested were found to be positive
for gonorrhea using a porA gene targeted NAAT by Real-time PCR with TaqMan probes,
but there was no positive result by culture. The gonorrheal prevalence for male genital
site, anal, and oropharyngeal, were 34.73% (95%CI 33.07, 45.08), 29.01% (95%CI
24.61, 34.33), and 27.93% (95%CI 23.35, 32.89), respectively, while 5.9% (21/355)
were positive for gonococcal infection in all anatomic sites (oropharynx + anus + urethra)
of one participant.

63. contd….
Previous history of diagnosed STDs was a significant factor associated urethral
gonorrhea (odds ratio = 3.52, 95%CI 1.87–6.66, P Value< 0.001). In addition,
having more than one partner was increased urethral gonorrhea (adjusted odds
ratio = 2.26, 95%CI 1.10–4.68, P Value = 0.026). 100% of condom use was
found decreasing urethral infection (adjusted odds ratio = 0.39, 95%CI 0.15–
0.99, P Value = 0.046).

64. Contd….
Conclusions
The most common anatomic site of gonorrhea infection was male genital site,
and the independent risk factors were having history of diagnosed STDs and
having more than one partner in the past 3 months, but 100% condom use was a
protective factor of this infection.

65. Chlamydia

66. Chlamydia is a sexually transmitted
infectious disease caused by the
bacterium Chlamydia trachomatis.
Chlamydia trachomatis is part of
the Chlamydophila genus. These
bacteria are gram-negative,
anaerobic, intracellular obligates
that replicate within
eukaryotic cells.

67. Epidemiology
Urogenital chlamydia infections are the most commonly reported
bacterial infections in the U.S and the most common cause of sexually
transmitted infections in the world.
The overall rate of urogenital infection amongst U.S. women is two
times that of U.S. men, with a higher prevalence in women 15-24
years of age and a higher incidence in men between 20-24 years of
age.

68. Etiology
C. trachomatis differentiates into 18 serovars (serologically variant strains) based on
monoclonal antibody-based typing assays.
These serovars correlate with multiple medical conditions as follows
Serovars A, B, Ba, and C: Trachoma is a serious ocular illness that is endemic in Africa and
Asia. It is characterized by chronic conjunctivitis and has the potential to cause blindness
Serovars D-K: Genital tract infections, neonatal infections
Serovars L1-L3: Lymphogranuloma venereum (LGV), which correlates with genital ulcer
disease

69. Pathophysiology
● Chlamydia is unique among bacteria, having an infectious cycle and two developmental
forms.
● These include the infectious form called the elementary body (EB) and the reticulate body
(RB).
● The EB is metabolically inactive and is taken up by host cells. Within the host cell, the EB
will differentiate into the metabolically active RB.
● The RB will then use host energy sources and amino acids to replicate and form new EB,
which can then infect additional cells.
● C. trachomatis targets the squamocolumnar epithelial cells of the endocervix and upper
genital tract in women, and the conjunctiva, urethra, and rectum in both men and women.
● The bacterium is transmitted through direct contact with infected tissue, including vaginal,
anal, or oral sex, and can even be passed from an infected mother to the newborn during
childbirth.

71. Clinical features
Cervicitis
Pelvic Inflammatory Disease
Urethritis
Perihepatitis
Epididymitis
Proctitis
Prostatitis
Reactive Arthritis
Pneumonia

72. pharyngitis

73. Conjunctivitis

74. Lymphogranuloma
Venereum
Lymphogranuloma venereum (LGV) is an ulcerative disease of the genital area.
Lymphogranuloma venereum primarily affects the lymphatic system.

75. Evaluation
● The gold standard for the diagnosis of urogenital chlamydia infections is nucleic acid
amplification testing (NAAT)
● Culture, rapid testing, serology, antigen detection..
● The United States Preventive Services Task Force (USPSTF) recommends regular
screening for chlamydia in all sexually active women because if left untreated, the
infection is associated with PID, infertility, and chronic pelvic pain.
● In males, the leucocyte esterase test in urine can be done and is diagnostic for gonorrhea
or chlamydia in the absence of a UTI.

76. Treatment
● The goal of treatment is the prevention of complications associated with infection (e.g.,
PID, infertility), to decrease the risk of transmission, and the resolution of symptoms.
Treatment for uncomplicated urogenital chlamydia infection is with azithromycin.
Doxycycline is an alternative, but azithromycin is preferred as it is a single-dose
therapy.
● Other alternatives include erythromycin, levofloxacin, and ofloxacin.

77. Complications
Pelvic inflammatory disease confers a risk of ectopic pregnancy in women of childbearing
age.
Inflammation and scarring of the upper genital tract may also affect fertility or lead to chronic
pelvic pain.
Chlamydial infection in pregnancy can also increase the risk of prolabor rupture of membranes
(PROM), premature prolabor rupture of membranes (PPROM), and preterm delivery.

78. RESEARCH

79. Prevalence of genital Chlamydia
trachomatis infection in the general population: a
meta-analysis
Background
Estimating prevalence of Chlamydia trachomatis (CT)
worldwide is necessary in designing control programs and
allocating health resources. We performed a meta-analysis to
calculate the prevalence of CT in the general
population.

80. Methods
The Pubmed and Embase databases were searched for eligible
population-based studies from its inception through June 5, 2019.
Q test and I2 statistic were used to calculate the heterogeneity
between studies. Random effects models were used to pool the
prevalence of CT. Meta regression was performed to explore the
possible sources of heterogeneity. Publication bias was evaluated
using a funnel plot and “trim and fill” method.

81. Results
Twenty nine studies that reported prevalence of CT infection from 24 countries
were identified, including a total population of 89,886 persons.
The pooled prevalence of CT among the general population was 2.9% (95% CI,
2.4–3.5%), and females had a higher CT prevalence (3.1, 95% CI, 2.5–3.8%)
than males (2.6, 95% CI, 2.0–3.2%) (χ2 = 10.38, P < 0.01).
Prevalence of CT was highest in region of America (4.5, 95% CI, 3.1–5.9%),
especially in Latin America (6.7, 95% CI, 5.0–8.4%), followed by females in
region of Africa (3.8, 95% CI, 0.7–6.9%), while South-East Asia had a lowest CT
prevalence 0.8% (95% CI, 0.3–1.3%).

82. Conclusions
This study provided the updated prevalence of CT among
general population worldwide. General population from Latin
America, especially females, and women in Africa should be
given priority by WHO when design and delivery CT control
programs.

83. TRICHOMONIASIS

84. Trichomonas vaginalis is among
the most common causes of
protozoal infections in the United
States, and it is also a common
cause of symptomatic vaginitis in
women.
It is a motile organism that lives
in the lower genitourinary tract of
females and the prostate and
urethra of men.

85. Etiology
● Trichomoniasis is an infection that is sexually transmitted and is
acquired by direct sexual contact. It can live for a few hours in
moist environments, but virtually all cases are due to the venereal
transmission of the organism. Risk factors include:
• History of STIs
• New sex partner or multiple partners
• Contact with an infected partner
• Abusing IV drugs
• Not using any type of barrier contraception

86. Epidemiology
● Trichomoniasis occurs more frequently in people with multiple sexual partners who also
have other sexually transmitted infections. In one study with 4057
participants, T. vaginalis infection was found in 0.5% of males and 1.8% of females in the
study population. They found prevalence among Black study participants to be higher,
with 4.2% and 8.9% infection rates noted in males and females, respectively.
● According to another article, the estimated infection rate of Trichomoniasis vaginalis is
3.2%. T. vaginalis infection rates in the United States are higher than combining Neisseria
gonorrhoeae and Chlamydia trachomatis infection rates. Trichomoniasis is most prevalent
amongst women ages 40 to 49, which is starkly different from the rate of chlamydia
infections, which peaks in the 19 to 24-year-old age group

88. History and physical examination
● Women will often present with a chief complaint similar to other sexually transmitted
infections, including vaginal discharge, painful intercourse, urinary tract infection
symptoms, vaginal itching, or pelvic pain.
● Men may be asymptomatic, or on occasion, they may present with symptoms including
penile discharge, testicular pain, dysuria, urinary frequency, or cloudy urine.
Trichomoniasis can cause urethritis in men and occasionally epididymitis or
prostatitis.
● foul-smelling discharge.

89. STRAWBERRY CERVIX

90. Diagnostic evaluation
● Wet prep microscopy
● NAATs
● Culture
● Whiff

91. Treatment
● According to the 2015 CDC STI treatment guidelines, there are three recommended
strategies for the treatment of trichomoniasis. These include a single 2-gram dose of
metronidazole, a single 2-gram dose of tinidazole, or a seven-day course of 500 mg
metronidazole twice daily.
● In patients with known HIV infection, the recommended treatment regimen is a seven-day
course of 500 mg metronidazole twice daily.
● According to a study, the percent of women positive for trichomoniasis on their test of
cure was 19% when given a single dose of metronidazole versus 11% when patients
completed a seven-day course of metronidazole.
● If left untreated, trichomoniasis may remain subclinical or may resolve with host
immunity.
● Pregnant women must be treated otherwise it can result in adverse outcomes. The drug of
choice is metronidazole. Women should stop breastfeeding during treatment.

92. Nursing management

93. Contd….
 History collection
 Screen appropriately
 Use protection.
 Get vaccinated.
 Spread awareness.
 Counselling

94. Nursing diagnosis
● Acute Pain related to the reaction of infection
● Risk for infection transmission related to contact transmission exposure ,
multiple sexual partners, unprotected sexual intercourse secondary to syphilis
infection
● Impaired Urinary Elimination related to the inflammatory process
● Anxiety related to the disease
● Knowledge Deficit related to the disease process.
● Low self-esteem related to feelings of shame because of illness, ineffective
individual coping.
● Sexual Dysfunction related to the limitations allowed by the symptoms
(fatigue, decreased libido, depression) sense of rejection by a partner.

96. TAKE HOME MESSAGE
● An ounce of
prevention is worth a
pound of cure.
● Early treatment is
vital to reduce
transmission, prevent
complications.