🔥 Comprehensive Notes on Nursing Management of Patients with Sexually Transmitted Diseases (STDs) 🔥

I. Nursing Assessment of Patients with STDs

Nurses play a vital role in the early detection, treatment, and prevention of STDs.

a) History Taking

• Chief Complaint: Genital ulcers, pain, burning urination, vaginal or urethral discharge, pelvic pain.
• Sexual History:
  • Number of partners, condom use, past STDs.
  • High-risk behaviors (unprotected sex, IV drug use).
• Menstrual & Pregnancy History: Any irregular vaginal bleeding, infections during pregnancy.
• Medical History: Immunosuppression, Diabetes, Previous STD treatments.

b) Physical Examination

• General Examination:
  • Fever, Weight loss, Skin rashes, Enlarged lymph nodes.
• Genital Examination:
  • Ulcers (Syphilis, Herpes, Chancroid).
  • Discharge (Gonorrhea, Chlamydia).
  • Swelling & tenderness (Lymphogranuloma Venereum, Herpes).
• Oral & Rectal Examination (for high-risk patients).

c) Diagnostic Tests

Test	STD Detected	Comments
Gram Stain & Culture	Gonorrhea	Gram-negative diplococci
NAAT (Nucleic Acid Amplification Test)	Gonorrhea, Chlamydia	Most sensitive test
VDRL/RPR, TPHA	Syphilis	Non-treponemal & Treponemal tests
Dark-Field Microscopy	Syphilis	Detects Treponema pallidum
ELISA, Western Blot	HIV/AIDS	Confirms HIV infection
PCR for HSV	Genital Herpes	Best for Herpes diagnosis
Pap Smear & HPV DNA Test	HPV & Cervical Cancer	Detects precancerous lesions

II. Sexual Health & Hygiene

✅ Education on Safe Sex Practices:

• Abstinence or monogamous relationships with an uninfected partner.
• Correct & consistent use of condoms (Male & Female).
• Regular STD screenings for sexually active individuals.
• HPV Vaccination to prevent cervical cancer.

✅ Personal Hygiene Measures:

• Daily genital washing with mild soap.
• Avoid sharing personal hygiene items (towels, razors).
• Proper menstrual hygiene practices.

✅ Partner Notification & Treatment:

• Encourage partners of infected individuals to seek testing & treatment.

III. Syndromic Management of STDs

Syndromic management is based on symptoms rather than waiting for lab confirmation.

1. Gonorrhea (Neisseria gonorrhoeae)

• Symptoms:
  • Men: Urethral discharge, burning urination.
  • Women: Vaginal discharge, painful urination, pelvic pain.
• Complications: Pelvic Inflammatory Disease (PID), Infertility, Neonatal Ophthalmia.
• Treatment:
  • Ceftriaxone 500 mg IM + Azithromycin 1g PO (Single Dose).
  • Pregnant Women: Ceftriaxone + Erythromycin eye drops for neonates.

2. Syphilis (Treponema pallidum)

• Stages & Symptoms:
  • Primary Syphilis: Painless genital ulcer (Chancre) at infection site.
  • Secondary Syphilis: Rash on palms & soles, Generalized lymphadenopathy.
  • Tertiary Syphilis: Neurosyphilis (CNS symptoms), Cardiovascular damage.
• Diagnosis:
  • VDRL, TPHA (Confirmatory).
  • Dark-field microscopy for early lesions.
• Treatment:
  • Benzathine Penicillin G 2.4 million units IM (Single dose).
  • Neurosyphilis: IV Penicillin G for 10-14 days.

3. Granuloma Inguinale (Donovanosis) – Klebsiella granulomatis

• Symptoms:
  • Painless, beefy-red genital ulcers with tissue destruction.
  • No lymph node swelling.
• Diagnosis:
  • Donovan bodies on Wright-Giemsa Stain.
• Treatment:
  • Doxycycline 100 mg BID for 3 weeks.

4. Chancroid (Haemophilus ducreyi)

• Symptoms:
  • Painful genital ulcer with soft edges.
  • Painful inguinal lymphadenopathy (Bubo).
• Diagnosis:
  • Gram stain: Gram-negative coccobacilli.
• Treatment:
  • Azithromycin 1g PO (Single dose) or Ceftriaxone 250 mg IM (Single dose).

5. AIDS (HIV Infection)

• Symptoms:
  • Acute HIV Syndrome: Flu-like illness, Rash, Lymphadenopathy.
  • Chronic Stage: Opportunistic infections (TB, Candidiasis, Kaposi Sarcoma).
• Diagnosis:
  • ELISA, Western Blot, HIV RNA PCR.
• Treatment (ART Therapy):
  • Tenofovir + Lamivudine + Dolutegravir (TLD Regimen).
  • Opportunistic Infection Prophylaxis:
    • Cotrimoxazole (PCP pneumonia prevention).
    • Isoniazid (TB prevention).
• Prevention: PrEP (Pre-Exposure Prophylaxis) for high-risk individuals.

6. Genital Herpes (Herpes Simplex Virus – HSV 1 & 2)

• Symptoms:
  • Painful vesicular lesions on genitals, anus, or mouth.
  • Flu-like symptoms during primary infection.
• Diagnosis:
  • PCR, Tzanck Smear (Multinucleated Giant Cells).
• Treatment:
  • Acyclovir 400 mg TID for 7-10 days (Primary episode).
  • Suppressive Therapy for recurrent cases.

IV. Nursing Interventions for STDs

✅ Promote Early Detection & Treatment
✅ Educate on Prevention & Safe Sex Practices
✅ Emphasize Adherence to Medications
✅ Provide Psychological Support for stigma-related issues.
✅ Screen & Treat Sexual Partners to prevent reinfection.

V. High-Yield Key Points for Competitive Exams

✅ Most common bacterial STD worldwide: Chlamydia (often asymptomatic).
✅ Gold standard test for Syphilis: Dark-field Microscopy.
✅ Drug of choice for Gonorrhea: Ceftriaxone + Azithromycin.
✅ Best treatment for Granuloma Inguinale: Doxycycline.
✅ Most common viral STD: HPV (Causes Genital Warts & Cervical Cancer).
✅ Primary symptom of Genital Herpes: Painful Vesicles.
✅ First-line HIV treatment: Tenofovir + Lamivudine + Dolutegravir (TLD).
✅ Opportunistic infection prevention in HIV/AIDS: Cotrimoxazole (PCP pneumonia prophylaxis).

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📝 Competitive Exam Practice MCQs

1. The recommended first-line treatment for gonorrhea is:

a) Penicillin G
b) Ceftriaxone + Azithromycin
c) Doxycycline
d) Acyclovir
✅ Answer: b) Ceftriaxone + Azithromycin

2. A painless genital ulcer that disappears after a few weeks is seen in:

a) Genital Herpes
b) Syphilis
c) Chancroid
d) Gonorrhea
✅ Answer: b) Syphilis