Chapter 53: STIs – Flashcards
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The current incidence of sexually transmitted infections (STIs) is related in part to what? a. Increased social acceptance of homosexuality b. Increased virulence of organisms causing STIs c. The use of oral agents rather than condoms as contraceptives d. Development of resistance of microorganisms to common antibiotics
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c. Although many factors relate to the current sexually transmitted infections (STI) rates, one major factor is the widespread use of oral contraceptives instead of condoms (both male and female). Condoms are the only contraceptive device that protects against STIs.
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In establishing screening programs for populations at high risk for STIs, the nurse recognizes that which microorganism causes nongonococcal urethritis in men and cervicitis in women? a. Herpes simplex virus b. Treponema pallidum c. Chlamydia trachomatis d. Neisseria gonorrhoeae
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c. Chlamydia trachomatis can cause nongonococcal urethritis in men and cervicitis in women. Herpes simplex virus causes genital herpes. Treponema pallidum causes syphilis. Neisseria gonorrhoeae causes gonorrhea.
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The laboratory result of a specimen from a 20-year-old female patient shows human papillomavirus (HPV). What would the nurse suspect the patient's diagnosis to be? a. Syphilis b. Gonorrhea c. Genital warts d. Genital herpes
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c. Genital warts are caused by human papillomavirus (HPV). Syphilis is caused by T. pallidum. Gonorrhea is caused by N. gonorrhoeae. Genital herpes are caused by herpes simplex virus.
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A female patient with a purulent vaginal discharge is seen at an outpatient clinic. The nurse suspects a diagnosis of gonorrhea. How would this STI be treated? a. Oral acyclovir (Zovirax) b. Benzathine penicillin G given IM c. Ceftriaxone (Rocephin) IM or oral cefixime (Suprax) d. Would need a second confirmatory test result before treatment
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c. An established diagnosis of gonorrhea is treated with cefixime (Suprax) orally or with a single dose of IM ceftriaxone (Rocephin). If chlamydia is also present, azithromycin (Zithromax) or doxycycline (Vibramycin) may also be used. Gram stain smears are not useful in diagnosing gonorrhea in women because the female genitourinary tract normally harbors a large number of organisms that resemble N. gonorrhoeae and cultures must be performed to confirm the diagnosis in women. Penicillin was used to treat gonorrhea but gonorrhea is now resistant to penicillin. Penicillin G is used to treat syphilis. Although gonorrhea may lead to pelvic inflammatory disease (PID), its diagnosis would not necessarily indicate that the patient has PID.
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A 22-year-old woman with multiple sexual partners seeks care after several weeks of experiencing painful and frequent urination and vaginal discharge. Although the results of a culture of cervical secretions are not yet available, the nurse explains to the patient that she will be treated as if she has gonorrhea and chlamydia to prevent a. obstruction of the fallopian tubes. b. endocarditis and aortic aneurysms. c. disseminated gonococcal infection. d. polyarthritis and generalized adenopathy.
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a. Upward extension of gonorrhea or chlamydia commonly causes PID, which can cause adhesions and fibrous scarring, leading to tubal pregnancies and infertility. Disseminated gonococcal infection is rare and endocarditis and aneurysms are associated with syphilis. Polyarthritis and adenopathy are not seen in gonorrhea or chlamydia.
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Priority Decision: During evaluation and treatment of gonorrhea in a young man at the health clinic, what is most important for the nurse to question the patient about? a. A prior history of STIs b. When the symptoms began c. The date of his last sexual activity d. The names of his recent sexual partners
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d. All sexual contacts of patients with gonorrhea must be notified, evaluated, and treated for STIs. The other information may be helpful in diagnosis and treatment but the nurse must try to identify the patient's sexual partners.
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Which manifestations are characteristic of the late or tertiary stage of syphilis (select all that apply)? a. Heart failure b. Tabes dorsalis c. Saccular aneurysms d. Mental deterioration e. Generalized cutaneous rash f. Destructive skin, bone, and soft tissue lesions
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a, b, c, d, f. In the tertiary (or late) stage of syphilis there can be gummas (chronic destructive lesions), cardiovascular problems (heart failure, aneurysms, valve insufficiency), and neurosyphilis manifestations (mental deterioration, tabes dorsalis, and speech disturbances). Generalized cutaneous rash occurs in the secondary stage of syphilis, a few weeks after the chancre appears.
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Which stage of syphilis is identified by the absence of clinical manifestations and a positive fluorescent treponemal antibody absorption (FTA-Abs) test? a. Latent b. Primary c. Secondary d. Late (tertiary)
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a. Lack of clinical manifestations but a positivetreponemal antibody test with normal cerebrospinal fluid (CSF) occurs in the latent stage. The primary stage is characterized by a chancre, regional lymphadenopathy, and genital ulcers. The secondary stage has flu-like symptoms and cutaneous lesions. The late or tertiary stage is characterized by gummas, cardiovascular changes, and neurosyphilis.
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A premarital blood test for syphilis reveals that a woman has a positive Venereal Disease Research Laboratory (VDRL) test. How should the nurse advise the patient? a. A single dose of penicillin will cure the syphilis. b. She should question her fiancé about prior sexual contacts. c. Additional testing to detect specific antitreponemal antibodies is necessary. d. A lumbar puncture to evaluate cerebrospinal fluid (CSF) is necessary to rule out active syphilis.
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c. Many other diseases or conditions may cause falsepositive test results on nontreponemal Venereal Disease Research Laboratory (VDRL) or rapid plasma reagent (RPR) tests and additional testing is needed before a diagnosis is confirmed or treatment is administered. The diagnosis is confirmed by specific treponemal tests, such as the fluorescent antibody absorption (FTA-Abs) test or the TP-PA test. Analysis of CSF is used to diagnose asymptomatic neurosyphilis.
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Why should the nurse encourage serologic testing for human immunodeficiency virus (HIV) in the patient with syphilis? a. Syphilis is more difficult to treat in patients with HIV infection. b. The presence of HIV infection increases the risk of contracting syphilis. c. The incidence of syphilis is increased in those with high rates of sexual promiscuity and drug abuse. d. Central nervous system (CNS) involvement is more common in patients with HIV infection and syphilis.
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c. The risk factors of drug abuse and sexual promiscuity are found in patients with both syphilis and human immunodeficiency virus (HIV) infection and persons at highest risk for acquiring syphilis are also at high risk for acquiring HIV. Syphilitic lesions on the genitals enhance HIV transmission. Also, HIV-infected patients with syphilis appear to be at greatest risk for central nervous system (CNS) involvement and may require more intensive treatment with penicillin to prevent this complication of HIV.
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A male patient returns to the clinic with a recurrent urethral discharge after being treated for a chlamydial infection 2 weeks ago. Which statement by the patient indicates the most likely cause of the recurrence of his infection? a. "I took the Vibramycin twice a day for a week." b. "I haven't told my girlfriend about my infection yet." c. "I had a couple of beers while I was taking the medication." d. "I've only had sexual intercourse once since my medication was finished."
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b. Notification and treatment of sexual partners are necessary to prevent recurrence and the "ping-pong effect" of passing STIs between partners. Vibramycin is prescribed twice a day for 7 days and although alcohol may cause more urinary irritation in the patient with chlamydia, it will not interfere with treatment.
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What is the most common way to determine a diagnosis of chlamydial infection in a male patient? a. Cultures for chlamydial organisms are positive. b. The nucleic acid amplification test (NAAT) is positive. c. Gram stain smears and cultures are negative for gonorrhea. d. Signs and symptoms of epididymitis or proctitis are also present.
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b. The nucleic acid amplification test (NAAT) is more sensitive than other diagnostic tests, can be done with a urine sample, and has results within 24 hours. A cell culture can be used to detect chlamydia organisms but it requires specific handling and is not as easy or as fast to perform as the NAAT. Gonorrhea and chlamydia have very similar symptoms in men and frequently occur together. Gram stain smears and cultures for N. gonorrhoeae do not definitively diagnose Chlamydia. Manifestations of epididymitis or proctitis may be present, as with other STIs, but are not diagnostic.
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What are characteristics of a herpes simplex virus infection (select all that apply)? a. Treatment with acyclovir can cure genital herpes. b. Herpes simplex virus type 2 (HSV-2) is capable of causing only genital lesions. c. Recurrent symptomatic genital herpes may be precipitated by sexual activity and stress. d. To prevent transmission of genital herpes, condoms should be used when lesions are present. e. The primary symptom of genital herpes is painful vesicular lesions that rupture and ulcerate.
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c, e. Sexual activity and stress may precipitate the recurrence of genital herpes symptoms of painful vesicular lesions that rupture and ulcerate. Acyclovir only decreases recurrences of genital herpes. Herpes simplex virus type 2 (HSV-2) may cause oral or genital lesions. Prevention of the spread of genital herpes is best done with avoidance of sexual activity when lesions are present.
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During the physical assessment of a female patient with HPV infection, what should the nurse expect to find? a. Purulent vaginal discharge b. A painless, indurated lesion on the vulva c. Painful perineal vesicles and ulcerations d. Multiple coalescing gray warts in the perineal area
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d. HPV is responsible for causing genital warts, which manifest as discrete single or multiple white to gray warts that may coalesce to form large cauliflower-like masses on the vulva, vagina, cervix, and perianal area. Purulent vaginal discharge is associated with gonorrhea or chlamydia. Painful perineal vesicles and ulcerations are characteristic of genital herpes and a chancre of syphilis is a painless indurated lesion on the vulva, vagina, lips, or mouth.
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Priority Decision: What is most important for the nurse to teach the female patient with genital warts? a. Have an annual Papanicolaou (Pap) test. b. Apply topical acyclovir faithfully as directed. c. Have her sexual partner treated for the condition. d. Use a contraceptive to prevent pregnancy, which might exacerbate the disease.
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a. There is a strong association of genital warts with the development of dysplasia and neoplasia of the genital tract, especially when lesions involve the cervix, introitus, and perianal and intraanal mucosa of women or the penis and perianal and anal mucosa of men. Regular Papanicolaou (Pap) tests in women are critical in detecting early malignancies of the cervix. Oral acyclovir is used to treat HSV-2 but topical use has no value in treating viral STIs. Sexual partners of patients with HPV should be examined and treated but because treatment does not destroy the virus, condoms should always be used during sexual activity. Genital warts often grow more rapidly during pregnancy but pregnancy is not contraindicated.
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Which STI actively occurring at the time of delivery would indicate the need for a cesarean section delivery of the woman's baby? a. Syphilis b. Chlamydia c. Gonorrhea d. Genital herpes
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d. Women with an active herpes simplex virus (HSV) genital lesion at the time of delivery have the highest riskof transmitting genital herpes to the neonate, so delivery will be done with a cesarean section (C-section). Syphilis is spread to the fetus in utero and has a high risk of stillbirth but C-sections are not required. Treatment with parenteral penicillin will cure both the mother and the fetus. Chlamydia spread to the fetus can be prevented by treating the pregnant woman, so a C-section is not required. Prevention of the spread of gonorrhea to the neonate's eyes is done with erythromycin ophthalmic ointment or silver nitrate aqueous solution.
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Although an 18-year-old girl knows that abstinence is one way to prevent STIs, she does not consider that as an alternative. She asks the nurse at the clinic if there are other measures for preventing STIs. What should the nurse teach her? a. Abstinence is the only way to prevent STIs. b. Voiding immediately after intercourse will decrease the risk for infection. c. A vaccine can prevent genital warts and cervical cancer caused by some strains of HPV. d. Thorough hand washing after contact with genitals can prevent oral-genital spread of STIs.
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c. A vaccine is available for HPV types 6, 11, 16, and 18 that protects against genital warts and cervical cancer. Although sexual abstinence is the most certain method of avoiding all STIs, it is not usually a feasible alternative. Undamaged condoms also serve to protect against infection. Conscientious hand washing and voiding after intercourse are positive hygienic measures that will help to prevent secondary infections but will not prevent STIs.
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Patients with which STI are most likely to avoid obtaining and following treatment measures for their infection? a. Syphilis b. Gonorrhea c. HPV infection d. Genital herpes
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a. STIs, such as syphilis, that can be treated with a single dose or short course of antibiotic therapy often lead to a casual attitude about the outcome of the disease, which leads to nonadherence with instructions and delays in treatment. This is particularly true of diseases that initially show few distressing or uncomfortable symptoms, such as syphilis.
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The individual with the lowest risk for sexually transmitted pelvic inflammatory disease is a woman who uses:
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barrier methods of contraceptives
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The nurse is obtaining a subjective data assessment from a woman reported as a sexual contact of a man with chlamydial infection. The nurse understands that symptoms of chlamydial infection in women:
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are frequently absent
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A primary HSV infection differs from recurrent HSV episodes in that: (select all that apply)
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-symptoms are less severe during recurrent episodes -systemic manifestations such as fever and myalgia are more common in primary infection
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Explain to the patient with gonorrhea that treatment will include both ceftriaxone and doxycycline because:
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the high rate of coexisting chlamydial infection and gonorrhea indicates coverage with both drugs
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In assessing patients for STIs, the nurse needs to know that many STIs can be asymptomatic. Which STIs can be asymptomatic: (select all that apply)
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-Syphilis -Gonorrhea -Genital Warts -Genital Herpes -Chlamydial Infection
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To prevent the infection and transmission of STIs, the nurse's teaching plan would include an explanation of:
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sexual practices that are considered high-risk behaviors
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Provide emotional support to a patient with an STI by:
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showing concern when listening to the patient who expresses negative feelings
