PID,STIs and HIV

1
 Learning outcomes
• Learning outcomes
• At the end of this unit the student nurse should
be able to:
• Define the related concepts
• Discuss the causes
• Describe the pathophysiology.
• Outline the clinical manifestations.
• Describe the types/classification/stages.
• Name the surgical procedures
• Recognise the possible complications.
2
 Learning outcomes cont
• Design a nursing care plan of patient with PID.

3
 STIS syndromes

Most common STIs syndromes

• Genital ulcer diseases(GUD)
• Ureteral discharges(UD)
• Vaginal discharges(VD)
• Pelvic inflammatory diseases(PID)

4
 What does syndromes mean?
• Is a group of symptoms a patient complains
about and they are clinical signs that you
observe during examination.
• What does syndromic management mean?
Treatment of all the common causes of those
symptoms.

5
 HIV vs STIs
Why do you think it is important to treat STIs in HIV
patients?
• Answer-Treatment of STIs is an important
component of HIV prevention and care
management.
• Interaction of HIV and STIs is bi-directional.
• Presence of STIs could increase vulnerability to
HIV infection.
• clinical presentation of various types of STIs is
influenced by co-infection with HIV.

6
 HIV vs STIs continues
• In HIV positive patient syphillis can have
atypical presentation and a tendency to
rapidly progress to neurosyphillis.
• Coinfection with genital ulcers organisms is
not uncommon.
• Both specific and non-specific treponemal
serology tests for syphillis can be non-reactive
in presence of infection with HIV.

7
 HIV vs STIs continues
• Recurrent or persistent genital ulcers caused
by herpes simplex are common in patients
with HIV(often multiple and expensive).
• Increase number of HPV(Human papilloma
virus)to produce epithelial dysplasia and
cervical cancer occurs in the presence of HIV.
• STIs can be a marker of unprotected sex.

8
 PID continues
What does PID mean?
Pelvic inflammatory disease(PID)includes several
inflammatory disorders of the upper female genital
tract often with the infection that involve the fallopian
tubes ,ovaries, uterus, or peritoneum.
Pathophysiology and etiology
• high reoccurrence rate.
• Causative agents includes

9
 PID continues
Pathophysiology and etiology cont
• N.gonnorhoeae,
• C.trochomatis,anaerobes(gardnerella vaginalis),
• Gram- negative bacteria and streptococci.
• Cervical infection ascends through the endometrium,
into the fallopian tubes and to the peritoneal cavity.

10
 PID continues

Pathophysiology and etiology cont

• Predisposing factors: sexual multiple partners,
• Early onset of sexual activity,
• Use of IUDs,
• THerapeutic abortion, caesarean sections and
hysterosalpingograms.

11
 PID continues
Clinical manifestations
• Pelvic pain usually dull and bilateral.
• fever> 39 grade cercius –gonococal infection.
• Mucopurulent vaginal discharge
• Irregular bleeding
• GI symptoms-nausea and vomiting-
• acute lower abdominal pain-signify abscess.
• Dysuria, frequency

12
 PID continues
Clinical manisfestations
• Presentation with chlamydia may be mild
• Irregular and heavy menstrual bleeding
• Pain during sexual intercourse

13
 PID continues
Clinical manifestations
Nursing alert!!!
• Localised right and lower quadrant tenderness with
the following:
• Guarding ,rebound or palpable mass-tubo ovarian
mass with peritoneal inflammation.

14
 PID continues
Diagnostic evaluation
1)Diagnostic criteria for empiric treatment of PID in women
at risk for STDs is warrant if :
• no cause of pelvic pain can be identified or
if any of the three criteria /signs are present:
• Cervical motion tenderness
• Uterine tenderness
• Adnexal tenderness
• find out about: cervical exudate, friable cervix and white
blood cells on

15
 PID continues
Diagnostic evaluation cont
1.Vaginal smear = BV + Candida,
2.Pap smear = Carcinoma
3.Vaginal swab(PCR) to identify the following
organisms/agents:
• Chlamydia trachomatis (CT)
• Trichomonas Vaginalis(TV)
• Blood for RP

16
 PID continues
Management
(See Namibian STIs treatment guide)
• Mild +moderate cases: antibiotics orally
• Follow-up 48-72 hours after initiation + 2 weeks
after completion
• Admission
• Aggressive antibiotics.

17
 Complications of PID
• Abscess rupture + sepsis
• Infertility .
• Ectopic pregnancy
• Dyspareunia due to adhesions.

18
 Nursing assessment
• Obtain history of menstruation, contraceptions,
sexual activities(no of partners ,new partners)STDs
history, symptoms in sexual partner.
• Assess level of pain, fever, hypotension, increase
pulse indicating hypervolemia.
• Perform abdominal and pelvic examination(check for
• abdominal tenderness, rebound,rebound ,quarding
or mass.
• Assess patient feeling about having STDs.

19
 Nursing diagnosis
• Acute pain related to pelvic inflammation and
infection.
• Deficient fluid volume related to fever and decrease
oral intake
• Risk for infection related to STDs/SRis.
Nursing interventions
See nursing care plan 22-1 pg 878 Lippincott

20
 PID continues
Activity
Dived into 4 group
• Draw up a nursing care plan of a patient with
PID based on the nursing diagnosis made.
• Draw up a education and maintenance plan.

21
 PID continues
Education and health maintenance

22
 PID continues
Evaluation: expected outcomes

23
 References cont
• Sandra,M.N.(2010)Lippincott:Manual of
Nursing practice.(9th Ed)Lippincott:New york.
• Brunner,L,S.,& Suddaarth,(1992).The textbook
of Adult Nursing:London ,Chapman Hall.
• Mogothlane,S.motschedish C.
,Mokgadi,M.,Joyce ,M.,& Young,A.(2014)Juta
‘s complete text book of medical Surgical
Nursing.Cape Town:Lebone Publisher

24
 References cont
• Ministry of health and social services
(2009).Guidelines for sexual transmitted
infections using syndromic approach.
Directorate of special programmes: Windhoek

25
 Urethral discharges syndromes(UDS)
• Definition: presence of secretion (pus)from the
anterior urethra.
Clinical manifestations
• Burning and urethral discomfort when passing
urine.
• Complications
• Epididymitis,
• scrotal swelling and
• urethral stricture

26
 UDS continues
Etiology
• Common causes of uretral discharges and dysuria
are:
• Neisseria gonorrhoeae
• Chlamidia trachomatis
• Tricomonas vaginalis
• Other causes of urethral discharges and dysuria
are:Mycoplasma genitalium,herpes simples,urea

27
 UDS continues
Etiology
• NB.urethritis in man is usually due to STS
• Not to be confused with the symptoms UTI
which causes pain within the
bladder(suprapubic pain) ureters(frank and
abdomen) or kidneys(back) and is usually not
STIs.

28
 UDS continues
Recommended syndromic treatment
• Cefixime 400mg po or ceftriaxone 250 imi stat
• Azithromycin 1g per os stat
• Metronidazole po stat

29
 UDS continues
• Nursing assesment (see the handout)
Diagnositic evaluation
Take blood for RPR(syphyllis)
Urine:Nesserria Gonorrehea,Chlamydia
trachomatis, Trichomona vaginalis
Nursing interventions
• Collect urine,blood as per DR s orders
• Administer antibiotics

30
 Genital ulcer diseases(GUD)
Definition: Loss of continuity of the skin of the
genitalia.
Clinical manifestations
• Painful or painless ulcers
• Single or multiple ulcers associated with
enlarged lymph nodes.
Aetiology:
Causative cause differ from different parts of the
world.

31
 Genital ulcer diseases(GUD)
Common cause in Sub sahara africa caused by:
• Herpes simplex type 2(genital herpes
• Treponema pallidum(syphillis)
• Haemophillus ducrei(chancroid)
Clinical manifestations (Handout page 13)

32
 Genital ulcer diseases(GUD)
• Treatment(handout pg 13
Diagnostic evaluation
Male :take the following:
blood
for RPR- identify Treponema pallidum causes
syphillis.
genital Swab
identify herpes simplex-HSV 1 +2 cause genital
herpes

33
Genital ulcer diseases(GUD)continues
Genital swab
• Identify Haemophillus ducreyi -causes
chancroid
• Identify chlamidia trachomatis-causes-
Lymphogranuloma venereum(LGV)
• identify Klebsiela granulomatis –causes
Donovanosis (granuloma inquinale

34
 References
• Sandra,M.N.(2010)Lippincott:Manual of
Nursing practice.(9th Ed)Lippincott:New york.
• Brunner,L,S.,& Suddaarth,(1992).The textbook
of Adult Nursing:London ,Chapman Hall.
• Mogothlane,S.motschedish C.
,Mokgadi,M.,Joyce ,M.,& Young,A.(2014)Juta
‘s complete text book of medical Surgical
Nursing.Cape Town:Lebone Publisher.

35
 References cont
• Ministry of health and social services
(2009).Guidelines for sexual transmitted
infections using syndromic approach.
Directorate of special programmes: Windhoek

36
 Vaginal discharge syndromes(VD)
Definition - Abnormal vaginal discharges(
offensive, muco –purulent
VD can be as a result of :
• Cervicitis, BV, PID/LAP, vaginitis, vulvitis
Aetiology ,causes and clinical manifestations of
each page 17-19 hand out)

37
 VDS continues
Diagnostic evaluation
• Vaginal smear: for bacterial vaginosis( BV) +
Candida,
• Papsmear - Carcinoma
• PCR - GV, chlamydia trachomatis (CT)TV,MG
• Vaginal swab - if ulcer present (GUD)

38
 VDS continues
Causative organisms/Aetiology
• Haemophillus ducreyi -chancroid
• Chlamidia trachomatis (CT)--
Lymphogranuloma venereum(LGV)
• Klebsiela granulomatis – Donovanosis
(granuloma inquinale (GI)

39
 Inguinal/femoral bubo
Definition: localised enlargements of lymph
nodes in groin area, can be uni or bilateral.
Clinical manifestations
Pain inguinal bubo and fluctuant
Aetiology
• LGV
• H.Ducreyi
• C.granulomatis

40
 Inguinal bubo continues
Diagnostic evaluation
Treatment pg23 guidelines of STIs

41
 References
• Sandra,M.N.(2010)Lippincott:Manual of
Nursing practice.(9th Ed)Lippincott:New york.
• Brunner,L,S.,& Suddaarth,(1992).The textbook
of Adult Nursing:London ,Chapman Hall.
• Mogothlane,S.motschedish C.
,Mokgadi,M.,Joyce ,M.,& Young,A.(2014)Juta
‘s complete text book of medical Surgical
Nursing.Cape Town:Lebone Publisher.

42
 STIs without syndromes
• Genital warts
• Genital scabies
• Pediculosis pubis
• Neotal herpes
• Balanitis/Balanoposthitis

43
 References
• Sandra,M.N.(2010)Lippincott:Manual of
Nursing practice.(9th Ed)Lippincott:New york.
• Brunner,L,S.,& Suddaarth,(1992).The textbook
of Adult Nursing:London ,Chapman Hall.
• Mogothlane,S.motschedish C.
,Mokgadi,M.,Joyce ,M.,& Young,A.(2014)Juta
‘s complete text book of medical Surgical
Nursing.Cape Town:Lebone Publisher.

44
 References continues
• Ministry of health and social services
(2009).Guidelines for sexual transmitted
infections using syndrome approach.
Directorate of special programmes: Windhoek.

45