Sexually Transmitted Infections
Key Points
- STIs affect all populations and may be asymptomatic while still transmissible.
- Prevention includes abstinence, consistent barrier use, vaccination, risk-reduction counseling, and timely testing.
- Major STI groups include bacterial/protozoal infections (for example gonorrhea, chlamydia, trichomoniasis, syphilis) and viral infections (for example HPV, HSV, HIV).
- Nursing priorities include nonjudgmental risk assessment, partner-management education, treatment adherence support, and complication surveillance.
Pathophysiology
STIs are transmitted through sexual contact involving genital, oral, anal, skin, mucosal, or body-fluid exposure. Infection can remain clinically silent while causing tissue inflammation, immune dysregulation, and long-term reproductive sequelae if untreated.
Bacterial and protozoal infections are generally treatable, but delayed care can lead to pelvic inflammatory disease, infertility, ectopic pregnancy risk, chronic pelvic pain, adverse pregnancy outcomes, and enhanced HIV acquisition risk. Viral STIs are often chronic or latent, with management focused on suppression, prevention of transmission, and cancer-risk reduction where applicable.
Screening strategy depends on age, anatomy, sexual practices, and exposure risk. Prevention programs combine behavioral counseling, partner notification/treatment, vaccination, and high-risk interventions such as HIV PrEP.
Classification
- Bacterial STIs: Gonorrhea, chlamydia, and syphilis (with stage-dependent manifestations).
- Protozoal STI: Trichomoniasis with reinfection risk and partner-treatment implications.
- Viral STIs: HPV, HSV, HIV, and hepatitis-related transmission contexts.
- Complication pathways: PID, infertility, ectopic pregnancy, congenital infection, and systemic disease progression.
Nursing Assessment
NCLEX Focus
Prioritize exposure risk assessment, anatomic-site specific testing needs, and recognition of asymptomatic transmission risk.
- Use structured sexual-history tools (for example partners, practices, protection, past STIs, pregnancy plans).
- Screen for high-risk patterns: multiple/new partners, inconsistent condom use, substance-associated risk behavior.
- Assess symptoms by syndrome cluster (discharge, ulcers, dysuria, pelvic pain, rash, bleeding, fever).
- Evaluate pregnancy status and trimester-specific STI screening requirements.
- Screen for trauma, coercion, and intimate partner violence with private, trauma-informed methods.
Nursing Interventions
- Provide evidence-based prevention education: condoms, vaccination, testing intervals, and safer-sex planning.
- Reinforce treatment adherence and abstinence guidance during recommended post-treatment windows.
- Coordinate partner evaluation/treatment pathways according to local policy and legal standards.
- Arrange retesting/test-of-cure where indicated by infection type and pregnancy status.
- Educate on urgent warning signs of complications (worsening pelvic pain, fever, heavy bleeding, neurologic symptoms).
Asymptomatic-Transmission Trap
Absence of symptoms does not rule out STI infection or contagiousness, so risk-based screening must not be deferred.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| antibiotics | Ceftriaxone, doxycycline, penicillin contexts | Site- and organism-specific regimens require adherence and partner-treatment coordination. |
| antiretroviral-therapy | HIV treatment and PrEP contexts | Sustained adherence reduces morbidity and transmission risk; specialist coordination is essential. |
Clinical Judgment Application
Clinical Scenario
A 22-year-old patient presents with mild dysuria and intermittent discharge, reports multiple recent partners, and says they “feel mostly fine” so they delayed testing.
Recognize Cues: High exposure risk with potentially mild or asymptomatic STI presentation. Analyze Cues: Delayed care increases risk of ascending infection and partner transmission. Prioritize Hypotheses: Priority is prompt multi-site STI testing and empiric management as indicated by syndrome/risk. Generate Solutions: Provide nonjudgmental counseling, testing, treatment plan, and partner notification guidance. Take Action: Start guideline-based care and schedule retesting/follow-up. Evaluate Outcomes: Symptoms resolve, partner management occurs, and reinfection risk is reduced.
Related Concepts
- vaginal-infections-and-other-conditions - Differential diagnosis of discharge and vulvovaginal symptoms overlaps with STI presentations.
- urinary-tract-infections - Dysuria and pelvic symptoms require STI-versus-UTI differentiation.
- emergency-contraception - STI exposure assessment should accompany unprotected-intercourse visits.
- contraception-the-nurses-role - Dual-protection counseling integrates contraception with STI prevention.
- culturally-competent-care - Stigma-sensitive communication improves disclosure and adherence.
Self-Check
- Why is symptom-based screening alone insufficient for STI control?
- Which STI management plans require partner presumptive treatment and retesting?
- How does nursing counseling reduce reinfection and long-term reproductive complications?