Transcript Adult Medical-Surgical Nursing 2

Reproductive Health Module:
Sexually Transmitted Diseases 1:
HIV/AIDS
Sexually Transmitted Disease: Definition
 A sexually transmitted disease (STD) is a disease
acquired through sexual contact with an infected
person
STD: Classification
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Chlamydia
Human Immunodeficiency Virus
Herpes simplex
Human Papillovirus (HPV)
Cytomegalovirus (CMV)
Gonorrhoea
Syphilis
Hepatitis B (HBV)
Hepatitis C (HCV)
STD: Transmission
 Portals of entry of STD micro-organisms are the skin
and mucosal linings of:
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Urethra
Cervix
Vagina
Rectum
Oropharynx
STD: Modes of Transmission
 Sexual
 Perinatal (vertical transmission from mother to
foetus/ newborn in utero, at birth, through
breastfeeding): HBV, HCV, chlamydia, gonorrhoea,
syphilis, HIV
 Percutaneous in addition to sexual: HBV, HCV, HIV
STD: Risk Factors
 High risk behaviours:
 Sexual relations with infected persons
 Multiple sexual partners
 Relations with prostitutes
 Oral or anal sex
 Using IV injections/ drug abuse (high risk associated
behaviour)
STD: Prevention
 Health education about risk factors/ high risk
behaviour
 Use of a condom as a protective barrier: reduces but
does not eliminate risk of transmission:
 “Safer sex” rather than “safe sex”
STD: Public Health Challenge
 Sexually transmitted diseases may progress
without symptoms
 Those persons with symptoms often reluctant to
disclose and seek help:
 Through embarrassment (stigma)
 Fear of losing partner
 Often more than one STD co-infect
 Delay in diagnosis/ treatment risks health
complications and transmission to others
 Human Immunodeficiency Virus (HIV)
Human Immunodeficiency Virus:
Description
 HIV is the causative agent of AIDS
 An RNA retrovirus (which transcripts DNA)
 Targets CD4-positive (CD4+) T lymphocytes
reducing count and function
 May progress to severe immune dysfunction:
 Acquired Immune Deficiency Syndrome (AIDS)
 Immunosuppression leads to:
 Opportunistic infections
 Neoplasms
 Lymphadenopathy
HIV: Transmission
 Transmitted in body fluids of an infected person:
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Blood
Seminal fluid
Vaginal secretions
Amniotic fluid
Breastmilk
Blood transfusion (screening → now rare)
HIV/AIDS: Pathophysiology
 HIV RNA retroviruses attach to CD4 cell surface
receptor/ fuse with cell membrane
 Uncoating: viral contents empty into cell
 HIV enzyme reverse transcriptase copies viral genetic
material to DNA:
 Blueprint for replication of viral RNA and repeat
process
 Dormant infected cells reactivated against any new
infection: further replicate virus
HIV/AIDS:
Clinical Manifestations
 Persistent enlargement of lymph nodes
 Fatigue (lack of energy)
 Weight loss
 Frequent fevers and night sweats
 Persistent oral or genital candida (thrush)
 Persistent skin rash/ flaky skin
 Short-term memory loss
HIV/AIDS:
Complications
 Disease progress may involve:
 Opportunistic Candidiasis of the bronchial tract,
oesophagus
 Pneumocystis carinii pneumonia
 HIV encephalopathy
 Kaposi sarcoma
 Invasive cervical cancer/ other neoplasms
 Lymphoma
 TB
 Multiple associated infections
 Wasting
HIV/AIDS: Diagnosis
 Patient history and clinical picture
 CD4 positive T cell count: (HIV destroys CD4 T cells)
 CD4/ CD8 ratio
 EIA (ELISA) enzyme immunoassay ( HIV antibodies
detected)
 Western blot (antibodies confirm EIA)
 Viral load (measures HIV RNA in plasma)
HIV Test Result: Patient Education
 Positive result: HIV antibodies are present
 Patient infected: HIV active in body
 Despite HIV infection may not have AIDS
 Does NOT indicate immunity to AIDS
 Negative result:
 No antibodies present at test time
 Not infected, or infected but no antibodies as yet
(3 weeks to 6 months to develop): take precautions
HIV: Anti-retroviral Agents
 Anti-HIV drugs attempt to block viral replication
within the cells
 Inhibit reverse transcriptase (interfere and confuse
HIV in converting RNA to DNA)
 Inhibit HIV protease (enzyme which cuts and
disperses viral particles to new CD4+)
 Multiple drug protocols used
AIDS: Treatment/ Prophylaxis
 Anti-retrovirals (HIV)
 Antibiotics
 Antiviral agents: Amphotericin B (meningitis), Alpha-
interferon (Kaposi), Acyclovir, Gancyclovir
 Anti-fungal agents: TMP-SMZ (Pneumocystis carinii
pneumonia)
 Anti-TB medication
 Anti-depressants
 Anti-diarrhoea medications
 Nutrition therapy (wasting)
AIDS:
Prophylactic Measures in Pregnancy
 Anti-retrovirals to pregnant women have reduced risk
to the newborn
 A caesarian section may be recommended
 Breastfeeding should be discouraged
HIV: Vaccines
 Uniquely difficult to produce HIV vaccine
 Usually vaccines activate the humoral immune
response: B lymphocytes and production of antibodies
(long-term memory IgG)
 HIV affects T lymphocytes (and also a retrovirus)
 Trials of HIV vaccine were discontinued as detrimental
to health of participants
 No vaccine available at present time
HIV/AIDS: Nursing Considerations
 Patient education related to risk factors related to
infection and spread of virus
 Importance of complying with medication protocol
 Importance of maintaining healthy lifestyle, good
nutrition, adequate sleep
 Psychological support to patient/ family
 Management of symptoms/ total care