Chlamydia and Gonorrhea - Vulvovaginal Infections

CHLAMYDIA AND GONORRHEA

Chlamydia and gonorrhea are the most common causes of endo-cervicitis, although Mycoplasma may also be involved. Chlamydia causes about 3 million infections every year in the United States; it is most commonly found in young, sexually active people with more than one partner and is transmitted through sexual inter-course (U.S. Surgeon General’s Report, 2001). It can result in serious complications, including pelvic infection, an increased risk for ectopic pregnancy, and infertility. Up to 40% of un-treated women develop pelvic inflammatory disease (PID). One in 20 women of reproductive age in the United States is infected. Chlamydial infections of the cervix often produce no symptoms, but cervical discharge, dyspareunia, dysuria, and bleeding may occur. Other complications include conjunctivitis and peri-hepatitis. If a pregnant woman is infected, stillbirth, neonatal death, and premature labor may occur. Infants born to infected mothers may experience prematurity, conjunctivitis, and pneumonia.

Chlamydial infection and gonorrhea often coexist. As many as 25% of females who have chlamydial infections also have gonor-rhea. The inflamed cervix that results from this infection may leave a woman more vulnerable to HIV transmission from an in-fected partner. Gonorrhea is also a major cause of PID, tubal in-fertility, ectopic pregnancy, and chronic pelvic pain. Fifty percent of women with gonorrhea have no symptoms, but without treatment 40% may develop PID. In males, urethritis and epididymi-tis may occur. Diagnosis can be confirmed by culture, smear, or other methods, using a swab to obtain a sample of cervical dis-charge or penile discharge from the patient’s partner.

Medical Management

The Centers for Disease Control and Prevention (CDC) recom-mends treating chlamydia with doxycycline for 1 week or with a single dose of azithromycin. Because of the high incidence of coin-fection with chlamydia and gonorrhea, treatment for gonorrhea should include treatment for chlamydia as well (CDC, 2002). Partners must also be treated. Pregnant women are cautioned not to take tetracycline because of potential adverse effects on the fetus. In these cases, erythromycin may be prescribed. Results are usually good if treatment begins early. Possible complications from delayed treatment are tubal disease, ectopic pregnancy, PID, and infertility.

Cultures for chlamydia and other STDs should be obtained from all patients who have been sexually assaulted when they first seek medical attention; patients are treated prophylactically. Cul-tures should then be repeated in 2 weeks. Annual screening for chlamydia is recommended for all sexually active women 20 to 25 years of age and older women with new sex partners or multi-ple partners (CDC, 2002).

Nursing Management

All sexually active women may be at risk for chlamydia, gonor-rhea, and other STDs, including HIV. Nurses can assist patients in assessing their own risk. Recognition of risk is a first step be-fore changes in behavior occur. Patients should be discouraged from assuming that a partner is “safe” without open, honest dis-cussion. Nonjudgmental attitudes, educational counseling, and role playing may all be helpful.

Because chlamydia, gonorrhea, and other STDs may have a serious effect on future health and fertility and because many STDs can be prevented by the use of condoms and spermicides and careful choice of partners, the nurse can play a major role in talking with patients about how to make sex as safe as possible. Exploring options with patients, determining their use of safer sex practices and their knowledge deficits, and correcting misinfor-mation may prevent morbidity and mortality.

PROMOTING HOME AND COMMUNITY-BASED CARE

Teaching Patients Self-Care. 

Nurses can educate women andhelp them to develop communication skills and to initiate dis-cussions about sex with their partners. Communicating with part-ners about sex, risk, postponing intercourse, and using safer sex behaviors, including use of condoms, may be lifesaving. Some young women report having sex with someone but not being comfortable enough to discuss sexual risk issues. The nurse can pose the question, “If you are uncomfortable talking about sex with this person, how do you feel about having a sexual relation-ship with this person?”

Reinforcing the need for annual screening for chlamydia and other STDs is an important part of patient teaching. Instructions also include the need for the patient to abstain from sexual inter-course until all of her sex partners are treated (CDC, 2002). The CDC has revised its guidelines and recommends rescreening of all women with chlamydial infections 3 to 4 months after treatment is completed; this is in an effort to protect young women from infertility.