Introduction to Medical-Surgical Nursing, 6th ed.
51
Lesson Plans for
Sexually Transmitted Infections
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 51.1:
2. Explain why specific sexually transmitted infections must be reported to the health department.
4. For selected sexually transmitted infections, describe the pathophysiology, signs and symptoms,
complications, and medical treatment.
5. Explain the importance of the nurse’s approach when dealing with patients who have sexually
transmitted infections.
Lesson 51.2:
7. Identify data to be collected when assessing a patient with a sexually transmitted infection.
9. Design a teaching plan on the prevention of sexually transmitted infections.
CHAPTER TEACHING FOCUS
• In this chapter, students will focus on the recognition, diagnosis, and treatment of sexually transmitted
infections.
• Students will have the opportunity to learn to distinguish between the various sexually transmitted
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Sexuality and Reproduction
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Which of these people would be more likely to acquire a sexually transmitted infection (STI)?
a) A divorced female professor at a junior college
b) A widowed homemaker receiving Medicare with secondary insurance
c) A single, unemployed male with a tenth-grade education
d) A married male history teacher
2) A chancre lesion is the first sign of __________.
a) syphilis
b) gonorrhea
c) chlamydia
d) trichomoniasis
3) Condylomata acuminata, which are caused by the human papillomavirus, are also called
__________.
a) genital herpes
b) Kaposi sarcoma
c) scabies
d) venereal warts
4) When instructing patients about condom use, which of the following statements should the nurse
include?
a) Condoms provide 100% protection against STIs.
b) Latex condoms are more effective in protecting against STIs than natural membrane condoms.
c) Do not use K-Y jelly with a condom as it can cause the condom to break.
d) Be sure to apply the condom so that the tip of the penis fits snugly into the tip of the condom.
5) Herpes simplex virus (HSV) type 2 is infectious __________.
a) when lesions are present
b) only through vaginal and anal intercourse
c) for 1 year after onset
d) when accompanied by any other virus
6) Tetracycline is an effective treatment for __________.
a) hepatitis
b) HIV
c) herpes
d) chlamydial infections
7) A patient has just been prescribed Flagyl for trichomoniasis. The nurse should instruct her to
__________.
a) double her dose if she forgets to take one
b) avoid drinking alcohol while taking the drug
c) expect her urine to become lighter in color
d) take the medication on an empty stomach
8) Nonspecific vaginitis that is accompanied by a thin, gray discharge and a fishy odor is also called
__________.
a) cytomegalovirus
b) Candida albicans
c) bacterial vaginosis
d) pubic lice
9) When counseling a person undergoing human immunodeficiency virus (HIV) testing, inform the
patient that __________.
a) there can be false-negative and false-positive results
b) a positive HIV test indicates that acquired immunodeficiency syndrome (AIDS) will develop
c) a negative result means that he or she has not been infected with HIV
d) an infected person will test positive within 72 hours after exposure
Introduction to Medical-Surgical Nursing, 6th ed.
10) The most common way a newborn acquires an STI from the mother is __________.
a) through breastfeeding
b) during a vaginal birth
c) during a cesarean delivery
d) through placental transfer in utero
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are four ways of preventing the spread of sexually transmitted infections?
Answer: There are several ways to prevent the spread of STIs. The most effective is to abstain from having
infected themselves.
Question: What are some of the symptoms associated with several common sexually transmitted
infections?
Answer: HSV-2 (genital herpes) symptoms include painful blisters or open sores and pruritus in the
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 51.1
Instructor Preparation
Textbook Objectives Covered
1. Describe tests used to diagnose sexually transmitted infections and the nursing considerations
associated with each.
3. List infectious diseases classified as sexually transmitted infections.
5. Explain the importance of the nurse’s approach when dealing with patients who have sexually
transmitted infections.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: health department representative
• Student performance evaluation of all entry-level skills required for student comprehension of
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• chancre (p. 1170)
(p. 1176)
• sexually transmitted infection
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 1165-1166)
ANSWER – Study Guide
2
READ – Textbook (p. 1166)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 1181)
ANSWER – Study Guide
• Part IB: 1 (p. 345)
3
READ – Textbook (pp. 1166-1176)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 51.1
4
READ – Textbook (pp. 1166-1176)
REVIEW
• Table 51-1: Chlamydial Infection (p. 1170)
• Table 51-2: Drug Therapy: Drugs Used to Treat Sexually Transmitted Infections (pp. 1167-
1169)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2, 3, 5, 6, 7, 8 (pp. 1181-1182)
ANSWER – Study Guide
5
READ – Textbook (p. 1176)
ANSWER – Study Guide
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 51.1
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 51
Sexually Transmitted Infections
1
Slide 2
Sexually Transmitted Infections (STIs)
• Serious public health problem in the United States despite medical advances
• Spread primarily through sexual contact and may have serious and permanent
TALKING POINTS:
Slide 3
Diagnostic Tests and Procedures
• Serologic tests
• Hepatitis A, B, C, D, and E
• Syphilis
TALKING POINTS:
• How are these samples collected?
2
Slide 4
Reporting STIs
• Confirmed cases of HIV, AIDS, gonorrhea, syphilis, chlamydia, chancroid, and viral
hepatitis must be reported to the local health department
• Investigator asks patient to name sexual contacts
3
&
4
Slide 5
Chlamydial Infection
• Most common bacterial STI in the United States
• Estimated 1 million diagnosed each year
• Organism viruslike bacterium Chlamydia trachomatis; infects men and women
• Transmitted by contact with the mucous membranes in the mouth, eyes, urethra, vagina,
or rectum
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LESSON 51.1
Slide 6
Chlamydial Infection (cont.)
• Signs and symptoms
TALKING POINTS:
• How long after infection are symptoms usually noted?
Slide 7
Chlamydial Infection (cont.)
• Complications
• Sterility
• Risk of ectopic pregnancy is increased
• Women with chlamydia are approximately 5 times more likely to become infected with
HIV if exposed to it
TALKING POINTS:
• Why is erythromycin ophthalmic ointment used for the newborn?
Slide 8
Chlamydial Infection (cont.)
• Medical diagnosis and treatment
• Laboratory studies
• Chlamydia antigen test
• Nucleic acid amplification test (NAAT)
• Treated with a single dose of azithromycin (Zithromax) or 7-day course of doxycycline
(Vibramycin)
• Repeat culture in 4 to 7 days; confirms successful treatment
• Patient to avoid all sexual contact (genital, oral, anal) until cured
Slide 9
Gonorrhea
• Commonly reported STI in the United States
• Most often through direct sexual contact
TALKING POINTS:
• It is estimated that more than 321,849 cases were reported in the United States in 2011.
• What other modes of transmission may occur other than sexual contact?
• The infection is not picked up from toilet seats, doorknobs, or towels.
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 51.1
Slide 10
Gonorrhea (cont.)
• Signs and symptoms
• Many people have no symptoms
• Males: whitish or greenish discharge from penis; often a burning sensation during
urination, testicular pain and swelling
TALKING POINTS:
Slide 11
Gonorrhea (cont.)
• Complications
• Sterility in both sexes and infections may lead to damage to heart tissue and joints
• Males may develop epididymitis and prostatitis
Slide 12
Gonorrhea (cont.)
• Medical treatment
• Single dose of IM ceftriaxone (Rocephin), oral cefixime (Suprax),
• If concurrent chlamydial infection, initial drug followed with 7 days of oral doxycycline
TALKING POINTS:
• Why is penicillin not used as much as it was in the past?
• Follow-up examination is essential after antimicrobial therapy for gonorrhea to be sure the
infection has been eradicated.
Syphilis
• Caused by microscopic organism, a spirochete (coiled bacterium) called Treponema
pallidum
TALKING POINTS:
• How many new cases of syphilis were reported in 2011?
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LESSON 51.1
Slide 14
Syphilis (cont.)
• Signs and symptoms
• Primary stage
• Chancre: first sign of syphilis
• Reddish papule appears where the organism entered the body, usually on
genitals, anus, or mouth
TALKING POINTS:
• When is the chancre generally first noticed?
Slide 15
Syphilis (cont.)
• Signs and symptoms
• Secondary stage
• Occurs 1 to 6 months after contact
• Rash on extremities, chest or back, palms, soles
Slide 16
Syphilis (cont.)
• Signs and symptoms
• Latent stage
• There are no symptoms
• Organisms are invading major organs
Slide 17
Syphilis (cont.)
• Signs and symptoms
• Late stage
• Generally 3 years after contact before late syphilis develops, although it may be
decades
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 51.1
Slide 18
Syphilis (cont.)
• Complications
• Blindness, mental illness, paralysis, heart disease
• Infected woman who becomes pregnant has increased risk of fetal infection,
deformities, or death
• Easier for a person to contract HIV
• Medical diagnosis
TALKING POINTS:
• Screening tests can be inaccurate because other factors can cause false–positive
reactions.
Syphilis (cont.)
• Medical treatment
• Parenteral penicillin G, unless contraindicated
Slide 20
Herpes Simplex
• Cold sores
• Caused by herpes febrilis or herpes simplex virus 1 (HSV-1)
• Transmitted through contact with open lesions, usually on the lips or inside the mouth
• Genital herpes
TALKING POINTS:
• What prevention strategies are used for herpes simplex?
• Although herpes simplex virus types 1 and 2 are similar, type 1 is usually nongenital, with
lesions typically above the waist.
• Type 2 is considered an STI because it is most often below the waist and is transmitted by
genital contact.
Slide 21
Herpes Simplex (cont.)
• Signs and symptoms
• Painful, itching sores on or around the genitals approximately 2 to 20 days after
infection
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LESSON 51.1
Slide 22
Herpes Simplex (cont.)
• Complications
• Increased risk of cervical cancer
• Obstetricians recommend cesarean sections for infected women who have active
lesions to decrease risk of transmission to the baby
Slide 23
Herpes Simplex (cont.)
• Medical diagnosis and treatment
• Diagnosed by
• Appearance of genital lesions
• Exudate from lesions examined under a microscope and cultured
TALKING POINTS:
• How long does it take to get results of a Herp-Check?
Slide 24
Trichomoniasis
• Caused by the protozoan parasite Trichomonas vaginalis
• Usually sexually transmitted
• Parasite can survive for hours on damp cloths and clothing
Slide 25
Trichomoniasis (cont.)
• Signs and symptoms
• Women
• Frothy, yellowish discharge that has a foul odor
• Vaginal irritation and itching
Slide 26
Trichomoniasis (cont.)
• Medical diagnosis and treatment
• Detected by microscopic study of vaginal discharge or urine (in males)
• Discharge can be cultured to reveal organism
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 51.1
Condylomata Acuminata (Genital Warts)
• Caused by the human papillomavirus
Slide 28
Condylomata Acuminata (Genital Warts) (cont.)
• Signs and symptoms
• Males
• Glans, foreskin, urethral opening, penile shaft, or scrotum
TALKING POINTS:
• Multiple warts can become so large that they obstruct the vaginal opening or rectal canal.
• When do genital warts tend to grow large?
Condylomata Acuminata (Genital Warts) (cont.)
• Medical diagnosis
• Observation of the warts
Slide 30
Bacterial Vaginosis
• Caused by Gardnerella vaginalis and other anaerobic bacteria
• Infectious bacteria emerge when normal bacteria in vagina are suppressed
• Associated with having multiple sex partners and douching; unclear if actually transmitted
sexually
• Signs and symptoms
• Genital irritation and itching, thin gray discharge, and a fishy odor, but some women
report no symptoms
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LESSON 51.1
Slide 31
Bacterial Vaginosis (cont.)
• Diagnosed by microscopic examination of the discharge fluid and by culture
• Treated with metronidazole (Flagyl) administered orally or vaginally or clindamycin vaginal
cream
• Combination of alcohol and metronidazole may trigger a disulfiram-like reaction, with
vomiting, tachycardia, and hypotension
TALKING POINTS:
• What should patients know about the use of clindamycin cream?
• Infection in a pregnant female may be caused from bacterial vaginosis.
Human Immunodeficiency Virus Infection
• HIV gradually destroys T4 lymphocytes, which are essential for resisting pathogens
Slide 33
Question 1
• Which one of the following statements is not true about sexually transmitted infections
(STIs)?
A. Drug abuse and having multiple sexual partners are risk factors for STIs.
B. Worldwide, the incidence of STIs decreases every year.
C. Almost half of the new STIs are in persons ages 15 to 24.
D. In the United States, STI rates are highest among African Americans, followed by
Latinos, and then by non-Latino whites.
TALKING POINTS:
Slide 34
Question 2
• A chlamydial infection is usually treated with a single dose of ________.
A. Augmentin
B. Azithromycin
C. Erythromycin
D. Penicillin
TALKING POINTS: