Nursing Education and Management of STD Prevention

Abstract

The purpose of this paper is to discuss sexually transmitted diseases and what nurses in the community can do to educate and help prevent at-risk populations from contracting those diseases. The pathophysiology, screening methods, nursing diagnoses, and management of these diseases will be discussed. Finally, barriers to nursing education such as STD-related shame, stigmas, and poverty level will be explored. This paper will reflect on the nursing perspective, as well as exploring patient viewpoints, to understand why high levels of patients do not take advantage of prevention strategies. This paper will show how education can be used to decrease the spread of STDs in the community.

A Nursing Approach to STD Prevention

Sexually transmitted diseases, commonly abbreviated as STDs, affect 1 in 2 sexually active individuals by the age of 25 (BeforePlay, 2019). Every day, more than 1 million people are diagnosed with an STD, and yearly an estimated 357 million new cases are detected (World Health Organization, 2019). The eight most common STIs (sexually transmitted infections) will be discussed throughout this paper. They include syphilis, gonorrhea, chlamydia, trichomoniasis, hepatitis B, herpes simplex virus, human immunodeficiency virus (HIV), and human papillomavirus (HPV). For the purpose of this paper the abbreviations STD and STI will be used interchangeably. STDs can be avoidable and manageable. However, by the time nurses encounter these patients they are most likely providing tertiary prevention and treatments. If more primary education were done in the community, the rates of STDs could be drastically lowered. In this paper, I will discuss nursing diagnosis and interventions, along with ways to educate the at-risk populations on how to prevent contracting STDs. Treatments, resources, and the stigma surrounding STDs will also be addressed. Through research I will illustrate how education can help these vulnerable populations stay safe.

Overview of STDs

Over 30 strains of bacteria, viruses, and parasites can be contracted through sexual contact. Of the eight most common STIs, four are curable, while the other four can be only be managed through treatment. The primary mode of transmission for STDs is through sexual contact, including vaginal, anal, or oral sex. However, some STIs can be spread through blood or blood products, or through childbirth from a mother to her child (World Health Organization, 2019). Signs and symptoms of STDs can vary drastically. Common symptoms include vaginal discharge, painful urination, lesions or warts on the genital area, rashes, or blisters. However, many STDs are asymptomatic leading to longer, more systemic problems including infertility and cancer, making them chronic issues.

Hepatitis B is an STD spread through blood, semen, and other bodily fluids. HBV commonly exhibits no symptoms. If a patient with hep B does show signs, they may experience joint pain, skin eruptions, hives, fatigue, loss of appetite, headache, fever, darkened urine, jaundice, hepatomegaly, and tenderness on palpitation of the liver (BeforePlay, 2019). Once contracted there is no cure for hepatitis B. The symptoms can be managed and lessened with medications to help improve the quality of life for the patient. Hepatitis B does, however, have a preventative vaccine available. If the full dose of the vaccine is administered properly the rate of contracting the disease if exposed is less than 10% (Center for Disease Control, 2019).

Another disease, the human papillomavirus (HPV), has many levels of prevention that can be utilized. Certain strains of HPV, if left untreated have been known to lead to cervical, vaginal, vulva, penile, anal, and throat cancers. Gardasil, the HPV vaccine, protects against 80% of cervical cancer cases, 90% of genital warts cases, and against cases of other previously mentioned cancers (BeforePlay, 2019). Screening tools are also available. Women ages 21-65 are recommended to receive a pap smear and an HPV test every three years to screen for HPV and cervical cancer.

Health care professionals are frustrated over why people aren’t taking the necessary steps to protect themselves when there are so many prevention strategies available. Less than half of sexually active individuals receive the recommended yearly STI screenings (Center for Disease Control, 2019). The CDC estimates that of the nearly 20 million yearly diagnosed STD cases, half are contracted in ages 15-24. Derouin et al. research shows that during most adolescents’ yearly examinations only 5% of 13-18-year-olds receive any sort of education on HIV/ STIs (Derouin, et al., 2017). Older adults are also at an increased risk of contracting STIs and pose a challenge with education as many older patients are not open to taking on new prevention strategies (Peate, 2012). Nurses can identify these populations as at-risk and help to decrease the rates of STDs spread throughout the US by educating patients and their parents during these visits. Education should focus not only on prevention and vaccines, but on vaccine safety which remains a growing issue today.

Nursing Diagnoses and Interventions

A nurse’s role in STD prevention, management, and education is extremely important.

A large part of nursing is diagnosing a patient in order to properly treat them. Patients with sexually transmitted diseases are at risk for multiple nursing diagnoses with the most relevant being knowledge deficit related to diagnosis and treatment. One of the most important aspects of an STD diagnosis is the fact that most patients do not know much about their diagnosis. While many patients probably did not know primary prevention strategies they could have taken, at this stage it is important for the nurse to focus on managing symptoms and educating patients on how to have their best quality of life and prevent further infection and spread.

Education for these patients could include ways to stop the patient from infecting other partners including condoms, which the nurse can provide, abstinence, or communication between partners. It’s important to have the patient inform any recent sexual partners they have been with to also get checked. The nurse can assist the patient in making a list of sexual partners from the last 90 days to call and inform. Nurses can also educate the patient on how the lessen their symptoms. Medications and treatments are available for most STDs that can greatly improve a patient’s lifestyle while living with their disease. The teach back method would be appropriate in a case where a patient has a knowledge deficit of his/her STD.

Another diagnosis important to assess for is situational low self-esteem related to diagnosis of STD. As this paper will later discuss, stigmas largely surround sexually transmitted diseases. Patients with STIs may experience anxiety, shame, and guilt related to their own feelings and their perception of other people’s thoughts about them. Research showed that following a positive STD test result, patients’ shame and self-esteem were both negatively and significantly associated (Passanisi, et al., 2013). The study reports that women are at a higher risk of these negative feelings and emphasizes the need for open communication between doctor and patient. They found that HPV had a higher impact over other STIs because of the fear of the disease becoming chronic and causing cancer (Passanisi, et al., 2013). Nurses can help to manage a patient’s anxiety. Talking to patients about their feelings can significantly help reduce negative feelings and clear up misconceptions they may have.

Even with chronic STDs it is important to educate patients on how they can manage their symptoms and improve their quality of life. While they may have to make some adjustments, it’s important that they are aware that they can live without the stigma of the STD. Nurses should be sure to assess a patient’s feelings, anxiety level, and any suicidal ideations during their routine assessment. Nursing interventions that could be used in this situation would be verbalizing the client’s anxieties and informing them that they should not be ashamed, that there are treatment strategies, and that they can live a healthy life without living in the shadow of their diagnosis.

Lastly, patients have a higher chance of developing additional STD’s because of a higher risk for infection related to the disease process. Certain STDs can increase the risk of developing further infections. According to the WHO certain strains of herpes and syphilis have been found to increase the risk of HIV acquisition. It has also found that childbirth transition of STIs results in an increase of stillbirth, death, SGA, sepsis, pneumonia, conjunctivitis, and other deformities. HPV increases the risk of cervical cancer, and gonorrhea and chlamydia can cause pelvic inflammatory disease and infertility (World Health Organization, 2019). Nurses can collect blood and urine samples to send to the lab to detect STDs. If the sample is positive the nurse can explain the treatment and medications the patient may need to take. Related to educating the patient, nurses can teach about further infection and complication risk, which is extremely important and can not only improve a patient’s life but maybe even save it.

Diagnostics and Treatment Management

Diagnostic testing varies among STDs. Blood, urine, and swabbing are all common methods depending on the type of STD being tested for. The samples can be either rapid or sent to a lab for further analysis. Chlamydia and gonorrhea are commonly diagnosed through urine tests or swabbing of the genitals with the results being sent to a lab for analysis. Other STIs like syphilis, HIV, and hepatitis are analyzed through blood tests. As discussed earlier, HPV can be screened using pap smears and HPV tests. Patients can be tested in a variety of places including doctors’ offices, clinics, hospitals, Planned Parenthood, or through visiting nurses and doctors (World Health Organization, 2019).

Research recommends getting tested annually for most STDs if you are sexually active under the age of 25, if you are above 25 with multiple partners, if you are HIV positive, or if you have been forced into intercourse against your will. For HIV they recommend anyone ages 13-64 or are otherwise at a high risk of becoming infected annually. High risk individuals for HIV, hepatitis, or syphilis include anyone with another STI, multiple sex partners, IV drug use, male to male partners, pregnant or plan on becoming pregnant, or being forced against your will. (Center for Disease Control, 2019).

The Sexually Transmitted Diseases Treatment Guidelines created by the CDC discuss the treatment plans for all STDs and are updated as needed. It discusses clinical prevention, special populations, emerging issues and trends, detection, counseling, and referrals, characteristics, alternative treatments, sexual assault, and screening recommendations (Center for Disease Control, 2019).

Unfortunately, access to necessary diagnostic tests used for detecting STDs is not equal across the country. While in higher SES communities screening is more common and regularly checked, the same is not true for lower status communities. However, syphilis and HIV screenings are the least expensive and are beginning to be used in patients who cannot afford annual testing. For syphilis, a rapid test is available yielding results in 15-20 minutes; only simple training is needed. According to WHO, more rapid tests are being trialed and hopefully will be available for lower and middle classes in the near future (World Health Organization, 2019). For reasons like this, nurses must place an emphasis on primary prevention. Nurses can also utilize syndromic management for communities which may not have access to testing. Syndromic management involves identifying and diagnosing a specific STD just by observing a patient’s symptoms. While this may help in some cases, unfortunately many STIs do not show any physical signs (World Health Organization, 2019).

Questionnaires used among students are a common way of looking at sexual health among the high-risk population. In the Youth Risk Behavior Survey: Data Summary and Trends Report 2007-2017 sexual history among high school students is analyzed from responses from questionnaires from all over the country. In 2017 39.5% of students have ever had sex. Interestingly, 53.8% of students used a condom during last intercourse, 29.4% used an effective hormonal birth control, but only 8.8% used both (Center for Disease Control, 2019). This is another example of where nursing education can come into play.

A higher percentage of that population should be using condoms to accurately protect against STDs, and more education should be placed on the fact that hormonal birth control does not protect against any STDs and a condom should be used along with it. The Health Education Curriculum Analysis Tool (HECAT) identifies affordability and pros and cons of current curriculum used. Developing a Scope and Sequence for Sexual Health Education is a guideline for developing the ways to teach each specific grade level about STD prevention to most accurately affect them. The School Health Policies and Practices Study (SHPPS) helps decide which policies are working and which may need to be changed to improve health education. School nurses play one of the biggest roles in policy development for school education. They can use guidelines like SHPPS and HECAT to find what is working for their school, what’s not, and advocate for their students’ needs. (Center for Disease Control, 2019).

Barriers to Nursing Education

If more emphasis was placed on education and preventing STDs before they were transmitted, there would be less of a need to worry about testing and treating the diseases. School nurses are an excellent source of community nursing who could implement this type of education to the target population of 15-24 years old. Education for STDs should include important vaccinations for diseases like HPV, HAB and HBV. Nurses should also place emphasis on the use of condoms and other protection methods, the ways STDs could be spread, and signs and symptoms to look out for. One study showed that a significant amount of students ages 15-25 did not seek testing because they didn’t think they were at a risk (Cuffe, 2016). The study goes on to suggest that many in this age group did not get tested for confidentiality reasons because of the correlation of STDs and stigmatization. Cuffe, et al. suggest bringing up these privacy issues with younger clients.

The stigma surrounding STDs is one of the biggest barriers for people getting tested. In Cunningham, et. al.’s (2009) Relationships Between Perceived STD-Related Stigma, STD-Related Shame and STD Screening Among a Household Sample of Adolescents, they define STD-related stigma as, “personal fears about negative societal attitudes toward STD infection”. They define STD-related shame as, “anticipated negative personal feelings resulting from a positive STD test”. The results of their studies showed that for both males and females, increase in perceived STD-stigma was associated with decreased likelihood to receive STD testing.

Similarly, in another study by Cunningham et.al (2002), they found that females who perceived stigmas about STDs were less likely to disclose sexual behaviors to doctors and nurses and less likely to seek STD related care. If patients feel stigmatized by their nurse, they’re less likely to ask important questions or seek screenings or treatment.

A nurse’s job is to advocate for the patient and educate them whenever they can. Nurses are first-line providers who know their communities well and are at an advantage to provide informed care. Stigmas are an important topic to bring up. School nurses have many opportunities and tend to gain their students’ trust, as they are around them on a daily basis. By integrating sexual health into primary health care nurses can normalize the subject and make their patients more comfortable discussing STDs (Rowniak, 2014).

Conclusion

Throughout this paper, sexually transmitted diseases and their impact on the community and nursing were discussed. The pathophysiology, screening methods, nursing diagnoses, and management of these diseases were outlined. The paper explored barriers to treatment such as low socioeconomic status and stigmas surrounding the disease. STD-related stigmas lead to a high number of patients whom do not seek prevention or education because of feelings of shame, embarrassment, and judgement. Nurses have an important role of decreasing the patients’ anxiety levels, showing no judgments, and advocating for them. Prevention methods, signs and symptoms, screening tools, and stigmatized feelings, are important topics in nursing education. If more primary prevention strategies were implemented, talk of STDs could be normalized and more individuals would openly talk with their medical professionals. Education is a key to lowering STD rates and spread among at-risk populations.