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Sexually Transmitted Infections


Ns who are BCCNP certified in reproductive health - STI use the DSTs listed below to diagnose and treat the following diseases and disorders:

  • bacterial vaginosis
  • chlamydia trachomatis
  • genital warts
  • lower urinary tract infection (female)
  • mucopurulent cervicitis
  • gonorrhea
  • recurrent urethritis (male)
  • trichomoniasis
  • urethritis (male)

 Introduction to Sexually Transmitted Infections Management

About STI Management

STI Overview

Definitions

Registered Nurses who complete BCCNP certification in Reproductive Health: Sexually Transmitted Infections may diagnose and treat the following sexually transmitted syndromes and infections in clients 14 years of age and older unless otherwise specified within an individual decision support tool (DST).

Consultation or referral to a physician or nurse practitioner is required for all pregnant or breastfeeding clients.

The following DSTs are included in Sexually Transmitted Infections Certified Practice:

  1. STI Assessment
  2. Chlamydia (Reportable)
  3. Gonorrhea (Reportable)
  4. Mucopurulent cervicitis
  5. Trichomoniasis
  6. Bacterial Vaginosis (BV)
  7. Urethritis (Male)
  8. Recurrent Urethritis (Male)
  9. Lower Urinary Tract Infection (UTI) (Female) 
  10. Genital Warts
  11. Contact Treatment

Sexually Transmitted Infections Certified Practice includes the following resources:

  • Core competencies for Reproductive Health: Sexually Transmitted Infections
  • Decision Support Tools for Reproductive Health: Sexually Transmitted Infections

Decision Support Tools for aspects of sexually transmitted diseases that are not considered part of certified practice can be found on the B.C. Centre for Disease Control's website.

Overview

Nursing practice in the assessment and management of STI is based on either a syndrome management or infection specific approach. The spectrum of syndromes and infections covered in the DSTs for certified and non-certified Reproductive Health STI clinical practice are:

Syndromes

  • Mucopurulent cervicitis
  • Urethritis
  • Recurrent Urethritis

Infections

  • Neisseria gonorrhoeae (Reportable)
  • Chlamydia trachomatis (Reportable)
  • Genital Warts - Human Papillomavirus (HPV)
  • Bacterial Vaginosis (BV)
  • Trichomonas vaginalis
  • Lower Urinary Tract Infection (UTI) - female

Non-certified Practice (requires consultation or referral or over the counter management by RN)

Syndromes

  • Pelvic Inflammatory Disease
  • Epididymitis
  • Proctitis Infections
  • Syphilis (Reportable)
  • Human Immunodeficiency Virus ( HIV)(Reportable)
  • Herpes Simplex Virus (HSV) (Lab reportable only)
  • Molluscum contagiosum
  • Vulvovaginal candidiasis (VVC)
  • Scabies
  • Pediculosis pubis

The RN must consult or refer when the following infections or syndromes are suspected:

  • Syphilis
  • Genital Herpes Simplex Virus (HSV) – new onset or when medication is required
  • Epididymitis
  • Pelvic Inflammatory Disease (PID)
  • Human Immunodeficiency Virus (HIV)
  • Proctitis
  • Chancroid
  • Lymphogranuloma Venereum (LGV)

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Definitions

Anal Fissure: A painful linear ulcer at the margin of the anus. Anal verge: Anal: pertaining to the anus. Verge: a circumference or ring.

Anal verge: the external or distal boundary of the anal canal; the line where the walls of the anus come in contact during the normal state of apposition.

Asymptomatic: Without symptoms

At Risk: Embedded within the registered nurses' STI assessment is the current epidemiology of infection rates, population sub-groups that experience increased likelihood for risk of STI often associated with social (e.g., discrimination) and economic marginalization (e.g., poverty) and barriers in access to health care and clients who travel and engage in sexual contact in countries with high incidence of STI. Within Canada men who have sex with men, Aboriginal women, and survival commercial sex workers have been reported to experience higher rates of STI than within the general population.

Clue Cells: Vaginal epithelial cells covered with numerous coccobacilli. Clue cells detected microscopically in vaginal fluid are suggestive of BV.

Consultation: Seeking the assistance of a physician or nurse practitioner as needed in making clinical judgements. Consultation provides an opportunity for the RN to discuss the findings with another health care professional and may lead to receiving treatment orders.

Dilation and Curettage: Dilation: the condition of an orifice or tubular structure, of being dilated or stretched beyond the normal dimensions. Curettage: the removal of growths or other material from the wall of a cavity or other surface. Uterine curettage: by use of vacuum removal of uterine contents after cervical dilation.

Dyspareunia: Pain during sexual intercourse.

Endogenous: Growing from within. Friable: Able to easily crumble or break. H208 form: Confidential Notification of a Sexually Transmitted Infection. Required documentation for reportable infections.

Friable: Able to easily crumble or break.

H208 form: Confidential Notification of a Sexually Transmitted Infection. Required documentation for reportable infections.

Incubation period: the time lapse between point of infection and the onset of symptoms.

Indurated: to make or become hardened.

Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a body part.

Microscopy: Microscopes may be used in the assessment of vaginal, urethral, or rectal discharge for the detection of STI (bacteria), fungal infection (Candida), protozoans (Trichomonas vaginalis) or inflammation suggestive of infection (≥ 5 PMNs).

Nugent Score: standardized method for scoring gram stained smears for diagnosis of BV.

Order: An instruction or authorization for a specific client given by a health professional (i.e., a physician, midwife, podiatrist, nurse practitioner, naturopath or dentist) to a registered nurse to carry out an activity that includes a restricted activity listed in Section 7 of the Regulation. This includes pre-printed orders that set out the usual care for a particular client group or client problem and are made client-specific by the health professional adding the name of the individual client, making any necessary changes to the pre-printed order to reflect the needs of the individual client, and signing the order. The Regulation also permits orders that refer to other documents. However, to support safe practice, these documents should be placed on the client's chart.

PID: Pelvic Inflammatory Disease. Inflammatory condition of the pelvic cavity that may involve the uterus, fallopian tubes, ovaries, pelvic peritoneum, or pelvic vascular system. Often caused by Gonorrhea and Chlamydia. PID may be acute or chronic. Acute PID produces very tender bilateral adnexal areas. Chronic PID produces bilateral tender irregular and fairly fixed adnexal areas. Movement of the cervix is usually painful.

PMNs: Polymorphonuclear neutrophils. White blood cells that increase during inflammation/infection.

Pyoderma: any purulent skin disease.

Referral: Transferring the care of a client to a physician or nurse practitioner. Through consultation the patient may be referred for further investigations and/or treatment.

Smear: Secretions (urethral, vaginal, and rectal) collected via swab that is rolled onto a slide for microscopic evaluation (e.g. gram staining, wet mount). Used for the detection of PMNs, bacteria, fungus and/or protozoans.

Symptomatic: Serving as a symptom.

Tenesmus: Straining, especially ineffectual and uncomfortable straining to defecate. The continual feeling of needing to empty the bowel.

TID: Typical intracellular diplococci are gram negative bacteria suggestive of Neisseria gonorrhoeae that are identified inside PMNs.

Vaginal pH: Determined via swab or pH paper. Normal vaginal pH is 3.5-4.5.

Upper female genital tract instrumentation: Insertion of an instrument through the vaginal canal, cervical os into the uterus.

Wet Mount: For the detection of bacteria (clue cells) and protozoans (Trichomonas vaginalis). Secretions collected via swab are dipped onto a slide with normal saline and then evaluated microscopically.

Window period: the time lapse between point of infection and the ability to detect infection through diagnostic testing

Whiff Test: Vaginal discharge is collected by swab and dipped into a KOH solution to determine the presence of an amine odour or KOH is dropped onto vaginal discharge on a slide.

≥ 5 PMNs: The number of PMNs per microscopic field (x1000) in five non-adjacent fields is greater than 5. This indicates the presence of inflammation.

≤ 5 PMNs: The number of PMNs per microscopic field (x1000) in five non-adjacent fields is less than 5.

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 Competencies

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