Chronic Illness and STDs

By Janella Schroeder RN

When the phrase “chronic illness” is thought of, many diseases come to mind…hypertension, diabetes, COPD, cancer…but some that might not pop in your head but can be equally devastating and equally life threatening are sexually transmitted diseases.

There are currently 4 non-curable STD’s including Herpes, Human Papillomavirus (HPV), Hepatitis, and Human Immunodeficiency Virus (HIV) which are all viral.

In order to educate patients on STD’s it is important to first understand the important facts about them.

Genital Herpes can be symptomless at first, but then develop into blisters that can break and form ulcers to the genital and anal areas caused by the herpes simplex virus (HSV-1 or HSV-2).
• It can be months to years before the blisters develop enough to cause visible ulcers, but the virus can still be contagious without obvious blisters via sexual contact (oral, genital, or anal).
• It is believed that as many as 1 in 6 Americans 14-49 have genital herpes. A definitive diagnosis can be made by culturing blister or ulcer.
• There are suppressive therapies taken daily that can reduce the number of outbreaks and lessen the risk of transmission to partners, but there is no cure for herpes.
• Condoms can reduce the risk of herpes, but not prevent it completely because the herpes may be on areas not covered by the condom.

Human Papillomavirus is the most common STD in America today with as many as 50% of those sexually active being infected. There are over 40 types of HPV that can affect the mouth, throat and genital areas of both men and women.
• Some may fight the virus on their own with no s/s, but others are unable to fight the virus and it can lead to genital warts or cancers such as cervical, penile, anal, throat, or mouth.
• HPV is passed through sexual contact (oral, anal, or genital)
• Condoms do not fully protect against HPV because it can live on areas not covered by a condom
• There is a vaccine for girls and women that protects against certain strands of HPV that cause cervical cancer and genital warts. Recently there has been a vaccine developed for boys/men to protect against certain stands that cause genital warts
• There is currently no test laboratory test for HPV, it is diagnosed only by the visualization or genital warts of when the virus has already caused cervical changes or other cancerous changes

HIV is probably the most well known STD
• HIV is transmitted through body fluids such as blood, semen, vaginal fluid, and breast milk
• HIV often has no symptoms for months to years but can still be transmitted and can be transmitted even with a condom
• It is tested for with a blood test, and should be tested on all patients seeking treatment or testing for other sexually transmitted disease
• There is no cure for HIV but there are meds to suppress the virus and help people live healthy lives for years, the medications however do not lessen the risk of passing the virus on to sexual

Hepatitis B is a liver disease can be caused by sexual contact through infected body fluids including blood, semen, vaginal fluids.
• Symptoms can take up to 6 months to appear and can include fever, fatigue, abdominal pain, loss of appetite, and jaundice.
• Hepatitis B is diagnosed with a blood test
• There is a vaccine for Hepatitis B given in 3 steps
• Treatment is supportive only for acute symptoms and select antiviral drugs are used for chronic management of hepatitis B, but there is no cure.

What you can do as a community health nurse:
 The most important preventative tool for these non-curable STD’s is EDUCATION.
 It is not enough anymore to tell patients to “get tested” or “practice safe sex” because those two things cannot prevent all STDs.
 Time must be spent with patients to educate them on the different types of STDs and the ways they are transmitted, signs and symptoms, diagnostic tests, and treatments if there are any.
 Scare tactics may be used when focusing on these four chronic STDs that have no cure and can be deadly. The attitude of many is "I will just take a pill if I catch something".
 It is still important to encourage use of condoms if the patient will be sexually active even if they do not prevent all STDs 100% because people with one STD are more susceptible for other STDs.

References:
Center for Disease Control. (2010). Retrieved March 31, 2010, from http://www.cdc.gov/

Note: This material was created by Janella Schroeder RN with minor editing by Shirley Comer Rn. The content is indented as information only. Please consult your primary health care provider before beginning or changing your healthcare regimen.