Guide — Infection Control
Sexually Transmitted Infections (STI) Nursing Care
Most STIs are silent — the patient who feels fine is still transmitting, and untreated infection quietly causes pelvic inflammatory disease, infertility, and congenital disease. The nursing work is equal parts recognition, treatment teaching, partner management, and creating a space where patients tell you the truth.
10 min read · Infection Control
Educational use only. Treatment regimens, screening intervals, and partner-therapy options follow current CDC guidelines, provider orders, and state law — reporting requirements and minor-consent rules vary by state. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview — Curable vs Manageable
The most useful first division is bacterial and parasitic STIs, which are curable (chlamydia, gonorrhea, syphilis, trichomoniasis), versus viral STIs, which are managed but not cured (genital herpes, HPV, HIV, hepatitis B). Curable infections still cause permanent damage when treatment is delayed — cured chlamydia does not reverse the tubal scarring it already caused.
The second key fact: most STIs are asymptomatic, especially in women. Screening — not symptoms — is how most chlamydia and gonorrhea is found, which is why routine screening of sexually active young women is a core preventive-health intervention.
Key Concepts — The Major Infections
Chlamydia & gonorrhea — the silent pair
Chlamydia is the most commonly reported bacterial STI; gonorrhea often travels with it, so they are frequently treated together. Both are usually silent in women; when symptomatic, think discharge, dysuria, and bleeding between periods. Untreated, both ascend to cause pelvic inflammatory disease (PID) — lower abdominal pain, fever, cervical motion tenderness — the path to ectopic pregnancy and infertility.
Syphilis — the stages
Primary: a painless chancre at the inoculation site that heals on its own (the patient assumes it’s gone). Secondary: systemic spread — the classic rash that includes the palms and soles, plus fever and lymphadenopathy. Latent: silent, detectable only by serology. Tertiary: years later — cardiac, gummatous, and neurosyphilis damage. Penicillin (often a single IM benzathine dose in early disease) remains the treatment; congenital syphilis makes screening in pregnancy mandatory.
Genital herpes — painful and recurrent
Painful grouped vesicles that ulcerate, with a flu-like first episode; the virus then lives in nerve ganglia and recurs with stress and illness. Antivirals (acyclovir, valacyclovir) shorten outbreaks and suppress recurrence but do not cure. Transmission occurs even without visible lesions — that asymptomatic shedding is the hardest teaching point.
HPV — warts and cancer
Low-risk types cause genital warts; high-risk types cause cervical and other cancers, which is why HPV has a vaccine and a screening program (Pap/HPV testing). The vaccine is cancer prevention — frame it that way.
Trichomoniasis — the frothy one
A parasite causing frothy, yellow-green, malodorous discharge and vulvar irritation (often asymptomatic in men). Treated with metronidazole — both partners, with the classic no-alcohol teaching.
Assessment Findings
Take a sexual history matter-of-factly using the 5 P’s — partners, practices, protection, past STIs, and pregnancy plans — in private, with confidentiality stated up front. Physical findings to note: discharge (color, odor, consistency), dysuria, genital lesions (painless ulcer suggests syphilis; painful vesicles suggest herpes), inguinal lymphadenopathy, and in women the lower abdominal pain and cervical motion tenderness of PID. Remember that an STI diagnosis in a child is a red flag for abuse and triggers mandatory reporting.
Nursing Priorities
Get the full course finished — in the patient and the partner
Reinfection from an untreated partner is the most common reason treatment “fails.” Teach completion of the entire antibiotic course, abstinence until both partners finish treatment (typically 7 days after single-dose regimens), and partner notification. Many states allow expedited partner therapy — medication or a prescription sent for the partner without an exam.
Report what must be reported
Chlamydia, gonorrhea, syphilis, and HIV are reportable to public health in every state — a legal duty that coexists with patient confidentiality. Public-health follow-up is contact tracing, not punishment; explain it that way.
Protect the pregnancy
Screen in pregnancy and treat promptly: untreated syphilis causes congenital syphilis and stillbirth; chlamydia and gonorrhea cause neonatal conjunctivitis and pneumonia (the reason for newborn erythromycin eye ointment); active herpes lesions at labor indicate cesarean delivery.
Screen for the co-travelers
One STI means risk for others — offer HIV and syphilis testing whenever any STI is diagnosed, and check hepatitis B vaccination status.
Therapeutic Communication Considerations
Shame is the main barrier to testing, treatment, and partner notification. Be private, unhurried, and clinically matter-of-fact — the same tone you’d use for a blood pressure. Avoid assumptions about partners and practices; ask open questions and mirror the patient’s language. For adolescents, know that all states allow minors to consent to STI testing and treatment (details vary) — confidentiality concerns are often why a teen delays care, so address them directly. A herpes or HPV diagnosis frequently lands as grief; separate the medical reality (manageable, common) from the stigma the patient has absorbed.
Patient Education
Condoms used consistently and correctly prevent most STI transmission — but not infections spread by skin contact outside the covered area (herpes, HPV, syphilis chancres). Teach the vaccine options (HPV and hepatitis B), routine screening for sexually active patients, and symptom awareness with the reminder that no symptoms doesn’t mean no infection. Medication-specific points: finish every course; no alcohol with metronidazole (severe nausea/flushing reaction); doxycycline causes photosensitivity and is avoided in pregnancy; herpes antivirals work best started at the first tingle. Patients treated for chlamydia or gonorrhea should be retested in about three months — reinfection is common.
NCLEX Pearls
- ✦Painless chancre = syphilis; painful grouped vesicles = herpes; frothy green discharge = trichomoniasis; rash on palms and soles = secondary syphilis.
- ✦Untreated chlamydia/gonorrhea → PID → ectopic pregnancy and infertility — the “why” behind screening questions.
- ✦Both partners treated + abstinence until treatment is complete — otherwise expect reinfection.
- ✦Metronidazole + alcohol = severe reaction; doxycycline = photosensitivity, not in pregnancy; penicillin treats syphilis even in pregnancy.
- ✦Chlamydia, gonorrhea, syphilis, and HIV are reportable; minors can consent to STI care; an STI in a child = suspect abuse and report.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with CDC / HICPAC · Infectious Diseases Society of America (IDSA) / SHEA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →