Sexually transmitted infections (STI) are higher among the incarcerated population than the general public and female inmates have higher rates of chlamydia and gonorrhea than their male counterparts. Early detection and treatment of these conditions reduces transmission in the community and reduces the likelihood of subsequent illness and disability.
Fix It Early
Chronic inflammation from sexually transmitted infections leads to chronic pelvic pain, ectopic pregnancies, and infertility. Correctional nurses have opportunity to reduce these outcomes through assessing, treating, and educating patients about chlamydia and gonorrhea. This can start with routine screening for both conditions upon entry into the correctional setting. Treatment, then, should be guided by national standards. The CDC 2010 STI Treatment Guidelines have some recent revisions, but remain the current national standard.
Longstanding STIs lead to chronic inflammation. Pelvic inflammatory disease (PID) should be considered and receive follow-up evaluation when female patients come to sick call with a fever, nausea, vomiting and severe abdominal pain – even when the flu is making the round in the housing unit. According to CDC STI Guidelines, the following findings are definitive for PID:
- Oral temperature >101° F (>38.3° C);
- Abnormal cervical or vaginal mucopurulent discharge;
- Presence of abundant numbers of WBC on saline microscopy of vaginal fluid;
- Elevated erythrocyte sedimentation rate;
- Elevated C-reactive protein; and
- Laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis.
Treating for Two
Most women with STI’s are sexually active and fertile; making pregnancy a concern when assessing for and treating infection. It is important to know the pregnancy status of any patient diagnosed with an STI in order to arrange for appropriate treatment. The CDC recommends that all pregnant women be screened for chlamydia and gonorrhea.
Ectopic pregnancy should also be considered when a women of reproductive age experiences significant pelvic pain. This pain may or may not be accompanied by bleeding. With high rates of STIs and PID, sexually active female inmates are at high risk for this condition. Disregarding pelvic pain in this patient population can be deadly, as this unfortunate situation in one jail illustrates.
Let’s Not Talk About It
We really don’t like talking about STI’s as this research on chlamydia confirms. However, it is an important topic and we should make the effort, especially as many women are uninformed or have misconceptions about how to prevent and treat the condition. The Centers for Disease Control and Prevention have patient education resources in English and Spanish that can help in your efforts to educate yourself and your patients about STI’s.
How do you manage sexually transmitted infection in your setting? Share your thoughts in the comments section of this post.
To read more about the unique aspects of women’s health care in the correctional setting see Chapter 9 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.
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