MICROBIAL DISEASES OF THE RESPIRATORY SYSTEM:

PERTUSSIS (WHOOPING COUGH)

Pathogenesis

Bordetella Pertussis is a small, obligately aerobic, Gram-negative coccobacillus that

produces numerous virulence factors which facilitate the proliferation of Pertussis in the
respiratory system. These virulence factors are responsible for several inflammatory processes,
epithelial cell damage, and mediated adhesion. Of note, they contribute to the pathogenesis of
the bacterium. Through its adhesins, the filamentous hemagglutinin and pertussis toxin, the
bacterium is able to attach to the ciliated epithelial cells in the trachea. According to Bauman,
Primm, Siegesmund, Cosby & Montgomery (2018), upon attachment, the bacterium hinders the
ciliary action and progressively destroys the epithelial cells via the tracheal cytotoxin. This
destruction of the epithelial cells then prevents the ciliary escalator from moving the mucus. As
the ciliary action is compromised, mucus continues to accumulate, and as a natural defense
mechanism, the affected person will continue to cough up the mucus aggregations.

Pertussis is characterized by four distinct phases namely the incubation, catarrhal,

paroxysmal, and convalescent phase (Tortora, Funke & Case, 2019). The incubation period may
last for 7-10 days followed by the catarrhal stage where the infected person may present with
coughing and sneezing. In the catarrhal stage, a massive number of organisms are sprayed via
droplets which makes the person highly infectious but not severely ill. The paroxysmal stage
then follows, this stage is distinguished by its explosive coughs which produce copious mucus
along with the characteristic ‘whoop’ produced by an inspiratory gasp of air, hence the term
“Whooping Cough”. Its convalescence stage can last for months following the recession of the
cough. The complications of severe coughing common among pediatric patients are broken
ribs, irreversible brain damage, and ruptured blood vessels in the eye.

Diagnosis
There are several diagnostic laboratory tests that can confirm the prevalence of B.
Pertussis. These tests include culturing, direct fluorescent antibody test, polymerase chain
reaction, and serology. However, among these methods most scientists consider culturing to be
the gold standard because it is the only 100% specific method for identification (CDC, 2019). In
obtaining a culture of the specimen, nasopharyngeal (NP) swabs or NP aspirates are used, and

1
for adults, cough droplets are expelled directly onto a “cough plate” held in front of the
patient’s mouth. Upon collection, the specimen is then cultured on a solid media that permits
the growth of the B. Pertussis but hinders the growth of other microorganisms (Richards &
Edwards, 2014). The same organisms are identified through immunofluorescence staining or
slide agglutination with specific antiserum. Another diagnostic test is the direct fluorescent
antibody test. It can similarly examine NP swabs with a 50% sensitivity; it is commonly utilized
after obtaining a culture on solid media. As an alternative to culture, polymerase chain reaction
(PCR) uses a molecular approach to detect DNA sequences of the bacterium. Serologic tests, on
the other hand, are used to evaluate patients who have been presenting the illness for 2 to 4
weeks. In this test, several antibodies such as IgA, IgG, and IgM occur upon exposure to the
bacterium, and these antibodies can be effectively detected via enzyme immunoassays.

Treatment and Management

Supportive care is of prime importance among patients with Pertussis. Intake of plenty
of fluids,combined with plenty of rest can significantly improve the patient’s symptoms. The
patient’s diet may be altered to small, frequent meals to prevent recurrent vomiting. Health
professionals advise that the exclusive use of over-the-counter cough medicines are proven
ineffective and are highly discouraged. For pediatric patients most especially children of less
than 1 year of age, admission to the hospital is highly necessary due to the risk of
complications. As such, antibacterial treatment through macrolide antibiotics e.g. Erythromycin,
Clarithromycin, or Azithromycin are often started upon detection during the paroxysmal phase
and are attributed to reducing the severity, infectivity, and risk of secondary infection from the
disease.

Prevention
The Centers for Disease Control and Prevention (CDC) recommends vaccination for
people of all ages. Specifically, there are two widely known vaccines addressing Pertussis such
as DTaP (for children under 7 years of age) and TDaP vaccine (for older children, teens, and
adults). These vaccines are the aggregate combination of vaccines for Pertussis, Tetanus and
Polio. According to Centers for Disease Control and Prevention (2020), the vaccination for
infants is given at either 2, 4, or 6 months after birth, and boosters shots are given at 15 to 18
months, at 4 to 6 years of age and again at 11 years old. Adults who have never received TDaP
are also recommended to obtain a shot, and later on, get a booster shot 10 years thereafter.

Nursing Care
The nursing care plan for patients with Pertussis is directed to prevent
bronchopulmonary complications, promote open airways, enhance mucus secretion removal,
and suppress the possibility of secondary infections and further transmission. This denotes the
consistent effort to maintain the quality of ventilation, proper nutrition, and maintenance of an
overall conducive environment for the patient (Choate,1935). With these considerations, the
nurse should be able to: alter the patient’s resting position into a more optimal one to improve
lung expansion and promote a more effective cough, encourage the patient to increase in fluid
intake due to the patient’s increased susceptibility to dehydration, provide the patient and the
patient’s family with an appropriate health teaching involving the necessity of vaccination to
prevent the further infection and spread of the disease.

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 MICROBIAL DISEASES OF THE RESPIRATORY SYSTEM:

CORONAVIRUS (SARS-CoV)

Pathogenesis

Coronaviruses commonly penetrate their hosts through droplet transmission having the
mucus membranes, especially the nasal and larynx mucosa, as its primary entrance route. It
then travels towards the lungs through the respiratory tract. Upon the establishment of
infection in the respiratory tract, Chen, Liu & Guo (2020) note that SARS-CoV causes tissue
damage through the lysis of the host’s cells and causes indirect disease manifestation as part of
the host’s immune response. The virus may penetrate the peripheral blood from the lungs
eventually causing viremia. The Angiotensin-converting enzyme 2 (ACE2) is the virus receptor
on host’s cells that binds the viral protein. In its adhesion, the receptor’s response is
significantly suppressed which results in lung injury brought by the increased production of
Angiotensin 2 (Sheahan & Baric, 2009). This heightened production of Angiotensin 2 stimulates
the ACE2 which then increases the lung blood vessel permeability and induces respiratory
distress.

As pointed by Weiss & Leibowitz (2011), the clinical phase of SARS-CoV can be
subdivided into three: the viremia phase, the acute phase, and the recovery phase. The
incubation period of coronavirus typically lasts for 2-7 days with manifestations of common
cold, nasal discharge, headache, dizziness, cough, and malaise. In its viremia phase, the virus
attacks the targeting organs that express ACE2, e.g. the lungs, heart, renal, gastrointestinal
tract. In the acute phase, commonly recognized as the “Pneumonia phase”, the lower
respiratory tract is significantly affected. In this phase, asthmatic children may suffer from
wheezing attacks and exacerbated respiratory symptoms. If the virus is effectively suppressed
during its acute phase, the recovery phase follows. However, if the patient is an elderly or in an
immunosuppressed state, the patient may progress to severe respiratory distress which may
require ventilatory support.

Diagnosis
Doctors diagnose coronavirus through several laboratory procedures such as antigen
and nucleic acid detection, isolation and identification of virus, and serology. Currently, the
most notable diagnostic measure is the antibody detection by indirect immunofluorescence
assay or enzyme-linked immunosorbent assay (ELISA) with cell culture extracts (Lau, Woo,
Wong, Tsoi, Woo, Poon, & Yuen, 2004). Respiratory secretions that contain coronavirus antigen
cells can be detected through the ELISA test. Of note, “ELISA-based antigen detection tests are
well known to offer high specificity and reproducibility. The technique is less expensive and

3
labor-intensive than RT-PCR is easy to acquire and standardize, and is free of the problem of
contamination.”, Lau, Woo, Wong, Tsoi, Woo, Poon, & Yuen (2004) reasoned. Despite its
difficulty, isolation of human coronaviruses in cell culture can also be conducted at a certain
extent, however. Current advancements have allowed the SARS and MERS viruses to be
recovered from oropharyngeal specimens using Vero monkey kidney cells; it is only about time
that epidemiologists effectively isolate human coronavirus. Serodiagnosis, through the use of
acute and convalescent sera, can be another means of confirming coronavirus infections
specifically for epidemiologic purposes.

Treatment and management

The treatment for SARS-CoV is primarily supportive care because there remains no
proven vaccine to address the virus. The treatment is symptomatic, and oxygen therapy is the
major treatment intervention for patients presenting with severe cases of the infection. In
addition, mechanical ventilation may be necessary in cases of respiratory failure that is
unmanageable to oxygen therapy (Chen, Liu & Guo, 2020). Hemodynamic support, on one
hand, is essentially conducted for managing septic shock. Protease inhibitors used in the
treatment of Human Immunodeficiency Virus (HIV) infections such as lopinavir have in vitro
activity against SARS coronavirus; however, vaccines are still under development (Riedel,
Jawetz, Melnick & Adelberg, 2019). Much still has to be understood to come up with a proven
treatment. Some measures that can control the continuous spread and transmission of the
virus include the isolation of patients, quarantine of those who had been exposed, travel
restrictions, accompanied by the proper donning and use of personal protective gloves, gowns,
goggles, and respirators by health care workers.

Prevention
Preventive strategies must be employed to diminish probable transmission among
infected persons and the people they have possibly had contact with. The World Health
Organization (WHO) in combined efforts with other organizations, recommend limiting travel to
known endemic areas; quarantining infected persons and their contacts; avoiding close contact
with subjects suffering from acute respiratory infections; observance of proper hand washing
etiquette especially after contact with infected people or their environment; and
immunocompromised individuals to avoid public gatherings; conduct proper cleaning and
disinfection frequently touched objects and surfaces, especially objects that have come in close
contact with the infected persons (WHO, 2017). Meanwhile, healthcare workers in charge of
caring for infected individuals are recommended to utilize contact- and airborne- precautions
such as the use of PPE e.g. N95 or FFP3 masks, eye protection, gowns, and gloves to prevent
transmission of the pathogen.

Nursing Care
The nursing care plan for patients suffering from the SARS-CoV infection aims to limit
the spread of infection, improve the patient’s body temperature levels, rehabilitate the
patient’s breathing pattern back to normal, and alleviate the family’s anxiety. Specifically, in
caring for the patient, the nurse should be able to initially monitor the patient’s vital signs to
track the changes in the patient’s conditions allowing the recognition of early patient
deterioration, and prevent complications that can possibly occur. The nurse should also
effectively manage the patient’s hyperthermia through the use of appropriate therapy to
preserve the patient’s normal temperature and further reduce the exacerbated metabolic
demands. In response to limit the spread of the pathogen, Schnur (2020) acknowledges the
nurse should dispose of secretions properly e.g. segregating them as clinical waste, observe
proper hand washing techniques and employ the use of PPEs to prevent the transmission of the
pathogen. With the visitation restrictions enacted among family members, anxiety becomes
more prevalent. To address this drawback, the nurse should be able to provide a sensible and
substantial health teaching to the family, and devise compromises to be able to relay the status
of the patient to the family members.

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 MICROBIAL DISEASES OF THE DIGESTIVE SYSTEM:

PEPTIC ULCER

Pathogenesis

The digestive tract is lined by a mucosal fence which acts as a barrier to several acidic
gastric secretions. However, despite its acidic nature, the digestive tract remains to be a
vulnerable home to Helicobacter pylori, a Gram-negative, partly helical, highly motile
bacterium. H. pylori grows optimally at 6.0–7.0 pH hence why it can be found deep in the
mucous layer near the epithelial surface where the physiologic pH is present. Predisposing
factors that attenuate the protective barrier of the digestive tract further provide a hospitable
environment for the bacterium. H. pylori possesses numerous virulence factors allowing it to
thrive in its host. Specifically, Nettina & Brunner (2019) posit that H. pylori protects itself from
the corrosive actions of gastric secretions by releasing a massive amount of urease, which
neutralizes Hydrochloric acid of the stomach. In the digestive tract, the bacterium attaches
itself via its adhesins later on inducing apoptosis in gastric epithelial cells. The bacterium also
releases toxins and enzymes that reduce the efficiency of mucus in protecting the mucosal
lining of the gastrointestinal tract such as the protein that inhibits acid production by stomach
cells. As the mucosal protection deteriorates, the gastric secretion breaks down the epithelial
layer of the stomach lining eventually paving an entrance for the bacterium leading towards the
underlying tissues and blood vessels. The bacterium survives phagocytosis through the release
of enzymes like catalase and superoxide dismutase that hinder phagocytic killing.

Patients suffering from peptic ulcers commonly present with Epigastric pain (dyspepsia)
described as a gnawing, dull, aching pain, accompanied by nausea, anorexia, vomiting, and
fever. Similarly, patients with exacerbated symptoms, those suffering of gastrointestinal
bleeding, obstruction or peritonitis convey early satiety, melena, hematemesis, significant
weight loss, and chest pain.

Diagnosis
There are a myriad of diagnostic laboratory tests to detect the presence of H. Pylori;
these include, tissue biopsy, specimen culture, urea breath test, and stool antigen test. With a
tissue biopsy approach being the gold diagnostic standard, the use of an endoscope is utilized
to obtain a sample tissue from the patient’s digestive tract. The obtained samples are then
assessed to detect the presence of infections or signs of inflammation. Notably, a tissue biopsy

5
is considered to perform the best as it provides an accurate diagnosis and differential diagnosis
of peptic ulcer disease and ulcer complications allowing other probable diseases to be ruled
out. On the other hand, for a gastric tissue culture, the obtained tissue is placed in a special dish
to observe whether the specific bacterium or some other organisms grow. The urea breath test,
on the other hand, is the most commonly conducted procedure because it is less invasive. In
fact, it is regarded as the gold standard procedure among asymptomatic patients (Abadi, 2018).
In this procedure, the patient will swallow radioactively labeled urea. In the presence of H.
pylori, CO2 labeled with radioactivity can be detected in the breath within about 30 minutes.
Among pediatric patients, the stool antigen test is proven to be the most efficient. In this test,
stools are tested for the presence of antigens associated with H. pylori infection.

Treatment and management

Physicians often treat Peptic Ulcer Disease with proton pump inhibitors e.g. Omeprazole
combined with antibiotics like Amoxicillin and Clarithromycin for 1 to 2 weeks. Proton pump
inhibitors moderate the production of acid secretion of the stomach which promote the healing
of ulceration, and the antibiotic medications aid in treating the H. pylori infection (Goering,
Zuckerman, Dockrell, Chiodini & Mims, 2019). With these interventions, the peptic ulcer is
healed in about 8 weeks. To prevent further exacerbation of the infection, the patient will be
advised to avoid steroids, NSAIDs, and aspirin. The patient is also regarded to cease smoking,
avoid stressful situations, avoid increased coffee and alcohol beverage intake as they can
further exacerbate the disease.

Prevention
Several lifestyle choices and habits can limit a person’s risk of developing peptic ulcer.
Lifestyle alterations specifically eating in moderation at regular times reduce the proliferation of
bacteria in the mucosal lining. Of note, limiting alcohol or eliminating alcohol intake altogether,
drinking water only from secured sources, avoiding foods that can irritate the stomach e.g.
citrus, spicy foods, carbonated drinks, and seeking safer alternatives for steroids, aspirin, and
NSAID medications can make the occurrence of an irritated gastric lining less likely.

Nursing care
In caring for peptic ulcer patients, the nurse should be able to guide the patient towards
recovery and promote cessation of previous lifestyle habits to prevent the recurrence of the
disease (Nettina & Brunner, 2019). As such, the patient may be taught relaxation therapy such
as listening to music to reduce stress levels. Referral to counselling services can also be an
alternative. Notably, advising the patient to cease smoking and alcohol consumption can highly
benefit the patient and can promote prompt healing. In the same way, dietary advice should
also be offered to the patient. Small regular meals specifically having 5 small meals per day
deters the hunger pain. The patient should also be reminded to moderate consumption of spicy
food and coffee as these foods could irritate the stomach’s mucosal membrane which may
result in inflammation and epigastric pain.

6
 MICROBIAL DISEASES OF THE DIGESTIVE SYSTEM:

FOOD POISONING (INTOXICATION)

Pathogenesis

The inherent member of the microbiota, the Staphylococcus Aureus, an anaerobic,

Gram-positive bacteria is responsible for food poisoning. The bacteria produces an enterotoxin,
the Superantigen, and has the propensity to survive in heat 60°c for half an hour. This heat
resistance allows the bacteria to survive on the skin’s surface. In the same way, its osmotic
pressure resistance also permits it to grow in foods such as ham, a food that contains a high
osmotic pressure of salts. This member of the normal microbiota can be easily displaced
especially during food preparations. With the hospitable environment, the bacteria is
completely capable of incubating and releasing its innate toxin. Food poisoning then becomes
the outcome of ingesting foods that contain bacterial substances. The physiopathology of food
poisoning’s symptoms is only partially understood. However, it is known that S. aureus’
enterotoxins directly penetrate and affect the intestinal epithelium and the vagus nerve causing
stimulation to be sent in the medullary center (Ogori & Ogori, 2014). The diarrhea in
staphylococcal food poisoning may be due to the inhibition of water and electrolyte
reabsorption in the small intestine brought by the enterotoxins (Hernández-Cortez, Palma-
Martínez, Gonzalez-Avila, Guerrero-Mandujano, Solís & Castro-Escarpulli, 2017). A patient
suffering of food poisoning may exhibit intense vomiting and watery diarrhea 1 to 4 hours after
food ingestion, and can last for 24-48 hours. Despite being self-limiting for completely healthy
individuals, food poisoning can be very severe for the children, the elderly, and the
immunocompromised.

Other bacteria may likewise be considered as other causative agents such as Bacillus
cereus and Clostridium perfringens. C. perfringens is a large, Gram-positive, endospore forming
anaerobic bacteria. Cases of food poisoning caused by this bacterium is often associated with
intake of contaminated meat. The microbe grows in the intestinal tract and produces the CPE

7
enterotoxin which induces hypersecretion in the small intestine. Consequently, this causes the
characteristic abdominal pain and diarrhea (Ogori & Ogori, 2014). Another causative agent can
be B. cereus, it is a large, Gram-positive, endospore-forming bacterium usually found in soils
and vegetation. As much as it is believed that heating food kills bacteria, it does not suffice to
completely eliminate the existing spores, allowing them to germinate as the food cools. Due to
the lack of competition as the food is heated, B. cereus can grow rapidly and eventually produce
its own toxin. B. cereus’ enterotoxins can come into two forms; it can either be emetic (causes
vomiting) from contaminated fried rice or diarrheal (loose watery bowels) from poorly
prepared meat. The mechanisms of emetic enterotoxin is limitedly understood, but Tortora,
Funke & Case (2019) reasoned that the diarrheal enterotoxin is known to increase intestinal
secretion through the activation of adenylate cyclase in intestinal epithelium.

Diagnosis
The diagnosis for bacterial food poisoning can be easily conducted through the
observance of several signs and symptoms such nausea, vomiting, diarrhea, abdominal pain,
discomfort, bloating, appetite loss, and fever. Having an adequate and proper patient history
may also be of significant help as it aids in pointing the cause of food poisoning. Physicians may
conduct diagnostic tests such as stool culture which specifically identifies the underlying
organism causing the symptoms or a blood culture if the bacteria is suspected to have reached
the bloodstream.

Treatment and management

The treatment for food poisoning is mostly symptomatic. Often, patients are also
prescribed antidiarrheal and antiemetic agents to relieve the symptoms (Goering, Zuckerman,
Dockrell, Chiodini & Mims, 2019). In accordance with the treatment, patients are given
adequate fluid replacement and nutritional support to prevent fluid and electrolyte imbalances.
Supplementary to the given treatment, allowing the patient to have sufficient bed rest can be
helpful most especially for those experiencing severe abdominal pain.

Prevention
Cases of food poisoning can be prevented through scrupulous practice, observance of
proper food handling, and infection control techniques (Bauman, Primm, Siegesmund, Cosby &
Montgomery, 2018). Proper hand washing, adequate cooking of food, proper food
refrigeration, and being cautious of food expiration dates are the ideal preventive measure that
can efficiently prevent occurrence of bacterial food poisoning.

Nursing care
In managing patients with food poisoning, the nurse should be able to: maintain or
restore fluid and electrolyte balance, decrease the severity of abdominal pain and nausea,
monitor the patient’s defecation pattern, and educate the patients involving the preventive
measures to prevent the recurrence (Peate, 2017). These nursing care goals warrant the
dependent and interdependent actions of the nurse such as: giving ice chips to patients to
alleviate nausea, and for the patient eventually gain appetite; the nurse also has to make sure
that the patient is given an adequate amount of fluids to replenish the loss from the patient’s
output; the nurse can also portion the food intake in order for the patient to gradually ease
back to eating. Following these nursing actions, the nurse should allow the patient to rest and
when recovery is due, it is imperative for the nurse to advise several preventive measures to
avert food poisoning from happening again.

8
 MICROBIAL DISEASES OF THE URINARY AND REPRODUCTIVE SYSTEM:

GONORRHEA

Pathogenesis

Neisseria gonorrhoeae is the primary etiologic agent responsible for Gonorrhea. It is a

gram-negative diplococcus that contains numerous virulence factors allowing it to grow
effectively in their human hosts. N. gonorrhoeae is highly sensitive to desiccation hence why it
cannot thrive well outside the human host. In order to transmit the bacteria, close contact
specifically sexual contact is needed. To be able to infect, the gonococcus attaches to the
mucosal cell membranes of the epithelial wall of the genitourinary tract, eye, rectum, and
throat through the use of their fimbriae and Opa proteins. These adhesive mechanisms prevent
them from being easily flushed away by urine or other bodily discharges. Upon attachment, the
gonococcus rapidly multiplies and spreads in the women’s cervix and in the men’s urethra. This
site invasion induces inflammation and when leukocytes aggregate in the area, the
characteristic pus forms. The gonococcus’ Por proteins evade intracellular killing by neutrophils
through the prevention of phagosome-lysosome fusion. In a similar premise, Richards &
Edwards (2014) elaborate that the gonococcus also releases an IgA protease to destroy the
human host’s IgA1 whose function is to promote immune functions along the mucosal
membrane. With the hindered ability of IgA1, the immunoglobulin is rendered ineffective.

Several unconventional sexual practices also predispose the bacteria to several peculiar
places such as the rectum, pharynx, and gums. Men affected by Gonorrhea usually present
with urethritis, yellow, creamy pus discharge and painful urination which may extend towards
the epididymis. Among women, only the epithelial columnar walled cervix is commonly
affected. This is the primary reason as to why women sometimes remain oblivious about their
disease not until manifestations such as abdominal pain from complications arise. If by chance
that a mother is affected by Gonorrhea, the eyes of her infant may become infected upon the
passage through the infected birth canal. In this scene, the conjunctivitis can rapidly progress to
blindness unless treated promptly.

Diagnosis
Urogenital infections are commonly diagnosed through culture or non culture
techniques and vary among men, women and asymptomatic individuals. The most widely
preferred diagnostic tool for Gonorrhea is the Nucleic Acid Amplification Test (NAAT), it directly

9
detects N. gonorrhoeae in genitourinary specimens. This test has excellent specificity and
sensitivity when used in high-prevalence populations, and is comparatively rapid and
convenient as it uses urine as a specimen source, especially for men (Richards & Edwards,
2014). Women and asymptomatic men are best diagnosed through cultures from the infected
sites such as the cervix, rectum or throat). The collected pus or mucus is streaked in a modified
Thayer-Martin medium (MTM) and incubated in an atmosphere with a regulated amount of
CO2. This test, however, is highly sensitive to adverse environmental influences like the
temperature and desiccation thereby requiring a special transporting media to keep it viable.
Despite its environmental sensitivity, culturing has the advantage of allowing the determination
of antibiotic sensitivity.

Treatment and management

Numerous strains of N. gonorrhoeae have now become resistant to penicillin,
tetracycline, erythromycin, aminoglycosides, and fluoroquinolones. This drawback to resistance
has occurred to a leading recommendation of Ceftriaxone and Azithromycin (Gonococcal
Infections - 2015 STD Treatment Guidelines, 2015). Affected newborns are given the routine
instillation of Erythromycin or 1% silver nitrate drops into their eyes. Succeeding the antibiotic
therapy, a follow-up culture may be ordered to ensure the complete cure from the disease
because as introduced earlier, some strains have become highly resistant to antibiotic
treatment.

Prevention
At present, there are no known effective vaccines to prevent all the strains of
Gonorrhea. However, the effectiveness of using pilus proteins or other outer membrane
proteins components of the bacteria are being investigated. Acquiring an immunization for
Gonorrhea may prevent the symptomatic disease but not the infection Justesen (2002) claims.
Still, preventive measures are proven to be the most effective in protecting people from the
disease. These practices include sexual abstinence (e.g. oral, anal, or vaginal sex), mutual
monogamy, proper use of latex condoms, and prompt screening of individuals who have come
in sexual contact with the carrier.

Nursing care
In treating patients with Gonorrhea, it is important to note the standard precautions. In
conjunction with this approach, the desired outcomes should be: for the patient to experience
relief of pain, and provide a sensitive patient-centered care and health teaching to the patient
and their partner (Pearson Education, n.d.). Specifically, the nurse should highlight the
importance of adherence to the treatment plan and follow-up testing to prevent the recurrence
of the disease. It is also essential to educate the patients with the right information regarding
the transmission of the disease to alleviate confusion and anxiety because common
misconceptions may induce unnecessary harm and stereotyping towards genital infections.
Discussion of feelings and concerns about being diagnosed with Gonorrhea may be
supplemental to reassure the patient that being diagnosed with such disease does not
determine one’s self-worth. Most importantly, the nurse should also stress the importance of
mutual monogamy, proper use of condoms, and provide suggestions in terms of modifications
in the patient’s sexual behavior.

10
 MICROBIAL DISEASES OF THE URINARY AND REPRODUCTIVE SYSTEM:

GENITAL WARTS

Pathogenesis

Genital warts are caused by a contagious virus known as the Human Papillomavirus
(HPV). It can be transmitted from one person to another via direct contact particularly sexual
contact such as vaginal and anal intercourse. The known incubation period from the onset of
infection to the manifestation of a noticeable wart range from 3 to 4 months. In this period,
Bhatia, Lynde, Vender & Bourcier (2019) illustrate that the virus invades the basal layer of the
epithelial cells later on penetrating the skin and the mucosal microbrations of the genital area.
Once superficial tissue invasion has occurred, the viral antigen and infectious virus are
produced once the cells start to become keratinized as they continue to ascend towards the
skin’s surface. The infected cells are stimulated to divide, and 1-6 months thereafter, the
created mass of the infected cells will protrude in the genital area to form a visible wart. These
visible projections are often caused by serotypes 6 and 11, which rarely cause cancer. On one
hand, serotypes 16 and 18 are attributed to cause cervical cancer.

Diagnosis
Physicians diagnose genital warts through its characteristic appearance. However,
health professionals order a biopsy to rule out possible carcinoma. HPV cannot be cultured in
the laboratory, but HPV detection methods may be utilized to examine samples to identify the
genetic material of the virus and confirm the infection.

Treatment and management

30% percent of the cases of genital warts go away even without medical treatment, but
this does not ascertain the complete elimination of the underlying virus (Riedel, Jawetz,
Melnick, & Adelberg, 2019). Physicians often remove these projections through chemical or
surgical removal, but recurrence of the same protrusions may occur. Specifically, doctors may
utilize procedures such as cryosurgery and electrodessication. In the same way topical drug
treatments are also administered to patients. For instance, Podofilox and Trichloroacetic acid,
and Imiquimod may also be used. Imiquimod, an antiviral cream, is widely utilized to hinder
new forming genital warts to emerge.

11
Prevention
Cases of genital warts can be best addressed and diminished through the practice of
sexual abstinence or through mutual monogamy with an uninfected sexual partner.
Furthermore, individuals can decrease the chances of contracting the infection through proper
condom use. In particular, CDC (2019) suggests that three doses of HPV vaccine be done for
adults aged 50 or younger, and two doses for children at ages 11-12. This vaccine is attributed
to prevent HPV infections and probable cervical cancer.

Nursing care
“Caring for a patient with genital warts requires utmost respect, empathy, and
unprejudiced nursing support”, Peate (2006) highlights. It is imperative that the nurse provide
the patient with appropriate physical and psychological support to address the patient’s needs.
Relaying counselling advice in a well-tailored approach to educate the patient and their partner
regarding prevention and transmission of genital warts will be significantly helpful to hamper
the recurrence of the infection. Because of its infective nature, genital warts must be properly
learned about so that the couple will be able to understand the implications of employing the
use of risk-reduction methods to lessen their susceptibility to infection.

12
 REFERENCES (Journal Articles)

Abadi, A. T. B. (2018). Diagnosis of Helicobacter pylori Using Invasive and Noninvasive

Approaches. Journal of Pathogens, 2018, 1–13. doi: 10.1155/2018/9064952

Bhatia, N., Lynde, C., Vender, R., & Bourcier, M. (2019). Understanding Genital Warts:
Epidemiology, Pathogenesis, and Burden of Disease of Human Papillomavirus. Journal of
Cutaneous Medicine and Surgery. doi: https://doi.org/10.2310/7750.2013.13072

Chen, Y., Liu, Q., & Guo, D. (2020). Emerging coronaviruses: Genome structure, replication,
and pathogenesis. Journal of Medical Virology, 92(4), 418–423. doi: 10.1002/jmv.25681

Hernández-Cortez, C., Palma-Martínez, I., Gonzalez-Avila, L. U., Guerrero-Mandujano, A.,

Solís, R. C., & Castro-Escarpulli, G. (2017). Food Poisoning Caused by Bacteria (Food Toxins).
Poisoning - From Specific Toxic Agents to Novel Rapid and Simplified Techniques for
Analysis. doi: 10.5772/intechopen.69953

Justesen, S. (2002). Slowing the spread of gonorrhea. Nursing, 32(4), 22. doi:
10.1097/00152193-200204000-00014

Lau, S. K. P., Woo, P. C. Y., Wong, B. H. L., Tsoi, H.-W., Woo, G. K. S., Poon, R. W. S., … Yuen, K.-
Y. (2004). Detection of Severe Acute Respiratory Syndrome (SARS) Coronavirus
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