Education and Counseling
This section contains discussion and/or specific guidelines for
the following topics:
General STD Prevention Education
 Health care providers
should provide clients with general information regarding sexually transmitted
diseases, information that is chlamydia-specific, and appropriate counseling and
referral. All clients should be provided with information to assist them in
judging their risk for contracting an STD and modifying their behavior to reduce
their risk.
General STD information
should be provided in verbal communication with the client and reinforced and
supplemented with written brochures. All education and counseling should be
language and culturally appropriate. Because lectures are not generally
effective with clients, the education and counseling should be two-way,
interactive communication, i.e., ask open-ended questions to find out what
the client already knows, listen for the client’s feelings, affirm the client’s
plan for telling partner(s), and have the client practice what he or she might
say.
General STD Information should include:
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Names and brief
descriptions of the common STDs.
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Description of how STDs
are transmitted (that STDs are passed from one person to another by sexual
contact, vaginal or anal intercourse, and/or oral contact).
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Discussion of various
symptoms such as sores, discharge, pain, skin rashes, lumps, or swollen
glands.
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Emphasize that many
infected people, especially women, have no noticeable symptoms. Even without
symptoms, the disease can be transmitted and damage a person’s body.
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Information that
untreated STDs can have serious complications including infertility. STDs can
also harm a baby during pregnancy or birth when untreated in the mother.
Education to reduce the risk of STD to those who are
sexually active must be client-centered and appropriate to the client, and
should include the following messages:
- Limiting sexual contact to monogamous
relationships
- Use condoms if client or client’s partners
are having other sexual partners
- Avoiding multiple partners, anonymous
partners, prostitutes, and other persons with multiple sex partners
- Avoiding sexual contact with persons who
have a genital discharge, genital warts, genital herpes lesions or other
suspicious genital lesions, HIV infection or hepatitis B or C infection
-
Avoiding oral-anal sex to
prevent enteric (intestinal) infections
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Having a periodic
examination (at least annually) for sexually transmitted agents and syndromes
if at high risk for STD
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Using condoms for sexual
contact (oral, genital, anal)
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Avoiding use of an
Intrauterine Device (IUD) for a birth control method if either partner has
more than one sex partner
-
Examining one’s own and
one’s partner’s genitals for evidence of infection before sexual contact
-
Refraining from all
sexual activity is an option that eliminates almost any risk of STD
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When
do you consider someone “cured” for chlamydia?
The
client can be considered cured under the following conditions:
Counseling/Education for Clients and Their Partners
Reactions of clients being
told they have chlamydia may include anger, denial, depression, and blame.
Similar reactions may also occur with partners. The way in which the counseling
and education session is handled may enhance compliance with partner referral
and treatment.
Clients with a presumptive diagnosis of
chlamydia or a confirmed positive chlamydia test should be provided with the
following information to assist them in understanding chlamydia, especially its
treatment and prevention.
At a minimum, education about
chlamydia should include:
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Name of disease
-
Signs and symptoms of the disease
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How disease is transmitted
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Incubation period
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Possibility of both sexes having asymptomatic
disease for a long period of time
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Complications of untreated chlamydia for
women, men, and babies
Discussion of chlamydia treatment
must include:
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Name of the drug(s) being used in treatment
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Quantity and frequency of drug usage
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Probable efficacy of treatment
-
Potential side effects (include discussion of possibility of moniliasis,
vaginal yeast infection, in susceptible women with systemic antibiotic
therapy)
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Foods, drugs, conditions (e.g., sunlight exposure) or behaviors that should be
avoided (alcohol is not contraindicated during therapy for chlamydia
trachomatis)
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What to do if side effects occur or symptoms develop or do not resolve
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Stressing importance of abstinence or using condoms and spermicide until
treatment has been completed by client and partner(s)
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Importance of completing medication, not missing doses, etc.
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Stressing that treatment of all partners and their contacts is needed to
prevent re-infection
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Not sharing medication with partners
Discussion of partner(s)
management should include:**
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The importance of all
partners being examined and treated to prevent reinfection
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Meaning of negative test
results, sensitivity of tests, likelihood of infection, need for treatment
-
Where partner can go for
care (clinic, health dept., private doctor, etc.); provide a referral card or
letter to facilitate completion of referral
-
Consequences to partners’
partners if not treated (breaking the chain of transmission in community)
-
Suggestions of techniques
of how to communicate with partner(s)
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Discussion of possible
partner reaction and effects upon relationship
-
denial
-
depression (anger at
self)
-
anger at person
perceived as source of infection
-
problems of
relationship (blame, suspicion, increased stress)
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If the client is
reluctant to discuss the referral of sex partner(s), coach the client on what
to say and how to say it
-
Suggestions for
alternatives to anal, oral or vaginal sex until treatment completed
** Partners include
all individuals who fall within the critical exposure periods defined below.
Critical Exposure Periods
-
All sex partners exposed to
chlamydia-infected women or chlamydia-infected asymptomatic men
within 60 days of infected client’s treatment
should be referred for evaluation and treatment.
-
All sex partners exposed to symptomatic
infected men within 60 days from onset of symptoms
should be referred for their own evaluation and treatment.
-
If there have been no sex partners within the
above exposure periods, the most recent sex partner
is presumed to be at increased risk for chlamydia infection and should be
evaluated and treated.
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Summary
All clients should be
provided with general STD information to assist them in judging their risk for
contracting an STD infection and in modifying their behavior, if necessary, to
reduce the risk.
Education should emphasize
that many people, especially women, may have no noticeable symptoms even though
they are infected. Even without symptoms, the disease can still damage a
person’s body, and this person may be able to transmit the STD.
Clients who are diagnosed
with chlamydia or another STD may react with anger, denial, depression, and
blame. Partners can have the same reactions.
All sex partners who have
been exposed to chlamydia within the critical exposure periods should be
referred for evaluation and treatment.
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Case Study
Case 4:
A client returns to your clinic 6 days after being given azithromycin for a
positive Ct test. She brings in one of her partners who has not been treated
and they had sex this morning. (He has had at least 5 partners in the past 3
months).
Question:
Do you treat client again?
(Case Study answers found in Appendix)
Counseling/Education for Adolescents
All of the information on counseling and education for adult
clients found in the preceding text applies to adolescents as well. However,
additional factors must be considered when caring for those young adults ages
eighteen and under.
Although some adolescents have the maturity and life skills to
enable them to cope with information regarding Sexually Transmitted Diseases and
the importance of follow-up and prevention, most do not. It is those teens that
are essentially "high risk" that may need additional staff expertise in
counseling, education and follow-up.
OPA through the Program Archive on Sexuality, Health and
Adolescence (PASHA) developed the following definition of "high risk teens":
-
the very young teen
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the developmentally slow teen
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the teen with no future plans
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the teen who thinks pregnancy would be okay
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the teens with a lack of parental support
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the teen who has infrequent intercourse
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the teen with short-term sexual relationships
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the teen who did not initiate the visit
The average age that a young woman makes a visit to a
reproductive health clinic is fifteen, or mid-adolescence. Planning for those
younger adolescents (ages 11 to 13) or those older adolescents (16 or older)
will vary on the individual as well as factors relating to her risk status as
described above. It is most important to individualize counseling and education
to meet the developmental stages of the adolescent client.
Mid-adolescents will often exhibit the following characteristics:
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Continues effort to establish separate identity form parents and
finds identity in peer groups.
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Exhibits concrete thinking dealing with the "here and now."
Planning for the future is generally limited to short-term goals relating to
school and career.
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Loves intensely, "desperately."
Using specialized counseling skills with adolescents is a unique
skill that takes time to learn and practice. It is important that all staff
working with adolescents and sexually transmitted diseases are provided on-going
training. Staff must be familiar with techniques that utilize specialized skills
in order to maximize their limited time with each interaction. Staff members
need to be reminded of the importance of open-ended questions, reflecting
content and feelings and affirmation. The following section is a sampling of
questions and phrases that allow for effectively communicating with the
adolescent client.
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Client-Centered Communication Tools to Use
With Adolescents
Open-ended questions - can not be
answered with a yes or no
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What symptoms are you having?
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What other information would you like from me today?
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How did you feel when your boyfriend told you he had sex with
someone else?
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What worries you about taking this medicine?
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How does having chlamydia affect your decision to use condoms?
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What are your feelings about having sex?
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You've said your boyfriend told you he doesn't mind using
condoms, but you never use them. Can you explain this to me so that I can really
understand?
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What do you plan to do to reduce your risk of getting chlamydia
again?
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So you've decided to ....?
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What are you doing to protect yourself?
Reflection - communicating to the
client what you "sense" the client is feeling; communicating empathy or
understanding of client
concerns
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You're worried about your mother finding the medication?
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It's hard to have values and feelings different from your
mother's.
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Earlier you mentioned you were nervous about using condoms
because it meant you were really having sex. You said it made it harder to
pretend.
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Sounds like you are planning to use condoms every time you have
sex.
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You seem to be fed up with his behavior.
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You feel "dirty" because you think you may have a sexually
transmitted disease.
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You're thinking of never ever having sex again?
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It appears that you are upset because you think having chlamydia
may cause you to not get pregnant.
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You feel conflicted in wanting to please your boyfriend, but not
in wanting to have unprotected sex.
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You're not sure about what the next step is.
Affirmation - providing positive
feedback to the client
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You really have a lot of knowledge about reproductive health
care.
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Good for you!
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It sounds like you have made a thoughtful decision.
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In spite of it being very uncomfortable, you must feel very
proud of yourself for discussing this with your mother.
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I bet you are not able to share a lot of the facts we've
discussed today with your friends.
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I'm so pleased with the fact that you made the decision to come
in and have this checked out.
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Thanks for completing all this paperwork. You did a great job of
answering all the questions and you have such neat handwriting!
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You were able to relax during the exam and that made it much
easier for me. Thanks for being so cooperative during this uncomfortable
procedure.
-
You have asked some very good questions.
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Case Study
Case 4a:
Jill, aged seventeen, has been with the same partner, Tim, for eight
months. Before that she had sexual intercourse with Rick for one year. Those are
her only reported sexual contacts. She has just broken down in tears after you
have informed her that she has chlamydia. She looks at you and sobs..."I can't
believe this! I feel so dirty! I know I haven't been sleeping around, so it must
be Tim!!!...or could I have gotten this from Rick? How long have I had this??
Who did this to me? What am I going to do??"
Question:
How would you structure your counseling to Jill using open-ended questions or
reflection?
(Case Study answers found in Appendix)
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NM Department of Health Family Planning Program
