1229 Exam 5: Sexually Transmitted Infections Flashcards
An infection that can be transferred from one person to another through sexual contact
Can be bacterial, viral, protozoa, or ectoparasites
Organisms that can live outside the body like lice
Sexually Transmitted Infections
Means that a germ that can cause sickness is present inside a person’s body and may not cause any adverse effects
Infection
Means that the infection is actually causing the infected person to feel sick, or to notice something is wrong
Disease
Chlamydia Gonorrhea Syphilis PID Group B Strep
Bacterial
Caused by infection
Most common STI
Chlamydia (Chlamydia trachomatis)
Risk Factors of Chlamydia
Sexually active women under 20
Women or men with multiple sex partners
People who do not use a barrier form of birth control
Symptoms of Chlamydia
Often asymptomatic and lack abnormal findings (Silent Disease) If symptoms present, usually appear several weeks after exposure: -Cervicitis -Urthritis Lower back pain Painful sex Burning urination Bleeding between periods
Complications of Chlamydia
PID (Pelvic Inflammatory Disease) Ectopic pregnancy Infertility Increase risk for other STIs Reactive arthritis
Screening for Chlamydia
CDC recommends screening:
- All sexually active women 25 yrs or younger
- All pregnant women
- Men who have sex with men
- Anyone with symptoms
- Anyone who had sex with someone recently treated/tested positive for Chlamydia
- Multiple sex partners
Diagnosis for Chlamydia
Culture testing
NAAT (nucleic acid amplification test)
-Vaginal swabs
-Urine specimen
Treatment for Chlamydia
Doxycycline 100mg BID x 7 days Azithromycin 1 gram PO x 1 dose Abstain from sex for 1 week Pregnant: -Erythromycin for 7 days -Amoxicillin for 7 days
Management for Chlamydia
Treat all partners
Do not need retested unless pregnant
Abstain from sex until finished with antibiotics
Take all medications as directed
Can get it again even after being treated, so just retreat them with antibiotics
Newborn Chlamydia
Neonatal conjunctivitis
-Clear water discharge
-Develops 5 days to 2 weeks after birth
-Complications: Conjunctival scarring, corneal microgranulations
Pneumonia:
-Repetitive staccato cough, tachpnea, rales, hyperinflation
Treatment:
-Erythromycin orally or Sulfonamide orally for 2-3 weeks
Caused by a sexually transmitted bacterium, neisseria gonorrhoeae that can infect both males and females
Oldest communicable disease
Reportable to the CDC
Gonorrhea
Risk Factors for Gonorrhea
Sexually active teens and young adults
Symptoms of Gonorrhea
May be asymptomatic
Women: Painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods
Men: burning sensation when urinating, or a white, yellow, or green discharge from the penis that usually appears 1 to 14 days after infection, occasional swollen testicles
Can get in the throat
Complications of Gonorrhea
PID Infertility Chronic pelvic pain Internal abscess Ectopic pregnancy Epididimytitis Increase the risk of contracting HIV
Diagnosis for Gonorrhea
Culture testing Gram stain (males) NAAT -Vaginal swabs -Urine specimen
Treatment for Gonorrhea
Ceftriaxone 125mg IM x 1 OR Cefisime 400mg PO x 1 PLUS: Azithromycin 1 gram PO x 1 OR Doxycycline 100mg PO BID x 7 days PREGNANT: Azithromycin 2 grams
Newborn Gonorrhea
Blindness or Conjunctivitis Gonococcal joint infections Septicemia TREATMENT: -0.5% Erythromycin ointment to eyes within first hour of birth -Ceftriaxone IM
Caused by a sexually transmitted Treponema pallidum that can infect both males and females
Earliest described STI
Reportable to the CDC
Syphilis
Risk Factors for Syphilis
Sexually active individuals with out use of barrier methods
Primary Syphilis
Primary lesion (at site where Syphilis entered the body)
-The Chancre lasts for 5-90 days
-Begins as a painless papule and then progresses to shallow ulcer
Symptoms will resolve without treatment and progress to next stage
Secondary Syphilis
Widespread, maculopapular rash on the palms and soles
-Rough, red or reddish-brown
Lymphadenopathy
Fever, headache, malaise, patchy haïr loss
6 weeks to 6 months
-May appear when primary chancre is healing or weeks after primary chancre
Condylomata
-Large raised grey or white lesions to the vulva, perineum, or anus
Symptoms will resolve without treatment and progress to next stage
Latent Syphilis
Begins when Primary and Secondary disappear
Can last for years and can appear 10-30 years after infection
15% of people not treated will develop Latent Syphilis
Symptoms of Latent Syphilis
Difficulty coordinating movements Paralysis Numbness Dementia Disease damages the internal organs: brain, nerve, eyes, heart, blood vessels, liver, bones, joints Can lead to death
Screening for Syphilis
CDC recommends:
- All who have another STI
- All pregnant women
- Men who have sex with men
- Persons with HIV/AIDS
- Persons with partner tested positive Syphilis
Diagnosis for Syphilis
Nontreponemal Tests: VDRL (Venereal Disease Research Laboratories) and RPR (rapid plasma reagin) are screening tests
-False-positive tests are not uncommon due to acute infections, autoimmune disorders, malignancy, pregnancy, drug addiction
Microscopic Examination of primary and secondary lesions
Treponemal Tests for T. Pallidum are used to confirm positive results and seroconversion usually takes place 6-8 weeks after exposure
Treatment for Syphilis
Penicillin G 2.4 million units IM x 1 dose
Monitor for Jarisch-Herxheimer Reaction
Pregnant:
-Skin Testing or desensitized
Management for Treatment
Monthly follow-up
Long-term serologic testing even in the absence of symptoms
Practice sexual abstinence until treatment completed
Notify all partners
Newborn Syphilis
If Syphilis is left untreated, 40-50% of newborns will have symptomatic congenital syphilis
25% of untreated syphilis can result in fetal death, miscarriage, or stillbirth
Can occur 5-15 years after a baby is born
Newborn Syphilis Symptoms
Poor feeding, slight hyperthermia
Snuffles: copious, clear serosanguineous mucus discharge from the neonates nose
Copper colored maculopapular rash
Complications of Syphilis
Neurosyphilis Deafness Hutchinson's teeth Saber skins Saddle nose Gummas Interstitial keratitis Seizures
Most commonly involves the uterine tubes and uterus
Caused by bacteria, Chlamydia, and Gonorrhea
Pelvic Inflammatory Disease (PID)
Risk Factors of PID
Sexually active women
Young age (> 25 yrs)
Multiple sexual partners
History of STI
Symptoms of PID
Vary from mild to severe If caused by Chlamydia, may have no signs at all Low abdominal pain Fever Adnexal tenderness on exam Urethral or cervical discharge Elevated WBC and ESR
Complications of PID
Permanent damage to female organs Scar tissue in the fallopian tubes Infertility Ectopic pregnancy Chronic pelvic pain Painful sex
Screening & Diagnosis for PID
No precise test to detect PID
Thorough history and physical exam
Screening for potential organisms
Ultrasound
Treatment for PID
Broad spectrum antibiotic -Dependent on bacteria Hospitalization?? -Only if severely ill or pregnant IUD for birth control?? -Generally no!! Increases risk for infections
Management for PID
Treat all partners Take all medications as directed Abstain from sex until finished with antibiotics Education Counseling
Considered normal vaginal flora in non pregnant women
Present in 9-23% of pregnant women
Associated with poor outcomes
Screen all women at 36-37 weeks
Group B Strep
Complications for Group B Strep
Preterm birth > 37 weeks
Premature rupture of membranes
Intrapartum maternal fever > 101*F
Treatment for Group B Strep
PCN G 5 million units IV
Newborn Group B Strep
Low birth weight Preterm birth Respiratory distress syndrome Septic shock Meningitis
Viral STIs
HPV
Herpes
Hepatitis
HIV
(A.K.A) Genital Warts
Can lead to cervical cancer
Can be passed through oral and anal sex
In 90% of cases the body clears of this naturally within 2 years
Human Papillomavirus (HPV)
Risk Factors for HPV
Sexually active persons who do not use barrier birth control
Gay and bisexual men
People with weaken immune system
Symptoms of HPV
Genital warts (condylomata acuminata) Chronic vaginal discharge Pruritius Dysparenunia Most women with HPV do not have any symptoms at all
Complications for HPV
Cervical Cancer
Other HPV cancers
Recurrent Respiratory Papillomatosis (RRP)
*If warts in throat EDUCATE**
Screening for HPV
Complaints of profuse, irritating vaginal discharge, itching, dysparenuia, or postcoital bleeding
Complaints of “bumps”
Known exposure
Diagnosis for HPV
Thorough history and physical Pap test HPV-DNA No test for men No test to check throat
Treatment for HPV
NO treatment for the virus itself
Visible warts: medication applied directly to lesions
Cervical Cancer: most is treatable if found early
RRP: treated with surgery or medicines
No affect on baby unless mom has large warts and they would do a C-section
Management of HPV
Prevention:
- Gardasil-vaccine approved for both males and females
- Cervarix-vaccine for females
HSV-1 (Oral)
HSV-2 (Genital)
Blisters crust over and heal within 10-15 days
Common viral infection
Risk Factors:
-Contact with lesions, mucosal suffices, genital secretions, or oral secretions
Don’t have to have symptoms to transmit virus
Can get with skin-skin contact even with use of condom
Herpes Simplex Virus
Symptoms of Herpes Simplex Virus
Can be asymptomatic or have mild symptoms Vesicles on genitals, rectum, or mouth *After exposure takes 4 days for symptoms to show* Systemic symptoms (1st exposure) -Fever -Body aches -Swollen lymph nodes -Headache
Complications of HSV
Painful genital ulcers Rare: -Blindness -Encephalitis -Aseptic Meningitis
Diagnosis for HSV
Thorough history and physical
Viral Culture
NAAT
Screening for HSV
CDC doesn’t recommend screening the general population for HSV-1 or HSV-2:
Only screen if they have symptoms or have partner with it.
Doctor recommends it or they ask to be tested
Treatment for HSV
NO CURE Daily suppressive treatment: -Acyclovir -Valacyclovir -Famciclovir
Management for HSV
Clean lesions to prevent secondary infection Oral analegesics Counseling EDUCATION Abstain from sex when symptoms present
Newborn HSV
HSv-2 most common cause of HSV in newborns
Modes of transmission:
-Transplacental infection
-Ascending infection by way of the birth canal
-Direct contamination during passage through an infected birth canal
-Direct transmission from infected personnel or family
Neonatal Herpes
Involves all organs Disseminated infection Localized CNS disease Localized infection Herpes keratitis (high morbidity)
Inflammation of the liver and a group of viral infections that affect the liver
Hepatitis (A, B, C)
Incubation period of 28 days
Acquired primarily through fecal-oral route
Can be transmitted sexually
Can live outside the body
Killed by heating to 105 degrees
Transmitted by food if contaminated after cooking
Hepatitis A
Risk Factors for Hepatitis A
Living in western US, Native Americans, Alaskan Natives, and Children/Employees in daycare centers
Symptoms for Hepatitis A
Flu-like:
- Malaise
- Fatigue
- Anorexia
- Nausea
- Abdominal Pain
- Dark Urine
- Clay Colored Stools
- Jaundice
Hepatitis A is…
Self limiting
May need hospitalization due to dehydration
Avoid medications metabolized in liver
Get Hep A vaccine
Transmitted through sex, injection drug use, birth to infected mother, contact with blood or open sores of an infected person, needle sticks, sharing personal items of infected person
Can live outside body for 7 days
Incubation period of 90 days
Hepatitis B
Risk Factors for Hepatitis B
Infants born to infected mothers Sex partners with infected persons Men who have sex with men Injection drug users Household contacts with infected person Healthcare workers Hemodialysis patients Travelors
Symptoms of Hep B
Symptoms typically last from several weeks to 6 months
Hep B vaccine
Fever Fatigue Loss of appetite Nausea Vomiting Abdominal pain Dark urine Clay colored stools Joint pain Jaundice
Serology
HBsAg IgM anti HBc (recent or acute infection) Anti-HBs HBeAg HBeAB
HbsAg negative
anti-HBc positive
anti-HBs positive
Immune due to natural infection
HBsAg negative
anti-HBc negative
anti-HBs positive
Immune due to vaccination
HBsAg positive
anti-HBc positive
anti-HBs negative
IgM anti-HBc positive
Acute infection
HBsAg positive
anti-HBc positive
IgM anti-HBc negative
anti-HBc negative
Chronic infection
Treatment for Hep B
Acute- no medication available
Chronic- antiviral drugs
Newborn Hep B
Increased risk for preterm birth
Rate for transmission highest when mother contracts while pregnant
Increased mortality
High risk of chronic hepatitis, cirrhosis, or liver cancer
Hep B vaccine given before discharge from hospital
Most common blood borne infection in the US
3.2 million people chronically infected
No vaccine available
Hepatitis C
Risk Factors for Hep C
Current/former injection drug users Recipients of blood transfusions before 1992 Chronic hemodialysis patient Health care workers Persons with HIV infection Children born to Hep C + mothers
Transmitted by:
Injection drug use Receipt of blood products Needle sticks Birth to an Hep C + mother Sex with Hep C + person Sharing personal care items
Symptoms of Hep C
Average time from exposure to symptoms is 4-12 weeks
Fever Fatigue Dark urine Clay colored stools Abdominal pain Loss of appetite Nausea Vomiting Joint pain Jaundice
Testing Hep C
Anti-HCV
RIBA
HCV RNA
Liver enzyme tests
Most infants infected with Hep C at birth have no symptoms and do well during childhood
I LOVE Y’ALL!!! :)
Protozoa STIs
Trichomoniasis
Very common STI
Caused by protozoan Trichomonas vaginalis
Trichomoniasis
Risk Factors for Trichomoniasis
Unprotected sex
Older women
Symptoms for Trichomoniasis
70% do not have symptoms
Unpleasant sex
Symptoms continued…
Men:
- Itching/irritation in the penis
- Burning after urination or ejaculation
- Penile discharge
Symptoms for Trichomoniasis
Women:
- Itching, burning, redness, or soreness of the genitals
- Discomfort with urination
- Thin discharge with unusual smell that can be clear, white, yellow, or green
- Strawberry spots to cervix
Diagnosis for Trich
Thorough history and physical
Pap tests
Wet prep
Vaginal culture
Treatment for Trich
Metronidazole 2 gram PO x 1 dose
Treat all partners
Use barrier form of birth control
An acronym for a group of five infectious diseases: Toxoplasmosis Other (Hepatitis B) Rubella (German measles) Cytomegalovirus (CMV) Herpes Simplex Virus (HSV)
TORCH
Each disease may be teratogenic
Each crosses the placenta
Each may adversely affect the developing fetus
The effect of each varies, depending on developmental stage at time of exposure
