1229 Exam 5: Sexually Transmitted Infections Flashcards
1
Q
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
A
Sexually Transmitted Infections
2
Q
Means that a germ that can cause sickness is present inside a person’s body and may not cause any adverse effects
A
Infection
3
Q
Means that the infection is actually causing the infected person to feel sick, or to notice something is wrong
A
Disease
4
Q
Chlamydia Gonorrhea Syphilis PID Group B Strep
A
Bacterial
5
Q
Caused by infection
Most common STI
A
Chlamydia (Chlamydia trachomatis)
6
Q
Risk Factors of Chlamydia
A
Sexually active women under 20
Women or men with multiple sex partners
People who do not use a barrier form of birth control
7
Q
Symptoms of Chlamydia
A
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
8
Q
Complications of Chlamydia
A
PID (Pelvic Inflammatory Disease) Ectopic pregnancy Infertility Increase risk for other STIs Reactive arthritis
9
Q
Screening for Chlamydia
A
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
10
Q
Diagnosis for Chlamydia
A
Culture testing
NAAT (nucleic acid amplification test)
-Vaginal swabs
-Urine specimen
11
Q
Treatment for Chlamydia
A
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
12
Q
Management for Chlamydia
A
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
13
Q
Newborn Chlamydia
A
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
14
Q
Caused by a sexually transmitted bacterium, neisseria gonorrhoeae that can infect both males and females
Oldest communicable disease
Reportable to the CDC
A
Gonorrhea
15
Q
Risk Factors for Gonorrhea
A
Sexually active teens and young adults
16
Q
Symptoms of Gonorrhea
A
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
17
Q
Complications of Gonorrhea
A
PID Infertility Chronic pelvic pain Internal abscess Ectopic pregnancy Epididimytitis Increase the risk of contracting HIV
18
Q
Diagnosis for Gonorrhea
A
Culture testing Gram stain (males) NAAT -Vaginal swabs -Urine specimen
19
Q
Treatment for Gonorrhea
A
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
20
Q
Newborn Gonorrhea
A
Blindness or Conjunctivitis Gonococcal joint infections Septicemia TREATMENT: -0.5% Erythromycin ointment to eyes within first hour of birth -Ceftriaxone IM
21
Q
Caused by a sexually transmitted Treponema pallidum that can infect both males and females
Earliest described STI
Reportable to the CDC
A
Syphilis
22
Q
Risk Factors for Syphilis
A
Sexually active individuals with out use of barrier methods
23
Q
Primary Syphilis
A
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
24
Q
Secondary Syphilis
A
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
25
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
26
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
```
27
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
28
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
29
Treatment for Syphilis
Penicillin G 2.4 million units IM x 1 dose
Monitor for Jarisch-Herxheimer Reaction
Pregnant:
-Skin Testing or desensitized
30
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
31
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
32
Newborn Syphilis Symptoms
Poor feeding, slight hyperthermia
Snuffles: copious, clear serosanguineous mucus discharge from the neonates nose
Copper colored maculopapular rash
33
Complications of Syphilis
```
Neurosyphilis
Deafness
Hutchinson's teeth
Saber skins
Saddle nose
Gummas
Interstitial keratitis
Seizures
```
34
Most commonly involves the uterine tubes and uterus
| Caused by bacteria, Chlamydia, and Gonorrhea
Pelvic Inflammatory Disease (PID)
35
Risk Factors of PID
Sexually active women
Young age (> 25 yrs)
Multiple sexual partners
History of STI
36
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
```
37
Complications of PID
```
Permanent damage to female organs
Scar tissue in the fallopian tubes
Infertility
Ectopic pregnancy
Chronic pelvic pain
Painful sex
```
38
Screening & Diagnosis for PID
No precise test to detect PID
Thorough history and physical exam
Screening for potential organisms
Ultrasound
39
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
```
40
Management for PID
```
Treat all partners
Take all medications as directed
Abstain from sex until finished with antibiotics
Education
Counseling
```
41
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
42
Complications for Group B Strep
Preterm birth > 37 weeks
Premature rupture of membranes
Intrapartum maternal fever > 101*F
43
Treatment for Group B Strep
PCN G 5 million units IV
44
Newborn Group B Strep
```
Low birth weight
Preterm birth
Respiratory distress syndrome
Septic shock
Meningitis
```
45
Viral STIs
HPV
Herpes
Hepatitis
HIV
46
(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)
47
Risk Factors for HPV
Sexually active persons who do not use barrier birth control
Gay and bisexual men
People with weaken immune system
48
Symptoms of HPV
```
Genital warts (condylomata acuminata)
Chronic vaginal discharge
Pruritius
Dysparenunia
Most women with HPV do not have any symptoms at all
```
49
Complications for HPV
Cervical Cancer
Other HPV cancers
Recurrent Respiratory Papillomatosis (RRP)
*If warts in throat EDUCATE**
50
Screening for HPV
Complaints of profuse, irritating vaginal discharge, itching, dysparenuia, or postcoital bleeding
Complaints of "bumps"
Known exposure
51
Diagnosis for HPV
```
Thorough history and physical
Pap test
HPV-DNA
No test for men
No test to check throat
```
52
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
53
Management of HPV
Prevention:
- Gardasil-vaccine approved for both males and females
- Cervarix-vaccine for females
54
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
55
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
```
56
Complications of HSV
```
Painful genital ulcers
Rare:
-Blindness
-Encephalitis
-Aseptic Meningitis
```
57
Diagnosis for HSV
Thorough history and physical
Viral Culture
NAAT
58
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
59
Treatment for HSV
```
NO CURE
Daily suppressive treatment:
-Acyclovir
-Valacyclovir
-Famciclovir
```
60
Management for HSV
```
Clean lesions to prevent secondary infection
Oral analegesics
Counseling
EDUCATION
Abstain from sex when symptoms present
```
61
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
62
Neonatal Herpes
```
Involves all organs
Disseminated infection
Localized CNS disease
Localized infection
Herpes keratitis (high morbidity)
```
63
Inflammation of the liver and a group of viral infections that affect the liver
Hepatitis (A, B, C)
64
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
65
Risk Factors for Hepatitis A
Living in western US, Native Americans, Alaskan Natives, and Children/Employees in daycare centers
66
Symptoms for Hepatitis A
Flu-like:
- Malaise
- Fatigue
- Anorexia
- Nausea
- Abdominal Pain
- Dark Urine
- Clay Colored Stools
- Jaundice
67
Hepatitis A is...
Self limiting
May need hospitalization due to dehydration
Avoid medications metabolized in liver
Get Hep A vaccine
68
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
69
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
```
70
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
```
71
Serology
```
HBsAg
IgM anti HBc (recent or acute infection)
Anti-HBs
HBeAg
HBeAB
```
72
HbsAg negative
anti-HBc positive
anti-HBs positive
Immune due to natural infection
73
HBsAg negative
anti-HBc negative
anti-HBs positive
Immune due to vaccination
74
HBsAg positive
anti-HBc positive
anti-HBs negative
IgM anti-HBc positive
Acute infection
75
HBsAg positive
anti-HBc positive
IgM anti-HBc negative
anti-HBc negative
Chronic infection
76
Treatment for Hep B
Acute- no medication available
| Chronic- antiviral drugs
77
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
78
Most common blood borne infection in the US
3.2 million people chronically infected
No vaccine available
Hepatitis C
79
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
```
80
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
```
81
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
```
82
Testing Hep C
Anti-HCV
RIBA
HCV RNA
Liver enzyme tests
83
Most infants infected with Hep C at birth have no symptoms and do well during childhood
I LOVE Y'ALL!!! :)
84
Protozoa STIs
Trichomoniasis
85
Very common STI
| Caused by protozoan Trichomonas vaginalis
Trichomoniasis
86
Risk Factors for Trichomoniasis
Unprotected sex
| Older women
87
Symptoms for Trichomoniasis
70% do not have symptoms
| Unpleasant sex
88
Symptoms continued...
Men:
- Itching/irritation in the penis
- Burning after urination or ejaculation
- Penile discharge
89
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
90
Diagnosis for Trich
Thorough history and physical
Pap tests
Wet prep
Vaginal culture
91
Treatment for Trich
Metronidazole 2 gram PO x 1 dose
Treat all partners
Use barrier form of birth control
92
```
An acronym for a group of five infectious diseases:
Toxoplasmosis
Other (Hepatitis B)
Rubella (German measles)
Cytomegalovirus (CMV)
Herpes Simplex Virus (HSV)
```
TORCH
93
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
