ch. 7 STI Flashcards
prevention
1) types:
- reproductive tract infections
- sexually transmitted infections (STIs)
2) primary prevention:
- the most effective way of reducing STI’s in women
- education: middle school/high school
3) secondary prevention:
- prompt diagnosis and treatment of current STI’s can prevent personal complications and transmission to others
prevention: risk reduction measures, reproductive coercion
1) risk reduction measures:
- knowledge of partner
- participating in a long term monogamous relationship with a partner known to be uninfected with an STI
- partner services (tinder)
- low risk sex (foreplay)
- avoiding exchange of body fluids (oral, blood, open cuts, anal sex)
- education on the influence of drug and/or alcohol use on sexual behavior
- avoid douching (strips protective vaginal layer)
2) reproductive coercion:
- not all women are in safe, healthy sexual relationships
- non-judgemental attitude by nurses is especially important (seek to understand)
prevention: reduction measures
1) physical barriers:
- condoms (male/female)
2) chemical barriers:
- nonoxynol 9: NOT recommended for prevention of HIV or STI’s
3) communication:
- expressing feelings and fears
- attention to partner’s response
- nurses must suggest strategies to enhance a woman’s condom negotiation and communication skills
4) vaccination:
- hep B
- HIV (pfizer)
BACTERIAL STI (chlamydia trachomatis (#1))
1) most common and fastest spreading STI
- infections often silent and highly destructive
- in 2019, rates were highest among black women, at slightly more than five times the rate among white women
2) screening and diagnosis:
- asymptomatic and pregnant women
- difficult from diagnose; CDC recommends nucleic acid amplification test (NAAT) for diagnosis (good vaginal/rectal cultures)
- recommended yearly screening of all sexually active women younger than age 25 years and women older than 25 years at high risk (multiple partners)
3) mgmt:
(a) doxycycline
(b) azithromycin
(c) levofloxacin
BACTERIAL STI (gonorrhea)
1) aerobic gram negative diplococcus
- second to chlamydia in reported cases
- women often asymptomatic
2) screening and diagnosis:
- CDC recommends screening all women at risk
- all pregnant women younger than AGE 25 and those older than 25 at high risk should be screened at first prenatal visit and retested during the third trimester (37-38 weeks)
3) mgmt:
- antibiotic therapy (same chlamydia)
- concomitant treatment for chlamydia
- perinatal complications of gonococcal infection
tip:
- transmission by vaginal, anal, oral sex
- inflammed cervix, purulent discharge
BACTERIAL STI (syphilis)
1) caused by treponema pallidum (motile spirochete)
2) complex disease that can lead to systemic problems and even death
3) infection manifests in distinct stages (3):
(a) primary: 5-90 days after exposure (flu like sx., canker sores, painless)
(b) secondary: 6 weeks - 6 months (copper spots, arrhythmic sx. -> fibromyalgia)
(c) tertiary: develops in 1/3 women infected (crossed blood brain barrier)
- 2/3 males
- CNS affect, brain damage
4) rates highest in women ages 20-29 years, black women
- allergic: will desensitize before reaching PCN
5) screening/diagnosis:
(a) 2 types serologic tests (blood tests):
- nontreponemal screening tests (VDRL, RPR)
- treponemal diagnostic test (FTA-ABS, TP-PA)
6) mgmt:
- penicilin G: kills bacteria of syphilis (allergic/desensitized? -> second line)
- sexual abstinence during treatment; follow up with medical provider (don’t write extra script for male, county health department can take care)
BACTERIAL STI: pelvic inflammatory disease (PID)
1) an infectious process that most commonly involves the fallopian tubes, uterus, and occasionally the ovaries and peritoneal surfaces
2) multiple organisms have been found to cause PID
3) risk factors:
- young age
- nulliparity
- multiple partners (new?)
- high rate of new partners
- history of STIs and PID
4) those with PID are at increased risk for:
- ectopic pregnancy
- infertility
- chronic pelvic pain
5) symptoms:
(a) depends on types of infection:
- acute:
- subacute:
- chronic:
6) screening and diagnosis:
- difficult to diagnose because of accompanying variety of symptoms
- CDC routine criteria
7) mgmt:
- prevention (primary)
- treatment with broad spectrum antibiotic
- education
8) women with a history of PID may still choose IUD as a contraceptive method
tip:
- sign: PID shuffle -> sepsis/scarring -> risks
VIRAL STI: human papillomavirus (HPV)
1) condylomata acuminata = genital warts
2) MOST COMMON viral STI: seen in ambulatory health care settings
3) there are over 150 types of HPV
4) primary cause of: cervical cancer
- HPV #16 & 18 = highest risk for cervical & penile cancer
5) screening and diagnosis:
- history of known exposure
- physical inspection
- pap test (21 years)
- ACS strongly advocates for phasing out of cytology based options and moving to hrHPV testing as preferred screening option for average risk women aged 25-65 years
6) mgmt:
- HPV often resolves spontaneously in young women
- removal if needed, to help with symptoms
- no thearpy has been shown to eradicate HPV
- medications; counseling
7) prevention: HPV vaccines are available
TIP:
- can get in secondary syphilis
- tx: podophalan, tricholertic acid, burn off with acid
- medical: laser to cauterize off
VIRAL STI: HSV (herpes simplex virus)
1) herpes simplex virus 1 (HSV 1):
- usually transmitted nonsexually
- touching hepatic lesions, canker sores on mouth
2) herpes simplex virus 2 (HSV 2):
- usually transmitted sexually
3) initial infection characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria and may last 2-3 weeks
- active lesions breast -> can’t breastfeed, active genital warts -> no vaginal birth, c section only
3) what:
(a) chronic and recurring disease for which there is no known cure
(b) systemic antiviral medications partially control the symptoms:
- acyclovir
- valacyclovir
- famcoclovir
4) maternal infection with HSV can have adverse effects on mother and fetus
5) stress, menstruation, trauma, febrile illnesses, chronic illnesses, and ultraviolet light can trigger outbreaks (beach)
6) cesarean birth is recommended if visible lesions are present (active lesions)
VIRAL hepatitis
Five different viruses (Hep A-E) account for almost all cases of viral hepatitis in humans
Hep D/E viruses are common among users of IV drugs and recipients of multiple blood transfusions
hepatitis is disease of the liver
hepatitis A
- acquired primarily through a fecal-oral route
- HAV vaccine and immunoglobulin for IM administration are effective in preventing most HAV infections
- characterized by flu like symptoms with malaise, fatigue, anorexia, nausea, pruritis, fever, and right upper quadrant pain
tip:
- A = anus
- unclean veggies/fruits
hepatits B
- most threatening to the fetus and neonate
- disease of the liver and often a silent infection
- transmitted parenterally, perinatally, and rarely through insemination and blood transfusions, and through intimate contact
- vaccination series available
- all at risk and pregnant women should be screened
- no specific treatment: client education includes explaining the meaning of HBV infection and describing transmission, state of infectivity, and sequelae (wears off overtime 10-15 years)
hepatitis C
1) most common chronic bloodborne infection in the US
2) risk:
- STI’s such as HBV/HIV
- multiple sexual partners
- history of IV drug use or blood transfusions (contaminated needles)
3) CDC recommended one time testing of adults age 18 years and older without prior determination of HCV risk factors
- NO VACCINE available, but HCV infection is CURABLE
4) treatment for HCV is available for women after giving birth
VIRAL STI: human immunodeficiency virus (HIV)
1) 2018 - approximately 23% of HIV infected were women
- men 5x greater than women
2) transmission of HIV occurs primarily through exchange of body fluids (cuts, exposure)
3) severe depression of the cellular immune system associated with HIV infection characterizes AIDs
- decreased t cells, <200 t cells
4) sx:
- fever
- headache
- night sweats
- malaise
- generalized lymphadenoapthy
- myalgias
- nausea
- diarrhea
- weight loss
- sore throat
- rash
5) screening and diagnosis:
- antigen/antibody combination tests
- detection: HIV antibodies detectable in 95% or more of persons within 3 months after infection
6) counseling for HIV testing:
- counseling before/after HIV testing is standard nursing practice today
- HIV testing offered early in pregnancy (have to consent)
- perinatal transmission decreases (if (+) HIV, start antiviral meds)
- consider confidentiality and documentation
- pretest and posttest counseling
- notifications of results
7) mgmt:
- RN must establish what the woman knows about HIV already (suicide prevention, financial assistance, legal advocacy)
- pregnancy can cause adverse health risk (contraceptive counseling important)
- prevention of transmission: NO CURE YET
8) HIV/pregnancy:
- CDC recommends women with HIV be offered antiretroviral therapy (ART) asap and linked to care with a HIV/communicable disease specialist
- perinatal transmission has decreased d/t antiretroviral prophylaxis
- antiretroviral therapy
- the decision to have a c birth vs vaginal birth is dependent on the degree of viral load
tip:
- must be consented for
vaginal infections: vulvovaginitis
inflammation of the vulva and vagina
- various causes
vaginal infections: bacterial vaginosis (BV)
1) most common cause of vaginal symptoms
2) RF:
- new/multiple sex partners
- douching
- lack of condom use
- lack of vaginal lactobacili
- “fishy” odor
- treatment of BV w/ oral or gel metronidazole (flagyl) and clindamycin cream are equally effective
vaginal infections: candidiasis
1) vulvovaginal candidiasis (VVC) or yeast infection - 2ND MOST common type of vaginal infection
2) most common organism: candida albicans or C.albicans infection
3) predisposing factors:
- antibiotic therapy
- diabetes
- pregnancy
- obesity
- diets high in refined sugars
- use of corticosteroids and hormones (BC pills)
- immunosuppressed states
4) common symptoms:
- vulvar pruitus
- vaginal pruritus
5) screening and diagnosis
- physical examination (speculum exam)
- vaginal pH
6) mgmt:
- OTC agents
- intravaginal treatment or oral agent (mecanozole/fungal treatment)
- full course of treatment must be completed
- other comfort measures (good underwear)
vaginal infections: trichomoniasis
1) caused by trichomonas vaginalis: an anaerobic one celled protozoan with characteristic flagellae
2) almost always sexually transmitted
3) common cause of vaginal infection
4) inflammation of the vagina and/or vulva (smelly discharge)
5) screening/diagnosis
- NAAT test recommended: most sensitive
- speculum examination with wet mount: NOT as accurate
6) mgmt/treatment:
- recommended treatment is metronidazole (flagyl) orally twice per day for 7 days or tinidazole orally in a single dose
- risk for sexual transmission must be commmunicated to infected women
TIP:
- have to be tested/treated in 2 weeks
- treatment must be completed
STI concerns in the LGBTQIA community
- important to note that persons in LGBTQIA community are at risk for STIs
- women who have sex with women (WSW) are at risk for bacterial, viral, and protozoal infections
- sexual orientation does NOT mean that those in this community are low risk for STIs
- effective screening by health care providers requires discussion of sexual orientation and open, accepting manner
maternal and fetal effects of STIs
1) STI’s in pregnancy are responsible for significant morbidity and mortality
2) TORCH infections: form group of infections capable of crossing the placenta and adversely affecting the fetus
- toxoplasmosis
- other infections (eg. hepatitis, HIV)
- rubella virus
- cytomegalovirus
- herpes simplex virus (HSV)
infection control: all states require these STIs be reported to public health officials
1) syphilis (including congenital syphilis)
2) gonorrhea
3) chlamydia
4) HIV infections, AIDS
a nurse is providing discharge instructions to a client who has just been diagnosed with HOV on her cervix. what is the most important discharge instruction for this client
have pap tests done as recommended by her provider
