Chapter 11: Sexually Transmitted Infections

Question 1

Chlamydia Trachomatis

Answer 1

C trachomatis causes genital infections that are frequently asymptomatic and thus difficult to treat
-if do experience symptoms; vaginal discharge, dysuria, and on occasion, abnormal vaginal bleeding
-on speculum examination, cervix exhibits a mucopurulent discharge along with marked inflammation of the endocervix
>Treatment: oral anti-infectives such as erythromycin or penicillin-based agents used during pregnancy

Question 2

What Happens to the infant if exposed to C. Trachomatis?

Answer 2

neonatal infection, manifested as conjunctivitis or pneumonia, results from exposure to the pathogen during birth
-topical antibiotic therapy, administered during the immediate neonatal period, is adequate for treatment of chlamydial infection
>infants requires follow-up

Question 3

Neisseria Gonorrhea

Answer 3

co-exist with chlamydia
-most common site of infection is genitourinary tract
-Symptoms of infection: vaginal discharge, dysuria, and abnormal vaginal bleeding
-On speculum exam, reveals inflamed, friable (easy to bleed) cervix
-Treatment: ceftriaxone IM, cefixime PO, or injectable cephalosporins, plus azithromycin PO or doxycycline PO
>the amniotic infection syndrome can also happen in pregnancy with this infection; manifests as placental, fetal membrane, and umbilical cord inflammation that occurs after PROM and associated with oral and gastric aspirate, leukocytosis, neonatal infection, and maternal fever

Question 4

What happens to the infant born with mother who are infected with Neisseria Gonorrhea?

Answer 4

• at risk for disseminated infection (bacteremia)
• at risk for ophthalmia neonatorum (an eye inflammation) that can result in permanent blindness from perforation of the globe of the eye

Question 5

Syphilis

Answer 5

acute and chronic infection caused by the spirochete Treponema pallidum
-long clinical course that begins with an incubation period followed by primary, secondary, an tertiary infection; there is progressive damage to the CNS, cardiovascular system, and musculoskeletal system
>onset is appearance of a painless, round, ulcerated lesion with a raised border and hardened base; most commonly on vulva, cervix, and vagina
>Treatment: penicillin for all stages

Question 6

Human Papillomavirus Infection (HPV)

Answer 6

a sexually transmitted virus that causes condylomata acuminata (genital warts) and is the primary cause of cervical neoplasia
-Risk factors: early onset of sexual activity, multiple sex partners, cigarette smoking, and long-term use of oral contraceptives
-the warts grow rapidly during pregnancy and may involve the cervix, vagina, and vulva so extensively that vaginal delivery is precluded
-Treatment includes: trichloroacetic acid, dichloroacetic acid, cryotherapy, and surgical excision; best approach during pregnancy = excision of lesions by laser, electrocautery, or cryosurgery
-risk for transmission: HPV is present in maternal blood and can be transmitted transplacentally to the fetus
>receive vaccination to prevent HPV

Question 7

HIV and AIDs

Answer 7

HIV type 1 (HIV-1) infection, causes a slow but destruction of the immune system that ultimately results in AIDs

• HIV type 2 (HIV-2) infection has a more variable and benign course
• AIDs leading cause of death for young children
• HIV testing is offered pre-conceptually; if not taken place as early in pregnancy as possible
• repeat testing in third trimester, or rapid HIV testing during labor or birth; if reactive, immediate anti-retroviral prophylaxis should be recommended

Question 8

Factors that Increase the Risk of Transmission with HIV/AIDs

Answer 8

• unprotected sexual intercourse
• sexual contact with an uncircumcised man
• increased number of sexual contacts
• presence of genital sores
• advanced disease state
• presence of other sexually transmitted infections, especially those who have genital ulcers (e.g. herpes, syphillis)

Question 9

Vertical Transmission of HIV to fetus

Answer 9

proportional to the concentration of virus in maternal plasma (viral load)

• occurs ante-partally when the virus crosses the placenta
• intra-partally (when it travels via bloodstream from the vagina up into the uterus during labor or following rupture of the membranes
• post-partally through transfer in the breast milk

Question 10

Decreasing The incidence of STIs in women and children

Answer 10

• alert the pediatrician to the patient’s positive history of an STI
• counsel women in a nonjudgmental and compassionate manner about safe sex habits (i.e. use of condoms)
• encourage routine checkups and promptly report any signs and symptoms of an STI to their provider
• must take all medications prescribed and keep any follow-up appointments
• remind the patient that her partner must also be treated, and if he refuses, she must abstain from sex with him until he is treated
• always use standard precautions