Chapter 34 Flashcards
1
Q
diagnostic evaluation of breast disorders
A
- U/S exam can differentiate fluid filled cysts from solid tissue (more likely to be malignant)
- fine needle aspiration (FNA): can be done to remove fluid or small tissue fragments for analysis of cells
- core biopsy: uses a larger needle to obtain a cylinder of tissue from an area of questionable breast tissue
- open/surgical biopsy: performed to remove all/part of the lump if other conditions exist like bloody fluid aspirated, recurrence of cyst after 1 or 2 aspirations, solid dominant mass, serous/serosanguineous nipple discharge, signs suspicious of inflammatory breast cancer, suspicious mammography
2
Q
Fibrocystic Breast Changes
A
- benign breast disorder
- common changes that occur during the reproductive years before menopause
- fibrosis (thickening) of breast tissue occurs in early stages
- cysts form later
- not cancerous, but if involved in terminal breast ducts may inc risk of cancer
- common symptoms: pain and tenderness
- pain is bilateral and most noticeable during PMS
- pain likely due to imbalance of estrogen to progesterone ratio
- to help manage: wear supportive bra, avoid caffeine and stimulants, oral contraceptives
- can use some pharmacological methods like Danazol to suppress estrogen production but this can only be ued for 4-6 mos
3
Q
Fibroadenoma
A
- benign breast tumor
- most common during teens-20s
- firm, freely mobile nodules that may or may not be tender
- do not change during mentrual cycle
- usualy located in upper, outer quadrant
- tx: careful observation to ensure that it is stable
- may excise the mass if changes in size
4
Q
ductal ectasia
A
- benign
- occurs as a woman approaches menopause
- characterized by dilation of collecting ducts, which become distended and filled with cellular debris
- this initiates an inflammatory response which results in a mass near the areola that feels firm/irregular, enlarged axillary nodes, nipple retraction and discharge
- must have a biopsy b/c S/S are similar to breast cancer
5
Q
intraductal papilloma
A
- benign
- often develops just before or during menopause
- occurs when papillomas (small elevations) develop in the epithelium of the ducts under the areola
- as it grows, it causes trauma and erosion w/in the ducts that leads to serous/bloody discharge from the nipple
- U/S and mammography aid in dx
- tx: excision of mass plus analysis of nipple discharge
6
Q
nursing considerations for benign disorders of breast tissue
A
- acknowledge anxiety
- they may find it helpful to learn that most breast disorders are benign
- explain diagnostic procedures
- teach about what the procedure entails and how long the woman will have to wait for results
7
Q
carcinoma in situ
A
- malignant neoplasm in surface tissue
- lumpectomy is usually performed
8
Q
incidence of malignant tumors of the breast
A
- white women after age 35 have a higher incidence than African American women
- but African American women have a higher incidence until the age of 35
- African American women have a higher risk of dying from breast cancer
- b/c of faster growing tumors and diagnosed more often at a more advanced stage
- Asian American, Hispanic, and Native Indian have a lower risk of developing cancer
9
Q
risk factors for malignant turmors of the breast
A
- mutations in BRCA1/2 are thorught to be responsible for most cases of familial breast and ovarian cancer
- mutation of CHEK-2 has higher risk of development of breast cancer in men and women
- mutation of p53 tumor suppressor gene has been assoc with breast cancer
10
Q
inflammatory breast cancer
A
- has cutaneous findings w/ invasive involvement in the dermis
- rare but more likely to occur in younger or African American women
- aggressive and may manifest as a pink or red skin rash
- tenderness, itching, or breast edema may be present
- often seems like an infection, so prescribed abx, so if the rash doesn’t go away, contact HCP
11
Q
staging of breast cancer
A
- based on TNM: tumor, node, metastasis
- Stage 1: small tumor w/o lymphatic involvement in the local area or metastases
- Stage 4: indicates spread to LNs and metastases to distant organs
12
Q
lumpectomy
A
- involves wide local excision of the tumor to microscopically clean margins for tumors that are small relative to the breast size
- AKA breast conservation tx
- can be performed w/o deformity
- some axillary LNs are removed to identify stage of breast cancer
13
Q
mastectomy
A
- simple mastectomy: removal of the entire breast
- axillary dissection is omitted, but some LNs may be removed
- can also be used prophylactically, but if no cancer present, does not eradicate risk for later breast cancer
- do not take BP on affected side
14
Q
radiation therapy
A
- a type of adjuvant therapy
- known to improve chance of long term survival
- uses high energy rays to destroy cancer cells that remain in the breast, chest wall, and underarm area after surgery
- also irradiate LNs above clavicle and the internal mammary LNs
- skin over affected area may have rxn similar to sunbrun
- lymphedema is more likely to occur if axillary LNs are treated
15
Q
chemotherapy
A
- designed to kill the proliferating cancer cells
- combo of drugs and # of tx varies for each woman
- may both precede and follow tumor removal
- often kill normal cells (esp those rapidly dividing like in mucosa, blood cells, and platelets)
- often leads to sore, bleeding gums; susceptibility to infection; loss of head/body hair; menstrual irregularities; anemia (and fatigue)
- antiemetics are often used for woman on chemo
16
Q
hormone therapy
A
- reduce production of estrogen b/c many tumors are estrogen/progesterone receptor positive
- tamoxifen: estrogen blocking drug
- some tumors become resistant and the drug may actually stimulate their growth
- may elevate calcium, cholesterol, and triglycerides
- anastrzole, exemestane, and letrozole: aromatase inhibitors which hinder production of estrogen
- raloxifene: estrogen modifier which reduces osteoporosis by blocking estrogen receptors
17
Q
immunotherapy
A
- trastuzumab (herceptin) is a biologically based therapy that targets cell pathways that promote cancer growth
- some tumore produce excessive amounts of the HER-2 protein which promotes cell growth, but this drug blocks this protein to inhibit growth of cancer cells
18
Q
nursing considerations of breast cancer
A
- emotional support and accurate info need to be provided to the woman
- woman needs time to express her feelings
- nurse should be empathetic
- provide a clear understanding of procedures and care to help reduce anxiety
- lymphedema: caused by blockage drainage of lymphatic system in the arm on the side of the mastectomy
- compression arm sleeves help control lymphedema
- discharge teaching: self care and need for continued care/tx
- teach how to reduce risk of infection, how to care for arm on affected side, S/Es post op and from meds,
- teach how to empty drains
19
Q
amenorrhea
A
- absence of menses
- normal: before menarche, during pregnancy, during puerperium and lactation, and after menopause
- abnormal: at other times
20
Q
when should mentrual periods begin?
A
- mentrual periods should begin w/in 2 yrs of breast development
- b/w the ages of 9-15 yo
21
Q
primary amenorrhea
A
- considered if onset of menstrual periods has not occurred by 16.5 yo, particularly if associated sexual changes have not taken place
- may be suspected if the girl is more than 1 yr older than the ages at which her mother/sisters had menarche
- causes:
- genetic: ovarian failure
- may occur in girl w/ Turner’s Syndrome (X); hormonal imbalances; cancer
- systemic
- low body weight for height (athletes, eating disorders), chronic stress, hypothyroidism, CNS dz, drug use
- genetic: ovarian failure
- mgmt: depends on cause
- counseling
- hormone therapy
22
Q
secondary amenorrhea
A
- cessation of menstruation for 6 mos or more in a woman who had established a pattern of menstruation, or absence for duration of 3 normal cycles
- causes:
- pregnancy
- systemic dz: DM, TB, hypothyroidism, CNS lesions, hormonal imbalance, poor nutrition, hormonal contraceptives
- stressors
- tx: tx the cause
- pregnancy test
- hormone level testing
- tx of anovulation
- ID of other abnormalities
- PCOS: characterized by acne, excess weight, body hair
23
Q
nursing considerations w/ amenorrhea
A
- emotional support
- teaching about adequate nutrition and exercise as well as discouraging rigourous dieting
- weight control may reduce factors related to PCOS
24
Q
abnormal uterine bleeding
A
- menorrhagia: prolonged or heavy bleeding
- metrorrhagia: bleeding that is irregular and occurs b/w periods
- menometrorrhagia: combo of the previous 2
25
Q
etiology of abnormal uterine bleeding
A
- pregnancy complications (ie spontaneous abortion)
- anatomic lesions, either benign or malignant, of vagina, cervix, or uterus
- drug induced bleeding, such as breakthrough bleeding that may occur in woman taking hormonal contraceptives
- systemic disorders, such as DM, uterine myomas (fibroids), and hypothyroidism
- failure to ovulate
26
Q
abnormal uterine bleeding: mgmt
A
- evaluation may include pregnant test, coagulation studies, and test to determine if ovulation is occurring
- hormone and liver function tests as well as tests to determine anemia are done
- U/S may be used to look for polyps
- hormone tx: progestin-estrogen combo oral contraceptives that suppress ovulation and allow a stable endometrial lining to form
- surgical therapy: D&C to remove polyps or to diagnose endometrial hyperplasia
- may use laser ablation to remove the endometrial lining w/o hysterectomy
27
Q
abnormal uterine bleeding: nursing considerations
A
- encourage women to seek medical attn promptly when irregular or prolonged bleeding occurs
- help woman keep record of bleeding episodes and amount of blood lost
- noting vaginal bleeding and pads/tampons saturated each day
- encourage importance of adequate nutrition and discourages rigorous dieting
- provide support for women who fear that irregular bleeding indicates a serious dz
- but do not offer false reassurance
28
Q
menopause
A
- the end of mentruation
- climacteric: the entire process of menopause including endocrine, somatic, and psychic changes that occur at the end of the reproductive period
- premenopause: early part of climacteric
- before menstruation but after the woman experiences some of the climacteric S/S like irregular menses
- perimenopause: include premenopause, menopause, and at least 1 yr after menopause
- postmenopause: phase after menopause when menstrual periods have ceased
- unexpected bleeding during this period should be investigated ASAP b/c may indicate endometrial cancer
29
Q
age of menopause
A
- avg age is 51.5 yrs
- natural climacteric takes place over 3-5 yrs
- menopause can be induced or created artificially at any age
- surgical removal of ovaries or destruction of the ovaries by radiation/chemo causes abrupt cessation of ovarian function
- most common reason for these procedures is tx of cancer or endometriosis
30
Q
physical changes of menopause: ovulation, estrogen, hot flashes
A
- ovulation is sporadic and mentrual periods are irregular during premenopause
- eventually ovulation, menstruation, and secretion of ovarian hormones cease
- estrogen declines and organs of reproduction regress
- labia: thin and pale
- vaginal mucosa: atrophies
- vaginal tissue loses lubrication and dyspareunia is common
- frequent vaginal infections–>atrophic vaginitis
- LDL increases and HDL decreases
- hot flashes: result of vasomotor instability
- cause is associated with inc secretion of gonadotropins
- more frequent at night and fatigue often results
31
Q
physical changes of menopause: testosterone, osteoporosis, heart dz
A
- decreased testosterone levels:
- changes in libido
- mood changes
- sleep changes b/c of dec tryptophan (serotonin precursor)
- osteoporosis risk inc
- heart dz risk inc
32
Q
physical effects on the woman’s body from menopause
A
- remains orgasmic
- pendulous breasts
- atrophy of ovaries, vagina, and fallopian tubes
- thinning of pubic hair
- labial regression
- vaginal dryness
- smooth, thin mucosa w/ decreased ruggae and elasticity
- vaginal pH inc
33
Q
psychological aspects of menopause
A
- influenced by:
- the woman’s expectations
- accurate knowledge
- general physical well-being
- family view
- marital stability
- socio-cultural expectations
- greater stability = easier transition
- often times menopause brings about coming to terms with aging: no longer can have a child, becoming grandparents
- S/S: mood swings, depression, irritability, agitation, insomina, fatigue
34
Q
recommendations during menopause
A
- consult HCP about botanical preparations
- maintain/establish adequate nutrition
- use water soluble lubricants
- regular exercise
- kegel exercises
- modest caffeine and alcohol
- drink 8 glasses of H2O
35
Q
therapy for menopause
A
- hormone replacement therapy (HRT): combination of estrogen and progesterone replacement therapy
- ACOG stopped recommending it in 2002
- WHI:
- inc risk of breast cancer and heart dz w/ combo of estrogen and progesterone replacement therapy
- inc risk of strokes w/ estrogen replacement therapy
- contraindications: unexplained uterine bleeding, endometrial cancer
- also smoking, HTN, diabetes, CV dz, renal/liver dz, seizures, migraines, gallbladder/pancreatic dz
36
Q
nursing considerations during menopause
A
- help women understand the changes that may occur
- edu about risks and benefits of HRT if prescribed
- teach them about the recommendations for uring water soluble lubricants to relieve vaginal dryness and dyspareunia
- do Kegel exercises to counteract genital atrophy
- drink at least 8 glasses of water/day to dec conc of urine, flushes urine from bladder, and reduces bacterial growth
- wipe front to back to prevent cystitis
37
Q
osteoporosis
A
- characterized by dec bone density which leaves the bones porous, fragile, and susceptible to fracture
- fractures most common in vertebrae, wrists, and hips (but also in forearms, feet, toes)
- assoc with lower estrogen and androgen levels
38
Q
risk factors of osteoporosis
A
- combination of peak bone density and rate of bone loss influences severity of osteoporosis
- small boned, fair skinned white women of northern European descent and Asian women are at greatest risk for osteoporosis
- family hx of dz
- late menarche
- early menopause
- sedentary lifestyle
- smoking, drinking alcohol, consumption of excessive caffeine
- drug intake of cortiocosteroids, some anticonvulsants, or aromatase inhibitors for rbeast cancer may reduce bone density
- inadequate intake of vit D and calcium
39
Q
S/S of osteoporosis
A
- first noticeable sign is loss of height and back pain that occurs when vertebrae collapse
- later signs include dowager’s hump (when vertebrae can no longer support the upper body in an upright position), waist disappears, abdomen protrudes as rib cage moves closer to the pelvis
- dx requires a hx, exam, and bone mineral analysis
40
Q
DXA bone density scan
A
- may be recommended if:
- over 50 and have a broken bone
- you are a woman over 65 or a man over 70
- yo are in menopause or past menopause and have risk factors
- you are a man age 50-69 w/ risk factors
- uses low dose x-rays to measure bone density in the hip and spine
- can confirm osteoporosis and detect low density before a frx and predict a frx
- repeated scans determine rate of bone loss and monitor tx effectiveness
41
Q
prevention of osteoporosis
A
- dec alcohol, caffeine, smoking
- Fosamax (alendronate) or Bisphosphonate to slow bone thinning and improve thickness
- Evista (raloxifene): prevents/txs and decreases cholesterol
- calcium: 1200-1500 mg/day
- vitamin D: 400-800 units/day
- regular weight bearing/resistance exercise
- diet high in vitamins E, D, and B complex
- protein: 80 grams/day
42
Q
Bisphosphonates
A
- class of drugs that slows bone thinning and improves thickness
- used to prevent and tx postmenopausal osteoporosis
- may be contraindicated if a woman has an ulcer or dysphagia or esophagitis
- ie Alendronate, Ibandronate, Risedronate, Zoledronic acid
- may inc risk of venous thromboembolism and death from stroke
43
Q
nursing considerations for osteoporosis
A
- counsel women about lifestyle factors that can cause bone loss: smoking, alcohol, caffeine
- counsel adolescents and young women about factors to promote ideal peak bone density
- prevention of falls
- make environment safe: ample lighting, no loose electrical cords, nonskid backing on rugs, grab bars , handrails
44
Q
S/S of ovarian cancer
A
- bloating
- pelvic or abdominal pain
- trouble eating or feeling full quickly
- feeling the need to urinate urgently or often
- fatigue
- upset stomach or heartburn
- back pain
- dyspareunia
- constipaion or menstrual changes
- persistent vaginal itching
- blood in stool
45
Q
risk factors for ovarian cancer
A
- menses started at <12 yo
- no child or first child after 30 yo
- late menopause (>55 yo)
- infertility
- family hx of ovarian, breast, or colorectal cancer
- personal hx of breast cancer
46
Q
prevention of ovarian cancer
A
- oral contraception
- breast feeding and pregnancy
- tubal ligation
- hysterectomy
- prophylactic oophorectomy
47
Q
ovarian cancer: diagnosis
A
- pelvic exams
- transvaginal sonography
- CA-125 tests
- BRCA test
48
Q
ovarian cancer treatment
A
- earliest stage: total abdominal hysterectomy, bilateral salpingo–oophorectomy, removal of ovarian tissue
- surgery followed by chemo
- but sometimes do chemo to reduce tumor’s size, then a hysterectomy or a salpino-oophorectomy
49
Q
Pelvic Inflammatory Dz
A
- infection of the upper genital tract
- can lead to ectopic pregnancy or infertility
- more likely to develop if under 25 b/c cervix is not mature which inc the susceptibility to infectious organisms
- also inc risk of infection if multiple sex partners
- douching inc risk for PID b/c canges natural vaginal flora
50
Q
etiology of PID
A
- most from C. trachomatis and N. gonorrhoeae
- some also caused by E. coli, streptococcus, group B strep. CMV
- organism invades endocervical canal where they cause cervicitis
- the organisms ascend and infect the endometrium, fallopian tubes, and pelvic cavity
- chronic inflammatory response results in tubal scarring and peritubal adhesions which interfere with conception or w/ transport of fertilized ovum thru the obstructed falloppian tubes to the uterus
51
Q
S/S of PID:
A
- pelvic pain
- fever
- purulent vaginal discharge
- anorexia
- irregular bleeding
- physical exam: abdominal or adnexal (accessory organ) tenderness and tenderness of the uterus/cervix during bimanual exam
- labs:
- leukocytosis: inc WBC
- inc sedimentation rate
- positive cultures
52
Q
mgmt of PID
A
- IV abx–broad spectrum
- cefoxitan
- cefotetan
- clindimycin + gentomycin
- usually changed to PO after 48 hrs and total duration of abx is usually 14 days
- laparoscopy can rule out surgical emergencies like appendicitis or ectopic pregnancy and to obtain cultures
53
Q
nursing considerations for PID
A
- prevent STDs to prevent PID: teach about this and how to prevent
- primary prevention: avoiding exposure to dz or preventing acquisition during exposure
- limiting # of sexual partners, avoid intervourse w/ those who had multiple partners, avoiding high risk behaviors like injectable drugs, condoms
- secondary prevention: keeping a lower genital tract infection from ascending to the upper genital tract
- seek medical attn promptly, periodic medical assessment, taking meds as prescribed
- primary prevention: avoiding exposure to dz or preventing acquisition during exposure
54
Q
toxic shock syndrome (TSS)
A
- caused by a strain of S. aureus
- rare, potentially fatal
- toxin alters capillary permeability which allows intravascular fluid to leak from the blood vessels, leading to hypovolemia, hypoTN, and shock
- toxin also causes tissue damage and defects in coagulation
- assoc with high absorbency tampons, cervical caps, diaphragm
55
Q
danger signs of TSS
A
- suddenly spinking a fever (102 F, 38.9 C)
- siarrhea
- vomiting
- muscle aches, sore throat
- sunburn like rash
- hypoTN
56
Q
nursing considerations for TSS
A
- tx includes fluid replacement, vasopressor drugs, antimicrobial therapy
- instruct women to:
- tampon use:
- wash hands before insertion
- change tampons q4 hrs to prevent excessive bacterial growth
- do not use superabsorbent tampons
- use pads during hours of sleep
- diaphragm/cervical cap:
- wash hands
- do not use during menstrual period
- remove w/in time recommended
- tampon use:
57
Q
cystocele
A
- occurs when weakened anterior wall of the vagina can no longer support the weight of urine in the bladder, so the bladder protrudes downward into vagina
- results in incomplete emptying of bladder
- cystitis likely to occur
- stress urinary incontinence may occur due to the urethral displacement when the urethra bulges into the anterior vaginal wall
58
Q
enterocele
A
- prolapse of upper posterior vaginal wall b/w the vagina and rectum
- most assoc with herniation of pouch of Douglas (fold of peritoneum dips down b/w rectum and uterus)
- often accompanies uterine prolapse
59
Q
rectocele
A
- occurs when posterior vagina becomes weak and thin
- each time woman strains at defecation, feves are pushed against the thin wall and cause further stretching until the rectum protrudes into vagina
- if large, may have problems emptying rectum
- some women facilitate bowel elimination by applying pressure along the posterior vaginal wall to keep rectocele from protruding during bowel movement
60
Q
uterine prolapse
A
- occurs when cardinal ligaments are unduly stretching during pregnant and do not return to normal
- allows the uterus to sag backward and downward into vagina
- common if woman has had many vaginal deliveries or when infants are large
- significance: when uterus is displaced, it impinges on other structures in lower abdomen
- bladder, rectum, and small intestine can protrude thru vaginal wall
61
Q
symptoms of uterine prolapse
A
- most obvious during menopausal period
- b/c estrogen diminishes leading to atrophy of the supporting structures
- most common:
- feelings of pelvic fullness
- dragging sensation
- pelvic pressure
- fatigue
- low backache
- sexual problems related to arousal, orgasm, and painful vaginal intervourse
62
Q
mgmt of uterine prolapse
A
- tx depends on woman’s age, physical condition, sexual activity, and degree of prolapse
- surgery may be needed
- pessary: device to support pelvic structures that is inserted into the vagina
- must be inspected and changed frequently
63
Q
nursing considerations for uterine prolapse
A
- PFMT (kegel exercises): isometric, contract and relax slowly 8-12 times for 6-8 sec each and do 3 sets
- should not tighten muscles of abdomen, thighs, and buttocks
- exhale and keep mouth open and avoid bearing down
- continue for rest of life
- evaluate urinary incontinence: can be stress or urge
- overactive bladder may also occur and is accompanied by sensations of urgency and nocturia
- may need bladder training
- do not restrict fluid
- weight mgmt
- limit caffeine and alcohol
- skin care
- social isolation
64
Q
4 types of hysterectomies
A
- partial hysterectomy: only uterus removed
- total hysterectomy: both uterus and cervix are removed
- total hysterectomy w/ bilateral salpino-oophorectomy: both ovaries, fallopian tubes, uterus, and cervix are removed
- radical hysterectomy: both ovaries, fallopian tubes, uterus, cervix, and LNs are removed
65
Q
STIs
A
- can have an STI and not know it
- can know about an STI and not be honest
- genital skin/genital skin contact, oral/genital skin contact, oral/anal contact, blood, sexual fluids can spread an STI
- latex condoms are very effective
- abstinence and mutual monogamy w/ an uninfected partner is ideal
66
Q
Trichomoniasis
A
- protozoan
- thrives in an alkaline environment
- S/S: purulent vaginal discharge that is thin or frothy, malodorous, and yellow-green or brownish gray
- pH of discharge is usually greater than 4.5
- vulvar itching, edema, and redness may occur
- tx: metronidazole
- 2 g in a single oral dose
- avoid alcohol while on medication and for 24 hours after last dose
- sexaul partners should refrain from intercourse until cure is established
67
Q
Bacterial Vaginosis
A
- normal flora replaced
- tissue trauma and vaginal intercourse may be contributing factors
- as well as multiple partners, douching, and lack of vaginal lactobacilli
- S/S: thin, grayish white vaginal discharge w/ a fishy odor
- tx: based on re-establishing normal flora
- metronidazole: can relieve symptoms and improve vaginal flora
- clindamycin: alternative
- refrain from sexual intercourse until cured and use a condom
68
Q
chlamydia trachomatis
A
- most common STD
- most common in sexually active teens and young adults
- often asymptomatic in young women
- should be suspected if male partner is treated for nongonococcal urethritis and when culture for gonorrhea is negative, but woman has symptoms similar to gonorrhea
- if untreated, can ascend and scar fallopian tubes–>PID, infertility, ectopic pregnancy
- tx: eradicate both chlamydia and gonorrhea
- azithromycin, doxycycline, ofloxacin, levofloxacin, erythromycin
- treat al sexual partners
- must use condom until cured
69
Q
Gonorrhea
A
- caused by neisseria gonorrhea
- often asymptomatic in women
- S/S: purulent discharge, dysuria, dyspareunia
- assoc with PID (inc risk of infertility and ectopic pregnancy)
- tx: can use the same drugs as chlamydia tx as well as ceficine, ceftriaxone, and ciprofloxacin
- tx all sexual partners and avoid intercourse and wear condom until cure established
70
Q
syphilis
A
- caused by Treponema pallidum
- Primary: painless chancre usually on genitals or lips
- highly contagious
- Secondary: occurs 2 mos after initial infection
- enlargement of spleen and liver, skin rash, HA, anorexia, skin rash, skin eruptions on vulva
- Latent: for several years
- Tertiary: follows latent phase and may involve the heart, blood vessels, and CNS
- general psychosis and paralysis may result
- lab tests: Venereal dz Research Lab (VDRL) serum test to check for antibodies; rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS) confirm a positive VDRL
- penicillin G is most effective
71
Q
herpes genitalis
A
- caused by HSV: type 1 and 2
- type 1: oropharyngeal infection
- type 2: genital lesions
- transmission thru direct contact w/ infected person
- w/in 2-12 days after primary infection, vesicles (blisters) cluster on genitals
- may cause severe pain, tenderness, dyspareunia, and flulike symptoms
- when symptoms abate, virum remains dormant in nerve ganglia and reactivates in times of stress, fever, and menses
- no cure exists by antivirals help reduce/suppress symptoms, shedding, and reoccurrence (acyclovir)
- abstain from sex during times of active lesions
- C/S if blister present
72
Q
human papilloma virus (HPV)
A
- genital warts
- dry, wart like growths may be small and discrete, or they may cluster and resemble cauliflower
- most commonly on vulva, vagina, cervix, or anus
- assoc with cervical cancer, so need frequent pap smears
- tx: goal is to remove warts to prevent transmission
- topical tx: podophyllin, TCA, and BCA
- cryotherapy (extreme cold)
- laser vaporization
- all sexual partners must be treated and sexual contact should be avoided if lesions are present
- use a condom to reduce transmission
73
Q
candidiasis
A
- moniliasis and yeast infections are the most common forms
- cause is related to a change in vaginal pH that allows accelerated growth of Candida albicans
- change in pH likely with pregnancy, DM, OC use, abx, spermicide
- more common in sexually active women although not a STD
- male partners may experience erythema and itching of the glans penis
- S/S: vaginal and perineal itching, vulvar and vaginal tissue are inflamed and cause burning on urination, white “cottage cheese” discharge
- tx: butoconazole, miconazole, clotrimacole, terconazole, tioconazole
- most nonprescription meds are used for 3-7 days
- oral fluconazole can be used w/ prescription
- if severe, then may need another dose in 4 days
- recurrent yeast infections that resist tx are assoc with DM and HIV infection
