Chapter 7 - Sexually Transmitted and Other Infections

Question 1

Reproductive Tract Infections

Answer 1

Sexually transmitted diseases (STDs)
Sexually transmitted infections (STIs)
Infections or infectious disease syndromes primarily transmitted by close, intimate contact
-Include more than 25 infectious organisms
-Bacteria, viruses, protozoa, and ectoparasites (lice and scabies)
-Cause tremendous human suffering

Question 2

Most common STIs in women

Answer 2

Chlamydia
Gonorrhea
Human papillomavirus
Herpes simplex virus type 2 
Syphilis
HIV infection

Question 3

Primary Prevention

Answer 3

Primary prevention the most effective way of reducing STIs in women
19 million Americans infected yearly-1/2 of them 15-24 yr olds

Question 4

Secondary Prevention

Answer 4

Prompt diagnosis and treatment can prevent personal complications and transmission to others

Question 5

Risk Reduction

Answer 5

Knowledge of partner
Reduction of the number of partners
Low risk sex
Avoiding exchange of body fluids
Immunization

Question 6

Risk Reduction Measures

Answer 6

Physical barriers - Condoms
Chemical barriers - Nonoxynol-9
Communication - Expressing feelings and fears, Attention to partner’s response
Vaccination

Question 7

Chlamydia trachomatis

Answer 7

Most common and fastest spreading STI
Infections often silent and highly destructive
Difficult to diagnose
PID scarring
15-19 yo highest rates of infection
(scarring end up being fertile when trying to get pregnant)

Question 8

Chlamydia trachomatis Screening and diagnosis

Answer 8

Asymptomatic and pregnant women

DNA probe

Question 9

Chlamydia trachomatis Management

Answer 9

Doxycycline
Azithromycin
Erythromycin (eye ointment on babies)
Amoxicillin

Question 10

Chlamydia trachomatis Perinatal transmission

Answer 10

Antibiotic ointment

Question 11

Gonorrhea

Answer 11

Aerobic gram-negative diplococcus
Oldest communicable disease in the U.S.
Second to chlamydia in reported cases
Highest rates among teenagers, young adults, and African-Americans
Women often asymptomatic
S/S: purulent discharge, menstrual irregularities, pain
Can have rectal gonorrhea

Question 12

Gonorrhea Screening and diagnosis

Answer 12

CDC recommends screening all women at risk
Testing during first trimester and at 36 weeks of pregnancy
Reportable disease

Question 13

Gonorrhea Management

Answer 13

Antibiotic therapy: cefixime or ceftriaxone PCN resistance 1 x IM
Treat partner-frequent reinfections

Question 14

Perinatal complications of gonococcal infection

Answer 14

Miscarriage
Preterm labor
Premature rupture of membranes 
Neonatal sepsis
Intrauterine growth restriction
Postpartum endometritis
Maternal postpartum sepsis

Question 15

Syphilis

Answer 15

Treponema pallidum, a motile spirochete
Earliest described STI
Transmission by entry in subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse
Also transmitted through kissing, biting, or oral-genital sex

Transplacental transmission may occur at any time during pregnancy

(can cure)

Question 16

Syphilis

Answer 16

Can lead to serious systemic disease and even death

Infection manifests itself in distinct stages

Question 17

Infection of Syphilis manifests itself in distinct stages

Answer 17

Primary: 5 to 90 days after exposure-chancre, painless papule, erodes to ulcer
Secondary: 6 weeks to 6 months-widespread rash, maculopapular, feel bad, painless, pink-gray, wartlike infectious lesions
Tertiary: develops in one third of women infected

Question 18

Syphilis Screening and diagnosis

Answer 18

-VDRL, RPR
Pregnant women
Serologic tests
False positives

Question 19

Syphilis Management

Answer 19

Penicillin

Sexual abstinence during treatment-monthly follow up

Question 20

Pelvic inflammatory disease (PID)

Answer 20

An infectious process that most commonly involves the fallopian tubes, uterus, and occasionally the ovaries and peritoneal surfaces
Multiple organisms have been found to cause PID

Question 21

Pelvic inflammatory disease (PID) Increased risk of

Answer 21

Ectopic pregnancy
Infertility
Chronic pelvic pain

Question 22

Pelvic inflammatory disease (PID) Symptoms

Answer 22

Lower abdominal tenderness, cervical motion tenderness 
Abx
Pain control (very painful to move cervix)

Question 23

Human papillomavirus (HPV)

Answer 23

Condylomata acuminata
Affects 20 million Americans
Most prevalent viral STI seen in ambulatory health care settings
Previously named genital or venereal warts
More frequent in pregnant women due to immunosupression

Question 24

Human papillomavirus (HPV) Screening and diagnosis

Answer 24

History of known exposure
Physical inspection-can get very large
Pap smear

Question 25

Human papillomavirus (HPV) Management

Answer 25

``` May resolve on their own Removal Medications-topicals Counseling *GARDISIL - (protects from 4 different types, 3 shots, 70% of cervical cancer from two types in shot) ```

Question 26

Herpes simplex virus (HSV)

Answer 26

Initial infection characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria 50 million people in US have Vesicular (if see vesicle than think herpetic)

Question 27

Herpes simplex virus 1 (HSV-1)

Answer 27

Transmitted nonsexually

Question 28

Herpes simplex virus 2 (HSV-2)

Answer 28

Transmitted sexually

Question 29

Maternal infection with HSV-2 can have

Answer 29

adverse effects on mother and fetus

Question 30

Neonatal herpes

Answer 30

``` Most severe complication of HSV Most mothers lack history of HSV Viral cx Chronic, recurring, NO CURE* Acylcolvir-control symptoms ```

Question 31

Viral hepatitis

Answer 31

Hepatitis A virus (HAV) Hepatitis B virus (HBV) Hepatitis C virus (HCV)

Question 32

Hepatitis A virus (HAV)

Answer 32

Acquired primarily through a fecal-oral route:foods Vaccination is the most effective means of preventing HAV transmission (2 shots 6 months apart)

Question 33

Hepatitis B virus (HBV)

Answer 33

Most threatening to the fetus and neonate Disease of the liver and often a silent infection Transmitted parenterally, perinatally, and rarely, orally, as well as through intimate contact Vaccination series (when sign VIS - yes want and yes recieved)

Question 34

Hepatitis C virus (HCV)

Answer 34

Most common blood-borne infection in the United States Important health problem as increasing numbers acquire disease Risk factor for pregnant women is history of injecting IV drugs Interferon alfa or ribavirin is main therapy for HCV infection Effectiveness of treatment varies (through sex and sharing needles)

Question 35

Human immunodeficiency virus (HIV)

Answer 35

37,000 new HIV infections occur in U.S. each year Heterosexual transmission now the most common means of transmission in women Women are the fastest-growing population of HIV infection and AIDS Transmission of HIV occurs primarily through exchange of body fluids Severe depression of the cellular immune system associated with HIV infection characterizes AIDS Symptoms: fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash

Question 36

Human immunodeficiency virus (HIV) Screening and diagnosis

Answer 36

Antibody testing | Detection

Question 37

Human immunodeficiency virus (HIV) Counseling for HIV testing

Answer 37

``` HIV testing offered early in pregnancy Perinatal transmission decreases Consider confidentiality and documentation Pretest and posttest counseling Notification of results ```

Question 38

Human immunodeficiency virus (HIV) Management

Answer 38

Resources - Death and dying, Suicide prevention, Financial assistance, Legal advocacy Prevention of transmission

Question 39

HIV and pregnancy

Answer 39

Counseling and testing offered to all women who enter the system for prenatal care Perinatal transmission has decreased due to antiretroviral prophylaxis Decreases transmission to 1% to 2% Intrapartum zidovudine Cesarean birth is recommended

Question 40

Vulvovaginitis

Answer 40

Infection caused by a microorganism | Also called abnormal vaginal discharge

Question 41

Bacterial vaginosis (BV)

Answer 41

Syndrome in which normal H2O2-producing lactobacilli are replaced with high concentrations of anaerobic bacteria Associated with preterm labor and birth Treatment with metronidazole orally

Question 42

Candidiasis

Answer 42

Candida albicans or non-C. albicans Vulvovaginal candidiasis, or yeast infection, is second most common type of vaginal infection In women with HIV, symptoms are more severe and persistent

Question 43

Candidiasis Predisposing factors

Answer 43

``` Antibiotic therapy Diabetes Pregnancy Obesity Diets high in refined sugars Use of corticosteroids and hormones Immunosuppressed states ```

Question 44

Candidiasis Common symptoms

Answer 44

Vulvar | Vaginal pruritus

Question 45

Candidiasis Screening and diagnosis

Answer 45

Physical examination | Vaginal pH

Question 46

Candidiasis Management

Answer 46

Over-the-counter agents | Intravaginal treatment or oral agent

Question 47

Candidiasis Methods of comfort

Answer 47

Sitz baths Aveeno powder No underpants to bed Complete full course of treatment

Question 48

Trichomoniasis

Answer 48

Trichomonas vaginalis STI Common cause of vaginal infection Inflammation of the vagina and/or vulva

Question 49

Trichomoniasis Screening and diagnosis

Answer 49

Speculum examination | Pap smear

Question 50

Trichomoniasis Management

Answer 50

Metronidazole, 2 g orally in a single dose | The risk for sexual transmission must be communicated to infected women

Question 51

Health History

Answer 51

Query for lifestyle behaviors that place clients at risk for STIs

Question 52

Physical Examination

Answer 52

Ensure comfort during examination

Question 53

Expected Outcomes of Care

Answer 53

Focus on physical and psychologic needs with emphasis on avoidance of reinfection and harmful sequelae

Question 54

Plan of care and interventions

Answer 54

Management during pregnancy | Infection control

Question 55

Key Points

Answer 55

Reproductive tract infections include STIs and common genital tract infections Risk reduction sexual practices are key STI prevention strategies HIV is transmitted through body fluids Prevention of mother-to-newborn HIV is most effective when the woman receives antiretroviral drugs during pregnancy, labor, and birth

Question 56

Key Points

Answer 56

HPV is the most common viral STI Syphilis has reemerged as common STI Chlamydia is the most common STI in U.S. women and the most common cause of PID Viral hepatitis has several forms of transmission; HBV infections carry the greatest risk

Question 57

Key Points

Answer 57

Young, sexually active women who do not practice safe sex and have multiple partners are at greatest risk for STIs and HIV STIs are responsible for substantial mortality and morbidity and present heavy economic burden in the U.S.

Question 58

Key Points

Answer 58

Everyone has a right to compassionate, objective, and effective health care for STIs Substance abuse can alter the body’s immune system and possibly increase the risk for AIDS Pregnancy confers no immunity against infection

Question 59

Key Points

Answer 59

Because history and examination cannot reliably identify everyone with HIV or other blood-borne pathogens, blood and body fluid precautions should be used consistently for everyone all the time