Chapter 7 - Sexually Transmitted and Other Infections Flashcards
Reproductive Tract Infections
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
Most common STIs in women
Chlamydia Gonorrhea Human papillomavirus Herpes simplex virus type 2 Syphilis HIV infection
Primary Prevention
Primary prevention the most effective way of reducing STIs in women
19 million Americans infected yearly-1/2 of them 15-24 yr olds
Secondary Prevention
Prompt diagnosis and treatment can prevent personal complications and transmission to others
Risk Reduction
Knowledge of partner Reduction of the number of partners Low risk sex Avoiding exchange of body fluids Immunization
Risk Reduction Measures
Physical barriers - Condoms
Chemical barriers - Nonoxynol-9
Communication - Expressing feelings and fears, Attention to partner’s response
Vaccination
Chlamydia trachomatis
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)
Chlamydia trachomatis Screening and diagnosis
Asymptomatic and pregnant women
DNA probe
Chlamydia trachomatis Management
Doxycycline
Azithromycin
Erythromycin (eye ointment on babies)
Amoxicillin
Chlamydia trachomatis Perinatal transmission
Antibiotic ointment
Gonorrhea
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
Gonorrhea Screening and diagnosis
CDC recommends screening all women at risk
Testing during first trimester and at 36 weeks of pregnancy
Reportable disease
Gonorrhea Management
Antibiotic therapy: cefixime or ceftriaxone PCN resistance 1 x IM
Treat partner-frequent reinfections
Perinatal complications of gonococcal infection
Miscarriage Preterm labor Premature rupture of membranes Neonatal sepsis Intrauterine growth restriction Postpartum endometritis Maternal postpartum sepsis
Syphilis
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)
Syphilis
Can lead to serious systemic disease and even death
Infection manifests itself in distinct stages
Infection of Syphilis manifests itself in distinct stages
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
Syphilis Screening and diagnosis
-VDRL, RPR
Pregnant women
Serologic tests
False positives
Syphilis Management
Penicillin
Sexual abstinence during treatment-monthly follow up
Pelvic inflammatory disease (PID)
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
Pelvic inflammatory disease (PID) Increased risk of
Ectopic pregnancy
Infertility
Chronic pelvic pain
Pelvic inflammatory disease (PID) Symptoms
Lower abdominal tenderness, cervical motion tenderness Abx Pain control (very painful to move cervix)
Human papillomavirus (HPV)
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
Human papillomavirus (HPV) Screening and diagnosis
History of known exposure
Physical inspection-can get very large
Pap smear
Human papillomavirus (HPV) Management
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)
Herpes simplex virus (HSV)
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)
Herpes simplex virus 1 (HSV-1)
Transmitted nonsexually
Herpes simplex virus 2 (HSV-2)
Transmitted sexually
Maternal infection with HSV-2 can have
adverse effects on mother and fetus
Neonatal herpes
Most severe complication of HSV Most mothers lack history of HSV Viral cx Chronic, recurring, NO CURE* Acylcolvir-control symptoms
Viral hepatitis
Hepatitis A virus (HAV)
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Hepatitis A virus (HAV)
Acquired primarily through a fecal-oral route:foods
Vaccination is the most effective means of preventing HAV transmission
(2 shots 6 months apart)
Hepatitis B virus (HBV)
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)
Hepatitis C virus (HCV)
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)
Human immunodeficiency virus (HIV)
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
Human immunodeficiency virus (HIV) Screening and diagnosis
Antibody testing
Detection
Human immunodeficiency virus (HIV) Counseling for HIV testing
HIV testing offered early in pregnancy Perinatal transmission decreases Consider confidentiality and documentation Pretest and posttest counseling Notification of results
Human immunodeficiency virus (HIV) Management
Resources - Death and dying, Suicide prevention, Financial assistance, Legal advocacy
Prevention of transmission
HIV and pregnancy
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
Vulvovaginitis
Infection caused by a microorganism
Also called abnormal vaginal discharge
Bacterial vaginosis (BV)
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
Candidiasis
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
Candidiasis Predisposing factors
Antibiotic therapy Diabetes Pregnancy Obesity Diets high in refined sugars Use of corticosteroids and hormones Immunosuppressed states
Candidiasis Common symptoms
Vulvar
Vaginal pruritus
Candidiasis Screening and diagnosis
Physical examination
Vaginal pH
Candidiasis Management
Over-the-counter agents
Intravaginal treatment or oral agent
Candidiasis Methods of comfort
Sitz baths
Aveeno powder
No underpants to bed
Complete full course of treatment
Trichomoniasis
Trichomonas vaginalis
STI
Common cause of vaginal infection
Inflammation of the vagina and/or vulva
Trichomoniasis Screening and diagnosis
Speculum examination
Pap smear
Trichomoniasis Management
Metronidazole, 2 g orally in a single dose
The risk for sexual transmission must be communicated to infected women
Health History
Query for lifestyle behaviors that place clients at risk for STIs
Physical Examination
Ensure comfort during examination
Expected Outcomes of Care
Focus on physical and psychologic needs with emphasis on avoidance of reinfection and harmful sequelae
Plan of care and interventions
Management during pregnancy
Infection control
Key Points
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
Key Points
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
Key Points
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.
Key Points
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
Key Points
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
