Exam 1 M1: STIs Flashcards
Sexually Transmitted & Other Infections
Overview
* Prevention:
◦ Primary prevention: most effective way of reducing STIs
◦ Secondary prevention: prompt dx and tx can prevent complications and transmission to others
◦ Risk reduction measures:
‣ 5 P’s: partners (how many), practice (oral, vaginal etc), prevention of pregnancy, past history of STIs
◦ Chemical barriers:
‣ Spermicides are NOT protective against STIs
‣ Nonoxynol-9 may increase risk of HIV transmission
Bacterial Sexually Transmitted Infections
* Chlamydia trachomatis
◦ Most common reportable STI
‣ Infxns are silent but highly destructive => difficult to dx
‣ Highest infxn rate: women 15-24
◦ S/S:
‣ Spotting, postcoital bleeding, purulent cervical discharge, dysuria
◦ Screening and dx:
‣ Screen asymptomatic women with risk factors present; screen pregnant women in** 1st trimester and at 36 weeks**
‣ Dx: culture, DNA probe, enzyme immunoassay, nucleic acid amplification of urine specimens
◦ Transmission:
‣ Genital to genital, oral-genital, anal-genital, vagina-rectum
‣ Perinatal transmission:
* Use antibiotic ointment for conjunctivitis
◦ Management:
‣ Doxycycline, azithromycin
‣ All exposed partners should be treated
Bacterial Sexually Transmitted Infections
* Gonorrhea
◦ Overview:
‣ Aerobic gram negative diplococcus
‣ Oldest communicable disease in the US, 2nd most common reportable STI
‣ Incidence is increasing => highest rates among teenages / young adults
◦ Perinatal complications:
‣ 1st trimester - Salpingitis
‣ Premature rupture ofm embranes, preterm birth, chorioamnionitis (infxn of membranes), maternal / neonatal sepsis)
◦ S/S:
‣ Purulent endocervical discharge, menstrual irregularities, abdominal pain, back pain
◦ Screening and dx:
‣ Pregnant women** 1st trimester and at 36 weeks**
‣ Dx: Thayer Martin culture
◦ Management:
‣ Abx therapy: ceftriaxone
‣ *If woman is < 18, pregnant, or lactating => tx regimen changes!
Bacterial Sexually Transmitted Infections
* Syphilis
◦ Overview:
‣ Treponema pallidum, a motile spirochete
‣ Earliest described STI
‣ Transmission rates are increasing
* Through abrasions during sexual intercourse, kissing, biting, oral-genital sex
* Transplacental transmission may occur at any time during pregnancy => devastating to fetus
◦ Stages:
‣ Primary: painless chancre => 5-90 days after exposure
‣ Secondary: maculopapular rash on palms and soles of feet and condylomata lata with systemic symptoms => 6 weeks to 6 months
* Latent phase: asymptomatic
‣ Tertiary: neurological, cardiovascular, multiorgan devastation => develops in 1/3 of infected women
◦ Screening and dx:
‣ Screen sexually active individuals with risk factors; screen at 1st and 3rd prenatal visits
‣ Dx: serologic testing (nontreponemal and treponemal)
◦ Management:
‣ ONLY Penicillin G
‣ May cause Jarisch Herxheimer rxn
‣ Must practice sexual abstinence during tx, partners notified and treated
Bacterial Sexually Transmitted Infections
* Pelvic inflammatory disease (PID)
◦ Overview:
‣ An infectious process that most commonly involves the fallopian tubes, uterus, and occasionally the ovaries and peritoneal surfaces
‣ Caused by multiple organisms
◦ Risk factors:
‣ Young age, nulliparity, multiple partners, high rate of new partners, hx of STIs, UID insertions within 3 weeks
◦ PID increases the risk for:
‣ Ectopic pregnancy, infertility, chronic pelvic pain, recurrence of PID
◦ S/S:
‣ Depends on if the infxn is acute, subacute, or chronic
‣ Lower abdominal tenderness, abnormal discharge, bilateral adnexal tenderness, cervical motion tenderness, increased temp
◦ Management:
‣ Abx, pain control, semi Fowler’s positioning
Viral Sexually Transmitted Infections
* Human papillomavirus (HPV)
◦ Overview:
‣ Condylomata acuminata
‣ Most prevalent viral STI
* Used to be called genital or veneral warts
‣ More frequent in pregnant women
◦ Screening and dx:
‣ Most cases are asymptomatic and resolve w/o tx
‣ Dx: physical inspection, pap test, viral screening
◦ Management:
‣ Removal => cryotherapy
‣ Medications => podopholin if not pregnant
‣ Oatmeal baths, loose cotton clothing, good nutrition, stress reduction
◦ Prevention:
‣ Gardaasil or Cervavarix vaccine for females and males
Viral Sexually Transmitted Infections
* Herpes simplex virus (HSV)
◦ Overview:
‣ Types:
* Herpes simplex virus 1 (HSV 1) => transmitted NON sexually
* Herpes simplex virus 2 (HSV 2) => transmitted sexually
‣ Chronic and recurring disease for which there is NO known cure
◦ S/S:
‣ Initial infxn: multiple painful lesions, fever, chills, malaise, severe dysuria, vulvar edema, cervicitis => 2-3 weeks
‣ Subsequent outbreaks less severe usually => 5-7 days
◦ Management:
‣ Systemic antiviral meds partially control the symptoms => acyclovir, valacyclovir, famciclovir
‣ Maternal infxn with HSV 2 => serious adverse effects on mom and baby
* Neonatal herpes => most severe complication of HSV, most mothers lack hx of HSV
Viral Sexually Transmitted Infections
* Viral hepatitis
◦ Hepatitis A
‣ Overview:
* NOT sexually transmitted => acquired through fecal oral route
‣ Prevention:
* Vaccination is most effective
‣ S/S:
* Flulike: malaise, fatigue, anorexia, nausea, pruritus, fever, RUQ pain
Viral Sexually Transmitted Infections
* Viral hepatitis
◦ Hepatitis B
‣ Overview:
* **MOST threatening **to mom and baby
* Disease of liver, often silent infxn
* Transmission: parenterally, perinatally, orally, intimate contact (blood, babies, boners)
‣ Prevention:
* Vaccination
‣ Tx:
* Recovery is usually spontaneous within 3-16 weeks
Viral Sexually Transmitted Infections
* Viral hepatitis
◦ Hepatitis C
‣ Overview:
* **Most common **blood-borne infxn in US
* Risk factor: pregnant women w/ hx of injecting IV drugs
‣ Management:
* Interferon-alfa or ribaviron
Viral Sexually Transmitted Infections
* Human immunodeficiency virus (HIV)
◦ Overview:
‣ Transmission: most common is heterosexual transmission => through body fluid exchange
* Transmitted to fetus through maternal circulation early in pregnancy
* Transmitted through breast milk (NO breastfeeding if HIV + !)
‣ Turns into AIDS after severe depression of cellular immune system
◦ S/S:
‣ Fever, HA, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, rash
◦ Screening and dx:
‣ Antibody testing: enzyme immunoassay with follow up Western Blot for confirmation
◦ Management:
‣ No cure
◦ HIV and pregnancy:
‣ HIV counseling and testing should be offered to all women during prenatal care
‣ Antiretroviral prophylaxis decreases perinatal transmission
* Intrapartum zidovudine
‣ Avoid invasive procedures such as FSE / AROM / scalp sampling
‣ C-section is recommended
Vaginal Infections (NOT sexually transmitted)
* Vulvovaginitis
◦ Overview:
‣ Inflammation of vulva and vagina
Vaginal Infections (NOT sexually transmitted)
* Bacterial vaginosis (BV)
◦ Overview:
‣ Syndrome in which normal lactobacilli are replaced with high concentrations of anaerobic bacteria
◦ S/S:
‣ Vaginal discharge has a fishy odor, profuse, thin, white or grey
◦ Tx:
‣ Metronidazole
Vaginal Infections (NOT sexually transmitted)
* Candidiasis
◦ Overview:
‣ Candida albicans or non-C. albicans infxn
‣ Vulvovaginal candidiasis aka yeast infxn => 2nd most common type of vaginal infxn
◦ S/S:
‣ If woman has HIV - symptoms are more severe and persistent
‣ Itching, thick, white, lumpy vaginal discharge
◦ Predisposing factors:
‣ Abx therapy prior, diabetes, pregnancy, obesity, diets high in refined sugar, use of corticosteroids / hormones, immunosuppressed states
◦ Tx:
‣ OTC agents: intravaginal tx or oral
Vaginal Infections (NOT sexually transmitted)
* Trichomoniasis
◦ Overview:
‣ Caused by Trichomonas vaginalis
‣ Inflammation of vagina and/or vulva => greenish frothy mucopurulent discharge, cervix and vaginal walls have “strawberry spots”
◦ Screening and dx:
‣ Speculum exam, pap test
◦ Management:
‣ Metronidazole
Infxn control & Reportable STIs
Key Points
