Exam 3: STI Flashcards
Risk factors for STIs
Abused youths
Homeless youths
Young men having sex with men
Gay, lesbian, bisexual, and transgendered youths
Factors placing teenagers at risk for STIs
Female anatomy predisposes them to STIs (columnar epithelial cells sensitive to invasion)
Teenagers feelings of invincibility
Unprotected intercourse
Partnerships of limited duration
Obstacles to using healthcare system
Vaginitis: Vulvovaginal Candidiasis
Not sexually transmitted - can put a person at risk for STI
Risk factors: Pregnancy, oral contraceptives with high estrogen content, broad-spectrum antibiotics, DM, steroid/immunosuppressive drugs, HIV, tight restrictive clothes, nylon underpants, trauma to vaginal mucosafrom chemical irritants, douching
Presentation: Pruritis, thick white curd-like discharge, soreness, vulvar burning, erythema in the vulvovaginal area, dyspareunia (pain during sex), external dysuria
Diagnosis: White plaques on vaginal walls, vaginal pH in normal range, wet smears with spores characteristic of fungus
Management: Preventive measures, cotton underwear, avoidance of irritants/douching, good body hygiene, avoid super-absorbent tampons, shower, reduce dietary intake of soda and sugar, DM: keep glucose under tight control
Medications: “-azole” tablet, cream, or suppositories
Vaginitis: Trichomoniasis
Presentation: Heavy yellow/green or gray frothy discharge, Petechiae on the cervix, vaginal pruritus and vulvar soreness, foul oder, erythema, dysuria, cervix may bleed on contact, dyspareunia
Diagnosis: Visualized on microscope, vaginal pH greater than 4.5
Management: Refrain from sex until cured, avoid alcohol during treatment, follow up testing not indicated
Medications: Metronidazole 5-7 day treatment for females, Males is single 2 gram oral dose
Vaginitis: Bacterial Vaginosis
Most prevalent cause of vaginal discharge or malodor, 50% of women are asymptomatic
Risk factors: Multiple sex partners, douching, lack of vaginal lactobacilli
Presentation: Thin, white homogenous discharge, fishy odor
Diagnosis: Vaginal pH 4.5, positive whiff test, presence of clue cells on wet-mount examination
Management: Primary prevention of risky sexual behaviors, nursing interventions noted to avoid vaginitis
Interventions: Metronidazole (oral or gel), clindamycin (cream), treatment of male partner not beneficial because sexual transmission of BV not proven
Cervicitis
General term that implies the presence of inflammation or infection of the cervix, usually caused by chlamydia or gonorrhea
Cervicitis: Chlamydia
Most common bacterial STI in the US, 75% of females asymptomatic, 25% males ansymptomatic
Risk factors: Adolescence, multiple sex partners, new sex partner, sex without condom, oral contraceptive use, pregnancy, history of another STI
Clinical manifestations: May have mucopurulent vaginal discharge, urethritis, bartholinitis, endometritis, salpingitis, dysfunctional
Diagnosis: Urine testing or swab specimen culture
Reportable communicable disease
Interventions: Safer sex practices, follow up 3 months after treatment, screen all women under 25 years, focus teaching for higher risk group
Interventions: Antibiotics, combination regimen if gonorrhea present, screening
Cervicitis: Gonorrhea
Second most commonly reported infection in the US, highly contagious
Reportable communicable disease
Risk factors: Low SES status, urban living, single, inconsistent use of barrier contraceptives, age <20 years, multiple sex partners
Presentation: Most asymptomatic, abnormal vaginal discharge, dysuria, cervicitis, abnormal bleeding, Bartholin abscess, PID, neonatal conjunctivitis risk for vaginal deliveries, mild sore throat, rectal infection
Pregnant patients screened at first prenatal visit and at 36 weeks
Interventions: Educate high risk factor groups, inform and treat sex partners with antibiotics, patient education
Dual therapy: Ceftriazone single IM injection, Doxycycline pills
Genital Ulcers: Syphilis
Curable bacterial infection, rates increasing with males who have sex with males
Biologic effect on HIV acquisition/transmission and impact on infant health
Primary: Chancre on place of bacteria entrance 2-3 weeks after inoculation
Secondary: 2-8 weeks after chancre, maculopapular rash, sore throat, lymphadenopathy, flu-like symptoms
Latent: No symptoms, not contagious (up to 20 years)
Tertiary: 20-40% infected do not show signs, slowly progressive inflammatory disease, usually not reversible
Diagnosis: Lab tests
Treatment: Penicillin deep IM injections
Reportable communicable disease
Genital Ulcers: Genital Herpes Simplex
Recurrent lifelong viral infection, transmissible via contact with mucous membranes or breaks in skin with visible or non-visible lesions
Presentation: Primary: Multiple painful vesicular lesions
Interventions: Antiviral medication, acyclovir, valavyclovir
Genital Ulcers: HPV
Most common viral infection in the United States, genital warts or condylomata
Manifestations: Most asymptomatic, visible genital warts
Diagnosis: Pap smear, HPV test
Interventions: HPV vaccines recommended for 11-12 year olds
