med surg STDs Flashcards
what are the 3 mandated to report STDs
-gonorrhea
-chlamydia
-syphilis
the bacterial infections
what increase risk of STDs
-early reproductive maturity
-increased sexual lifespan
-inconsistent use of barrier methods
-medias increased emphasis on sexuality w/o teaching safe sex
-substance use
+ everything you expect
what is the best form of protection against STIs
male condom (other than abstinence but we do not teach that)
which is the most common bacterial STD
chlamydia
chlamydia
-incubation period of 1 to 3 wks
-most common sites: urethra in males, cervix in women
-can be asym
-men: pain w/ urination and/or discharge
-women: mucopurulent discharge, bleeding, dysuria, pain w/ sex
rectum: pain, discharge, bleeding, pruritis, tenesmus, mucus coated stools
complications of chlamydia
can result in infertility (rarely in men) and pelvic inflammatory disease
PID
damages the fallopian tubes and increases risk for ectopic pregnancy, fertility comps and chronic pelvic pain
dx and treatment of chlamydia
-H&P + nucleic acid amplification test (NAAT)
-screen regularly
-treated w/ azithromycin or doxycycline
return for testing 3 month after treatment
if a patient test positive for chlamydia, what needs to be done
-all sexual contacts from prior 60 days should be notified/evaluated/treated
-abstain from sex for 7 days after treatment & until all partners have been tested/treated
gonorrhea
-incubation period of 1-14 days
-prior infection does not prevent reinfection
-sites: urethra for men, cervical for women
-men: dysuria, purulent urethral discharge or epididmyitis
-women: asym or minor, dysuria, frequent urination, bleeding after sex, redness & swelling, purulent exudate
rectal: rectal discharge, bleeding, anorectal pain, pruritus, painful BM
gonorrhea complications
men: infertility if not treated
women: bartholin’s glands inflamed causing reddened & enlarged labia, PID, pregnancy comps
gonorrhea can be passed to the neonate and cause conjunctivitis
gonorrhea dx & treatment
-H&P, culture discharge
-can begin treatment w/o results
-high dose IM single -dose ceftriaxone
if a patient test positive for gonorrhea, what needs to be done
-all sexual contacts from prior 60 days should be notified/evaluated/treated
-abstain from sexual contact at least 7 days after abx therapy completed
what is the most common not viral STD
trichomoniasis (a parasite)
trichomoniasis in men
mostly asym & often transient (spon resolution within 10 days)
trichomoniasis
-incubation: 1wk-3mo
-screening only recommended for high risk women
-men: burning w/ urination/ejac, discharge
-women: painful urination, vaginal itching, painful sex w/ bleeding after, yellow/green discharge w/ foul odor, strawberry appearance of cervix
complications to untreated trichomoniasis
more likely to get another STD, particularly HIV
trichomoniasis dx & treatment
-NAAT (detects RNA)
-treat w/ antifungals (azoles)
-abstain from sex for 7 days post antifungal
-high rate of recurrence so get tested again in 2wk-3mo
when is a person w/ herpes most contagious
when symptomatic but can be transmitted w/o apparent sx d/t asym viral shedding
herpes manifestations: primary
-primary episode (incubation 2-12 days) -> genital infection usually no recognizable symptoms -> regional lymphadenopathy & flu like sx -> whole process can take ~ 3wks
herpes manifestations: recurrent
occurs usually within the first year after primary episode, less severe & heals quicker -> decreased episodes over time
triggers to recurrent herpes episodes
stress, fatigue, acute illness, sunburn, immunosuppression
complications of herpes
blindness
encephalitis
aseptic meningitis
genital ulcer (inc risk for HIV)
can be transferred to baby
psychological impact of non curable disease
dx & treatment of herpes
-DX: by sx & culture of active lesion to distinguish between HSV 1&2
-tx: acyclovir to shorten durations of outbreak & control lesions
what is HPV highly linked w/
cancer so need more screenings
syphilis
-transmitted by direct contact w/ syphilitic ulcer
-incubation period 10-90 days
-can be transmitted to baby during pregnancy
syphilis: clinical stages
-early/primary: highly infectious, lesions appear
-secondary: highly infectious, 2-8 wks after primary, bacterial dissemination & starts to effect nerves (meningitis)
-early latent: asym, not contagious
-late: not infectious and rarely seen post abx treatment
early syphilis complications
-early chancres increase HIV transmission
-people w/ syphilis & HIV are more likely to have CNS involvement
neurosyphilis
permanent damage within the CNS, visual impairment, dementia
cardiovascular syphilis
chest pain, dyspnea, murmur, cardiomegaly
gummatous syphilis
unusual scarring on skin, changes in nasal septum & palate
syphilis dx & tx
-dx: serologic/blood test (VDRL) then a confirmatory positive screening (treponemal antigens) bc false results can occur based on timing of infection
-tx: w/ penicillin G for all stages (doxycycline or tetracycline if cillin allergy)
syphilis test precautions
-test for HIV
-follow up w/ sex partners from the last 90 days
-follow up care w/ HCP every 6 months for 2 years
