Module Five: Sexually Transmitted Infections in Pregnancy Flashcards
syphillis
screen all pregnancy
syphillis mode of transmission
direct contact with syphyllis sore, sexual contact
syphillis incubation period
primary 3-6weeks: chancre sore or sores (round firm raised painless
secondary: skin rash mucous membrane lesion palm and sore of feet.
syphillis preventive measures
screen all women on first visit
RPR to confirmed with treponemal specific test
syphillis sign & symptoms
may indistinguisable and unrecognized for many years.
syphillis dx criteria
RPR reactive, confirmation w/ Treponemal-specific test
syphillis - maternal effects
PTL
IUFD
neonatal infection
neonatal death
syphillis treatment
single dose of PNC IM injection will cure infection <1 year
Gonorrhea
screen ONLY for high risk people
** repeat test in 3rd trimester if dx in first **
Gonorrhea risk factors
live in Southern U.S.A. young women between 15 to 24 y.o. Black new partner multiple sexual partner hx inconsistent condom use
gonorrhea mode of transmission
oral
anal
vaginal
**contact with secretions from urogenital tract
vertical transmission–>ocular infection in neonate
Gonorrhea signs & symptoms
dysuria
abnormal vaginal discharge or bleeding (if infected from the vagina)
sore throat
anal itching soreness & bleeding (painful BM)
Gonorrhea dx criteria
NAAT
lymph node enlarge
mucopurulent
adnexal tenderness or CMT–> PID
gonorrhea maternal effect:
PID
fallopian tube damage = infertility, ectopic pregnancy, & chronic pelvic pain
**disseminated Gonorrhea: join pain & rash
gonorrhea fetal effect
preterm birth OPHTHALMIA NEONATORIUM pharygnitis rectal infections rare: pneumonia
chlamydia
most reportable
PRENATAL SCREEN at first visit
chlamydia mode of transmission
urogenital also orophragnx & rectum.
chlamydia signs & symptoms
mostly mild or absent
abnormal vaginal discharge or dysuria most common
33% have urethral syndrome urethritis or Bartholin’s gland infection
chlamydia dx criteria
NAAT (urine, cervical,vaginal or liquid cytology specimen)
chlamydia maternal effects
PID, ectopic pregnancy & infertility
chlamydia fetal effects
conjuntivitis
chlamydia management
single dose of azithromycin
treat all sexual partner from last 60 days
abstain from intercourse until partner is treat for 7 days after single dose treatment or until she complete multidose treatment
should be test for other STI as co-infect frequently
pregnant women should be retest no sooner than 3 weeks after tx then rescreen again 3 month later or in the 3rd trimester
Herpes
NO ROUTINE needed
>300,000 cases/year
Herpes risk factors
young women & college students
herpes s/sx
sore/lesion
vulvar pain
burning
itching
herpes dx criteria
PRC - more sensitive 1-2 days result differentiate from type 1 or type 2
Glycoprotein G-based: blood draw can detect absence of lesion but more time recommended by CDC
herpes treatments
acyclovir or valacyclovir for primary
secondary or suppressive therapy during last 4 weeks of pregnancy
herpes vaginal births/c-section births
C/C for women with HSV perineal lesion in labor.
human papillomavirus (HPV)
most common
no treatment for asymptomatic case
treatment is focus on warts & precancerous lesion
human papillomavirus. incubation period
week to month & years.
preventive measure HPV
Gardasil Cervarix (contraindicated for pregnancy)
HPV maternal effect
no link to pregnancy complications
HPV fetal effect
transmission is rare
spontaneous clear if infected –>respiratory papillomavirus.
HPV midwifery care/counseling
no tx for virus. just for genital warts.
may grow larger
may bleed
if too large occlude birth vaginally need laser or surgical treatment
C/S is not needed to prevent transmission
Bacterial Vaginosis
common in 10-30% during pregnancy
Bacterial Vaginosis risk factors.
new partner/multiple partner smoker chronic stress frequent or recent douching ethnic different
BV signs & symptoms
odor, pain pruritist or burning
BV dx criteria
odor (after sex) –> positive whiff test
wet prep clue cells
pH >4.5
BV maternal effect
SAB PTL LBW PPROM choriominitis Amniotic fluid infection Chronic BV may lead to PID
BV treatment
metronidazole/clindamycin PO or Vaginal gel
HIV
those infected with another STD are 2-5 x more become infected with HIV
women fastest grow in infection
SCREEN ALL PREGNANT women on 1st prenatal
HIV mode of transmission
perinatal (most common route)
HIV incubation period
days to week
acute HIV usually <10 days
HIV signs & symptoms
fever night sweat fatigue rash HA lymphadenopathy
HIV diagnostic criteria
ELISA (99.5% sensitive)
confirmed with Western Blot
Immunflorescene assay (IFA) –rapid available for unknown status & is in labor.
midwifery management for HIV
complex & alterations in medical regimens outside of CNM scope
bottle feed instead breastfeed :o(
