OB Ch. 5: STIs Flashcards
1
Q
8 infections total
A
-4 incurable
-4 curable
2
Q
Curable STIs
A
-syphilis
-gonnorrhea
-chlamydia
-trichomoniasis
3
Q
Uncurable STIs
A
-hepatitis B
-herpes simplex virus (HSV)
-HIV & HIV/AIDS
-human papillomavirus (HPV)
4
Q
Vaginitis STI or not STI?
A
NOT STI. inflammation and infection of vagina, not always caused by sex
5
Q
Vaginitis types
A
-candida: fungus
-trichomoniasis: protozoa
-gardnerella: bacteria
6
Q
primary role for RNs in relation to STIs…
A
EDUCATE
7
Q
P-LI-SS-IT model
A
P: permission
LI: limited information
SS: specific suggestions
IT: intensive therapy
8
Q
Permission of P-LI-SS-IT
A
allow woman to talk about experience
9
Q
Limited Information of P-LI-SS-IT
A
information given to woman about STIs are factual (dispel myths), and have specific measurements to prevent transmission
10
Q
Specific Suggestions of P-LI-SS-IT
A
an attempt to help the woman change their behavior to prevent recurrence and further transmission of STI
11
Q
IT of P-LI-SS-IT
A
involves referring woman or couple for appropriate treatment based on circumstance
12
Q
Vaginal Candidiasis
A
-fungal infection –> NOT STI
-vaginal discharge
-yeast
-monlia
13
Q
Vaginal Candidiasis TX:
A
-miconazole cream or suppository
-clotrimazole cream or tablet
-terconazole cream or intravaginal suppository
-fluconazol oral tablet (single dose 150 mg)
-either as cream, ointment, or suppository
for 3-7 days
14
Q
what happens if vaginal candidiasis is not treated before birth?
A
TRUSH: fungal yeast infection in mouth, vagina, and other parts of the body
-can be given to baby during delivery if not treated
15
Q
Vaginal Candidiasis nursing management
A
-100% white cotton panties
-avoid tight pants
-shower, avoid baths
-use unscented soap and dry gentle
-avoid vaginal sprays/deodorants
-avoid douching
-wipe front to back
16
Q
Trichomoniasis
A
-NOT CONSIDERED STI
-caused by protozoan Trichomonas vaginalis (found in contaminated still water)
-common cause of vaginal infection
17
Q
Trichomoniasis screening and diagnosis
A
-discharge is yellowish green or gray/frothy
-pruritis
-soreness
-cervix may bleed
18
Q
Trichomoniasis TX
A
metronidazole or tinidasole 2 g PO one time
19
Q
Bacterial Vaginosis S/S
A
-STALE FISHY ODOR!!!!!!!!
-thin, white discharge
20
Q
Bacterial Vaginosis TX
A
metronidazole (flagyl) PO or gel
-clindamycin cream up the vagina
21
Q
Chlamydia pathophysiology
A
-most common bacterial STI
-caused by chlamydia trachomitis bacteria
-can be asymptomatic
22
Q
Chlamydia clinical manifestations
A
-mucopurulent discharge
-urethritis
-bartholinitis
-endometritis
-salpingitis
-dysfunctional uterine bleeding
23
Q
Chlamydia diagnostic
A
-urine testing
-swab specimen collected from endocervix or vagina
24
Q
Chlamydia TX:
A
-doxycycline 100 mg PO BID for 7 days
-azithromycin 1 g PO single dose
25
How can chlamydia affect baby
-newborns delivered by chlamydia positive mothers may develop conjunctivitis
-opthalmia neonatorum is HIGHLY CONTAGIOUS and if untreated, leads to blindness, joint infection, or life threatening blood infection in newborn
26
Chlamydia Risk factors
-adolescence
-multiple sex partners
-new sex partner
-engaging in sex without using barrier contraceptive
-oral contraceptives
-being pregnant
-history of another STI
27
Gonorrhea Pathophysiology
-aerobic gram negative diplococcus; Nisserria gonorrhoeae infects mucosal surfaces
-STI
-severe STI; highly contagious
28
Gonorrhea clinical manifestations
-abnormal vaginal discharge
-dysuria
-cervicitis
-enlarged local lymph glands
-abnormal vaginal bleeding
-bartholin abscess
-PID (pelvic inflammatory disease)
-mild sore throat (for pharyngeal gonorrhea)
-rectal infection
-perihepatitis
29
Untreated gonorrhea
-enter bloodstream and produce a disseminated gonococcal infection. Severe form can invade joints and cause arthritis, endocarditis of the heart, meningitis of the brain , hepatitis of the liver
30
Gonorrhea Diagnosis
-urinalysis
-swab mucosal lining
31
Gonorrhea TX
-azithromycin 1 g PO single dose
-ceftriaxone 250 mg IM single dose
32
Genital Herpes Simplex Pathopysiology
-recurrent, lifelong, viral infection that has the potential for transmission throughout lifespan; will stay dormant until stimuli
-HSV 1/HSV 2
33
HSV1
mostly causes fever blisters or col sores on lips, eyes, and face
34
HSV2
typically invades the mucous membranes on the genital tract and is known as genital herpes
35
HSV transmission
-direct contact w/ infected individual who is shedding the virus
-kissing, oral sex, sexual contact, vaginal birth are means of transmission
36
HSV stimuli
-fever
-ultraviolet radiation
-stress
-immunosuppressants
37
HSV clinical manifestations (viral shredding)
-multiple painful vesicular lesions
-mucopurulent discharge
-superinfection w/ candida
-fever
-chills
-malaise
-dysuria
headache
-genital irritation
-inguinal tenderness
-lymphadenopathy
38
HSV TX
-uncurable
-antiviral therapy can help suppress clinical manifestations and outbreaks
-acyclovir 400 mg TID PO 7-10 days
-famciclovir 250 mg TID PO 7-10 days
-valacyclovir 1 g BID PO 7-10 days
-ABSTAIN FROM SEXUAL ACTIVITY UNTIL HSW LESIONS FULLY RESOLVE
-hand hygiene
39
Syphilis pathophysiology
chronic, multistage, CURABLE infection caused by Treponema pallidum that is transmitted via sexual activity or from mother to fetus
40
syphilis risk factors
-spontaneous abortion
-low birth weight, fetal growth restriction
prematurity
-stillbirth
-multisystem failure of heart, lungs, pancreas, liver, spleen
-structural bone damage w/ nervous system involvement
-mental retardation
41
syphilis stages
1. primary
2. secondary
3. early latent
4. late latent
5. tertiary
42
primary syphilis
-chancre (PAINLESS ulcer) at site of bacterial entry that will disappear within 1-6 weeks without intervention
-motile spirochetes present on dark field exam of ulcer exudate
-painless B/L adenopathy
43
secondary syphilis
appears 2-6 months after initial exposure
-flu like symptoms
-maculopapular rash of trunk, palms, soles
-alopecia
-adenopathy
-fever
-pharyngitis
-weight loss
-fatigue
-latency: THIS STAGE CAN LAST UP TO 20 YEARS. If not treated, heart disease and neurological disease slowly destroys heart, eyes, brain, CNS, skin
44
syphilis TX
-benzathine pcn G - IM or IV, 2.4 million units IM in one dose
-if syphilis duration longer than 1 year or unknown duration, 2.4 million units of benzathine pcn G given IM once a week for 3 weeks
-if allergic to PCN, doxycycline can be given
45
syphilis DX
-nontreponemal test (Veneral Disease Researc Laboratory (VDRL))
-Rapid Plasma Reagin (RPR)
-Treponemal tests (fluorescent treponemal antibody absorbed (FTA-ABS))
-T. pallidum particle agglutination (TP-PA)
46
Syphilis TX and Management
-abstain from intercourse during prodromal period and when lesions are present
hand hygiene
-comfort measures such as wearing non constricting clothes, wearing cotton underwear
-lukewarm sitz baths
-air drying lesions or using hair dryer on low heat
-avoid extreme temperatures (ice or hot packs)
-use condoms with all new or noninfected partners
47
Pelvic Inflammatory Disease
-when ovaries and peritoneum are involved; scarring to fallopian tubes
-can cause infertility and may cause ectopic pregnancy
-frequently caused by intreated chlamydia or gonorrhea
48
PID risk factors
-adolescence or young adulthood
-non white female
-multiple sex partners
-early onset of sexual activity
-history of PID or STI
-alcohol/drug use
-having intercourse with partner who has untreated urethritis
-recurrent insertion of intrauterine contraceptive (IUC)
-nulliparity
-cigarette smoking
-recent termination of pregnancy
-lack of condom or contraceptive use
-douching
-prostitution
49
PID S/S
-abnormal cervical or vaginal mucupurulent discharge
-oral temp above 101F
-cervical motion tenderness
-elevated erythrocyte sedimentation rate (ESR)
-elevated C-reactive protein level (CRP)
-N. gonorrhea or C. trachomatis infection documented
-white blood cells on saline vaginal smear
-prolonged or increased menstrual bleeding
-dysmennorrhea
-dysuria
-painful sex
-N/V
50
PID TX/Management
-broad spectrum ABX
-parenteral cephalosporin in single injection w/ doxycycline 100 mg BID for 14 days
-follow up appt
-IF HOSPITALIZED, maintain hydration w/ IV fluids, administer analgesics PRN, and put in semi-fowler position to promote pelvic drainage
51
PID DX
-endometrial biopsy
-transvaginal ultrasound
-laparoscopic examination
52
Human Papillomavirus (HPV) clinical manifestations
-visible warts diagnosed by inspection
-warts are fleshy papules with granular surface
-lesions can grow large during pregnancy, affecting urination, defecation, motility, mobility, descent of fetus
large lesions may resemble CAULIFLOWERS, existing in clusters, easy to bleed
**NO VAGINAL DELIVERY IF ACTIVE HPV
53
HPV Risk Factors
-multiple sex partners
-ages 15-25 years
-sex with make who has had multiple sex partners
-first intercourse at age 16 or younger
54
HPV TX/management
-no current medical treatment
-HPV vaccine
ages 11-14 are 2 injections, after age 15 is three injections
-side effects of vaccine include: pain, fainting, redness, swelling at injection site, fatigue, H/A, muscle and joint aches, GI distress
-serial pap smears performed for low risk women --> can detect cellular changes made by HPV
55
Treatment options for precancerous cervical lesions or genital warts d/t HPV
-topical tricholoroacetic acid 80-90%
-liquid nitrogen cryotherapy
-topical imiquimod 5% cream
-topical podophyllin 10-25%
-sincatechins 15% ointment
-laser carbon dioxide vaporization
-client applied podofilox 0.5% solution or gel
-simple surgical excision
-loop electrosurgical excision procedure (LEEP)
-intralesional interferon therapy
56
Hep. A
-acute, systematic viral infection that can be transmitted through sexual activity, or fecal-oral route
-drinking polluted water, uncooked shellfish from sewage contaminated waters or food handled by hep. carrier w/ poor hygiene
-oral sexual contact
-sexual activity between 2 men
57
Hep. B
-transmitted through saliva, blood serum, semen, menstrual blood, vaginal secretions
-incubation period from time of exposure to onset of symptoms is 6 weeks to 6 months
-virus can survive outside body for at least 7 days
58
Hep. B risk factors
-multiple sex partners
-engaging in unprotected receptive anal intercourse
-h/o other STIs
59
Hep. B TX
-pre exposure immunization
60
S/S of Hep B
-flu like symptoms with malaise
-skin rashes
-fatigue
-anorexia
-nausea
-vomiting
-pruritis
-fever
-RUQ pain
**Hep. A s/s are similar, with less fever and skin involvement
**Hep. B tested for in 1st and 3rd trimester
61
Hepatitis DX
-IgM antibody is diagnostic sign of acute Hep. A infection
-Hep. B detected by blood test that look sof antibodies and proteins produced by virus/positively DXed by presence of Hep. B surface antibody
62
Hepatitis C
-NOT STI
-women at risk if they use injection drugs
-targets liver cells
63
Hep. C high risk
-history of injection drug use
-nonsterile tattooing
-HIV positive
-h/o STIs
-multiple sexual partners
h/o blood transfusion or organ transplant before 1992
64
Ectoparasitic Infection
-caused by bed bugs, mites, scabies, pubic lice
65
ectoparasitic infection management
-symptomatic relief of itching and elimination of infestations
66
Scabies clinical manifestaions
intensely pruritic dermatitis with lesions
67
scabies S/S
history and appearance of burrows in webs of fingers and genitalia
68
scabies TX
-permethrin cream
-oral ivermectin
-benzyl benzoate
69
pubic lice clinical manifestations
-pruritis w/ lice or nits
-rash brough on by skin irritation
-usually asymptomatic until after 1 week
70
pubic lice TX
-permethrin 1% cream rinse
-pyrethrin w/ piperonyl butoxide
-lindane shampoo
-decontamination of bedding and clothing
-treatment of family members and sexual partners
71
HIV pathophysiology
-virus that causes destruction of T cells
-considerd HIV when T cell count is low, but above 200
-precursor to AIDS
72
AIDS
-most advanced stage of HIV infection
-considered AIDS when T cell count is 200 or less
-infected person can develop opportunistic infections or malignancies that can be fatal
-depletion of T cells leads to gradual loss of immune function
73
HIV/AIDS DX
-nucleic acid test (NAT)
-antigen/antibody test
-if positive antigen/antibody test --> multispot test done
if positive multispot test --> HIV confirmed
HIV or HIV/AIDS dependent on T cell count
74
HIV/AIDS clinical manifestations
-fever
-pharyngitis
-rash
-myalgia
-after acute phase, infected person becomes asymptomatic, HIV virus begins to replicate, immunity decreases
75
HIV/AIDS TX
-drug therapy to:
-decrease HIV viral load below level of detection
-restore body's ability to fight off pathogens
improve quality of life
-reduce HIV M&M
-antiviral retro therapy (ART)
76
antiviral retro therapy
-used for any person w/ AIDS defining illness or ASAP after DX
-long acting injectable medication and PO meds are available to suppress viral load
-used to prevent transmission to newborn (mother takes ART during pregnancy)
-during active labor, ART agent is given until delivery, administered 6-12 hours after birth and continued for 6 weeks
77
Post Exposure Prophylaxis (PEP)
-PEP is post exposure prophylaxis and prevents or controls spread of HIV within 72 hours after possible exposure
-will be taken for 28 days after exposure
-EX: accidental needle stick from positive HIV patient
78
Pre Exposure Prophylaxis (PrEP)
-medication taken daily to help reduce chances of contracting HIV for those at high risk of getting it
-partner who is having sexual activity with HIV positive partner
79
