Reproductive Infections Flashcards
What causes a UTI? What do they treat uti’s with?
What can a UTI lead to?
How can this affect PG?
Bacteria present in urine culture treated with antibiotics
Could lead to cystitis or a kidney infection.
That would cause premature birth and intrauterine growth restriction.
How to prevent cystitis/uti
contraception:
Avoid:
Do:
Change diaphragm method for contraception
Avoid bladder irritants such as alcohol or caffeine or carbonated beverages
Avoid holding pee in
Avoid sex
Do drink water
Do drinkn cranberry juice to help relieve UTI symptoms
Do wipe front to back
Do take all of your antibiotics for UTI infections
Vaginitis or Vaginosis types (3)
Vulvovaginal Candidiasis
Bacterial vaginosis/gardnerella
Trichomoniasis
Name for yeast infection
How is it spread?
General mucus appearance?
treatment meds?
risk in pregnancy?
treatment for newborn?
Vulva Candidiasis which is considered to be a vaginitis subtype
spread by contact
cottage cheese like mucus
tx: antifungals like miconazole
pill, creams, suppositories
If present for labor, newborn could be at risk for thrush or diaper dermatitis
but just give them antifungals
Bacterial vaginosis/ Gardnerella
Mucus appearance
Smell
How is it dx
Howo is it tx
Vaginosis is gray/yellow milky discharge
Smells like fish
dx by clue cells on slide of discharge
treated with metronadozaole or flagyl
Bacterial vaginosis/Gardnerella
risk to pregnancy?
PROM - pre-term rupture, PTC - preterm labor, and postpartum infections
Trichomoniasis
appearance
symptoms
Dx:
tx:
education for sex & substances:
green white frothy discharge
can have urinary symptoms or strawberries on cervix
Saline slide reveals a motile flagellated tail organism
Rapid test
Affirm test
Metronidazole (again) 2 grams
BUT you need to avoid coitus until infection is gone
Avoid alcohol
Chlamydia
bacteria
how common is this?
transmission
symptoms? in men?
what if it isn’t treated?
newborn risks
- treatment?
adult tx
chlamydia trachomatis
most common sti in us
sexual contact transmission
no symptoms or may have purulent discharge or dysuria . men may think they have uti
if not treated, then could lead to
PID, ectopic PG, tubal infertility in women
newborn risks include eye and lung infection
- need to do prophylaxis treatment with erythromycin
adults treated with Azithromycin or Doxycycline orally
Syphillis bacteria?
incubation?
transmission?
Syphillis caused by spirochete treponema pallidum
Incubation is 10-90 days meaning you can have it not know
sex, open wound, blood, or transplacentally during PG
Syphillis early signs
Chancre at site of organism entry (disappears after 4 weeks)
Fever
Wt loss
Malaise
Syphillis secondary signs
condylomata late (warts) rash arthritis hepatosplenamegaly tender lymph nodes iritis chronic ST with hoarseness
Blood test for syphillis
VDRL (less sensitive )
RPR
FTA-ABS (most effective but costly)
At what gestational week age will syphillis begin to affect the fetus
14 weeks
treatment if you’ve had syphillis symptoms for less than a year if pregnant
for unknown duration or more than year if pregnant
what if someone is allergic to pcn?
- 4 million u. PCN x3weeks IM
- 4 million PCN x3weeks
just have to desensitize them to it
treatment for syphillis if not pregnant
doxycycline or tetracycline
How long will the mom be positive for syphillis for after treatment
8 months for mom
3 months for baby
But it is ok as long as you see the load decrease. do titer.
PG effects of syphillis
small low birth weight of infant, preterm birth, or stillbirth
Gonorrhea
bacteria
transmission
dx
Gonorrhea
Neisseria gonorrhea
sexual contact transmission
swab culture
Gonorrhea
treatment
education
newborns?
- treatment
Ceftriaxone 250 mg IM
partner must be treated
Will have to retest in 3 months (both people)
Could have eye ophthalmia and pneumonia
- need eye ointment erythromycin but can do oral
What are TORCH infections?
A group of infections represented by the TORCH acronym. Toxoplasmosis Other such as Hep A ,B, C Rubella Cytomegalovirus Herpes
What is Toxoplasmosis cause?
What do Toxoplasmosis symptoms look like?
Caused by protozoa parasites that can be found in cats
Can have no symptoms or could have mono signs with a fever
How to avoid getting Taxoplosmosis?
Avoid eating undercooked meats
Don’t allow PG women to scoop litter w cat feces
Complications in PG if you get Taxoplasmosis?
Lots
hydrocephaly choriortenitis cerebral calcifications enlarged liver rash jaundice after birth
How to treatment Toxoplasmosis with meds
Pyrimethamine
sulfa and folic acid for 1 yr total
Why is an infection of Toxoplasmosis (or any infection) more worrisome if it occurs in the first trimester?
The younger the baby the more likely the infection will affect development
Rubella is what type of virus?
Rubella effects are greatest in which trimester? And to which systems?
It is the German measles virus but it has an immunization
First trimester
Hearing is main system but also the eyes, CNS, or cardiac
Cytomegalovirus is described as?
Cytomegalovirus is a transplacental infection due to active maternal infections going on
Neonate symptoms of cytomegalovirus?
rash liver is enlarged jaundice microcephaly IGM will be elevated
Cytomegalovirus treatment for newborn and mother
Antiviral to newborn
PG mother will be given CMV or a specific immunoglobulin
List Torch infections again
Toxoplasmosis Other hep a, b, c Rubella Cytomegalovirus Herpes
Different types of Herpes
1 - oral
2- genital
Herpes transmission
vaginal
anal
oral
generally any skin to skin contact with infected site
What do Herpes blisters feel , look, and act like?
When do blisters heel after they show up?
Painful vesicles that can last up to 20 days past exposure
Will heal in 2-4 weeks - but the virus isn’t gone. It remains dormant in nerve ganglia.
How can Herpes affect pregnancy?
May have to do C-section if there is an active break out at delivery.
Can also increase risk of spontaneous abortion , preterm labor, or IUGR ( slow growing fetus)
Treatment for PG mothers with herpes and when
antiviral therapy in the 3rd trimester to reduce fetal risks and c-section delivery
What will the symptoms be like for herpes during a primary outbreak?
How is herpes diagonsed?
Blisters or ruptured ulcers
Urination and urinary retention issues
Lymph nodes enlarged in groin
Flu symptoms and tingling of genitals.
Diagnosis requires a culture of the lesions
Meds for herpes to suppress virus?
Meds for herpes pain symptoms?
How to care for lesions?
Oral acyclovir, zovirax, or Famvir
Topical Lidocaine
Keep lesion area clean & dry
Wear cotton underwear
Is there a cure for herpes?
Nope but lesions do move internally and thus appear healed.
Why should a women with herpes go in for regular pap smears?
It increases risk of cervical cancers as well.
HPV is .. also known as
Genital warts or Condylomata Acuminata
How is HPV transmitted
Transmitted through oral, vaginal, and anal sex
How long can HPV be incubated
HPV can be incubated for 3 weeks to 3 years & so you won’t know who gave it to you
How is HPV diagnosed
Hx, Pap, and HPV test by specialists
Which HPV strains are responsible for genital warts
Which HPV strains are known to account for cervical cancers
6 & 11 for warts
16 & 18 for cancers
Is there any treatment that erradicates HPV
How to get rid of warts
None
But you can do certain procedures to remove warts
cryosurgery chloracetic acid scissor excision curettage cautery laser prepared gels
When is it recommended people get the HPV vaccines
How?
Before becoming sexually active
Will need 2 or 3 IM injections over 6 months for aged 9 and older
What contraceptive can help reduce hpv risk
Best prevention of hpv turning into cervical cancer
condoms
Need to do pap smears
How common are congenital herpes infections in newborns
How common are herpes infections when spread through labor?
rare
More common. 85% of newborn herpes infections happen during vaginal births (maybe from mom being unaware or not telling the provider)
Herpes symptoms and locations of lesions in newborns?
CNS issues oral eyes skin lesions It can be deadly to the newborn
Will culture them to make sure. BUT always make sure to wear gloves when handling a newborn
Med used to treat a newborn with a herpes infection?
Acyclovir (it won’t cure them but it will suppress it)
What is PID?
A syndrome that can occur due to stds and stis - and can occur with or without absess formation but ultimately causes inflammation
(Hense the name - P Inflammatory D)
PID endometritis
When the uterine lining is involved
endometrium of uterus
PID salpingitis
Involved fallopian tubes
PID Oophoritis
Has to do with ovaries
PID peritonitis
Means of thee peritoneum
Highest risk groups of PID
Teens and young adults
Low income & education
Smokers w multiple sex partners
Those who participate in early sexual activity
IUD users
Those who douche
Main organisms responsible for PID
Chlamydia
Gonorrhea
T/F
Women w PID can often still have children
Somewhat false.
PID is one of the main reasons women become infertile.
(A woman may still be able to have a child but this is in the minority)
PID symptoms
Pelvic pain Fever Chills Discharge Bleeding malaise NV
How to diagnose PID
How to check for abscesses?
How to confirm results?
Do exam
Check for adnexal tenderness
(tender tubes and ovaries)
Chandelier cervix sign (reaching up in pain when cervix is touched)
Might do sonogram for any abscesses
Results confirmed with Laparoscopy after culture is obtained
Treating PID
Education?
What if osmeone ahs an IUD?
Antibiotics for both partners
- Rocephin, Doxycycline, Clindamycin, Flagyl
Need to follow up & teach about prevention of Sti’s but also make sure they know early treatment is always best since late treatment is what caused the PID
Will need to remove IUD
What is GBS or Group B Streptococci
It is a certain bacteria of Streptococci that can be harmful to a fetus during pregnancy
What risks can happen if a PG mom develops GBS?
Chorioamnionitis
PROM or membrane rupture
UTI
PTL
Neonatal sepsis
Neonatal meningitis
Post partum infection
Dx for GBS
at 35-37 weeks need to screen w swab
Tx for GBS with antibiotics procedure?
What if the newborn ends up with GBS afterall?
IV antibiotics at early onset of active labor before the amniotic sac ruptures to reduce fetal effects
treated w antibiotics and will have to stay longer
What percent of PG women are recommended to screen for HIV 1&2?
All of them 100%
Name high risk groups of HIV
prostitutes bisexuals IV drug users Hemophiliacs W/ HIV + partners Native Africans (due to high % origin rates) African American women
Percent of pediatric cases with HIV due to PG mothers
Can you reduce the odds of transferring to the fetus?
Should women feel embarassed to be tested for HIV?
84% - from PG moms
Yes, treatment during pregnancy can help. Lowers infection rate to 1-2%.
While it is understandable, anonymous testing is available.
What are high risk HIV fluids?
Blood
semen
vaginal fluids
breast milk (HIV + mothers cannot breastfeed whatsoever)
What do most HIV tests screen for?
What is the test called? What does the test look for?
HIV antibodies - which are produced upon infection.
IFA - indirect fluorescent antibody test
- test looks for antigen or antibodies
Which cells does HIV affect & inhibit ?
T cells which affects immune system response of any infection
Where is HIV 1 geographically prominent
US & west europe
Where is HIV 2 geographically found
West africa
How many stages of HIv/AIDS
4
Acute stage of HIV
mono like symptoms
seroconversion
Asymptomatic stage of HIV
HIV for 5-10 years
- Where most PG women are
Symptomatic stage HIV infection
You begin to notice you have clinical manifestations
Aids stage of HIV
end stage HIV infection where tumors and infections occur :
Wasting syndrome Esophageal candidiasis Herpes lesions Kapasi's sarcoma pneumocystitis TN toxopolasmosis (a torch infection)
Vertical transmission of HIV
Transferring HIV from mom to baby
- either through labor or breastfeeding
Patient asks which class of meds will be given to manage her HIV during delivery. And when she’ll begin taking them. Your response?
antiretrovirals
- must be given orally after 14 weeks until birth
Is it safe to do an amniocentesis if mom has HIV?
No it is not safe.
Can a PG mother infected with HIV have any possibility of vaginal delivery?
When is it appropriate do a C-Section?
If viral load is low and ruptured bag of water
CS needed if the viral load is high and there is no rupture yet
Can an electrode fetal scalp monitor be used with HIV PG mom?
Vacuum extractor?
forceps?
External monitoring devices?
Should a PG HIV mom do frequent vaginal exams?
No
No
No
Yes - really just try to avoid anything internal if it can be helped.
No
HIV mother is about to do a vaginal birth. It’s not working out and so they decide to a c-section. What was the med you gave before hand that is distributed for both types of deliveries? What route?
An antiviral!
Given IV.
An HIV PG mom just gave birth to a healthy looking baby. What should you do immediately?
Bathe the baby.
A HIV mom is asking if she can breastfeed her newborn. Your response?
She also asks how long she’ll have to take antivirals since she’s given birth. Your response?
No she cannot due to breastmilk containing HIV antibodies.
Antivirals should be continued as long as they’re prescribed.
What complications can occur in a PG women postpartum due to HIV/AIDS?
Post partum considerations:
hemorrhage
infections
poor wound healing
Continue meds and labs
Parent child as condition allows
When a baby is born with HIV - can you tell right away?
Will they receive meds immediatley?
What if they do end up being positive?
No. Need to wait a year for screening. If they’re 18 months and still negative , then they’re good.
Yes - they’ll be given AZT/ZDV po per weight.
Then switch meds to ART(antivirals) just like adults.
General teachings concerning STI’s and STD’s
If you notice a sore or lesions anywhere near genitalia or mouth, should you abstain from sex?
You have sex and suddenly notice a change in discharge. Should you wait or go get it checked out?
You decide to wait to get treatment for sores on your genitalia but they end up going away. Should you still get tested?
Your sores go away before you finish all your meds. Now what?
Your providers notifies you that you are now the age able to have pap smears. You’ve been sexually active since you were 16 but feel fine. Should you avoid going in for your pap?
You are dx with HPV. Should you cancel your next screening if you want to go on vacation instead?
Yes - abstain if you are even the slightest bit suspicious.
Get it checked. Do not delay treatment anytime if ANY symptoms appear.
If sores go away, you still need to be tested.
Take ALL meds.
No, do not avoid a pap smear. HPV and cervical cancer often exhibit no symptoms. It is important women get pap smears when due. If you notice an infection, you should be making an appt with provider anyways.
Ideally, no. If you cancel make sure to reschedule and stay on top of your follow up appointments.
