Sexually Transmitted Diseases Flashcards
What is the purpose of screening for BV?
Over growth of bacteria however should not be screening routinely
Why and how would you screen for BV?
May notice discharge, an odour or fishy smell.
With Vaginal swab
What are the implications of untreated BV?
Preterm and low birth weight baby
What is the treatment for BV?
Metronidazole 400mg BD for 7 days.
It can be given as STAT dose (2g) if pregnancy at TERM, refrain from breast feeding if 2g prescribed for 12 - 24hours. Express but discard EBM as it has a bitter/metallic taste and high transfer rate to baby.
Is prescribing for BV in a midwifes scope?
No - treatment must be prescribed by obstetric team in pregnancy
What advice would you give to prevent thrush?
Hygiene, wipe from front to back, cotton underwear, showers, no douching
As a midwife, what is the management for symptoms of thrush?
Take a swab or if discharge suggest thrush can start treatment.
What is the recommended treatment for thrush in pregnant woman?
Clotrimazole 1% Cream for 6 days or Miconazole 2% cream (Micreme) for 7 days
Do you refer for thrush in pregnancy?
No - only if not responding to treatment that refer to GP/Obstetric team
What is the recommended treatment option for a positive swab result for gonorrhoea and who decides the treatment plan?
- Recommended injection of ceftriaxone 500mg and state dose of azithromycin 1g
- Decision is made by specalist/obstetric team
Do you need to refer for positive result of gonorrhoea?
Yes to specialist / obstetric team
How can gonorrhoea harm the baby?
Untreated gonorrhoea can cause preterm birth and low birth weight
Gonorrhoea can also be passed onto the neonate and presents as conjunctivitis
What are some symptoms of gonorrhoea
Often asymptomatic
Vaginal discharge
Bleeding between periods
Lower abdominal pain
Pain during sex
Pain when weeing (urinating)
Discharge from the penis or rectum
What is the most commonly reported STI in NZ?
Chlamydia
What are the signs and symptoms of chlamydia?
Painful urination, vaginal discharge in women,
pain during sex.
What do you advise to your client around risk factor of chlamydia to pregnancy and her baby?
Chlamydia can be passed from mother to baby during birth, the baby may subsequently develop eye and or ear infections or pneumonia
Untreated chlamydia can also cause infertility
When should you screen for chlamydia?
If they have a previous history of chlamydia
If they have symptoms of chlamydia
What is the test for chlamydia and how is it taken?
Self collect Chlamydia NAAT swab - NAAT detects the genetic material (DNA or RNA) of Chlamydia trachomatis
What is the treatment for chlamydia in pregnancy?
Azithromycin 1g STAT can be used in pregnancy
No harm to baby
Use condoms for 7 days
Is treating chlamydia within the midwifery scope?
Yes
What is the management for a baby that presents with red and weepy eyes
Swab. If swab result not available, clean with saline, refer to neonatal team as requires antibiotics
What swab would you use to test a baby for chlamydia
NAAT swab for Chlamydia
What is the recommended treatment for a neonate with a positive swab for chlamydia
Erythromycin or Azithromycin syrup – decided by neonatal team.
Do you refer for positive chlamydia in the neonate?
Yes to the neonatal team as it can lead to pneumonia
If a pregnant woman says her partner has been diagnosed with syphilis what management will you take
Ask when was he diagnosed
Has she had a test, if so what were the results
If not had a test offer one as a part of routine antenatal screening
Ask about symptoms
What are the symptoms of syphilis?
Chancre on genitals. mouth or anus, rash, swollen lymph glands, headaches, muscle aches.
What is the screening for syphilis?
A part of routine antenatal blood test screening - EIA (enzyme immunoassay)
What is the management for a “reactive” syphilis screening result?
All reactive EIA tests will be reflex-tested with a second treponemal test (TPPA - Treponema pallidum particle agglutination) and a non-treponemal test (RPR - Rapid Plasma Reagin). If the TPPA is also reactive then current or past syphilis infection is confirmed.
What is the management and treatment of syphilis infection?
Referral guidelines 1047 for urgent consultation with obstetric team/specialist.
Treatment started asap as decided by team referred to
Retest offered at 28 - 32 weeks or anytime woman request
What are the treatment options for genital warts / HPV
creams, laser, cryotherapy (may not always be treated in pregnancy) – Generally may get better on their own so may not be treated
Will HPV harm the baby?
Generally no but can have warts on vocal cords/mouth several weeks after birth
What advice do you give to a woman with HPV around risk factor to pregnancy and her?
Genital warts do not affect pregnancy - some cases complications can arise – large warts may affect urination or cause bleeding, warts on vaginal wall can affect stretching
What is the recommended treatment option for HPV?
No cure but treatment to make them less visible with creams, solutions and sometimes cryotherapy
Do you need to refer for HPV and if so who do you refer to?
Yes - to a specialist
How is diagnosis made of HPV?
Via speculum, genital, and perineal examination looking for warts
What are the symptoms of trichomonas
Greeny, frothy, watery discharge – fishy odour.
What advice do you give a woman around risk factor to pregnancy and her?
Can be recurrent
Can be mother to child transmission no significant effect, Can also have Chlamydia infection
Can lead to pre-term birth and Premature rupture of membranes
Untreated increases risk of infertility and and getting infected with HIV easier
What is the recommended treatment for trichomonad?
Metronidazole 400mg BD for 7 days.
Can be given as STAT dose (2g) if pregnancy at TERM. Refrain from breast feeding if 2g prescribed for 12-24hours, express but discard EBM as bitter/metallic taste and higher transfer rate to baby
Do you need to refer for trichomonas?
Yes - to a specalist
What STI can midwives prescribe for?
Chlamydia
What STIs are treated with Azithromycin 1g Stat
Chlamydia and gonorrhea
What STIs are treated with metronidazole 2g PO stat or 400mg PO BD 7/7 days
Bacterial vaginosis and trichomonas
The USUAL cause of genital herpes is:
Herpes simplex virus 2.
Trichomonas vaginalis is what type of infection:
Protozoan
Which is the most common STI caused by a bacteria?
Chlamydia
On day 2 postnatal visit you notice baby Tara has pussy eyes. You:
Offer Tara’s mum a consultation with a neonatologist.
Chancre due to syphilis is found in the:
anus, mouth and cervix
