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MED SURG COLLAB > Sexually Transmitted Infections > Flashcards

Sexually Transmitted Infections Flashcards

1
Q

<p>Sexually Transmitted Infection Definition</p>

A

<ul> <li>Infectious disease spread through sexual contact withthe penis, vagina, mouth, or sexual fluids from aninfected person</li> <li>Treatable and can be curable</li> <li>Complications can be <strong>SERIOUS and can includeinfertility and cancer</strong></li> <li>Lots of psychosocial implications</li> <li>Education, counseling, referrals are essential nursingroles</li></ul>

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2
Q

<p>Can STI's spread through casual contact?</p>

A

<ul> <li><strong>NOT spread through casual contact</strong></li></ul>

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3
Q

<p>How are STI's spread?</p>

A

<ul> <li>Mucosal tissues in genitals most susceptible</li> <li>Rectum and mouth</li> <li>Spread through direct skin-to-skin contact (genital warts)</li> <li>Can also spread from an infected person’s blood orblood products</li> <li>Birth, sharing needles</li> <li>Autoinoculation touching or scratching an infectedarea and transferring to another part of SAME person’sbody</li></ul>

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4
Q

<p>Factors Related to Incidence of STI"s</p>

A

<ul> <li>20 million new cases each year in US</li> <li>Having an STI increases risk for getting another</li> <li>Can have multiple STI's at the same time</li> <li>Incubation period</li> <li>Earlier reproductive maturity</li> <li>Longer sexual lifespan</li> <li>Greater sexual freedom</li> <li>Inconsistent or incorrect use of barrier methods</li> <li>Media’s increasing emphasis on sexuality withoutdiscussing safer sex</li> <li>Substance use</li></ul>

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5
Q

<p>Which STI's must be reported to the health department?</p>

A

<p><em>In the U.S.:</em></p>

<ul> <li><strong>Gonorrhea</strong></li> <li><strong>Chlamydia</strong></li> <li><strong>Syphilis</strong></li></ul>

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6
Q

<p>Risk factors for Infection of Sexually Transmitted Disease</p>

A

<ul> <li><25 (especially adolescents)</li> <li>Socially/economically disadvantaged</li> <li>High-risk behaviors</li> <li>Alcohol/drug use needle sharing</li> <li>Multiple sexual partners</li> <li>Inconsistent use of barrier methods</li> <li>High-risk medical history</li> <li>History of STI</li> <li>Lack of vaccinations</li> <li>Multiple uses of Prep (prophylaxis for HIV)</li> <li>Higher risk populations (Ex., MSM, transgender)</li></ul>

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7
Q

<p>Health Equity in STI's</p>

A

<ul> <li>Black Americans have highest number of many STIs</li> <li>Social & economic disadvantages lead to difficultyaddressing smaller problems (like sexual health)</li> <li>Fear and distrust of HCPs</li> <li>Difficulty accessing quality health services</li></ul>

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8
Q

<p>What is the best form of protection of STI's?</p>

A

<p>Male condom best form of protection against STIs</p>

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9
Q

<p>What is a better option than abstinence?</p>

A

<p>Safer Sex</p>

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10
Q

<p>Does the use of hormonal birth control OR long-acting reversible contraceptives prevent STI's?</p>

A

<p><u><em><strong>NO!</strong></em></u></p>

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11
Q

<p>What are the 3 bacterial STI's?</p>

A

<ul> <li>Chlamydia</li> <li>Gonorrhea</li> <li>Syphilis</li></ul>

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12
Q

<p>Are bacterial STI's reportable to the health department?</p>

A

<p>YES!</p>

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13
Q

<p>What is the most common bacterial STI?</p>

A

<p>Chlamydia (trachomatis)</p>

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14
Q

<p>What type of bacteria is Chlamydia?</p>

A

<p>Gram negative</p>

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15
Q

<p>How is Chlamydia transmitted?</p>

A

<ul> <li>Transmitted though exposure to sexual fluids duringvaginal, anal, or oral sex</li> <li>Incubation period 1-3 weeks</li> <li>Can be infected multiple times</li></ul>

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16
Q

<p>What is the most common site for infection for <u><em><strong>MEN</strong></em></u> with Chlamydia?</p>

A

<p>urethra - urethritis</p>

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17
Q

<p>What is the most common site for infection for <u><em><strong>WOMEN</strong></em></u>with Chlamydia?</p>

A

<p>cervical - cervicitis</p>

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18
Q

<p>What is another common site of Chlamydia in Men and Women?</p>

A

<p>rectum or the oropharynx</p>

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19
Q

<p>Between which partners is Chlamydia most commonly transmitted?</p>

A

<p>Men to Women</p>

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20
Q

<p>Chlamydia Manifestations & Complicationsin Men</p>

A

<ul> <li>Usually, no symptoms</li> <li>Men– pain with urination or urethral discharge</li> <li>Rarely pain or swelling of the testicles</li> <li>Complications can RARELY result in infertility</li></ul>

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21
Q

<p>Chlamydia Manifestations & Complications in Women</p>

A

<ul> <li>Usually, no symptoms</li> <li>Mucopurulent discharge, bleeding, dysuria, pain with intercourse</li> <li>Complications can result in infertility Pelvic Inflmmatory Disease (PID)</li></ul>

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22
Q

<p>Chlamydia Manifestations & Complications Rectal</p>

A

<ul> <li>Anorectal pain</li> <li>Discharge</li> <li>Bleeding</li> <li>Pruritis</li> <li>Tenesmus</li> <li>Mucus coated stools</li> <li>Painful bowelmovements<br></br> </li></ul>

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23
Q

<p>Chlamydia Diagnosis</p>

A

<ul> <li>Accurate sexual history, physical exam, lab testnucleic acid amplification test (NAAT)</li> <li>Always test for OTHER STIs as well</li> <li>Regular screening for high-risk populationsrecommended</li> <li>Return for testing 3 months after treatment</li></ul>

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24
Q

<p>Chlamydia Treatment</p>

A

<ul> <li>Treated with azithromycin or doxycycline</li> <li>ALL sexual contact from prior 60 days should benotified/evaluated/treated</li> <li>Abstain from sexual activity for 7 days AFTER treatment AND until all partners have been tested and treated</li> <li>Expedited partner therapy</li></ul>

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25
Q

<p>What is the second most common STI in the US?</p>

A

<p>Gonococcal Infections</p>

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26
Q

<p>What causes gonorrhea?</p>

A

<p>Neisseria gonorrhoeae a gram-negative, diplococcus bacteria</p>

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27
Q

<p>How is gonorrhea transmitted?</p>

A

<ul> <li>Transmitted through exposure to sexual fluids during vaginal, anal , or oral sex</li> <li>Incubation period 1-14 days</li> <li>Prior infection does not prevent reinfection</li></ul>

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28
Q

<p>What are symptoms of gonorrhea in men?</p>

A

<p>urethral infection (urethritis)or epididymitis</p>

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29
Q

<p>What are symptoms of gonorrhea in women?</p>

A

<p>cervical (cervicitis)</p>

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30
Q

<p>What is another common site of gonorrhea in Men and Women?</p>

A

<p>rectal or oropharynx</p>

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31
Q

<p>Is gonorrhea reportable to the health department?</p>

A

<p><em><u><strong>YES!!!</strong></u></em></p>

<p>It is reportable disease in every state (by lab or provider).</p>

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32
Q

<p>Who should be screened for gonorrhea?</p>

A

<ul> <li>Screen young, sexually active females</li> <li>Men who have sex with men</li> <li>Others at high risk for gonorrhea (& chlamydia) annually</li></ul>

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33
Q

<p>Gonorrhea Manifestations in Men</p>

A

<ul> <li>Usually symptomatic within a few days</li> <li>Dysuria, purulent urethral discharge or epididymitis</li> <li>Rectal– mucopurulent rectal discharge, bleeding,anorectal pain, pruritis, painful bowel movements</li></ul>

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34
Q

<p>Gonorrhea Manifestations in Women</p>

A

<ul> <li>Usually asymptomatic or have minor symptoms (often overlooked)</li> <li>Increased vaginal discharge, dysuria, frequency ofurination or bleeding after sex</li> <li>Redness and swelling of cervix can occur withpurulent exudate</li> <li>Rectal– mucopurulent rectal discharge, bleeding,anorectal pain, pruritis, painful bowel movements</li></ul>

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35
Q

<p>Gonorrhea Complications in Men</p>

A

<ul> <li>Men usually symptomatic and get treatment so lesslikely to have complications</li> <li>Infertility with epididymitis</li></ul>

36
Q

<p>Gonorrhea Complications in Women</p>

A

<ul> <li>Women- asymptomatic so more likely to getcomplications</li> <li>Bartholin’s glands (located behind the labia)</li> <li>Pelvic inflammatory disease</li> <li>Pregnancy complications</li> <li>Neonates- gonococcal conjunctivitis</li></ul>

37
Q

<p>Gonorrhea Treatment</p>

A

<ul> <li>Diagnosis– sexual history, physical exam</li> <li>Culture the discharge</li> <li>Usually begin treatment without results</li> <li>“High” dose IM single-dose ceftriaxone</li> <li>Antibiotic resistance ofN. Gonorrhoeae worldwide has rendered treatmentmore complex, with fewer options.</li> <li>Notify all sexual contacts within last 60 days</li> <li>Abstain from sexual contact at least 7 days afterantibiotic therapy completed (assuming all sexpartners were treated)</li></ul>

38
Q

<p>Trichomoniasis (vaginalis)</p>

A

<ul> <li>More common in women then men</li> <li>Men: ¾ cases = asymptomatic & often transient (spontaneous resolution within 10 days)</li> <li>Transmitted by exposure to sexual fluids-vaginal, anal, or oral</li> <li>Incubation period 1 week to 3 months (can be much longer)</li> <li>Routine screenings for high-risk women (including those with HIV); screening for men is not recommended</li></ul>

39
Q

<p>What is the most common STI Worldwide?</p>

A

<p>Trichomoniasis (vaginalis)</p>

40
Q

<p>What is Trichomoniasis (vaginalis)?</p>

A

<p>Protozoan parasite</p>

41
Q

<p>What is the commonality of Trichomoniasis?</p>

A

<ul> <li>More common in women then men</li> <li>Men: ¾ cases = asymptomatic & often transient(spontaneous resolution within 10 days)</li></ul>

42
Q

<p>How is Trichomoniasis transmitted?</p>

A

<ul> <li>Exposure to sexual fluids-vaginal, anal, or oral</li> <li>Incubation period 1 week to 3 months (can be muchlonger)</li></ul>

43
Q

<p>Who should be screened for Trichomoniasis?</p>

A

<ul> <li>Routine screenings for high-risk women (including those with HIV)</li> <li>Screening for men is not recommended</li></ul>

44
Q

<p>Trichomoniasis Manifestations in Men</p>

A

<ul> <li>Can be Asymptomatic carrier or have acute, severeinflammatory disease</li> <li>Men- when present, burning with urination/ejaculation,or urethral discharge</li></ul>

45
Q

<p>Trichomoniasis Manifestations in Women</p>

A

<ul> <li>Can be Asymptomatic carrier or have acute, severeinflammatory disease</li> <li>Painful urination</li> <li>Vaginal itching</li> <li>Painfulintercourse</li> <li>Bleeding after sex</li> <li>Yellow-greendischarge with foul odor</li> <li>Cervix may have a”strawberry” appearance</li></ul>

46
Q

<p>Trichomoniasis Complications</p>

A

<ul> <li>Complication r/t inflammation untreated more likelyto get another STI, particularly HIV</li> <li>Not related to PID</li></ul>

47
Q

<p>Trichomoniasis Diagnosis</p>

A

<p>Diagnosed with NAAT (nucleic acid amplification test) = gold standard for diagnosing (detects RNA)</p>

48
Q

<p>Trichomoniasis Treatment</p>

A

<ul> <li>metronidazole (7-day course twice daily) OR</li> <li>tinidazole (single-dose PO)</li> <li>Abstain from sexual activity until 7 days post-antibiotictherapy</li> <li>Inform & treat sexual partners</li></ul>

49
Q

<p>Trichomoniasis Recurrence</p>

A

<ul> <li>High rate of recurrence</li> <li>Recommended to get testedagain in 2 weeks to 3 months</li></ul>

50
Q

<p>What type of STI is Genital Herpes?</p>

A

<ul> <li>Viral</li> <li>Life-long, incurable</li></ul>

51
Q

<p>What are they 2 strains of Genital Herpes?</p>

A

<ul> <li>2 strains- herpes simplex virus type 1 (HSV-1) & herpes simplex virus type 2 (HSV-2)</li> <li>Both types can cause anogenital infections</li> <li>HSV-1 more commonly causes the oral lesions and HSV-2 anogenital</li></ul>

52
Q

<p>Which Genital Herpes is more common in women?</p>

A

<p>HSV-2 twice as common in women</p>

53
Q

<p>Racial Disparity in Genital Herpes</p>

A

<p>Hispanic and Black populations more likely to be infected</p>

54
Q

<p>How is Genital Herpes spread?</p>

A

<ul> <li>Usually spread by someone unaware they are infected</li> <li>Virus enters through mucous membranes or breaks inthe skin after contact with an infected person(vaginal,oral, anal)</li> <li>Can be dormant at times</li> <li>Viral reactivation (outbreak) occurs when virusdescends to initial site of infection or other mucousmembranes/skin</li> <li>HSV establishes permanent presence in dorsal rootganglia</li> <li>Have virus for LIFE</li></ul>

55
Q

<p>When is Genital Herpes most contagious?</p>

A

<ul> <li>Most contagious when infected person is symptomatic</li> <li>Can be transmitted without any apparent symptomsasymptomatic viral shedding</li></ul>

56
Q

<p>Where does HSV-1 typically manifest?</p>

A

<ul> <li>Above the waist</li> <li>HSV-1 primarily associated with orolabial disease (coldsores, fever blisters)</li></ul>

57
Q

<p>Where does HSV-2 typically manifest?</p>

A

<p>Below the waist infections</p>

58
Q

<p>Genital Herpes: Manifestation Primary Episode</p>

A

<ul> <li>Incubation 2-12 days</li> <li>With genital infection usually no recognizablesymptoms</li> <li>Regional lymphadenopathy and systemic flu-likesymptoms can occur</li> <li>Whole process can take around 3 weeks</li></ul>

59
Q

<p>Genital Herpes: Manifestation Recurrent Episodes</p>

A

<ul> <li>Occurs usually within the first year after primaryepisode</li> <li>Usually less severe and heal quicker</li> <li>Usually decreased episodes over time</li> <li>Stress, fatigue, acute illness, sunburn</li> <li>Immunosuppression can all trigger recurrent episodes</li> <li>Greatest risk of transmission is with active lesions (can transmit without)</li></ul>

60
Q

<p>Genital Herpes: Manifestation of Primary Genital Herpes Outbreak</p>

A

<p>In addition to hemorrhagic crusts (1-2 mm), there are perifollicular vesicopustules.</p>

61
Q

<p>Genital Herpes: Complications</p>

A

<ul> <li>Blindness</li> <li>Encephalitis</li> <li>Aseptic meningitis</li> <li>Genital ulcers increase risk of HIV transmission</li> <li>Pregnant women can transmit virus to the baby</li> <li>Lots of psychological impact (not curable)</li></ul>

62
Q

<p>Genital Herpes: Treatment</p>

A

<ul> <li>Refer to counseling</li> <li>Diagnosis made by symptoms</li> <li>Culture from activelesion can distinguish between HSV1 & 2</li> <li>Anti-viral medications (acyclovir) can shorten durationof outbreak episode</li> <li>Can be used to suppress outbreaks</li> <li>Keep lesions clean and dry</li></ul>

63
Q

<p>What are Genital Warts & Human Papilloma Virus (HPV)?</p>

A

<p>Benign growths on anogenital skin or mucosa caused by sexually transmitted (skin to skin) HPV</p>

64
Q

<p>How are Genital Warts & HPV spread?</p>

A

<ul> <li>Incubation period can be months to years</li> <li>HPV usually considered transient virus usually clearsor spontaneously resolves in 1-2 years</li> <li>Can persist even when warts are not present</li></ul>

65
Q

<p>Does removing genital warts help clear or <br></br> treat the virus?</p>

A

<p>Not necessarily</p>

66
Q

<p>Genital Warts & HPV: Manifestations</p>

A

<ul> <li>Most people have no idea they are infected</li> <li>Warts are generally discrete, white-to-grey or fleshcolored, or hyperpigmented</li> <li>Can have 1-10 warts; can coalesce together to make alarger mass</li> <li>Early lesions usually not detectable</li> <li>Warts can be confused with other STI lesions, so ruleout other conditions first</li></ul>

67
Q

<p>Manifestations of Genital Warts in Men</p>

A

<ul> <li>Penis</li> <li>Scrotum</li></ul>

68
Q

<p>Manifestations of Genital Warts in Women</p>

A

<ul> <li>Inner thighs</li> <li>Vulva</li> <li>Vaginally</li> <li>Intra-anally</li></ul>

69
Q

<p>Genital Warts & HPV: Complications</p>

A

<ul> <li>Very few long-term concerns with genital warts</li> <li>However, high-risk HPV strains highly linked withcancer so can need more screenings</li> <li>Psychosocial burden</li></ul>

70
Q

<p>Genital Warts & HPV Prevention</p>

A

<ul> <li>HPV vaccines for prevention</li> <li>Cover 90% of genital warts & 70%-90% of strains that cause cervical cancers</li></ul>

71
Q

<p>Genital Warts & HPV Treatment</p>

A

<ul> <li>Primary goal - remove symptomatic warts</li> <li>Chemical or ablative methods in the office</li> <li>Put petroleum jelly on recently removed sites andkeep clean</li> <li>Patient applied treatments also available</li> <li>Anal warts more difficult to treat</li> <li>Long-term follow-up recommended</li></ul>

72
Q

<p>Does removing Genital Warts decrease the spread?</p>

A

<p><u><em><strong>No!</strong></em></u></p>

73
Q

<p>What is Syphilis ?</p>

A

<ul> <li>Bacterial infection</li> <li>Caused by Treponema pallidum</li> <li><em><strong>SERIOUS long-term complications if not treated early</strong></em></li></ul>

74
Q

<p>How is Syphilis transmitted?</p>

A

<ul> <li>Direct contact with syphilitic ulcer (chancre)</li> <li>Chancre can be external or internal in the genitalareas</li> <li>Incubation period 10-90 days (average 21)</li> <li>Can be transmitted to baby during pregnancy- <u><em><strong>HIGHRISK!!!</strong></em></u></li></ul>

75
Q

<p>Syphilis: Early Primary Clinical Stage</p>

A

<ul> <li>Infectious syphilis</li> <li>Highly infectious</li> <li>Lesion (chancre) appears; lasts 3-6 weeks</li></ul>

76
Q

<p>Syphilis: Early Secondary Stage</p>

A

<ul> <li>Highly infectious</li> <li>Starts 2-8 weeks after primary; bacterial dissemination -starts to effect nerves (e.g., meningitis)</li></ul>

77
Q

<p>Syphilis: Early Latent Stage</p>

A

<p>No symptoms within past two years; not contagious</p>

78
Q

<p>Syphilis: Late & Tertiary Syphilis Stage</p>

A

<ul> <li>Rarely seen in antibiotic era</li> <li>Not infectious, usually 1-20 years after initial infection</li></ul>

79
Q

<p>Syphilis Complications with other STI's</p>

A

<ul> <li>Early chancres increase HIV transmission</li> <li>Patients with both syphilis and HIV more likely to haveCNS involvement</li></ul>

80
Q

<p>Syphilis Complications: Neurosyphilis</p>

A

<ul> <li>Permanent damage within the CNS</li> <li>Visual impairment</li> <li>Dementia</li></ul>

81
Q

<p>Syphilis Complications; Cardiovascular syphilis</p>

A

<ul> <li>Chest pain</li> <li>Dyspnea</li> <li>Murmur</li> <li>Cardiomegaly</li></ul>

82
Q

<p>Syphilis Complications: Gummatous syphilis</p>

A

<ul> <li>Unusual scarring on skin</li> <li>Changes in nasal septum & palate</li></ul>

83
Q

<p>Syphilis Diagnosis</p>

A

<ul> <li>Serologic/blood test</li> <li>Screening (VDRL)</li> <li>Confirmatory positive screening (treponemal antigens)</li> <li>False results can occur based on timing of infection</li> <li>Also recommend testing for HIV test</li></ul>

84
Q

<p>Syphilis Treatment</p>

A

<ul> <li>Treated with Penicillin G benzathine (Bicillin L-A) for allstages</li> <li>Doxycycline or tetracycline can be used for allergy</li> <li>Lots of follow-up with prior sex partners (past 90 days)</li> <li>Follow-up care with HCP every 6 months for 2 years</li> <li>Need repeat HIV testing</li></ul>

85
Q

<p>Related Nursing Problems for STI's</p>

A

<ul> <li>Lack of Knowledge</li> <li>Psychosocial issues: Depression/Anxiety</li> <li>Risk for infection</li></ul>

86
Q

<p>Nursing Assessment for STI's</p>

A

<ul> <li><u><em><strong>MUST</strong></em></u> Be aware of gender identity/currentanatomy/sexual preferences</li> <li>WSW, MSM & transgender persons are at higher risk</li> <li>Be warm, non-judgmental, reassuring</li></ul>

87
Q

<p>Nursing Teaching for STI's</p>

A

<ul> <li>Health promotion crucial</li> <li>HPV vaccines, routine testing, PREVENTION</li> <li>Know your health departments requirements forreporting and make patient aware</li></ul>

MED SURG COLLAB (75 decks)

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