Sexually Transmitted Infections Flashcards
<p>Sexually Transmitted Infection Definition</p>
<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>
<p>Can STI's spread through casual contact?</p>
<ul> <li><strong>NOT spread through casual contact</strong></li></ul>
<p>How are STI's spread?</p>
<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>
<p>Factors Related to Incidence of STI"s</p>
<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>
<p>Which STI's must be reported to the health department?</p>
<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>
<p>Risk factors for Infection of Sexually Transmitted Disease</p>
<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>
<p>Health Equity in STI's</p>
<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>
<p>What is the best form of protection of STI's?</p>
<p>Male condom best form of protection against STIs</p>
<p>What is a better option than abstinence?</p>
<p>Safer Sex</p>
<p>Does the use of hormonal birth control OR long-acting reversible contraceptives prevent STI's?</p>
<p><u><em><strong>NO!</strong></em></u></p>
<p>What are the 3 bacterial STI's?</p>
<ul> <li>Chlamydia</li> <li>Gonorrhea</li> <li>Syphilis</li></ul>
<p>Are bacterial STI's reportable to the health department?</p>
<p>YES!</p>
<p>What is the most common bacterial STI?</p>
<p>Chlamydia (trachomatis)</p>
<p>What type of bacteria is Chlamydia?</p>
<p>Gram negative</p>
<p>How is Chlamydia transmitted?</p>
<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>
<p>What is the most common site for infection for <u><em><strong>MEN</strong></em></u> with Chlamydia?</p>
<p>urethra - urethritis</p>
<p>What is the most common site for infection for <u><em><strong>WOMEN</strong></em></u>with Chlamydia?</p>
<p>cervical - cervicitis</p>
<p>What is another common site of Chlamydia in Men and Women?</p>
<p>rectum or the oropharynx</p>
<p>Between which partners is Chlamydia most commonly transmitted?</p>
<p>Men to Women</p>
<p>Chlamydia Manifestations & Complicationsin Men</p>
<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>
<p>Chlamydia Manifestations & Complications in Women</p>
<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>
<p>Chlamydia Manifestations & Complications Rectal</p>
<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>
<p>Chlamydia Diagnosis</p>
<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>
<p>Chlamydia Treatment</p>
<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>
What is the second most common STI in the US?
Gonococcal Infections
What causes gonorrhea?
Neisseria gonorrhoeae a gram-negative, diplococcus bacteria
How is gonorrhea transmitted?
- Transmitted through exposure to sexual fluids during vaginal, anal , or oral sex
- Incubation period 1-14 days
- Prior infection does not prevent reinfection
What are symptoms of gonorrhea in men?
urethral infection (urethritis) or epididymitis
What are symptoms of gonorrhea in women?
cervical (cervicitis)
What is another common site of gonorrhea in Men and Women?
rectal or oropharynx
Is gonorrhea reportable to the health department?
YES!!!
It is reportable disease in every state (by lab or provider).
Who should be screened for gonorrhea?
- Screen young, sexually active females
- Men who have sex with men
- Others at high risk for gonorrhea (& chlamydia) annually
Gonorrhea Manifestations in Men
- Usually symptomatic within a few days
- Dysuria, purulent urethral discharge or epididymitis
- Rectal– mucopurulent rectal discharge, bleeding, anorectal pain, pruritis, painful bowel movements
Gonorrhea Manifestations in Women
- Usually asymptomatic or have minor symptoms (often overlooked)
- Increased vaginal discharge, dysuria, frequency of urination or bleeding after sex
- Redness and swelling of cervix can occur with purulent exudate
- Rectal– mucopurulent rectal discharge, bleeding, anorectal pain, pruritis, painful bowel movements
Gonorrhea Complications in Men
- Men usually symptomatic and get treatment so less likely to have complications
- Infertility with epididymitis
Gonorrhea Complications in Women
- Women- asymptomatic so more likely to get complications
- Bartholin’s glands (located behind the labia)
- Pelvic inflammatory disease
- Pregnancy complications
- Neonates- gonococcal conjunctivitis
Gonorrhea Treatment
- Diagnosis– sexual history, physical exam
- Culture the discharge
- Usually begin treatment without results
- “High” dose IM single-dose ceftriaxone
- Antibiotic resistance of N. Gonorrhoeae worldwide has rendered treatment more complex, with fewer options.
- Notify all sexual contacts within last 60 days
- Abstain from sexual contact at least 7 days after antibiotic therapy completed (assuming all sex partners were treated)
Trichomoniasis (vaginalis)
- More common in women then men
- Men: ¾ cases = asymptomatic & often transient (spontaneous resolution within 10 days)
- Transmitted by exposure to sexual fluids-vaginal, anal, or oral
- Incubation period 1 week to 3 months (can be much longer)
- Routine screenings for high-risk women (including those with HIV); screening for men is not recommended
What is the most common STI Worldwide?
Trichomoniasis (vaginalis)
What is Trichomoniasis (vaginalis)?
Protozoan parasite
What is the commonality of Trichomoniasis?
- More common in women then men
- Men: ¾ cases = asymptomatic & often transient (spontaneous resolution within 10 days)
How is Trichomoniasis transmitted?
- Exposure to sexual fluids-vaginal, anal, or oral
- Incubation period 1 week to 3 months (can be much longer)
Who should be screened for Trichomoniasis?
- Routine screenings for high-risk women (including those with HIV)
- Screening for men is not recommended
Trichomoniasis Manifestations in Men
- Can be Asymptomatic carrier or have acute, severe inflammatory disease
- Men- when present, burning with urination/ejaculation, or urethral discharge
Trichomoniasis Manifestations in Women
- Can be Asymptomatic carrier or have acute, severe inflammatory disease
- Painful urination
- Vaginal itching
- Painful intercourse
- Bleeding after sex
- Yellow-green discharge with foul odor
- Cervix may have a ”strawberry” appearance
Trichomoniasis Complications
- Complication r/t inflammation untreated more likely to get another STI, particularly HIV
- Not related to PID
Trichomoniasis Diagnosis
Diagnosed with NAAT (nucleic acid amplification test) = gold standard for diagnosing (detects RNA)
Trichomoniasis Treatment
- metronidazole (7-day course twice daily) OR
- tinidazole (single-dose PO)
- Abstain from sexual activity until 7 days post-antibiotic therapy
- Inform & treat sexual partners
Trichomoniasis Recurrence
- High rate of recurrence
- Recommended to get tested again in 2 weeks to 3 months
What type of STI is Genital Herpes?
- Viral
- Life-long, incurable
What are they 2 strains of Genital Herpes?
- 2 strains- herpes simplex virus type 1 (HSV-1) & herpes simplex virus type 2 (HSV-2)
- Both types can cause anogenital infections
- HSV-1 more commonly causes the oral lesions and HSV-2 anogenital
Which Genital Herpes is more common in women?
HSV-2 twice as common in women
Racial Disparity in Genital Herpes
Hispanic and Black populations more likely to be infected
How is Genital Herpes spread?
- Usually spread by someone unaware they are infected
- Virus enters through mucous membranes or breaks in the skin after contact with an infected person (vaginal, oral, anal)
- Can be dormant at times
- Viral reactivation (outbreak) occurs when virus descends to initial site of infection or other mucous membranes/skin
- HSV establishes permanent presence in dorsal root ganglia
- Have virus for LIFE
When is Genital Herpes most contagious?
- Most contagious when infected person is symptomatic
- Can be transmitted without any apparent symptoms asymptomatic viral shedding
Where does HSV-1 typically manifest?
- Above the waist
- HSV-1 primarily associated with orolabial disease (cold sores, fever blisters)
Where does HSV-2 typically manifest?
Below the waist infections
Genital Herpes: Manifestation Primary Episode
- Incubation 2-12 days
- With genital infection usually no recognizable symptoms
- Regional lymphadenopathy and systemic flu-like symptoms can occur
- Whole process can take around 3 weeks
Genital Herpes: Manifestation Recurrent Episodes
- Occurs usually within the first year after primary episode
- Usually less severe and heal quicker
- Usually decreased episodes over time
- Stress, fatigue, acute illness, sunburn
- Immunosuppression can all trigger recurrent episodes
- Greatest risk of transmission is with active lesions (can transmit without)
Genital Herpes: Manifestation of Primary Genital Herpes Outbreak
In addition to hemorrhagic crusts (1-2 mm), there are perifollicular vesicopustules.
Genital Herpes: Complications
- Blindness
- Encephalitis
- Aseptic meningitis
- Genital ulcers increase risk of HIV transmission
- Pregnant women can transmit virus to the baby
- Lots of psychological impact (not curable)
Genital Herpes: Treatment
- Refer to counseling
- Diagnosis made by symptoms
- Culture from active lesion can distinguish between HSV1 & 2
- Anti-viral medications (acyclovir) can shorten duration of outbreak episode
- Can be used to suppress outbreaks
- Keep lesions clean and dry
What are Genital Warts & Human Papilloma Virus (HPV)?
Benign growths on anogenital skin or mucosa caused by sexually transmitted (skin to skin) HPV
How are Genital Warts & HPV spread?
- Incubation period can be months to years
- HPV usually considered transient virus usually clears or spontaneously resolves in 1-2 years
- Can persist even when warts are not present
Does removing genital warts help clear or
treat the virus?
Not necessarily
Genital Warts & HPV: Manifestations
- Most people have no idea they are infected
- Warts are generally discrete, white-to-grey or flesh colored, or hyperpigmented
- Can have 1-10 warts; can coalesce together to make a larger mass
- Early lesions usually not detectable
- Warts can be confused with other STI lesions, so rule out other conditions first
Manifestations of Genital Warts in Men
- Penis
- Scrotum
Manifestations of Genital Warts in Women
- Inner thighs
- Vulva
- Vaginally
- Intra-anally
Genital Warts & HPV: Complications
- Very few long-term concerns with genital warts
- However, high-risk HPV strains highly linked with cancer so can need more screenings
- Psychosocial burden
Genital Warts & HPV Prevention
- HPV vaccines for prevention
- Cover 90% of genital warts & 70%-90% of strains that cause cervical cancers
Genital Warts & HPV Treatment
- Primary goal - remove symptomatic warts
- Chemical or ablative methods in the office
- Put petroleum jelly on recently removed sites and keep clean
- Patient applied treatments also available
- Anal warts more difficult to treat
- Long-term follow-up recommended
Does removing Genital Warts decrease the spread?
No!
What is Syphilis ?
- Bacterial infection
- Caused by Treponema pallidum
- SERIOUS long-term complications if not treated early
How is Syphilis transmitted?
- Direct contact with syphilitic ulcer (chancre)
- Chancre can be external or internal in the genital areas
- Incubation period 10-90 days (average 21)
- Can be transmitted to baby during pregnancy- HIGH RISK!!!
Syphilis: Early Primary Clinical Stage
- Infectious syphilis
- Highly infectious
- Lesion (chancre) appears; lasts 3-6 weeks
Syphilis: Early Secondary Stage
- Highly infectious
- Starts 2-8 weeks after primary; bacterial dissemination -starts to effect nerves (e.g., meningitis)
Syphilis: Early Latent Stage
No symptoms within past two years; not contagious
Syphilis: Late & Tertiary Syphilis Stage
- Rarely seen in antibiotic era
- Not infectious, usually 1-20 years after initial infection
Syphilis Complications with other STI's
- Early chancres increase HIV transmission
- Patients with both syphilis and HIV more likely to have CNS involvement
Syphilis Complications: Neurosyphilis
- Permanent damage within the CNS
- Visual impairment
- Dementia
Syphilis Complications; Cardiovascular syphilis
- Chest pain
- Dyspnea
- Murmur
- Cardiomegaly
Syphilis Complications: Gummatous syphilis
- Unusual scarring on skin
- Changes in nasal septum & palate
Syphilis Diagnosis
- Serologic/blood test
- Screening (VDRL)
- Confirmatory positive screening (treponemal antigens)
- False results can occur based on timing of infection
- Also recommend testing for HIV test
Syphilis Treatment
- Treated with Penicillin G benzathine (Bicillin L-A) for all stages
- Doxycycline or tetracycline can be used for allergy
- Lots of follow-up with prior sex partners (past 90 days)
- Follow-up care with HCP every 6 months for 2 years
- Need repeat HIV testing
Related Nursing Problems for STI's
- Lack of Knowledge
- Psychosocial issues: Depression/Anxiety
- Risk for infection
Nursing Assessment for STI's
- MUST Be aware of gender identity/current anatomy/sexual preferences
- WSW, MSM & transgender persons are at higher risk
- Be warm, non-judgmental, reassuring
Nursing Teaching for STI's
- Health promotion crucial
- HPV vaccines, routine testing, PREVENTION
- Know your health departments requirements for reporting and make patient aware
