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L&D > STD’s and Vaginal Infections > Flashcards

STD’s and Vaginal Infections Flashcards

1
Q

Chlamydia (Chlamydia trachomatis)
(bacteria)
most common STD in US; most, prevalent in adolescents

What are CM?

A

Inflammation of cervix with mucopurulent discharge (dc).
May be asymptomatic
Untreated may lead to urethritis,
tubal occlusion, pelvic inflammatory disease (PID) and infertility.

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2
Q

Screening /Diagnosis of Chlamydia

A
  • Screen 1st trimester or when enter healthcare.
  • By culture or DNA, probe, or enzyme immunoassay. CDC
    recommends nucleic acid amplification test (NAAT) or urinary,
    vaginal or endocervical areas
  • Retest 3rd trimester/ if multiple sex partners or younger than 25
  • Test for gonorrhea.
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3
Q

Treatment and management for Chylamidia

A

Antibiotics (bacterial).
Azithromycin 1 g oral single dose.
Doxycycline 100mg bid for 7 days
Erythromycin ophthalmic ointment NB’s conjunctival sac 1 hour of birth.

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4
Q

Pregnancy/Fetal/Neonatal Effects of Chlamydia

A

Pregnancy: Increased incidence of PROM, PTL, PID, ectopic pregnancy
Newborn may be asymptomatic.
Conjunctivitis
Scarring
Blindness
Respiratory problems may result in pneumonia.

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5
Q

Gonorrhea
Neisseria gonorrhea – an aerobic gram-negative diplococcus
Clinical Manifestations

A

Often asymptomatic
Complaint of mucoid or mucopurulent vagina/endocervical discharge,
dysuria and swollen, reddened labia
Pelvic, lower abdominal or rectal pain
Vulvovaginal inflammation progresses to yellow-green
vaginal discharge.
May ascend to involve pelvic structures = PID

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6
Q

Gonorrhea Screening/Diagnosis

A

Gram stain culture of endocervical, vaginal, rectum and possibly pharynx
Also, chlamydia culture and serologic test for syphilis
Screened at 1st prenatal visit. At risk clients screened again in 3rd trimester (36 weeks)

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7
Q

Gonorrhea Treatment/Management

A

Ceftriaxone (Rocephin)
125 mg IM single dose

Baby - Erythromycin ophthalmic ointment within 1 hour of birth.

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8
Q

Gonorrhea Pregnancy/Fetal/Neonatal Effects

A

Pregnancy: amnionitis, PTL and postpartum salpingitis.
Newborn: ophthalmia neonatorum (gonococcal conjunctivitis) If untreated, blindness

Because of the prevalence of
Chlamydia and Gonorrhea all states
have a law requiring preventive
treatment to newborns at birth.

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9
Q

Syphilis
Treponema pallidum (spirochete)
CM’s

A

-Primary stage: Ulcer - (chancre)
-condyloma – warts maybe present on vulva, perineum or
anus. (flatter than HPV genital warts)
-Secondary - maculopapular rash can be on hands & soles of feet
-This disease progresses to secondary and tertiary stages with varying characteristics.

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10
Q

Syphilis Screening/Diagnosis

A

Screened at first prenatal visit VDRL or RPR serology and again in 3rd trimester and at time of birth if they are high risk.

(If HIV or other STI always check to see that a RPR or VDRL was done too)

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11
Q

Syphilis Treatment/Management

A

Penicillin G 2.4 million units single dose. If allergic doxycycline or tetracycline – not to be used in pregnancy)

Treatment by 18th gestational week prevents congenital syphilis in neonate. However, treat at time of diagnosis.

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12
Q

Syphilis Pregnancy/Fetal/Neonatal Effects

A

Pregnancy: May result in spontaneous abortion or PTL. Transmitted across placenta after approximately 18 weeks gestation.
Newborn: Congenital anomalies and/or congenital syphilis
Congenital syphilis. (Test on cord blood).

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13
Q

Herpes Simplex Virus Type 2
(HSV)

CM’s

A

Lesions: Pain, red papules; pustular vesicles that break and form wet ulcers that later crust.
Low grade fever, chills, malaise & severe dysuria;
Dyspareunia (pain during intercourse

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14
Q

Herpes Simplex Virus Type 2
(HSV)
Screening/Diagnosis

A

Screening by history and examination for lesions.
New cases by culture from active lesions.
Multinucleated giant cells in microscopic examination of lesion
exudates.

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15
Q

Herpes Simplex Virus Type 2
(HSV)
Treatment and Management

A

-Acyclovir (Zovirax) oral 400mg PO tid 7-10 days
-Suppressive treatment with Acyclovir/ 36 weeks decreases viral shedding during delivery.
-Counseled cesarean birth may be indicated if active lesions present.
-MEDICATION IS NOT A CURE.

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16
Q

Herpes Simplex Virus Type 2
(HSV)
Pregnancy/Fetal/Neonatal Effects

A

Crosses placenta as well as acquired during direct contact
during birth

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17
Q

Human Papilloma Virus (HPV)
CM’s

A

Condyloma acuminata (genital warts) that spread, enlarge
during pregnancy.
(small soft papillary swellings) in the genital and anorectal regions

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18
Q

Human Papilloma Virus (HPV)
Screening/Diagnosis

A

Speculum exam,
Pap test (Papanicolaou),
history and SNS

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19
Q

Human Papilloma Virus (HPV)
Treatment/Management

A

Trichloroacetic acid
Laser treatment
Cryocautery

20
Q

Human Papilloma Virus (HPV)
Pregnancy/Fetal/Neonatal Effects

A

Associated with cervical cancer later in life.

21
Q

Bacterial Vaginosis
Gardnerella
CM’s

A

Vaginal discharge thin,
grayish with fish-like odor.
Intense pruritus

22
Q

Bacterial Vaginosis
Gardnerella
Screening/Diagnosis

A

Wet-mount slide positive
for clue cells

23
Q

Bacterial Vaginosis
Gardnerella
Treatment/Management

A

Topical metronidazole
(Flagyl)

24
Q

Bacterial Vaginosis
Gardnerella
Pregnancy/Fetal/Neonatal Effects

A

Associated with PTL.

25
Q

Candidiasis
Candida albicans
(Yeast infection)
CM

A

Thick, white, pruritic vaginal discharge.
Common in pregnancy r/t changes in vaginal with antibiotic tx and with Diabetes Mellitus or HIV infection

26
Q

Candidiasis
Candida albicans
(Yeast infection)
Screening/Diagnosis

A

Wet-mount slide.

27
Q

Candidiasis
Candida albicans
(Yeast infection)
Treatment/Management

A

Monistat (antifungal) vaginal cream
Diflucan (oral)

28
Q

Candidiasis
Candida albicans
(Yeast infection)
Pregnancy/Fetal/Neonatal Effects

A

Candida infection (oral thrush) if baby in direct contact with
organism in birth canal.

29
Q

Trichomoniasis
Protozoan
CM’s

A

Frothy, odorous vaginal discharge.

30
Q

Trichomoniasis
Protozoan
Screening/Diagnosis

A

Flagellated trichimonads visible on microscopic exam of wet-mount slide

31
Q

Trichomoniasis
Protozoan
Treatment/Management

A

-Metronidazole (Flagyl) for sexual partners is usual treatment. –NO FLAGYL GIVEN TO PREGNANT CLIENTS IN 1st TRIMESTER.
-Clotrimazole (Gyne-Trimin) topical antifungal

32
Q

Group B
Streptococcus
CM’s

A

Asymptomatic
UTI

33
Q

Group B
Streptococcus
Screening/Diagnosis

A

Screening at 35-38 weeks gestation is recommended
for all pregnant women.

34
Q

Group B
Streptococcus
Treatment/Management

A

Penicillin (Ampicillin) broad
spectrum

35
Q

Group B
Streptococcus
Pregnancy/Fetal/Neonatal Effects

A

Intra-amniotic infection

36
Q

Hepatitis B
CM’s

A

Jaundice, fever, painful joints

37
Q

Hepatitis B
Screening/Diagnosis

A

HBsAG test detects acute and chronic infections.
IgM antibody to Hepatitis B detects acute or recent infection.
Identify carriers at prenatal screening.
Screened again 3rd trimester to allow tx during delivery and of
neonate at birth.

38
Q

Hepatitis B
Treatment/Management

A

-B vaccine for unvaccinated pregnant clients.
-A series of HBsAG recommended for all newborns. The 1st
injection is given within 24 hours/birth.
-Infants of mothers positive for HBsAG need Hepatitis B immune globulin and vaccine at birth

39
Q

Hepatitis B
Pregnancy/Fetal/Neonatal Effects

A

Maternal: Prematurity, LBW

40
Q

HPV (Human papilloma virus)
What are the CM’s, Screening and diagnosis, treatment, and effects?

A

CM’s: Condyloma acuminata (genital warts) that spread, enlarge during pregnancy. (Small soft papillary swellings) in the genital and anorectal regions
Screening/ diagnosis: Speculum exam, Pap test (Papanicolaou), history and SNS
Treatment: Trichloroacetic acid, Laser treatment, Cry cautery
Effects: associated with cervical cancer later in life

41
Q

Describe RPR
Rapid plasma result, shows syphilis; normal is negative

A

· Primary stage: Ulcer - (chancre) condyloma – warts maybe present on vulva, perineum, or anus. (Flatter than HPV genital warts)
· Secondary - maculopapular rash can be on hands & soles of feet
· Screened at first prenatal visit and again in 3rd trimester and at time of birth If they are high risk
· Treatment: Penicillin G 2.4 million unit’s single dose. If allergic doxycycline or tetracycline – not to be used in pregnancy)
· Treatment by 18th gestational week prevents congenital syphilis in neonate. However, treat at time of diagnosis.
· Pregnancy: May result in spontaneous abortion or PTL.
· Transmitted across placenta after approximately 18 weeks’ gestation.
· Newborn: Congenital anomalies and/or congenital syphilis (Test on cord blood).

42
Q

Describe UTi’s

A

§ Harder for pregnant women to wipe from front to back
§ Shorter ureters in cases
§ Elevated risk because of dilated ureters and renal pelvis
§ Relaxed tone> Increased capacity> Stasis of urine
§ UTI can lead to pregnancy loss
§ UTI is correlated to premature labor
§ Symptoms of UTI
· Frequency with urgency
· Dysuria
· Hematuria
§ Teach patients to report symptoms of UTI especially urgency to urinate

43
Q
  • Describe the effects of STIs and other matters on the mother and/or the fetus during pregnancy
A

o Many results in preterm labor or cross the placenta which leads to the baby contracting the disease in the womb
o Gonorrhea and Chlamydia >risk of corneal scarring of infant during vaginal birth
o Herpes Simplex Virus (HSV) - organism may cross placenta and contaminate fetus OR in contact during vaginal delivery —ACTIVE HSV…Always a C/S.

44
Q

what lab tests will be done to determine STIs

A

Type’s pe of labs
- Blood test, vaginal swabbing, urine samples

The type of STI’s
-Gonorrhea, Chlamydia, Syphilis, herpes

45
Q
  • Explain how toxoplasmosis can occur and what education needs to be done
A

o Do not change the cat litter box or allow a cat to lick your face when pregnant
o Do not eat undercooked meats (sushi, raw, deli meats)

46
Q

What do you have to remember about RH factor

A

o If the mother is Rh negative, she will be given RhoGAM to prevent her immune system from attacking fetal cells in subsequent pregnancies.

o Concerns if there is a difference
-If she happens to be Rh – and the baby’s blood is Rh+ her body immediately sets up a reaction to foreign substance…begins to develop antibodies to the Rh+ blood.

L&D (12 decks)

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