STD’s and Vaginal Infections Flashcards
Chlamydia (Chlamydia trachomatis)
(bacteria)
most common STD in US; most, prevalent in adolescents
What are CM?
Inflammation of cervix with mucopurulent discharge (dc).
May be asymptomatic
Untreated may lead to urethritis,
tubal occlusion, pelvic inflammatory disease (PID) and infertility.
Screening /Diagnosis of Chlamydia
- 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.
Treatment and management for Chylamidia
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.
Pregnancy/Fetal/Neonatal Effects of Chlamydia
Pregnancy: Increased incidence of PROM, PTL, PID, ectopic pregnancy
Newborn may be asymptomatic.
Conjunctivitis
Scarring
Blindness
Respiratory problems may result in pneumonia.
Gonorrhea
Neisseria gonorrhea – an aerobic gram-negative diplococcus
Clinical Manifestations
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
Gonorrhea Screening/Diagnosis
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)
Gonorrhea Treatment/Management
Ceftriaxone (Rocephin)
125 mg IM single dose
Baby - Erythromycin ophthalmic ointment within 1 hour of birth.
Gonorrhea Pregnancy/Fetal/Neonatal Effects
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.
Syphilis
Treponema pallidum (spirochete)
CM’s
-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.
Syphilis Screening/Diagnosis
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)
Syphilis Treatment/Management
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.
Syphilis Pregnancy/Fetal/Neonatal Effects
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).
Herpes Simplex Virus Type 2
(HSV)
CM’s
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
Herpes Simplex Virus Type 2
(HSV)
Screening/Diagnosis
Screening by history and examination for lesions.
New cases by culture from active lesions.
Multinucleated giant cells in microscopic examination of lesion
exudates.
Herpes Simplex Virus Type 2
(HSV)
Treatment and Management
-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.
Herpes Simplex Virus Type 2
(HSV)
Pregnancy/Fetal/Neonatal Effects
Crosses placenta as well as acquired during direct contact
during birth
Human Papilloma Virus (HPV)
CM’s
Condyloma acuminata (genital warts) that spread, enlarge
during pregnancy.
(small soft papillary swellings) in the genital and anorectal regions
Human Papilloma Virus (HPV)
Screening/Diagnosis
Speculum exam,
Pap test (Papanicolaou),
history and SNS
Human Papilloma Virus (HPV)
Treatment/Management
Trichloroacetic acid
Laser treatment
Cryocautery
Human Papilloma Virus (HPV)
Pregnancy/Fetal/Neonatal Effects
Associated with cervical cancer later in life.
Bacterial Vaginosis
Gardnerella
CM’s
Vaginal discharge thin,
grayish with fish-like odor.
Intense pruritus
Bacterial Vaginosis
Gardnerella
Screening/Diagnosis
Wet-mount slide positive
for clue cells
Bacterial Vaginosis
Gardnerella
Treatment/Management
Topical metronidazole
(Flagyl)
Bacterial Vaginosis
Gardnerella
Pregnancy/Fetal/Neonatal Effects
Associated with PTL.
Candidiasis
Candida albicans
(Yeast infection)
CM
Thick, white, pruritic vaginal discharge.
Common in pregnancy r/t changes in vaginal with antibiotic tx and with Diabetes Mellitus or HIV infection
Candidiasis
Candida albicans
(Yeast infection)
Screening/Diagnosis
Wet-mount slide.
Candidiasis
Candida albicans
(Yeast infection)
Treatment/Management
Monistat (antifungal) vaginal cream
Diflucan (oral)
Candidiasis
Candida albicans
(Yeast infection)
Pregnancy/Fetal/Neonatal Effects
Candida infection (oral thrush) if baby in direct contact with
organism in birth canal.
Trichomoniasis
Protozoan
CM’s
Frothy, odorous vaginal discharge.
Trichomoniasis
Protozoan
Screening/Diagnosis
Flagellated trichimonads visible on microscopic exam of wet-mount slide
Trichomoniasis
Protozoan
Treatment/Management
-Metronidazole (Flagyl) for sexual partners is usual treatment. –NO FLAGYL GIVEN TO PREGNANT CLIENTS IN 1st TRIMESTER.
-Clotrimazole (Gyne-Trimin) topical antifungal
Group B
Streptococcus
CM’s
Asymptomatic
UTI
Group B
Streptococcus
Screening/Diagnosis
Screening at 35-38 weeks gestation is recommended
for all pregnant women.
Group B
Streptococcus
Treatment/Management
Penicillin (Ampicillin) broad
spectrum
Group B
Streptococcus
Pregnancy/Fetal/Neonatal Effects
Intra-amniotic infection
Hepatitis B
CM’s
Jaundice, fever, painful joints
Hepatitis B
Screening/Diagnosis
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.
Hepatitis B
Treatment/Management
-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
Hepatitis B
Pregnancy/Fetal/Neonatal Effects
Maternal: Prematurity, LBW
HPV (Human papilloma virus)
What are the CM’s, Screening and diagnosis, treatment, and effects?
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
Describe RPR
Rapid plasma result, shows syphilis; normal is negative
· 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).
Describe UTi’s
§ 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
- Describe the effects of STIs and other matters on the mother and/or the fetus during pregnancy
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.
what lab tests will be done to determine STIs
Type’s pe of labs
- Blood test, vaginal swabbing, urine samples
The type of STI’s
-Gonorrhea, Chlamydia, Syphilis, herpes
- Explain how toxoplasmosis can occur and what education needs to be done
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)
What do you have to remember about RH factor
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.
