STI Flashcards
Sexually Transmitted Disease
STD
Most start on the genitalia (penis, vagina), anus and open skin lesions
Expedited Partner Therapy
check their partner;dont have to be checked. give pts
Autoinoculation-
can spread from one area of the body to another area
HSV-I –
HSV-II –
HSV-I – “oral herpes”
HSV-II – “genital herpes”
viral shedding
passing herpes without it being opened
Incubation:
how many days
2-12 days
Diagnosis –(4)
HSV serologic assays (blood work) antibody test,
symptoms,
visual examination,
wound/viral culture
Prodromal stage:HSV
(before lesions occur) burning, itching, tingling at the site (buttock, inner thigh, penis, scrotum, vagina, cervix, perianal region, labia)
Vesicular stage:
few small, painful vesicles(blisters) on genital areas, contain infectious particles, lymphadenopathy, flu-like symptoms (fever, headache, malaise)
Ulcerative stage:
lesions rupture and form moist ulcerations
Final stage:
crusting over of ulcers, epithelialization occur
is the crusting stage infectious? t or f
true
HSV Control:
________Precautions
Greatest risk is when _______________
Contact Precautions (hospital)
Don’t touch lesions!
Good handwashing
No sexual contact without condom
Greatest risk is when lesions are present
HT Condoms:
decrease transmission/decrease risk
Condom not 100% effective
Avoid sexual contact- when lesions present or during prodromal symptoms
HSV- Herpetic Whitlow
Herpetic infection of 1 or more fingers (usually enters through the cuticle), painful
HSV- Treatment- No Cure
state medication ( think about recyle video)
Obtain lesion/blister culture if present
Obtain blood test for HSV 1 or HSV 2 antibodies if client states hx
Medications: antiviral
Acyclovir 400mg po TID x 7-10 days or
Valacyclovir 1gm po BID x 7-10 days or
Famciclovir 250mg po TID x 7-10 days
Inhibits herpetic viral replication
Prescribed for both primary and recurrent outbreaks
IDU (idoxuridine)-
Zovirax
Lidocaine
Psychological support:
Topical Care:
OTC:
Maintain =
Avoid
topical,
Zovirax-topical,
Lidocaine gel can be used additionally
Psychological support: affects relationships, sexual lives
Topical Care: sitz bath, ice, cotton underwear, keep blisters/eruptions clean & dry
OTC: acetaminophen, ibuprofen
Maintain good hygiene
Avoid sexual contact until outbreak has completely healed.
Mother:
No newborn contact with an
active HSV lesion (orofacial or Whitlow).
Prevention of neonatal herpes
Close monitoring of mom prior to delivery last 6-8wks of pregnancy
Can give po Acyclovir during all stages of pregnancy
Vaginal delivery(ok if 2 neg results in a row and 1 within a week of delivery)
C-section(required if test + or herpetic lesions present)
HSV- Care of neonatal herpes ( meds)
IV Acyclovir
topical eye ointment:
Vidarabine, Idoxuridene (IDU)
Which medication would be prescribed
for a patient with HSV?
Ampicillin
Acyclovir
Penicillin
Cefazolin
Acyclovir
Syphilis
Caused by:
Transmission
Not spread through:
Transplacentally:
Incubation:
Caused by:
Treponema Pallidum Spirochete
Transmission
Direct contact with syphilitic lesion chancre found externally on the genitals, anus, internally in vagina, rectum, mouth, tongue, lips
Not spread through indirect contact only thru sexual contact
Transplacentally: transmit to fetus leads to preterm birth, stillbirth, complications after birth > seizures/death
Incubation 10 -90 days (average 21 days)
true or false lantency is the first stage of syphillis?
false
Primary:
Secondary: ( what is tatle tell)
Tertiary:
highly infectious(blood/exudate from chancre), painless chancre, regional lymphadenopathy (typically appears 3wks)
highly infectious, occurs after chancre heals, flu-like symptoms (malaise, fever, sore throat, headache) mucous patches in mouth or cervix, red rash on trunk, palms, and/or soles of feet, weight loss, alopecia, lymphadenopathy
NUMBER 1 INDICATO = RASH
Noninfectious, occurs 3-20yrs after initial infection, Gummas (chronic destructive lesions on skin, bone, liver, mucous membranes), Cardiovascular damage (scarring of aortic valves leads to heart failure), CNS damage, personality changes, psychotic, tremors, mental deterioration, ataxia (loss of full control body movements), death
Latent:
absence of s/s, period of dormancy, asymptomatic carrier, disease continues to develop internally, dx based on specific treponemal antibody test
WHAT STAGES ARE INFECTIOUS TO OTHER?
PRIMARY+SECONDARY
HSV Control:
Contact Precautions (hospital)
Don’t touch lesions!
Good handwashing
No sexual contact without condom
Greatest risk is when lesions are present
Syphilis treatment
Diagnosed by :
Antibiotic treatment: If allergic to _____, use ______________
Diagnosed by blood test:
1. Nontreponemal antibody test (VDRL or Rapid Plasma Reagin)
2. Treponemal test (FTA-ABS or EIA enzyme immunoassays)
Tx can not reverse internal damage
Antibiotic treatment: Penicillin G benzathine IM x 1 dose. If allergic to PCN, use Doxycycline or Tetracycline. Used in all stages and in pregnancy.
All sexual contacts in last ____ days need treatment.
Follow-up testing q_______ up to
All sexual contacts in last 90 days need treatment.
Follow-up testing q6months for up to 2 years
Gonorrhea
- Caused by __________
- Transmitted by exposure to ________
- Incubation: _________
- Site of infection:____________________
- S/S men: ________________,
- S/S women: ___________________
Can cause________________
Gonorrhea
*
* Caused by Neisseria gonorrhoeae bacteria
* Transmitted by exposure to sexual fluids
* Incubation: 1-14 days
* Site of infection: urethra-men, cervix-women
* S/S men: dysuria, purulent/thick discharge,
epididymitis (can lead to infertility)
* S/S women: Mostly asymptomatic, increase
vaginal discharge, dysuria, frequency, bleeding
after sex, redness/swelling of cervix or urethra.
Can cause PID (pelvic inflammatory disease)
which can lead to infertility, ectopic pregnancy,
chronic pelvic pain
Gonorrhea treatment
* Culture=
* History=
*
* High dose=
* Sexual partners within____days need
treatment
* HT to abstain from sexual intercourse for _
days after tx
Culture of discharge- NAAT (nucleic acid
amplification testing)
* History sexual activity
* Due high infectiousness, tx started before
results of positive culture obtained
* High dose 500mg ceftriaxone (Rocephin)
IM x1dose
* Sexual partners within 60 days need
treatment
* HT to abstain from sexual intercourse for 7
days after tx
Pregnant women same treatment (gonorrhea)
(Ceftriaxone)
Newborn
Ophthalmia
neonatorum(conjunctivitis)-
Erythromycin 50mg/kg po QID x 14
days for newborn
Treatment to
newborns-
Erthromycin 50mg/kg
po QID x 14 days.
Chlamydia
- Caused by =
- Transmitted
- Incubation:
- Site of infection:
- S/S men:
- S/S women:
Chlamydia
* Most common STI 2 million case/year
* Caused by Chlamydia trachomatis bacteria
* Transmitted by exposure to sexual fluids
* Incubation: 1-3 weeks
* Site of infection: urethra-men(urethritis), cervix-
women(cervicitis)
* S/S men: dysuria, white discharge, swelling
testicles/scrotum (epididymitis)
* S/S women: mucopurulent discharge(white
mucous), bleeding, dysuria, painful intercourse,
usually asymptomatic. If untreated, leads to
PID (infertility, ectopic pregnancy, chronic pelvic
pain)
Chlamydia treatment
- 7days of _______
- Follow-up testing
- High recurrence
- Tx all partners within
Chlamydia treatment
* Culture of discharge (NAAT)
* High prevalence of asymptomatic infection
(symptoms will subside w/o tx)- suggest
regular screening of high-risk populations
* 7days of doxycycline 100mg BID po
* Follow-up testing in 3 months is
recommended
* Abstain from sexual intercourse x 7 days after
tx and until all sexual partners have been tx.
* High recurrence
* Tx all partners within 60 days of diagnosis
HPV-Human Papillomavirus
* Also known as =
* Communicability-can be spread easily
through
* 100 virus types – 40 types sexually
transmitted. HPV type __–and ___ cause
genital _______
* Transmitted_____
* Incubation:
- Also known as anogenital warts
(Condylomata accuminate) - Communicability-can be spread easily
through sexual intercourse. Most people
don’t know they’re infected - 100 virus types – 40 types sexually
transmitted. HPV type 6 and 11 cause 90%
genital warts - Transmitted skin to skin (direct contact
vaginal, anal, oral sex) - Incubation: weeks to months to years
- May spontaneously resolve within a few
years
HPV Vaccine
*
Quadrivalnt HPV vaccine – targets
HPV 6,11,16, 18,5
– Administer to F/M ages 11-12 yrs
– 1-2 IM doses given over 6 mos period
– Can be given up to age 26, 27-45
years also
HPV S&S:
Female-
Male-
Bleeding may occur after
During pregnancy=
HPV S&S:
Most are asymptomatic: do not know they
are infected
Female- inner thighs, vulva, vagina,
cervix, perianal area
Male-penis, scrotum, anus, urethra
Itching with anogenital warts
Single or multiple papillary growths
(cauliflower-like mass, white to gray,
or pink-flesh color, or brownish on darker
skin)
Bleeding may occur after defecation with
anal warts
During pregnancy, multiply & grow rapidly
HPV diagnosis
- Visual inspection by health care provider.
- Biopsy if warts atypical or not responding
to treatment or becoming worse. - Psychosocial distress, removal for
cosmetic concerns - HPV infection can persist when warts are
not present, virus is. - Tx dependent on wart size, anatomical
site, symptoms, cost of tx and client
preference
HPV- Treatment
Physician administered:
* Chemical or ablative removal:
Trichloracetic acid (TCA) – applied
directly to wart. Petroleum jelly to
surrounding tissue to protect;
* Sharp stinging pain initially
* Caustic agent destroys wart
HPV- Treatment
Treatment
HPV- Treatment
Treatment
Primary goal is to treat visible genital warts
Patient applied:
*
* Imiquimod (Aldara) cream, immune response
modifier apply at bedtime, 3x week up to 16
wks. S/E: redness, irritation, ulceration,
vesicles may occur. Low risk in pregnancy
HPV Not to be used in pregnancy
Podofilox liquid or gel, apply BID x3 days,
Can be repeated for up to 4 wks or until warts
resolve. S/E: local irritation/pain,
Not to be used in pregnancy
HPV safe for pregnacy
Imiquimod (Aldara) cream, immune response
modifier apply at bedtime, 3x week up to 16
wks. S/E: redness, irritation, ulceration,
vesicles may occur. Low risk in pregnancy
HPV tx cont’
*
*
HPV tx cont’
* Cryotherapy- application of liquid
nitrogen>causes necrosis> blistering, use
local anesthesia
* Surgical tx – physically destroy by
electrocautery, use of scissors/scalpel,
carbon dioxide laser or curettage.
* F/U in several weeks to assess response.
* Most respond within 3months of therapy,
depends on tx compliance
* Recurrence and reinfection are possible,
virus is still present.
HPV-Control
HPV-Control
* Abstinence from sexual contact if warts
are present
* Use condoms
* HPV Vaccine, does not treat active
HPV infection.
* C-section delivery if warts
present .
HIV transmission
contact with infected
- Perinatal transmission during
- Exposure to blood during
- Puncture wound most common means of
work-related HIV transmission
- Sexual transmission (most common) -
contact with infected blood, semen,
vaginal secretions thru sexual
intercourse - Exposure to HIV-infected blood/blood
products - Perinatal transmission during pregnancy,
delivery, breastfeeding - Exposure to blood during drug-use
paraphernalia(needles, syringes, straws) - Puncture wound most common means of
work-related HIV transmission
Can not be spread through
through hugging,
shaking hands, using toilet seats or
casual encounters. Not spread in
tears, saliva, urine, emesis, sputum,
feces, or sweat.
Virus replication
leads to massive viremia and
wide spread of virus through body’s lymphoid
tissues ( CD4 + T cell destruction)
* An immune response against the virus
provides some protection but ultimately a
chronic persistent infection is established.
Normal CD4+
T cell count =
800-1200
Acute Infection:
- 2-4 wks after exposure,
- feels like mononucleosis (fever, swollen
glands, sore throat, muscle &joint pain,
diarrhea, rash, headache - some neurologic complications(peripheral
neuropathy, facial palsy, Guillain-Barre) - lg amt virus present in the blood, (high viral
load) - CD4 count drops temporarily then rebound to
baseline levels - Most infectious
Chronic Infection:
– Asymptomatic infection:
– Symptomatic infection:
– Asymptomatic infection: many do not
know they’re infected, asymptomatic,
continue high-risk behavior, infecting
others, low level virus in blood but still
contagious
– Symptomatic infection: CD4+ T cells
drop to 500-200, viral load increases,
s/s: fever, night sweats, chronic
diarrhea, headaches, severe fatigue
development of opportunistic infections
Opportunistic Infections
- Do not usually occur when immune
system is functioning properly
-thrush
-shingles
-Oral Hairy Leukoplakia
-Kaposi sarcoma
-Pneumocystis jiroveci
pneumonia
Pneumocystis jiroveci
pneumonia
Nonproductive
cough, SOB,
fever, night
sweats, fatigue
Acquired Immunodeficiency
Syndrome (AIDS)
- Diagnostic CDC criteria
– CD4+ T cell count below 200 cells/μl
– High viral load, very infectious
– Specific opportunistic infection or/+ cancer
– Specific opportunistic cancer
– Wasting syndrome: lost at least 10% ideal
body mass, especially muscle, diarrhea,
extreme weakness and fever (not r/t
infection)
HIV Testing
- Window period:
HIV Testing
* Confidentiality vs anonymous
* Counseling
* Window period: time period from initial
infection until detectable on screening
test, up to several weeks
* HIV Antibody/Antigen Testing Table 15-
19 p.253 Lewis
* Rapid HIV-Antibody Test: (saliva)
results available in 20mins, if
positive,need f/u with a standard blood
test (Western Blot)
Antiretroviral Therapy ART
Antiretroviral Therapy ART
* Goals:
– Decrease viral load
– Maintain or raise CD4+ T cells counts
– Prevent HIV-related symptoms and
opportunistic diseases
– Delay disease progression
– Prevent HIV transmission
Most effective is simultaneous administration of
at least 3 ART drugs from at least 2 different
classes used in full dosages and in optimum
schedules. Multiple drugs inhibit replication
differently, making difficult for virus to recover
and minimize drug resistance
PrEP
PrEP
Preexposure prophylaxis
* HIV medication for clients who are not
HIV+
* Reduces risk of acquiring HIV
* Used in conjunction with other risk
prevention interventions
* 2 medications in 1 tablet qd =
emtricitabine + tenofovir (Truvada or
Descovy)
