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Med/Surg 2 STI's > STI's Overview > Flashcards

STI's Overview Flashcards

1
Q

Sexually Transmitted Infection Definition

A
  • Infectious disease spread through sexual contact with the penis, vagina, mouth, or sexual fluids from an infected person
  • Treatable and can be curable
  • Complications can be SERIOUS and can include infertility and cancer
  • Lots of psychosocial implications
  • Education, counseling, referrals are essential nursing roles
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2
Q

Can STI’s spread through casual contact?

A
  • NOT spread through casual contact
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3
Q

How are STI’s spread?

A
  • Mucosal tissues in genitals most susceptible
  • Rectum and mouth
  • Spread through direct skin-to-skin contact (genital warts)
  • Can also spread from an infected person’s blood or blood products
  • Birth, sharing needles
  • Autoinoculation touching or scratching an infected area and transferring to another part of SAME person’s body
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4
Q

Factors Related to Incidence of STI”s

A
  • 20 million new cases each year in US
  • Having an STI increases risk for getting another
  • Can have multiple STI’s at the same time
  • Incubation period
  • Earlier reproductive maturity
  • Longer sexual lifespan
  • Greater sexual freedom
  • Inconsistent or incorrect use of barrier methods
  • Media’s increasing emphasis on sexuality without discussing safer sex
  • Substance use
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5
Q

Which STI’s must be reported to the health department?

A

In the U.S.:

  • Gonorrhea
  • Chlamydia
  • Syphilis
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6
Q

Risk factors for Infection of Sexually Transmitted Disease

A
  • <25 (especially adolescents)
  • Socially/economically disadvantaged
  • High-risk behaviors
  • Alcohol/drug use needle sharing
  • Multiple sexual partners
  • Inconsistent use of barrier methods
  • High-risk medical history
  • History of STI
  • Lack of vaccinations
  • Multiple uses of Prep (prophylaxis for HIV)
  • Higher risk populations (Ex., MSM, transgender)
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7
Q

Health Equity in STI’s

A
  • Black Americans have highest number of many STIs
  • Social & economic disadvantages lead to difficulty addressing smaller problems (like sexual health)
  • Fear and distrust of HCPs
  • Difficulty accessing quality health services
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8
Q

What is the best form of protection of STI’s?

A

Male condom best form of protection against STIs

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9
Q

What is a better option than abstinence?

A

Safer Sex

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10
Q

Does the use of hormonal birth control OR long-acting reversible contraceptives prevent STI’s?

A

NO!

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11
Q

What are the 3 bacterial STI’s?

A
  • Chlamydia
  • Gonorrhea
  • Syphilis
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12
Q

Are bacterial STI’s reportable to the health department?

A

YES!

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13
Q

What is the most common bacterial STI?

A

Chlamydia (trachomatis)

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14
Q

What type of bacteria is Chlamydia?

A

Gram negative

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15
Q

How is Chlamydia transmitted?

A
  • Transmitted though exposure to sexual fluids during vaginal, anal, or oral sex
  • Incubation period 1-3 weeks
  • Can be infected multiple times
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16
Q

What is the most common site for infection for MEN with Chlamydia?

A

urethra - urethritis

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17
Q

What is the most common site for infection for WOMEN with Chlamydia?

A

cervical - cervicitis

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18
Q

What is another common site of Chlamydia in Men and Women?

A

rectum or the oropharynx

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19
Q

Between which partners is Chlamydia most commonly transmitted?

A

Men to Women

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20
Q

Chlamydia Manifestations & Complications in Men

A
  • Usually, no symptoms
  • Men– pain with urination or urethral discharge
  • Rarely pain or swelling of the testicles
  • Complications can RARELY result in infertility
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21
Q

Chlamydia Manifestations & Complications in Women

A
  • Usually, no symptoms
  • Mucopurulent discharge, bleeding, dysuria, pain with intercourse
  • Complications can result in infertility Pelvic Inflmmatory Disease (PID)
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22
Q

Chlamydia Manifestations & Complications Rectal

A
  • Anorectal pain
  • Discharge
  • Bleeding
  • Pruritis
  • Tenesmus
  • Mucus coated stools
  • Painful bowel movements
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23
Q

Chlamydia Diagnosis

A
  • Accurate sexual history, physical exam, lab test nucleic acid amplification test (NAAT)
  • Always test for OTHER STIs as well
  • Regular screening for high-risk populations recommended
  • Return for testing 3 months after treatment
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24
Q

Chlamydia Treatment

A
  • Treated with azithromycin or doxycycline
  • ALL sexual contact from prior 60 days should be notified/evaluated/treated
  • Abstain from sexual activity for 7 days AFTER treatment AND until all partners have been tested and treated
  • Expedited partner therapy
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25
Q

What is the second most common STI in the US?

A

Gonococcal Infections

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26
Q

What causes gonorrhea?

A

Neisseria gonorrhoeae a gram-negative, diplococcus bacteria

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27
Q

How is gonorrhea transmitted?

A
  • Transmitted through exposure to sexual fluids during vaginal, anal , or oral sex
  • Incubation period 1-14 days
  • Prior infection does not prevent reinfection
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28
Q

What are symptoms of gonorrhea in men?

A

urethral infection (urethritis) or epididymitis

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29
Q

What are symptoms of gonorrhea in women?

A

cervical (cervicitis)

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30
Q

What is another common site of gonorrhea in Men and Women?

A

rectal or oropharynx

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31
Q

Is gonorrhea reportable to the health department?

A

YES!!!

It is reportable disease in every state (by lab or provider).

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32
Q

Who should be screened for gonorrhea?

A
  • Screen young, sexually active females
  • Men who have sex with men
  • Others at high risk for gonorrhea (& chlamydia) annually
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33
Q

Gonorrhea Manifestations in Men

A
  • Usually symptomatic within a few days
  • Dysuria, purulent urethral discharge or epididymitis
  • Rectal– mucopurulent rectal discharge, bleeding, anorectal pain, pruritis, painful bowel movements
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34
Q

Gonorrhea Manifestations in Women

A
  • 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
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35
Q

Gonorrhea Complications in Men

A
  • Men usually symptomatic and get treatment so less likely to have complications
  • Infertility with epididymitis
36
Q

Gonorrhea Complications in Women

A
  • Women- asymptomatic so more likely to get complications
  • Bartholin’s glands (located behind the labia)
  • Pelvic inflammatory disease
  • Pregnancy complications
  • Neonates- gonococcal conjunctivitis
37
Q

Gonorrhea Treatment

A
  • 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)
38
Q

Trichomoniasis (vaginalis)

A
  • 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
39
Q

What is the most common STI Worldwide?

A

Trichomoniasis (vaginalis)

40
Q

What is Trichomoniasis (vaginalis)?

A

Protozoan parasite

41
Q

What is the commonality of Trichomoniasis?

A
  • More common in women then men
  • Men: ¾ cases = asymptomatic & often transient (spontaneous resolution within 10 days)
42
Q

How is Trichomoniasis transmitted?

A
  • Exposure to sexual fluids-vaginal, anal, or oral
  • Incubation period 1 week to 3 months (can be much longer)
43
Q

Who should be screened for Trichomoniasis?

A
  • Routine screenings for high-risk women (including those with HIV)
  • Screening for men is not recommended
44
Q

Trichomoniasis Manifestations in Men

A
  • Can be Asymptomatic carrier or have acute, severe inflammatory disease
  • Men- when present, burning with urination/ejaculation, or urethral discharge
45
Q

Trichomoniasis Manifestations in Women

A
  • 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
46
Q

Trichomoniasis Complications

A
  • Complication r/t inflammation untreated more likely to get another STI, particularly HIV
  • Not related to PID
47
Q

Trichomoniasis Diagnosis

A

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

48
Q

Trichomoniasis Treatment

A
  • 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
49
Q

Trichomoniasis Recurrence

A
  • High rate of recurrence
  • Recommended to get tested again in 2 weeks to 3 months
50
Q

What type of STI is Genital Herpes?

A
  • Viral
  • Life-long, incurable
51
Q

What are they 2 strains of Genital Herpes?

A
  • 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
52
Q

Which Genital Herpes is more common in women?

A

HSV-2 twice as common in women

53
Q

Racial Disparity in Genital Herpes

A

Hispanic and Black populations more likely to be infected

54
Q

How is Genital Herpes spread?

A
  • 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
55
Q

When is Genital Herpes most contagious?

A
  • Most contagious when infected person is symptomatic
  • Can be transmitted without any apparent symptoms asymptomatic viral shedding
56
Q

Where does HSV-1 typically manifest?

A
  • Above the waist
  • HSV-1 primarily associated with orolabial disease (cold sores, fever blisters)
57
Q

Where does HSV-2 typically manifest?

A

Below the waist infections

58
Q

Genital Herpes: Manifestation Primary Episode

A
  • 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
59
Q

Genital Herpes: Manifestation Recurrent Episodes

A
  • 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)
60
Q

Genital Herpes: Manifestation of Primary Genital Herpes Outbreak

A

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

61
Q

Genital Herpes: Complications

A
  • 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)
62
Q

Genital Herpes: Treatment

A
  • 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
63
Q

What are Genital Warts & Human Papilloma Virus (HPV)?

A

Benign growths on anogenital skin or mucosa caused by sexually transmitted (skin to skin) HPV

64
Q

How are Genital Warts & HPV spread?

A
  • 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
65
Q

Does removing genital warts help clear or
treat the virus?

A

Not necessarily

66
Q

Genital Warts & HPV: Manifestations

A
  • 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
67
Q

Manifestations of Genital Warts in Men

A
  • Penis
  • Scrotum
68
Q

Manifestations of Genital Warts in Women

A
  • Inner thighs
  • Vulva
  • Vaginally
  • Intra-anally
69
Q

Genital Warts & HPV: Complications

A
  • Very few long-term concerns with genital warts
  • However, high-risk HPV strains highly linked with cancer so can need more screenings
  • Psychosocial burden
70
Q

Genital Warts & HPV Prevention

A
  • HPV vaccines for prevention
  • Cover 90% of genital warts & 70%-90% of strains that cause cervical cancers
71
Q

Genital Warts & HPV Treatment

A
  • 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
72
Q

Does removing Genital Warts decrease the spread?

A

No!

73
Q

What is Syphilis ?

A
  • Bacterial infection
  • Caused by Treponema pallidum
  • SERIOUS long-term complications if not treated early
74
Q

How is Syphilis transmitted?

A
  • 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!!!
75
Q

Syphilis: Early Primary Clinical Stage

A
  • Infectious syphilis
  • Highly infectious
  • Lesion (chancre) appears; lasts 3-6 weeks
76
Q

Syphilis: Early Secondary Stage

A
  • Highly infectious
  • Starts 2-8 weeks after primary; bacterial dissemination -starts to effect nerves (e.g., meningitis)
77
Q

Syphilis: Early Latent Stage

A

No symptoms within past two years; not contagious

78
Q

Syphilis: Late & Tertiary Syphilis Stage

A
  • Rarely seen in antibiotic era
  • Not infectious, usually 1-20 years after initial infection
79
Q

Syphilis Complications with other STI’s

A
  • Early chancres increase HIV transmission
  • Patients with both syphilis and HIV more likely to have CNS involvement
80
Q

Syphilis Complications: Neurosyphilis

A
  • Permanent damage within the CNS
  • Visual impairment
  • Dementia
81
Q

Syphilis Complications; Cardiovascular syphilis

A
  • Chest pain
  • Dyspnea
  • Murmur
  • Cardiomegaly
82
Q

Syphilis Complications: Gummatous syphilis

A
  • Unusual scarring on skin
  • Changes in nasal septum & palate
83
Q

Syphilis Diagnosis

A
  • 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
84
Q

Syphilis Treatment

A
  • 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
85
Q

Related Nursing Problems for STI’s

A
  • Lack of Knowledge
  • Psychosocial issues: Depression/Anxiety
  • Risk for infection
86
Q

Nursing Assessment for STI’s

A
  • MUST Be aware of gender identity/current anatomy/sexual preferences
  • WSW, MSM & transgender persons are at higher risk
  • Be warm, non-judgmental, reassuring
87
Q

Nursing Teaching for STI’s

A
  • Health promotion crucial
  • HPV vaccines, routine testing, PREVENTION
  • Know your health departments requirements for reporting and make patient aware

Med/Surg 2 STI's (2 decks)

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