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3.2 - ABSN NUR 405 STI, Visual, Prostate > STIs > Flashcards

STIs 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

3.2 - ABSN NUR 405 STI, Visual, Prostate (6 decks)

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