STIs

Question 1

CDC Classifications of STIs

Answer 1

-Caused by vaginal discharge: vulvovaginal candidiasis, trichomoniasis, bacterial vaginosis
-Characterized by cervicitis: chlamydia, gonorrhea
-Characterized by genital ulcers: genital herpes simplex, syphilis
-Vaccine preventable: Hep A/B/C, HPV
-Ectoparasitic infections: pediculosis pubis (crabs), scabies

Question 2

STI effects on fetus or newborn

Answer 2

-Chlamydia: can pass, neonatal conjunctivitis
-Gonorrhea: can pass, may cause ophthalmia neonatorum = blindness and sepsis
-Genital herpes: can pass, intellectual disability
-HIV: HIV positive status, miscarriage
-Syphilis: can pass, infant death, skin ulcers, rashes, hoarse cry, deafness, swollen liver, jaundice, anemia
-Trichomoniasis: PROM
-Genital warts: may develop warts in throat (laryngeal papillomatosis), uncommon but life-threatening

Question 3

STIs in adolescents

Answer 3

-Women especially sensitive to STIs
-Risky behavior

Question 4

Barriers to condom use

Answer 4

-Decreases sexual pleasure: encourage client to try, put lubricant inside condom
-Decreases spontaneity of sex: incorporate condom use into foreplay
-Embarrassing: it is “manly” protect himself and others
-Poor fit: smaller and larger sizes available
-Requires prompt withdrawal after ejacuation: reinforce protective nature of prompt withdrawal
-Fear of breakage: use water-based lubricant
-Nonpenetrative sex: can be used during. oral sex, dental dam
-Latex allergy: polyurethane condoms available, natural skin condom can be used w/ latex condom

Question 5

Infections characterized by vaginal discharge

Answer 5

-Vaginitis: inflammation of vagina
-Avoid douching
-Use condoms
-Urinate w/ knees spread apart
-Avoid tight clothing or nylon underwear
-Wash using hypoallergenic soaps
-Avoid powders, bubble baths, vaginal perfumes
-Change out of wet bathing suits asap

Question 6

Infections characterized by vaginal discharge: candidiasis

Answer 6

-Fungus: candida
-Not considered an STI bc candida is normal part of vagina
-Tx: miconazole, clotrimazole, terconazole, fluconazole
-Can cause oral infection (thrush) to baby
-Dx: speculum exam reveal white plaques on vaginal wall, vaginal pH is normal, wet smear reveals fungal spores

Question 7

Infections characterized by vaginal discharge: trichomoniasis

Answer 7

-Protozoan: trichomoniasis
-Can live on wet surfaces or poorly cleaned hot tubs
-Men are asymptomatic carriers
-Tx: single dose of metronidazole or tinidazole
-s/s: petechiae on cervix (strawberry cervix), pH > 4.5
-Dx: OSOM rapid test, Affirm VPIII

Question 8

Infections characterized by vaginal discharge: bacterial vaginosis (BV)

Answer 8

-Bacterium: gardnerella
-Shift in balance of woman’s vaginal microflora
-Tx: metronidazole, clindamycin
-s/s: abnormal vaginal flora, bothersome symptoms such as fishy odor after sex, chronic infection (3+ annually), differential dx (resembles other STIs
-Dx: (3 of 4) thin grayish-white discharge, pH > 4.5, positive whiff test, presence of clue cells on wet-mount exam

Question 9

Infections characterized by cervicitis

Answer 9

-Inflammation of cervix
-Caused by gonorrhea or chlamydia

Question 10

Infections characterized by cervicitis: chlamydia

Answer 10

-Most common bacterial STI in US
-Highest in 15-19 yrs
-Asymptomatic common
-Can cause PID and infertility
-Tx: doxycycline, azithromycin, usually combined w/ ceftriaxone
-s/s: mucopurulent discharge
-Dx: urine, vaginal swab, DNA probe

Question 11

Infections characterized by cervicitis: gnorrhea

Answer 11

-Significant morbidity among gay men and women
-Can pass to newborn (give erythromycin or tetracycline ophthalmic ointment)
-Tx: ceftriaxone, azithromycin or doxycycline
-s/s: mild sore throat, bartholin abscess, rectal infection, perihepatitis
-Can enter bloodstream and produce disseminated gonococcal infection (arthritis, endocarditis, meningitis, toxic hepatitis)
-Dx: gen probe (nucleic acid)

Question 12

PLISSIT model

Answer 12

-Permission for woman to talk about experience
-Limited info given to women
-Specific suggestion
-Intensive therapy

Question 13

Infections characterized by genital ulcers: genital herpes

Answer 13

-Recurrent, lifelong viral infection
-HSV-1 = oral herpes
-HSV-2 = genital herpes
-Tx: acyclovir, famciclovir, valacyclovir
-Suppressive therapy for those w/ 6+ episodes per year
-Lesions in vagina or perineal area, takes up to 2 weeks to heal

Question 14

Infections characterized by cervicitis: syphilis

Answer 14

-Bacterial infection
-More in gay men or women of color in south
-Tx: azithromycin, ceftriaxone, erythromycin, ciprofloxacin (not for pregnant women), penicillin G
-Affects nearly all body systems of fetus

Question 15

Caring for genital ulcers

Answer 15

-No sex
-Wash hands after touching lesions
-Nonrestrictive clothing, cotton underwear, urinating in water, air-dry lesions w/ low heat
-Cool compresses to area
-Avoid extreme temps (ice/hot packs)
-Use condoms

Question 16

Pelvic inflammatory disease (PID)

Answer 16

-From chlamydia or gonorrhea
-Inflammation of upper female genital tract
-Tx: abx and fluids
-Dx: lower abdominal tenderness, mucopurulent vaginal discharge, fever, elevated erythrocyte, elevated CRP, WBC in vaginal smear, increased menstrual bleeding, dysuria, dyspareunia, N/V
-Laparoscopy

Question 17

Vaccine-preventable STIs: HPV

Answer 17

-Most common viral infection US
-Nearly all sexually active ppl will get it at some point in their lives
-Genital warts or condyloma are caused by HPV 6 or 11
-Large lesions resemble cauliflower, bleed easily
Dx: HPV test, pap smears
-Tx: no cure, cervarix and gardasil 9 to prevent cervical cancer, HPV vaccine btwn ages of 11-26 w/ 3 injections over 6 m

Question 18

Vaccine-preventable STIs: Hep A and B

Answer 18

-Viral infection, liver inflammation
-Hep A: highly contagious, spreads thru fecal-oral route or ingesting contaminated food or water, sex
-Hep A s/s: flu-like
-Hep B: body fluids, puncture thru skin, sharing needles, razors, or toothbrushes
-Hep B: less fever and skin involvement
-Self-limiting, not chronic
-Tx: supportive care
-Dx: IgM antibody, HBsAg antigen

Question 19

Vaccine-preventable STIs: hep C

Answer 19

-Liver inflammation
-Injection use, tattoos or piercings, hx of blood transfusions

Question 20

Zika virus disease

Answer 20

-Bite of infected aedes mosquito during daytime
-Majority have no s/s
-Causes microcephaly
-No current vax, prevention measures
-Abstain from sex with anyone who has traveled to areas with active infections

Question 21

Ectoparasitic infections

Answer 21

-Parasites that live on outside of body (host)
-Causes rash and pruritus
-Scabies: linear burrows in webs btwn fingers, elbows, underarms, buttocks, genitalia; tx w/ scabicide and abx
-Lice: found on head or in pubes, presence of nits in hair shaft, tx w/ antilouse and permethrin shampoos, malathion, spinosad, ivermectin

Question 22

HIV

Answer 22

-Targets immune system
-CD4 T-cell depletion
-Spread via sex, blood transfusions, needlesticks, childbirth
-Dx: when ELISA is pos, western blot test must be pos, rapid test
-Tx: ART (3+ meds daily)
-Tx for mothers: antiretroviral agent at 13 and 34 weeks gestation, antiretroviral agent via IV until delivery, antiretroviral syrup given to infant within 12 hrs after birth
-Mgmt: separate intake of food and fluids, eat dry crackers when arising, 6 meals daily, high-protein supplements, eat comfort foods, eval oral cavity for painful white patches (fungus), prevent overexertion
-1s stage Acute seroconversion: flu-like s/s, viral load drops
-2nd stage Asymptomatic: immune system fxn drops, CD4 T-cell < 200
-3rd stage AIDS: after abt 11 yrs

Question 23

Preventing STIs

Answer 23

-Primary: education
-Secondary: screening