STIs and Contraception Flashcards
bacterial vaginosis
bacterial overgrowth in the vagina caused by excessive douching, sexual intercourse, and perfume/wash
bacterial vaginosis s/s
-thin white grayish discharge with a fishy odor, typically after sexual intercourse
-may be asymptomatic
dx bacterial vaginosis
-positive “whiff test”, vaginal discharge secretions are mixed with k+ hydrogen on a slide, producing a characteristic stale fishy odor
-presence of “clue cells” on wet-mount examination
bacterial vaginosis tx
-metronidazole (Flagyl), 500mg po BID, 7 days
-metrogel (metronidazole, 1 applicatorful PV at HS x5 days
-clindamycin cream 1 applicator PV at HS x7 days
candidiasis
-yeast infection
-fungal in nature, not considered an STI
candidiasis s/s
-thick, white (cottage-cheese-like) or grey discharge
-itchy (mild to extreme)
-common after abx
-can also be in breast or armpits
candidiasis tx
-diflucan 150mg PO 1 dose, may repeat in 3 days
-yogurt with “active cultures”
-various OTC and RX vaginal creams and suppositories available as well
trichomoniasis
-non viral STI
-protozoan in nature
trichomoniasis s/s
-male: may be asymptomatic or itchy/irritated penis
-female: yellow, green frothy discharge, foul odor, not fishy
-dysuria, dyspareunia
trichomoniasis tx
-metrondiazole (Flagyl)
-abstinence (7 days sx free)
chlamydia
-most common bacterial STI
-can be reported without pt consent
-most common infectious cause of infertility in women worldwide, causes scarring in fallopian tubes & can lead to PID
chlamydia s/s
-mucopurulent vaginal discharge (white, cloudy, watery discharge)
-urethritis (men)
-bartholinitis
-cervicitis
-acute urethral syndrome
-ectopic pregnancy
-PID
-infertility
chlamydia testing
-urine testing
-GenProbe (endocervical or vaginal swab)
chlamydia tx
-doxycycline 100mg po bid x7days
-azithromycin 1g po, single dose
-combo of ceftriaxone (Rocephin) with doxycycline or azithromycin (prescribe freq. to cure both chlamydia or gonorrhea
chlamydia test of cure
repeat testing 3-4 weeks after completing therapy, no longer recommended
gonorrhea
-sexually transmitted bacterial infection
-potential for developing resistance to multiple abx classes
-highly contagious
-mandatory reporting to OPH
-travels with chlamydia frequently
gonorrhea s/s
-males: dysuria and urethral discharge
-females: dysuria, yellowish to green discharge, dysmenorrhea
gonorrhea testing
-genprobe
-urine testing
gonorrhea tx
-dual therapy recommended
-ceftriaxone (rocephin) 500mg IM, 1 dose if <150kg or 1gm if >150kg
-azithromycin 1gm x 1 dose
-if cephalosporin allergy, gentamicin 240mg IM- 1 dose, or azithromycin 2gm x 1 dose
-if chlamydia is not ruled out then doxycycline or azithromycin must accompany tx
syphilis
-sexually or transplacental transmitted bacterial infection caused by spirochete
-rapidly penetrates mucous membranes or lesions in the skin, w/in hours enters the lymphatic system and bloodstream & produces a systemic infection, before appearance of lesions
-can cross placenta at any time during pregnancy leading to SAB, low birth weight, growth restriction, MR, multiorgan failure & still birth
-often travels with HIV
-testing at first prenatal appointment
-if not treated leads to neuro damage
primary stage of syphilis
-Single chancre (SHANG-kur) may be multiple sores appearing ~ 21 days from exposure
-Usually (but not always) firm, round, and painless.
-Appears at the location where syphilis enters the body
-Chancres can occur in locations that make them difficult to notice (e.g., the vagina or anus)
-Chancre lasts 3 to 6 weeks and heals regardless of whether a person is treated
-Infection will progress to the secondary stage if the person with syphilis does not receive treatment.
secondary stage of syphilis
-Rash on body usually does not itch
-swollen lymph nodes
-sore throat
-patchy hair loss
-headaches
-weight loss
-muscle aches
-Fatigue
-fever
-Symptoms of secondary syphilis will go away on their own with or without treatment but the disease will progress
latent phase of syphilis
-Period when there are no visible signs or symptoms (Hidden)
-Without treatment, syphilis will remain in the body even though there are no signs or symptoms
-Early latent: infection occurs within the past 12 months.
-Late latent: infection occurs more than 12 months ago
-unknown duration: not enough evidence to confirm initial infection was within the previous 12 months.
-can last for years.
tertiary (late) stage of syphilis
-rare and develops in a subset of untreated syphilis infections.
-Can appear 10–30 years after a person gets the infection & may be fatal.
-May affect multiple organ systems
-Symptoms vary depending on the organ system affected.
syphilis labs
-Serology
-RPR– Rapid Plasma Reagin
-Nontreponemal Test & Traditional Algorithm
-Treponemal Test & Reverse Sequence Algorithm
-VDRL
-CSF –Cerebrospinal Fluid from Spinal Tap
syphilis tx
-Penicillin G–IM or IV
-<1 year = 2.4 million units IM x 1 dose
->1 year = 2.4 million units IM q weekly x 3 weeks
-Doxycycline may be used only if PCN allergy
herpes genitalis
-viral, chronic life-long
-fluid filled vesicles/blisters
-types: HSV-1, HSV-2
herpes genitalis labs
-Viral Culture–Low sensitivity esp with healing sores
-HSV-NAAT assay – most sensitive
-HSV PCR of the blood should not be used for dx purposes– low accuracy
herpes genitalis tx
-3 meds: Initiate within first 24 hours
-Valacyclovir (Valtrex): 1 g q bid x 10 days -initial500 mg bid x 3 days
-Acyclovir (Zovirax):
-Famciclovir (Famvir)
-Topical antivirals offer minimal benefits and is discouraged
HPV 1
-most common viral infection
-causes genital warts (condylomata)
-HPV vaccine (9 strains) for males and females preferably before sexually active
HPV 1 s/s
-grey or pink cauliflower-like sores
-friable (bleeds easily), itchy or asymptomatic
HPV 1 tx for warts
-topical (TCA)
-cryotherapy
-surgical
PID
-pelvic inflammatory disease
-Most often women of child-bearing age
-Usually sexually active, multiple partners, or douching
-Acute pain, fever >101, chills
-Symptoms of related STI, pain will become more severe
-Can lead to tubal damage, ectopic pregnancy, infertility, or chronic pelvic infections
PID tx
-iv abx
-iv fluids
-pain meds
HIV
-No longer considered a death sentence
-Babies infected in utero are now of reproductive age & want a family
-PrEP & PEP available
-Always assess patient’s reproductive needs
zika virus
-Transmitted through blood & semen
-use protecting during sex
-Causes mild disease in adults
-Microcephaly in fetuses
fertility methods
-Abstinence
-Rhythm method (calendar)
-Basal Temp method
-Taken temp every morning before getting out of bed
-Coitus interruptus (withdrawal)
-Pull out before ejaculation
barrier methods
-Condoms – male (penis) and female (vagina)
-Diaphragms & sponges (against cervix)
-Insert before sex/leave in place for 6 hours after sex
-Diaphragm-reusable & sponge-disposal
-Requires planning of sexual relations
-Spermicide
-Used with all of these to increase efficacy
hormonal methods, daily or near daily dosing
-Oral contraceptives (po)- daily
-Consistency is key!
-Antibiotics»> back-up method needed
-Plan B
-Transdermal patch (skin)-
-1 wk x 3
-Injectable (depo-provera) (IM)-
-Q3 months or 10-13 weeks, depletes Calcium
-Needs supplemental vitamin D
hormonal methods- montly to long term prevention
-Vaginal ring (Nuva-ring) (vagina)-
-Q 3 wk
-Implantable (Nexplanon) (arm)
-Q3 years
-Intrauterine (IUDs) (uterus)
-Q3-10 years
birth control meant to be permanent
-Transcervical (essure) (fallopian tubes), Multiple lawsuits; FDA ordered new research studies
-Bilateral Tubal Ligation (BTL) (fallopian tubes)
-Hysterectomy (uterus) Permanent form of sterilization. Not used for actual birth control
-Vasectomy– Male–(vas deferens-penis)
-Follow up Sperm Counts necessary
