The Child with an Infectious Disease Flashcards
Disease Process
?
Time interval between initial infection and 1st appearance of signs and symptoms
Incubation period
?
Early, mild symptoms of disease
Prodromal period
Period of Illness
* Overt signs and symptoms of disease
* WBC may increase or decrease
* Death may result if immune system or treatment fails
Period of Decline
* Signs and symptoms subside
* Vulnerable to secondary infections
Period of convalescence
* Regains strength and body returns to pre-disease state
* Recovery has occurred
Chain of Infection
* For a pathogen to maintain an infectious state it needs to be transmitted to another host
* To spread the infection, the pathogen must follow the chain of infection
Agent > Reservoir > Portal of exit > Transmission mode > Portal of entry > Host susceptibility >
Characteristics of the Organism (Pathogen)
- Type (viruses, bacteria, fungi, parasites)
- Ability to invade host
- Virulence
- Degree to which it causes disease
Portal of Entry
- Eyes
- Mucus membranes
- Respiratory tract
- Placenta
- Breaks in host barriers
Reservoir
- Humans
- Animals
- Environmental surfaces
Portal of exit
- Respiratory tract
- Genitourinary tract
- Gastrointestinal tract
- Skin/mucosal surfaces
- Placenta
- Blood
Mode of Transmission
- Direct contact
- Droplets
- Vectors
- Airborne
Characteristics of the Host
- Lack of effective resistance
- Changes in host defenses
- Tissue destruction
Viral Infections
Viruses
* Small parasitic organisms
* One type of DNA or RNA
* Lack reproductive ability - need host
* Infected host can respond to that viral invasion
- Lysis
- Continue functioning (asymptomatic)
* May remain dormant until triggered
* Rubeola (“ordinary” measles, 7-day)
* Rubella (German measles, 3-day)
* Erythema infectiosum (“Fifth Disease”, Parvovirus B19)
* Roseola Infantum (Exanthem Subitum, 3-day fever)
* Coxsackievirus A (hand-foot-mouth)
* Varicella zoster infections (chickenpox, shingles)
* Mumps
* Cytomegalovirus (CMV)
* Infectious mononucleosis (EBV)
* Rabies
Viral Exanthemas (Rashes)
Rubeola (Measles) - “7-day Measles”
* Causative agent: RNA virus
* Incubation: 8-12 days from exposure to onset of symptoms
* Infectious Period: 3-5 days prior to rash through 4-6 days after onset of rash
* Transmission: Direct contact with droplets and airborne (less frequent)
* Manifestations:
- Prodromal period: 10 days of high fever, 3 C’s = __, __, and __
- __ spots
- Exanthem (rash) - deep red macular rash, blanches with pressure and gradually turns brownish
coryza, cough, conjunctivitis
Koplik
Therapeutic management
* Treating symptoms
* Airborne precautions
* Antipyretics
* Quiet activities and bed rest
* Fluids and humidification
* Antitussives
Prevention ⇒ immunization
> 2 doses of MMR
? (German Measles, 3-day Measles)
Causative agent: RNA virus
Incubation period: 14-21 days
Infectious period: 7 days before onset of symptoms to 14 days after appearance of the rash
Transmission: airborne particles or direct contact with droplets and transplacental transmission (congenital)
Rubella
Manifestations
* Mild disease - rash 14-21 days after exposure
* Young children - asymptomatic until the rash appears
* Older children - profuse nasal drainage, diarrhea, malaise, sore throat, headache, low grade fever, polyarthritis, eye pain, aches, chills, anorexia, and nausea
* Posterior cervical, posterior auricular, and occipital lymphadenopathy
* Pinkish rose maculopapular exanthem - on the face, scalp, and neck - pruritic
* Petechiae (spots) red or purple color or pinpoint on the soft palate - __ __
Forchheimer’s sign
Congenital rubella syndrome (CRS) - after maternal infection
- Intrauterine growth retardation, weight less than 2500 g, failure to thrive in infancy
- Pregnant females should avoid contact
- Presumed contagious until one year or after repeated negative nasopharyngeal and urine cultures
Therapeutic management
- Supportive and symptomatic
- Exclusion from school and should be on droplet precautions for 7 days after onset of rash
- Primary prevention for rubella - MMR vaccine
? (“Fifth Disease” Parvovirus B19)
* Causative agent: parvovirus B19
* Incubation period: 4-17 days up to 28 days
* Infectious period: shedding - 5 and 12 days - from the prodromal period until onset of rash
* Transmission: airborne respiratory droplets, blood, blood products, transplacental transmission
Erythema Infectiosum
Manifestations
* Common in children ages 5-15
* Mild systemic disease
* Prodromal period: headache, runny nose, malaise, and mild fever
* Rash:
> Intense, fiery red edematous rash on face (maculopapular rash) - “slapped cheek” appearance
> 1-4 days after facial rash appears - erythematous, maculopapular rash appears on trunk and extremities - lacy appearance
* Rash can last from 2 to 39 days; can reappear with environmental factors
Therapeutic management
- Symptomatic and supportive
- Antipyretics
- Antihistamines
? (Exanthem Subitum, 3-day fever)
* Causative agent: human herpesvirus 6 (HHV-6)
* Incubation period: 5-15 days
* Infectious period: unknown most likely from febrile stage to onset of rash
* Transmission: contact with secretions such as saliva, CSF
Roseola Infantum
Manifestations
- Prodromal period - sudden high fever 103-106, malaise, irritability, child remains active and alert - fever persists for 3-5 days
- Mild cough, runny nose, abdominal pain, headache, V/D
- After fever subsides within several hours to 2 days - rash appears
- Rose-pink maculopapules or macules, blanche with pressure, whitish ring
Therapeutic management
- Symptomatic
- Antipyretics
- Lightweight clothing
- Cooler environmental temperatures
- Increase fluid intake
Enteroviruses - ___ (hand, foot and mouth)
Causative agents: RNA viruses
Incubation period: 3-6 days
Infectious period: unknown
Transmission: fecal-oral and oral-oral: contact precautions
Manifestations
- Prodromal period: fever
- Vesicles in mouth, on palms of hands, soles of feet, and sometimes on buttocks
Coxsackievirus A
Therapeutic management
- Symptomatic
- Special attention to dehydration
- Hand hygiene/personal hygiene/diaper changes/bathroom use
- Analgesics (acetaminophen)
- Soft or cool liquid diet - milk-based ice cream
- For oropharyngeal lesions
> Rinse mouth with salt and water or
> “Magic mouthwash”
* Equal parts of lidocaine gel, diphenhydramine liquid, and liquid antacid
Varicella zoster infections (chicken pox and shingles)
* Causative agent: varicella zoster virus
* Incubation period: 10-21 days
* Infectious period: 1-2 days before onset of rash and until all lesions are dried and crusted over
* Transmission: direct contact (open vesicles), droplet, airborne particles
* Immunity: either by natural disease of varicella or varicella vaccine
Manifestations: Varicella
* Prodromal period: 24-48 hours before onset of lesions
> Low-grade fever, malaise, headache, and anorexia
* On trunk and scalp
> teardrop vesicles with an edematous base > pustular vesicles > crust
Herpes zoster (shingles)
* Primary infection with varicella - lays dormant
* Activation causes herpes zoster - shingles
> Must have had chickenpox previously to get herpes zoster
* Tenderness along the involved nerve and surrounding skin for approximately 2 weeks before lesions
* Rash is unilateral - along a single dermatome of one or more sensory nerves
Therapeutic management (chickenpox and shingles)
* Symptomatic and supportive
* Oatmeal baths
* Antipyretics (acetaminophen and NEVER ASA)
* Antihistamines
* Avoid scratching the lesions to prevent scars and infection
* Airborne and contact precautions until lesions scabbed
* Prevention through vaccination (1st dose on or before 1st birthday and booster between ages 4-6)
* For herpes zoster
> analgesics; acyclovir; airborne and contact precautions (strict isolation)
?
* Causative agent: paramyxovirus
* Incubation period: 16-18 days can go up to 25 days
* Infectious: 7 days prior to swelling (parotitis) and up to 9 days after onset
* Transmission: airborne droplets, salivary secretions, and possibly urine
Manifestations
- Prodromal: fever, myalgias, headaches, and malaise
- Pain with chewing, earache, pain in the jaw line in front of the ear
- Male complication - inflammation of the testes (___ ?)
Mumps
orchitis
Therapeutic management
* Symptomatic care and adequate hydration
* Soft or liquid diet
* Avoid acidic foods such as orange juice
* Droplet precautions until 5 days after onset
* Antipyretic
* For orchitis - bedrest, intermittent application of ice packs, pain management, emotional support and diversional activities
* Prevention - vaccination with the MMR vaccine
?
* Causative agent: human cytomegalovirus
* Incubation period: unknown
* Transmission: saliva, urine, blood, semen, cervical secretions, breast milk, organ transplants
* Leading cause of hearing loss and intellectual disability in infants in the US
Therapeutic management
> Early detection of disabilities
> Hearing aids, cochlear implants, speech therapy
> Detect learning disabilities and early interventions with physical speech and cognitive therapy
Cytomegalovirus (CMV)
? (Epstein-Barr Virus [EBV])
* Incubation period: 4-7 weeks
* Infectious period: unknown
* Transmission: direct contact through saliva, intimate contact or blood
Infectious Mononucleosis
Manifestations
* Prodromal period: fever, exudative pharyngitis, lymphadenopathy (cervical, axillary, and inguinal)
* Enlarged lymph nodes, sore throat, high fever, pain with swallowing, petechiae on palate, enlarged tonsils with white exudate, and firm, tender, cervical lymph nodes
* May develop to abdominal pain with liver and spleen enlargement - hepatosplenomegaly
Therapeutic management
* Supportive
* Steroids PRN for acute tonsillar swelling
* Rest; avoid physical activity and contact sports to minimize the risk of rupturing the spleen
* Antipyretics
* Hydration
* Soft or liquid diet and foods; milkshakes
?
* Causative agent: rhabdovirus
* Incubation period: 5 days to more than 1 year
* Infectious period: 10 days
* Transmission: bites with contaminated saliva, scratches from claws of infected animals, airborne from bat infested caves
Manifestations
> Slowly developing infection
> Prodromal period: sore throat, headache, fever, anxiety
> Discomfort at the site of the bite, hyperactivity, muscle spasms (involuntary twitching) or convulsions
> Decreased ability to swallow (contractions of the mouth) resulting in drooling or aspiration
> Coma, death
Rabies
Therapeutic management
- Prevention is important
- Cleanse bite wound with large amounts of soap and water
- Administer human rabies immune globulin (HRIG)
- Rabies vaccination
Bacterial Infections
* Organisms that contain both DNA and RNA
* Complex cell wall
* Classified as gram-positive or gram-negative bacteria
* Bacteria secrete toxins (exotoxins, endotoxins)
* Whooping cough
* Scarlet fever
* Cellulitis
* Methicillin Resistant Staphylococcus Aureus (MRSA)
* Clostridium difficile (C. diff)
* Impetigo
Rare Viral & Bacterial Infections
* Poliomyelitis infantile paralysis
* Diphtheria
?
Portion of a gram-negative cell and cause fever, shock, and DIC
Endotoxins
?
May cause cell damage by cell lysis, inhibition of protein synthesis, or interference with passage of nerve impulses
Exotoxins
?
* Causative agent: Bordetella pertussis (gram-negative bacteria)
* Incubation period: 5-21 days
* Infectious period: catarrhal stage 1-2 weeks up until the 4th week
* Transmission: direct contact or respiratory droplets from coughing
Manifestations
> 3 stages of
Whooping cough
? stage
Episodes of coughing and vomiting
Convalescent
? stage
Rhinorrhea, lacrimation, mild cough, and low-grade fever
Catarrhal
? stage
Increased severity of cough; repetitive series of coughs with a whoop; cyanosis
Thick, tenacious mucous; protrusion of the tongue; salivation; distention of neck veins
Coughing spells may be triggered by yawning, sneezing, eating or drinking; coughing may induce vomiting
Paroxysmal
Treatment regimen
- Push fluids
- Monitor respiratory status (with cardiopulmonary monitor), pulse oximeter and vital signs
- Keep oxygen and suction equipment available
- Quiet and calm environment
- Monitor nutritional status - small frequent to avoid exhaustion
- Erythromycin, azithromycin, or clarithromycin may be given during catarrhal stage
- Droplet precautions
- Prevention with vaccination administration of 5 doses of the pertussis vaccine in combination with tetanus and diphtheria (DTaP)
?
* Causative agent: Group A beta-hemolytic streptococci
* Incubation period: 1-7 days
* Infectious period: acute stage until 24 hours after antibiotic therapy has begun
* Transmission: direct contact and airborne (inhalation or ingestion)
Scarlet fever
Manifestations
* Prodromal period: fever, vomiting, headache, pain, pharyngitis, and chills
* Within 24 hours - rash fine red papules - axillae, groin, and neck (feels like sandpaper)
* Rash blanches on pressure (__ __)
* Desquamation (peeling of the skin) > flaking
* Tongue is coated - a white furry covering with red projecting papillae (called __ __ __) > slough off leaving a red swollen tongue (called __ __)
* Tonsils edematous and covered with grey-white exudate that can spread to the pharynx
* Petechial hemorrhages cover the soft palate
Pastia’s sign
- *white strawberry tongue**
- *strawberry tongue**
Therapeutic management
* Diagnostic is done with rapid streptococcal screening in the office setting
* Penicillin - complete full course - 10 days
* Supportive care for symptoms like antipyretics and analgesics, antipruritics, throat lozenges, antiseptic spray (chloroseptic)
* Droplet precautions until the child has been on antibiotic for 24 hours
* Hydration - soft or liquid diet - avoid acidic foods or fluids - encourage ice-pops or milkshakes
* Bedrest and quiet activities - prevent fatigue
* Oral care - avoid acidic mouthwash preparations - may do saline rinses
* Complications - rheumatic fever and acute post-streptococcal glomerulonephritis
?
* Bacterial infection of the subcutaneous tissue and dermis
* Causative agents: Haemophilus influenzae type B, Group A streptococci, and Staphylococcus aureus
- Manifestations*
- Affected area red, hot, tender, and indurated
- If Haemophilus influenzae - affected area may have purplish tinge
- With periorbital cellulitis - edema and purple discoloration of the eyelids and decreased eye movement
> ___ - red streaking of surrounding area and enlarged regional lymph nodes (lymphadenitis) - Fever, malaise, and headache
Cellulitis
Lymphangitis
Therapeutic management
* Initial dose of IM or IV antibiotic - ceftriaxone
* Extremity - oral antibiotics such as cephalosporin, cloxacillin, or dicloxacin
* Joint or face - IV antibiotics; incision and drainage
* Rest with elevated extremity
* Warm moist soaks
* Analgesics and antipyretics
* Frequent hand washing
Methicillin Resistant Staphylococcus Aureus (MRSA)
* Causative agent: Staphylococcus aureus (a gram-positive cocci)
* May cause cellulitis
* Transmission: contact
> Can be hospital-acquired or community-acquired
> Source of most skin and soft tissue infections
Manifestations
- HA-MRSA: are medical device-related infections, pneumonia (VAP), and catheter related bloodstream infections
- CA-MRSA: are infections of skin and soft tissue
Therapeutic regimen
* Warm soaks
* Severe cases - incision and drainage and IV vancomycin or linezolid
* Blood cultures
* Most cases - treated with a 5-10 day course of oral vancomycin, clindamycin, sulphamethoxazole-trimethoprim or linezolid
* Handwashing important for prevention
* Contact precautions
Clostridium difficile (C. diff)
* Causative agent: Clostridium difficile (gram-positive anaerobic bacterium)
* Transmission: contact (fecal-oral)
* Incubation period: unknown
* Manifestations
> May be asymptomatic
> May have watery diarrhea, abdominal cramps, fever, and possible systemic toxicity
> Associated with antibiotic therapy
Diagnosis - identification of toxins in stool
Treatment regimen:
- Initial treatment would be cessation of antibiotic
- C. difficile associated diarrhea (CDAD)
> Includes a 7-10 day course of oral metronidazole for mild-to-moderate disease
> or vancomycin for more severe diseases
* Contact precautions (requires meticulous hand hygiene)
* C. difficile spores are not killed by alcohol-based hand sanitizers
?
* Highly contagious
* Incubation period: 7-10 days
* Transmission: direct contact or indirect contact
* Causative agent: Staphylococcus aureus, group A beta hemolytic streptococci or both
Impetigo
Manifestations
* __ __ - small vesicles - progress to bullae - lesions filled with serous fluid and later become pustular - rupture - a shiny lacquered-appearing lesion surrounded by a scaly rim
* __ __ - vesicle or pustule - ruptures - honey-colored crust erosions that bleed easily when crusts are removed
* May be pruritic
* Located around the mouth and nose
* Usually resolve within 12-14 days with treatment
Bullous impetigo
Crusted impetigo
Therapeutic regimen
- Topical and oral antibiotics
- Gently wash 3x/day with warm soapy washcloth, crust soaked, and carefully removed
* Topical ointment - muciprocin (Bactroban) or bacitracin (Baciguent) x7-10 days
* Good hand washing and careful hygiene
* NOT attend school or daycare for 24 hours after beginning treatment
* Child should sleep alone and bathe alone daily
* Caregiver should wear gloves when caring for the child
* Complete full course of topical or systemic antibiotics as prescribed
* Keep fingernails short and wash child’s hands frequently with antibacterial soap
* Do not share towels, combs or eating utensils with the infected child
Poliomyelitis Infantile Paralysis
* Causative agent: polio virus
* Incubation period: 7-10 days
* Infectious period: just before and after onset of symptoms 1-6 weeks
* Transmission: fecal-oral or oral-oral: direct and indirect contact
Manifestations
- Prodromal period: fever, headache, nausea, vomiting, abdominal pain, mild neck, back, and leg stiffness
- Intense pain, tremors of extremities, and paralysis due to CNS involvement
- Difficulty swallowing and respiratory paralysis
Treatment regimen
- Mechanical ventilation
- Physical therapy
- Analgesics
- Contact precautions
Prevention - routine immunization (polio)
Diphtheria
* Causative agent: Corynebacterium diphtheriae (gram-positive non-motile bacillus)
* Incubation period: 2-6 days
* Infectious period: 2-4 weeks untreated or 1-2 days treated
* Transmission: direct contact with respiratory secretions
Manifestations
- Prodromal period: resemble common cold
- Gradually progresses to nasal discharge of foul-smelling mucopurulent material and brassy cough
- Low-grade fever
- Hallmark sign - “bullneck” or neck edema
- May lead to myocarditis, HF, paralysis, and airway obstruction
Treatment regimen
* IV diphtheria antitoxin
* IV antibiotics - erythromycin or penicillin G within 3 days of symptom onset
* Bed rest
* Droplet precautions
* Prevention - with vaccination (DTaP)
Fungal Infections
* Normal human flora (mouth, intestine, vagina, skin)
* Transmitted through inhalation or penetration of tissue
* Slow growth
* Resistant to temperatures and most antibiotics
* Pathogenic fungi: molds and yeasts
* Infections caused by fungi are classified as:
- Opportunistic
- Systemic
- Subcutaneous
- Superficial (skin and nails)
?
Ringworm of the scalp
Interventions: oral griseofulvin for at least 6 weeks
Tinea capitis
?
Jock itch
* Not contagious - results from poor hygiene, friction from tight clothing, and obesity
* Interventions: clotrimazole cream or lotion
Tinea cruris
?
Athlete’s foot
Interventions: clotrimazole (Lotrimin) cream, lotion or spray; Miconazole (Monistat) or oxiconazole (Oxistat) 2x/day until lesions have cleared for 1 week
Tinea pedis
?
Ringworm of the body
Interventions: Clotrimazole (Lotrimin) cream or lotion or Miconazole (Monistat) 2x/day for 4 weeks
* Keep dry and avoid contact, handwashing
Tinea infections are transmitted from person to person, animal contact, or by contact with contaminated fomites (combs, hats, headrests, pillows)
Tinea corporis
Candidal Infections - Candidiasis
Oral = ?
> Superficial fungal infection of oral mucous membranes resulting from an overgrowth of C. albicans
Manifestations
- white curd-like plaques on tongue and buccal mucosa
Diaper area
- Lesions caused by passage of C. albicans through the intestine
- Manifestations: bright red and coalesced lesions may spread to the child’s abdomen and thighs
thrush
Therapeutic Management
* Nystatin oral suspension (100,000 units per mL) every 6 hours until 3-4 days after the symptoms have resolved
> Applied to mucous membranes of the mouth (gums, tongue, and buccal mucosa); applied after feedings
* Pacifiers, nipples, and bottles should be cleaned thoroughly
* Teach hand hygiene technique
* If breastfeeding - breast should also be treated with Nystatin
* Encourage small frequent feedings and for older children - cool liquids
* Oral fluconazole may be given as an alternative
* Candidal diaper dermatitis treated with topical antifungal agent - Nystatin or clotrimazole (Lotrimin)
> Leave diaper area exposed to air to reduce moisture
Rickettsia Infections
?
* Rickettsiae - small, parasitic bacteria
Causative agent: Rickettsia rickettsii
Reservoir: Wild rodents and dogs
Vector: ticks (wood, dog, or Lone Star)
Incubation period: 2-14 days
Transmission period: bite of infected tick
Rocky Mountain Spotted Fever
Manifestations
- Headache, fever, and anorexia, restlessness
- Maculopapular rash (wrists, palms, ankles, and soles)
- Hemorrhagic and necrotic lesions may appear
Therapeutic managment
- Doxycycline (may stain teeth - use straws and flush mouth after adminstration)
- Fluoroquinolone as an alternative
- Treatment lasts 7-10 days
Borrelia Infections
Lyme Disease
* Causative agent: Borrelia burgdorferi (spirochete)
* Vector: Tick
* Incubation period: 3-33 days
* Infectious period: not communicable from one person to another
* Transmission: bite of infected deer tick
Manifestations
- Early localized stage
- Early disseminated stage
- Late disseminated
__ __ stage
- Intermittent, chronic arthritis, profound fatigue, chronic neurological manifestations
Late disseminated
__ __ stage
- Severe headaches with myelitis, N/V, facial nerve paralysis (Bell’s palsy), forgetfulness or decreased concentration, and cerebral ataxia
- General lymphadenopathy and joint and muscle pain
Early disseminated
__ __ stage
- Local reactions - erythematous papule at bite site - erythema migrans or “bullseye rash” and flu-like symptoms (headaches, chills, fatigue, muscle aches, and pains)
Early localized
* Primary prevention - anticipatory guidance and measures to prevent and avoid insect bites
- Protective, light-colored clothing
- Inspect skin thoroughly after exposure to heavily wooded area
- Proper use of insect repellents (DEET - not over 30%)
* Oral antibiotic therapy - doxycycline, amoxicillin, or cefuroxime - 14-21 days
* If neurologic or cardiac symptoms - IV ceftriaxone 2-3 weeks
* Analgesics and antipyretics (fever, arthralgias, headaches)
Helminthic Infections
- Tapeworms
- Roundworms
- Pinworms
- Hookworms
Education focus on medication administration, primary prevention (personal hygiene and health habits), and identifying resources for basic living needs (running water)
?
Handling or eating infected beef or pork
Manifestations
> Asymptomatic, abdominal pain, nausea, anorexia, weight loss, insomnia
Treatment
> Praziquantel, niclosamide
Tapeworms
?
Ingestion or inhalation of eggs, transfer from hands to mouth
Manifestations: nocturnal anal itching, sleeplessness
Treatment: Pyrantel pamoate, mebendazole, albendazole
Pinworms
?
Ingestion of eggs from contaminated soil or food, transfer to mouth from fingers, toys, or other vectors
Manifestations: abdominal pain or distention, abdominal obstruction, vomiting with bile staining, pneumonitis
Treatment: Mebendazole, albendazole, ivermectin
Roundworms
?
Skin penetration from direct contact with contaminated soil
Manifestations: dermatitis, blood loss - anemia, pneumonitis, malnutrition
Treatment: Mebendazole, albendazole, pyrantel pamoate
Hookworms
Sexually Transmitted Diseases (STDs)
* Chlamydia (chlamydial infection)
* Gonorrhea
* Human Papillomavirus (HPV)
* Herpes simplex virus
* Syphilis
* Trichomoniasis
Chlamydial Infection
* Most prevalent
* Transmission: during birth with infected mother or through sexual activity
* Manifestations
> __ __ - watery discharge - purulent; eyelids edematous and conjunctiva inflamed; mucoid rhinorrhea; may progress to infection of nasopharynx with progression to pneumonia
> Adolescents - urethritis with dysuria; urinary frequency; mucopurulent vaginal discharge
Neonatal conjunctivitis
Therapeutic management
* Conjunctivitis and pneumonia: 14-day course of erythryomycin
* Genital tract infection - single dose of azithromycin or 7-day course of doxycycline
* Treat all sexual partners
Gonorrhea
* Transmission: intimate contact (perinatally - during birth, sexual abuse, sexual intercourse)
* Manifestations
> __ __: 1-4 days after birth - thick purulent discharge from eyes may progress to corneal ulceration, rupture, and blindness
- Prophylactic treatment with ophthalmic antibiotic ointment immediately after birth
> Females - purulent vulvovaginitis
> Males - urethritis
Ophthalmia neonatorum
Therapeutic management
- Ceftriaxone for children and adolescents
- Cefotaxime for infants
- Sexual partners should also be treated
Human Papillomavirus (HPV)
* Responsible for common wart and genital warts (condylomata acuminata)
* Transmission: direct sexual contact; multiple sexual partners; or perinatal contact during birth
> Children with anogenital warts should be investigated for sexual abuse
* Manifestations: anal genital warts; found in moist areas (labia minora, vagina, cervix, anus, rectum, and glans of the penis)
Therapeutic management: most resolve spontaneously;
- Topical gels, creams, cryotherapy, electrocautery laser treatment or surgical removal
- Screening for cervical cancer - Papanicolau (Pap) test
- Vaccinations
> HPV 6/11/16/18 vaccine (Gardasil) females and males ages 9-26
> Recommendation is for females ages 11-12 to be immunized with one of the HPV vaccines
> Males can receive the HPV 9 or HPV 4 vaccine
Herpes Simplex Virus
* Most frequent STD in US
* Causative agent: Herpes Simplex Virus type 2 (genital herpes)
* Incubation period: 2-14 days
* Transmission: Direct sexual contact with infected person
- Infected mother can transmit to newborn with vaginal delivery
- Women with active HSV advised to have C-section delivery
Manifestations
- Vesicles on the vulva, perineum, perianal area
- Pain and tenderness in the affected area
- Flu-like symptoms (fever, malaise, dysuria, and enlarged lymph nodes)
- Virus remains dormant in the nerve ganglia and reappear with stressful trigger
Therapeutic management
- Culture from the secular fluid confirms diagnosis
- No cure for HSV 2
- Acyclovir (Zovirax) - reduce symptoms and shedding time
- Infected neonates - treated with parenteral acyclovir
- Adolescents treated for 10 days with oral acyclovir, valacyclovir, or famciclovir
Syphilis
* Transmission: intimate contact; transplacentally or sexually
* __ syphilis transmitted through placenta or during birth
> Symptoms within the first 3 months of life
* __ syphilis transmitted through sexual contact
Manifestations
- Rhinitis, maculopapular rash, hepatosplenomegaly
- Bones, teeth, eyes, and eighth cranial nerve involved - teeth notched (Hutchinson’s teeth) and hearing loss may occur around age of 8-10
Treatment: penicillin and tetracycline
Congenital
Acquired
Trichomoniasis
* Transmission: perinatal contact during delivery, sexual activity
Manifestations
- Mostly asymptomatic in males
- Females - dysuria, vaginal itching, burning, frothy yellowish green foul-smelling discharge
- Classic - strawberry cervix
Therapeutic management
- One dose of metronidazole (Flagyl, Protostat) or tinidazole
- Sexual partners should also be treated
Prevention is major nursing goal
Nursing Considerations
* Prevention, early identification, and treatment are major goals of nursing care related to any STD
- Nurse plays key role in educating
- Being non-judgmental
- Reassuring confidentiality
- Build trust and rapport with adolescents
> School nurses - healthcare professional with whom adolescents establish trusting relationships
To prevent STDs - encourage abstinence for adolescents who are not sexually active and condoms for those who are sexually active
Nursing Diagnosis Associated with Infectious Process
- Acute Pain
- Impaired comfort
- Impaired skin integrity
- Risk for infection
- Risk for imbalanced body temperature
- Ineffective thermoregulation
- Deficient fluid volume
- Impaired swallowing
- Fatigue
- Deficient knowledge
- Social isolation
- Deficient diversional activity
