Sexually Transmitted Diseases Flashcards
Vaginosis, HPV, Gonorrhea, Chlamydia, HIV, Syphilis
STIs
VAGINAL CANDIDIAS
Sources of Infection, Nurse Management, Medications
Source: yeast, monilla, fungal infection
S/S:
Mother
* Resistant to treatment during pregnancy
* Uncomfortable localized genital itching and discharge
Fetus
* Can acquire thrush in the mouth during birthing process if mother infected
NMx:
* Wear white, 100% cotton panties
* Wipe front to back
* Shower, instead of bathe
* Use unscented soap and dry gently.
* Avoid douching, tight pants, and sprays and deodorants
Medications:
* Creams, tablets, suppositories “-azole”
Not an STI
STIs
VAGINAL TRICHOMONIASIS
Risk Factors, S/S, NMx, MEDs, Affects on Mother and Fetus
Protozoan
R/F: jacuzzies, hot tubs, pools
S/S:
Mother
* yellow, green frothy discharge
* vaginal pruritis
* vulvar soreness
* inflammation of vagina and/ or vulva
* assymptomatic for men
* Has been implicated to cause PROM and preterm births
Fetus
* Risk of prematurity
NMx:
* avoid alcohol while taking meds
* no sexual action until partner is cured
Meds:
* single 2g dose of metronidizole and tinidizole
Not an STI, common cause of vaginal infection, protozoa stays for days
STIs
Bacterial Vaginosis/ Vagina Gardnerella
R/F, S/S, MEDs
Bacteria
R/F:
S/S:
Mother
* inflammation in the vagina
* thin, white discharge
* stale fish odor
* Increases risk for spontaneous abortion, PROM, chorioamnionitis, postpartum endometritis, and preterm labor
Fetus
* Risk of neonatal sepsis
MEDs:
* metronidizole (gel/cream)
* clyndamicin
Not an STI, 3rd common infection in vagina, 50-75% women are asymptomatic
STI
HIV
What, Therapeutic Management, Medications
HIV is the destruction of T-cells from sexual intercourse, dirty needles, or mother passing to baby.
S/S
* Mother: Fatigue, nausea, weight loss
* Fetus: Transmission can occur transplacentally, during childbirth or through breast milk
Therapeutic Management
To cope w/ anorexia, N/V
* Increase in protein intake
* Eat cracker upon rising
* eating six small meals daily.
* using high-protein supplements (Boost, Ensure) to provide quick and easy protein and calories.
* eating “comfort foods,” which may appeal to them when other foods don’t.
* decrease the HIV viral load below the level of detection.
* restore the body’s ability to fight off pathogens.
* improve the client’s quality of life.
* reduce HIV morbidity and mortality
* Antiretroviral Therapy (ART)
Providing care during pregnancy:
* Getting adequate sleep each night (7 to 9 hours)
* Avoiding infections (e.g., staying away from crowds, handwashing)
* Decreasing stress in her life
* Consuming adequate protein and vitamins
* Increasing her fluid intake to 2 L daily to stay hydrated
* Planning rest periods throughout the day to prevent fatigue
HIV/AIDS
Antiretroviral Therapy (ART)
- Treatment must begin ASAP after diagnosis
- Current therapy to prevent the transmission of HIV to the newborn includes having the mother take ART agents consistently throughout pregnancy
- Medication must be administered to the infant w/in 6 to 12 hours after birth and continues after 6 weeks
*Duration of the treatment is lifelong and requres perfect adherence to succeed the treatment.
STI
Human Papillomavirus (HPV)
Risk Factors, Affect on Mother/Fetus, S/S, Therapeutic Management
Most common viral infection in the US.
Risk Factors: Smoking, coinfection with partner, longterm contraceptive use, multiple sex partners
S/S: genital warts
Mother: May cause dystocia if large lesions
Therapeautic Management
* Treatment is aimed at removing the lesions rather than HPV itseld.
* Most methods rely on chemical or physical destruction:
- 20% Podophyllin antimititic solution
- 0.5% podofilox solution
- 5% 5-flouracil cream Trichloroacetic Acid (TCA)
*Small warts can be remove by:
- freezing (cryosurgery)
- burning (electrocautery)
- laser treatment
- surgucal excision
- Large warts may have to removed surgically
- Start vaccination by 11-12 years old with 2 doses.
- Abstain from sex during treatment to promote healing
*HPV can lead to cervical cancer
STI
Chlamydia
Risk Factors, Affect on Mother/Fetus, S/S, Therapeutic Management
Most common bacterial STI in the U.S.
S/S: mucopurelent discharge, urethritis, endometritis, dysfuctional uterine bleeding
Mother:
* Postpartum endometritis, PROM, and preterm birth
Fetus:
* Newborn can be infected during childbirth
* Eye infections (neonatal conjunctivitis), pneumonia, low birth weight, increased risk of premature rupture of the membranes (PROM), and preterm birth
Medications: ANTIBIOTICS
Docycycline 100mg PO BID
Azythromicin 100mg PO BID
Erythromycin (EES)
Levoflaxin Ofloxacin (Floxin)
Patient Education
- Make sure the baby gets erythromycin upon birth to treat thrush and conjunctivitis
- Combine with gonorhea regime if present in screening
- abstain from sex until therapy is complete and free from symptoms
*Can be asymptomatic
STI
Gonorrhea
Risk Factors, Affect on Mother/Fetus, S/S, Therapeutic Management
2nd mst common STI in the US, contagious
Transmission: Sexual actions, child birth
Site: Columnar epithelium of the endocervix
S/S: rectal/ vaginal bleeding, PID, endocervitis, and bartholin abcess
Mother: Chorioamnionitis, preterm birth, PROM, fetal growth restriction, postpartum sepsis
Fetus: Newborn can be infected during childbirth. Eye infection gonococcal ophthalmia neonatorum can lead to blindness and sepsis (including arthritis and meningitis)
Therapeutic Managment:
* Sexual partners need evaluation, testing and treatment
* Abstain from sex until treatment is complete
* Retesting in 3 months to rule our reoccurence
* Antibiotic (Dual) Therapy
- Azythromicin 1g PO Daily
- Ceftriaxone 250 mg IM
*symptoms are mostly asymptomatic
*pelvic inflammatory disease (PID)
STI
Genital Herpes (ULCERS)
Risk Factors, Affect on Mother/Fetus, S/S, Therapeutic Management
Recurrent Lifelong Infection
Transmission is through the mucous membranes or breaks in the skin with visible or non visible lesions from kissing, sexual contact, and vaginal delivery.
S/S:
* Primary: Vesicular lesions
* Recurrent: Genital *
Effects
- Mother: Spontaneous abortion, intrauterine infection, preterm labor, PROM, fetal growth restriction
- Fetus:Contamination can occur during birth. Birth anomalies; transplacental infection. Newborn may develop skin or mouth sores. Intellectual disability, premature birth, low birth weight, blindness, death
Therapeutic Management
- NO CURE (just control symptoms)
- Antiviral therapy to reduce or end symptoms, shedding, or recurrences.
- Counseling to help adolescent cope and to preent transmission
- sexual partners benefit from evaluation and counseling
- treatment is required, if symptomatic
- testing and education should be offered if asymptomatic
Medications: All meds for 7-10 days
* Aciclovir 400mg PO TID
* Famiclovir 250mg PO TID
* Valaclovir 100mg PO BID
*Vaginal deliveries cannot be done if infection is active.
STI
Syphillis
Risk Factors, Affect on Mother/Fetus, S/S, Therapeutic Management
Curable Bacterial Infection caused by spirochete.
Systemic disease that leads to death and disbalities.
Clinical Manifestations by Stages
1. Bacterial entrance
2. Maculopapular Rash (on trunk, palm, soles, flue-like symptoms
[LATENT PD: 1-2 years of no symptoms]
3. Tumor in skin, bones, liver, CNS & CV symptoms (that are not reversible)
Effects:
- Mother: Spontaneous abortion, preterm birth, stillbirth
- Fetus: Can be passed in utero. Can result in fetal or infant death. Congenital syphilis leads to multisystem organ failure, structural damage including teeth and bones, can lead to blindness, hearing loss, and mental retardation
Diagnostic Testing
* Venereal Disease Research Lab (VDRL)
* Rapid Plasma Reagin (RPR)
Treatment
- Benzathine penicillin G injection (if penicillin allergy, docycycline, tetreacycline, or erythromicin)
- sexual partners need evaluation
Non-STI
Pelvic Inflammatory Disease (PID)
Risk Factors, Affect on Mother/Fetus, S/S, Therapeutic Management
Secondary disease to chlymedia and gonorrhea, but not always caused by an STI.
PID is an infection-induced inflammation of the female upper reproductive tract.
S/S:
- lower abdominal tenderness
- bilateral adrexal tenderness
- temperature: at least 38.3C/ 101F
- abdominal or cervical discharge
- dysmenorhea
- dysuria
- dyspareuria
Therapeutic Management
Meds: Antibiotic Therapy
- parenteral cephalosporin single injection BID
- doxycycline 100mg BID
both medications have to be
BOTH at the same time for 14 days
Nonpharm
- oral fluids, bedrest; limit pelvic exams, sexual actions
What are the prevention guidelines for Pelvic Inflammatory Disease?
- Advise sexually active girls and women to insist their partners use condoms.
- Discourage routine vaginal douching, as this may lead to bacterial overgrowth.
- Encourage regular STI screening.
- Emphasize the importance of having each sexual partner receive antibiotic treatment.
How to take care of Genital Ulcers?
- Abstain from intercourse during the prodromal period and when lesions are present.
- Wash hands with soap and water after touching lesions to avoid autoinoculation.
- Use comfort measures such as wearing nonconstricting clothes, wearing cotton underwear, urinating in water if urination is painful, taking lukewarm sitz baths, and air-drying lesions with a hair dryer on low heat.
- Avoid extremes of temperature such as ice packs or hot pads to the genital area as well as application of steroid creams, sprays, or gels.
- Use condoms with all new or noninfected partners.
- Inform health care professionals of your condition.
The P-LI-SS-IT Model
Model to guide HCP on talking to clients about their sex experience to determine appropriate interventions.
P – Permission—gives the woman permission to talk about her experience
LI – Limited Information—information given to the woman about STIs
* Factual information to dispel myths about STIs
* Specific measures to prevent transmission
* Ways to reveal information to her partners
* Physical consequences if the infections are untreated
SS – Specific Suggestions—an attempt to help women change their behavior to prevent recurrence and prevent further transmission of the STI
IT – Intensive Therapy—involves referring the woman or couple for appropriate treatment elsewhere based on their life circumstances
How to prevent vaginitis?
- Avoid douching to prevent altering the vaginal environment.
- Use condoms to avoid spreading the organism.
- Avoid tights, nylon underpants, and tight clothes.
- Wipe from front to back after using the toilet.
- Avoid powders, bubble baths, and perfumed vaginal sprays.
- Wear clean cotton underpants.
- Change out of wet bathing suits as soon as possible.
- Become familiar with the signs and symptoms of vaginitis.
- Choose to lead a healthy lifestyle.
