Sexually Transmitted Infections Flashcards
(56 cards)
1
Q
Growing Concern
A
- Direct cause of human suffering and costs hundreds of millions of dollar to treat
- STI’s are the most common health problem in the US
- US surgeon general has targeted STI’s as a priority for prevention and control efforts!
2
Q
Prevention
A
- Prevention is critical!
- Prevention requires changes in behavior
- Education should include specific actions to avoid acquiring or transmitting STI’s - Tailored to the specific client with attention given to HER risk factors
- Absolute protection: abstinence or monogamous relationship with uninfected partner
3
Q
Safer Sex Practices
A
- KNOW YOUR PARTNER
- Use condoms when not sure about partners history
- Know the difference between low risk and high risk behaviors
- Practice the conversation
- Know that sexual transmission occurs through direct skin or mucous membranes
4
Q
Bacterial STIs ~Chlamydia
A
- Most common and fastest spreading
- Silent but highly destructive
- Acute Salpingitis (ectopic pregnancy risk)
- Pelvic Inflammatory Disease (PID)
- Increases risk of contracting HIV infection because of cervical ulcerations
- Reportable STI
5
Q
Implications for pregnancy
A
- Pregnancy
- Early or late pregnancy loss
- Stillborn
- Premature labor
- Postpartum endometritis
- Newborns
- Infants may develop conjunctivitis or pneumonia
- Most common cause of opthalmia neonatorum
- Prevention???
- Pre-term birth
6
Q
Screening and Management: Chlamydia
A
- Screening is expensive
- Cervical culture at first prenatal visit and may repeart at 36 weeks
- Symptoms usually asymptomatic- could have spotting, purulent cervical discharge or dysuria
Management:
- Erythromycin or amoxicillin for 7 days if pregnant- should be retested but not done
- Azithromycin
7
Q
Bacterial STI’s - Gonorrrhea
A
- Almost exclusively transmitted by sexual contact
- Transmitted to the newborn in the form of opthalmia neonatorum
- Highest incidence: teens, young adults and African Americans
- Highly contagious- reportable communicable disease
8
Q
Symptoms of Gonorrhea
A
- Women often asymptomatic
- May have minimal purulent endocervical discharge
- Menstrual irregularities- longer and more painful
- May have pain- chronic or acute severe pelvic or lower abdominal pain
- Diffuse vaginitis with vulvitis- most common in prepubertal girls
9
Q
Implications for Pregnancy
A
Pregnancy
- Miscarrage
- PROM
- Preterm labor
- Chorioamnionitis
10
Q
Implications for Newborn
A
Newborn
- Opthalmia neonatorum
- Prevention
- Neonatal sepsis
- Pre-term birth
11
Q
Screening and Management
A
Screening
- CDC recommendations- all women
- Pregnancy- screen at first visit; re-screen at 36 weeks if positive/risky behavior
- Culture endocervix, rectum, pharynx
- Co-infection common: Chlamydia & Syphillis
12
Q
Management: of Gonorrhea
A
Management
- Single Dose- cefixime (supra) or ceftriaxone (Rocephin)
- Most treatment failures are from re-infection
- Treat all sexual partners
13
Q
Bacterial STI’s ~ Syphillis
A
- Transmission through microscopic breaks in sub-cutaneous tissue, kissing, bitting, oral genital sex
- Transmitted to fetus via trans-placental tranmission - anytime during pregnancy
14
Q
Implications for pregnancy: Syphillis
A
Pregnancy:
- Preterm labor
- Miscarriage
Newborn
- Stillbirth
- Congenital infection
- Blindness, deafness, deformity of the face and neurological problems
- Much worse than if tranmission occurs at birth
15
Q
Symptoms of Syphillis
A
- Can lead to serious systemic disease- including death
- Three distinct stages
- –Primary
- –Secondary
- –Teritiary
- Reportable communicable disease
16
Q
Primary Stage
A
- 5-90 days after infected
- Chancre appears at the spot where syphillis entered the body
17
Q
Secondary Stage
A
- Secondary
- 6 weeks - 6 months
- Chondylomata lata
18
Q
Tertiary Stage
A
- 3-10 years after initial infection
- Solitary granulomatous lesions (gummas) found on the skin, in the mouth and throat or occur in bone. Skin lesions may be painless but gummas in long bones cause a deep boring pain that is worse at night
- Brain involvement (neurosphyillis)
- Spinal cord disease
- Other internal organs such as the heart, blood vessels, eyes, liver and blood may be damaged by infection
19
Q
Screening and Managment of Syphillis
A
Pregnant Women
- First prenatal visit and third trimester
- Culture lesions or serology
- VDRL
- RPR (rapid plasma reagin)
- If positive will have confirmative test
Management:
- Penicillin !!!!
- Desensitize if allergic to PCN and Pregnant
- Monthly follow up
20
Q
Pelvic Inflammatory Disease
A
- Infectious Process
- Fallopian tubes (salpingitis)
- Uterus (endometritis)
- Ovaries and perineal surfaces (rare)
Caused by multiple organisms:
- most common is Chlamydia and gonorrhea
- Can be acute, sub accute, chronic
Most commonly occurs at end of menses, after miscarriage, abortion, pelvic surgery or childbirth - bc during this time the cervix is open
21
Q
Risk factors for PID
A
- Young, nulliparity, multiple partners, history of STI’s, and use of IUD
- PID may lead to: ectopic pregnancies, infertility, chronic pain
22
Q
Symptoms:
A
- Pain
- Subacute: dull, cramping, intermittent
- Acute: severe, persistent, incapaciting
- Intermenstrual bleeding
- Chandelier sign
- Bilateral pelvic tenderness
- Possible: fever, purulent cervical or urethral discharge
23
Q
Screening & Managment
A
History and physical assessment
- Rule out appendicitis and endometriosis
Criteria for diagnosing PID:
-Temperature greater than 38.3 C, abnormal discharge, elevated erythrocyte sedimentation rate, and lab documentation of cervical infection
24
Q
Management
A
- Treatment varies with infecting organism-broad spectrum antibiotic used
- Those with acute infection- bedrest in semi-fowlers positon in hospital
- Primary prevention preferred!!! Secondary aimed at preventing upward spread of infection from lower gential tract!!!
25
Viral STI's: Human Papillomavirus
- Most common viral STI
- More than 30 serotypes
- Genital warts - lesions flesh colored- usually painless
- Most common in pregnancy
May enlarge in pregnancy (immunosuppression)
May deliver vaginally
Newborn may aquire infection
26
Screening and Diagnosis
Symptoms: Vaginal discharge, itching, dyspareunia, postcoital bleeding
- Visulization of lesions
- Differentiate from 2 degree syphillis (condylamata lata are flatter and wider )
- History and Physical
- Pap test screens for HPV that are likely to cause cancer
- Only definitive diagnosis- biopsy
27
Implications for Pregnancy
- Dystocia from large lesions
- Excessive bleeding from lesions after birth trauma
Newborns
- Respiratory papillomatosis (rare)
- Warts in the throat
- Pre-term birth
28
Management
- May resolve on own with healthy immune system
- Goal of treatment- Removal of warts and relief of symptoms
- Creams, solutions, cryotherapy
- No therapy has been shown to eradicate HPV
- Comfort measures: bathe in oatmeal solution- keep area clean and dry- cotton underwear- loose fitting clothing- healthy life style to aid immune system
29
Prevention
- Vaccine- Gardasil
- Recommendation for girls 9 to 26
- Series of 3 vaccinations over 6 months
- Protects against 4 types of HPV- two that cause 75% of cervical cancer
- In boys the vaccine can give 90% protection against genital warts
30
Herpes Simplex Virus
- Results in PAINFUL, recurrent genital ulcers
- Caused by herpes simplex virus 1 & 2
- Initial HSV Genital infection
- Multiple painful lesions- fever, chills, maliase,- severe dysuria (2-3)
- Prodromal genital tingling is common
- Transmission: skin to skin contact
- Can become infected when no visible lesions are present
31
Pregnancy and HSV
- Primary infections during first trimester may result in miscarriage
- Most severe complication is neonatal herpes -potentially fatal or severely disabling - systemic infection
- Highest risk is women with primary herpes near term
32
Fetus Newborn implications with HSV
Transmission
- intrauterine (rare)
- During delivery
- Postpartum (contact with mouth sores)
Intrauterine herpes and herpes acquired shortly after birth can cause:
- chorioretinitis
- severe brain damage
- Skin lesions
Infants with systemic herpes often to poorly despite medications
33
Screening and Management
- History and Physical
- Swab exudate in vesicular stage
- Blood tests will determine antibody formation only!
Management: NO CURE
- First outbreak is worse
- No maternal antibodies to help fetus fight infection
- Systemic antiviral meds partially control the symptoms
- Comfort measures: warm baths with oatmeal, anaglesics, loose clothing
34
Prevention of Recurrent Episodes
- Diet rich in vitamin C, B-complex vitamins, zinc and calcium
- Know precipitating factors
- Stress reduction
- Avoid excess heat or sun
- Start medication (acyclovir or valtrex) with first symptom- tingling, burning, blister....
- Pregnancy prophylaxis (last month)
35
Prevention of Tranmission
-No intercourse when lesions present until have crusted over
-Do not share towels, soaps, etc...
-Condoms
-Neonatal transmission
Ceasaren birth if lesions are present
Infants delivered through infected vagina should be cultured and watched
- Congenital HSV- reportable in ohio
36
Viral Hepatitis - HEP B
- Most threatening virus to fetus and neonate
- Screening is based on testing for antigens like HBsAg
- Found in blood, salivia, sweat, tears, vaginal secretions, and semen
37
Screening
-Recommended for ALL women on first prenatal visit
-Repeated later in pregnancy for high risk
-Serum test for presence of antigens and antibodies
---- Positive HBsAg
----can be transmitted
Window phase
38
Management
- No specific treatment- recovery usually spontaneous (3-16 weeks)
- Bed rest, high protein, low fat diet, increase fluids, avoid medications metabolized in the liver and alcohol
- Vaccination!- series of 3 over 6 months
- Pregnant women with definite exposure- hepatitis B immune globulin and being vaccination series
39
Newborns with HEP B
If mom tests positive for HBsAg
- Newborn recieves hepatitis B immune globulin within 12 hours
- Newborn begins series of vaccinations right away
- Reportable
40
HIV
Heterosexual transmission- most common in women
Transmission occurs through exchange of body fluids
Once infected, seroconversion to HIV positivly usually occurs within 6-12 weeks
-usually looks like influenza type response
-Tranmission from mother to child CAN occur
-maternal circulation (pregnancy)
-Ingestion of maternal blood (delivery)
-Breast milk
41
Pregnancy
- Avaliable treatments can reduce likelihood of perinatal transmission and maintain health of woman
- ACOG and CDC recommend HIV testing become standard and retesting in third trimester for high risk women
- Eventually rapid-testing will be ordered for laboring women so treatment can begin immediatley!
- Reportable !
42
Perinatal tranmission
- Decreased dramatically because of administration of antiretrovirals to pregnant women in prenatal and perinatal periods
- During pregnancy- tranmission at 1-2% because of treatment with HAART regardless of CD4 counts
43
HIV
- Cesearan Birth and no breastfeeding !
- ACOG Guidelines
- Maternal implications depending on CD4 counts!!!
44
Mother to child transmisson
- Via placenta - 5 to 10
- During L and D - 10- 20
- Breastfeeding - 10-20%
45
After Delivery
- All hospitals should have intravenous zidovudine for the mother and zidovudine suspension for the newborn
- The newborn will need to be treated with antiretroviral drugs within 8-12 hours after birth and for six weeks
- Certain situations present an increased risk of transmission and can require more complex drug regimens
- prolonged rupture of membranes, a mother who has not recieved antiretroviral treatment during pregnancy, and mothers with unknown or suspected antiretroviral drug resistance
46
Vaginal Infections: Bacterial Vaginitis
- Associated with preterm labor and birth
- Fishy odor, vaginal discharge, and itching
- Presence of clue cells
- Wiff test (KOH)
- May cause premature labor and delivery
- Treated with flagyl
- --- if breastfeeding - pump and discard until 48-72 hours after last dose
47
Candidiasis (yeast infection):
Predisposing Factors:
- Antibiotics
- Diabetes
- Obesity
- Immunosuppression
Itching is a common symptom
-thick, white, clumpy cottage cheese like discharge
Treated with anti-fungal medications
Lotriman or Monistat - no tampons or sex
48
Trichonmoniasis
```
Almost always sexually transmitted
May be asymptomatic
- some have yellow green discharge
-Malodorous discharge
-Itching and irritation
-Dysuria and dyspareunia often present
-Cervix may bleed with irriation
-Diagnosed on wet prep with saline
-Check for other STIs
```
Treat with Flagyl
Treat partner
49
Group B Streptococcus
Part of normal flora in women
has been associated with poor pregnancy outcomes
-usually resulting from vertical transmission from birth canal of infected mother to infant during birth
-Screen all women at 36 weeks gestation
-Positve- treat with intravenous antibiotics in labor-Penicillin !!!!
50
Treat in labor?
Yes
- have a positive culture test result during this pregnancy
- GBS status is not known and the following occur:
- go into labor at less than 37 weeks
- water breaks 18 hours or more before delivery
- Have a fever during labor
51
Treat in labor?
NO
- a planned cesarean delivery done before labor starts or water breaks
- have a negative GBS culture test result during this pregnancy
- GBS status unknown and no risk factors present
- CBC and blood cultures for newborn
- Newborn implications
52
Careful monitoring of newborn
Early Onset
- occurs in first 7 days- usually first 6 hours after birth
- Sepsis- meningitis- pneumonia
Late Onset
- can be caused by transmission at birth or from other people
- occurs after the first 7 days of life
- Meninigitis or pneumonia
- Reportable if occurs in newborn less than 3 months of age
53
TORCH
- Caused by group of organisms capable of crossing the placenta and affecting fetal development
- Generally all TORCH infections produce flu like symptoms in the mom
- Fetal and neonate effects are more serious
- Toxoplasmosis - Other- Rubella- Cytomegalovirus - Herpes Simplex Virus
54
Toxoplasmosis
- Protozoan Infection
- consumption of infected raw meat
- Poor hand washing after handling kitty litter
- Determined through blood studies
- Miscarriage may occur
- Parasitemia in fetus
- Treated with medications that may be potentially harmful to fetus
55
Rubella
Fetus: congential anomalies, severe malformations during first trimester, death
Vaccination of pregnant women is contraindicated (live vaccine)- given postpartum with instructions to avoid pregnancy for 1 month
56
Cytomegalovirus
Transmission by close contact
- semen, cervical and vaginal secretion , breast milk, placental tissue, urine, feces, banked blood
- Diagnosed by CMV presence in serum or urine
Fetal Implications
-Microencephaly, mental retardation, fetal death or severe generalized disease
No treatment is avaliable during pregnancy
Reportable
