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STI Flashcards

1
Q

Sexually Transmitted Disease
STD

A

Most start on the genitalia (penis, vagina), anus and open skin lesions

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2
Q

Expedited Partner Therapy

A

check their partner;dont have to be checked. give pts

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3
Q

Autoinoculation-

A

can spread from one area of the body to another area

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4
Q

HSV-I –
HSV-II –

A

HSV-I – “oral herpes”
HSV-II – “genital herpes”

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5
Q

viral shedding

A

passing herpes without it being opened

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6
Q

Incubation:

how many days

A

2-12 days

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7
Q

Diagnosis –(4)

A

HSV serologic assays (blood work) antibody test,
symptoms,
visual examination,
wound/viral culture

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8
Q

Prodromal stage:HSV

A

(before lesions occur) burning, itching, tingling at the site (buttock, inner thigh, penis, scrotum, vagina, cervix, perianal region, labia)

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9
Q

Vesicular stage:

A

few small, painful vesicles(blisters) on genital areas, contain infectious particles, lymphadenopathy, flu-like symptoms (fever, headache, malaise)

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10
Q

Ulcerative stage:

A

lesions rupture and form moist ulcerations

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11
Q

Final stage:

A

crusting over of ulcers, epithelialization occur

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12
Q

is the crusting stage infectious? t or f

A

true

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13
Q

HSV Control:
________Precautions

Greatest risk is when _______________

A

Contact Precautions (hospital)
Don’t touch lesions!
Good handwashing
No sexual contact without condom
Greatest risk is when lesions are present

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14
Q

HT Condoms:

A

decrease transmission/decrease risk
Condom not 100% effective
Avoid sexual contact- when lesions present or during prodromal symptoms

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15
Q

HSV- Herpetic Whitlow

A

Herpetic infection of 1 or more fingers (usually enters through the cuticle), painful

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16
Q

HSV- Treatment- No Cure

state medication ( think about recyle video)

A

Obtain lesion/blister culture if present
Obtain blood test for HSV 1 or HSV 2 antibodies if client states hx

Medications: antiviral
Acyclovir 400mg po TID x 7-10 days or
Valacyclovir 1gm po BID x 7-10 days or
Famciclovir 250mg po TID x 7-10 days
Inhibits herpetic viral replication
Prescribed for both primary and recurrent outbreaks

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17
Q

IDU (idoxuridine)-
Zovirax
Lidocaine
Psychological support:
Topical Care:
OTC:
Maintain =
Avoid

A

topical,
Zovirax-topical,
Lidocaine gel can be used additionally
Psychological support: affects relationships, sexual lives
Topical Care: sitz bath, ice, cotton underwear, keep blisters/eruptions clean & dry
OTC: acetaminophen, ibuprofen
Maintain good hygiene
Avoid sexual contact until outbreak has completely healed.

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18
Q

Mother:

A

No newborn contact with an
active HSV lesion (orofacial or Whitlow).

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19
Q

Prevention of neonatal herpes

A

Close monitoring of mom prior to delivery last 6-8wks of pregnancy
Can give po Acyclovir during all stages of pregnancy
Vaginal delivery(ok if 2 neg results in a row and 1 within a week of delivery)
C-section(required if test + or herpetic lesions present)

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20
Q

HSV- Care of neonatal herpes ( meds)

A

IV Acyclovir
topical eye ointment:
Vidarabine, Idoxuridene (IDU)

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21
Q

Which medication would be prescribed
for a patient with HSV?
Ampicillin
Acyclovir
Penicillin
Cefazolin

A

Acyclovir

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22
Q

Syphilis
Caused by:

Transmission

Not spread through:
Transplacentally:

Incubation:

A

Caused by:
Treponema Pallidum Spirochete
Transmission
Direct contact with syphilitic lesion chancre found externally on the genitals, anus, internally in vagina, rectum, mouth, tongue, lips
Not spread through indirect contact only thru sexual contact
Transplacentally: transmit to fetus leads to preterm birth, stillbirth, complications after birth > seizures/death
Incubation 10 -90 days (average 21 days)

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23
Q

true or false lantency is the first stage of syphillis?

A

false

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24
Q

Primary:

Secondary: ( what is tatle tell)

Tertiary:

A

highly infectious(blood/exudate from chancre), painless chancre, regional lymphadenopathy (typically appears 3wks)

highly infectious, occurs after chancre heals, flu-like symptoms (malaise, fever, sore throat, headache) mucous patches in mouth or cervix, red rash on trunk, palms, and/or soles of feet, weight loss, alopecia, lymphadenopathy

NUMBER 1 INDICATO = RASH

Noninfectious, occurs 3-20yrs after initial infection, Gummas (chronic destructive lesions on skin, bone, liver, mucous membranes), Cardiovascular damage (scarring of aortic valves leads to heart failure), CNS damage, personality changes, psychotic, tremors, mental deterioration, ataxia (loss of full control body movements), death

25
Latent:
absence of s/s, period of dormancy, asymptomatic carrier, disease continues to develop internally, dx based on specific treponemal antibody test
26
WHAT STAGES ARE INFECTIOUS TO OTHER?
PRIMARY+SECONDARY
27
HSV Control:
Contact Precautions (hospital) Don’t touch lesions! Good handwashing No sexual contact without condom Greatest risk is when lesions are present
28
Syphilis treatment Diagnosed by : Antibiotic treatment: If allergic to _____, use ______________
Diagnosed by blood test: 1. Nontreponemal antibody test (VDRL or Rapid Plasma Reagin) 2. Treponemal test (FTA-ABS or EIA enzyme immunoassays) Tx can not reverse internal damage Antibiotic treatment: Penicillin G benzathine IM x 1 dose. If allergic to PCN, use Doxycycline or Tetracycline. Used in all stages and in pregnancy.
29
All sexual contacts in last ____ days need treatment. Follow-up testing q_______ up to
All sexual contacts in last 90 days need treatment. Follow-up testing q6months for up to 2 years
30
Gonorrhea * Caused by __________ * Transmitted by exposure to ________ * Incubation: _________ * Site of infection:____________________ * S/S men: ________________, * S/S women: ___________________ Can cause________________
Gonorrhea * * Caused by Neisseria gonorrhoeae bacteria * Transmitted by exposure to sexual fluids * Incubation: 1-14 days * Site of infection: urethra-men, cervix-women * S/S men: dysuria, purulent/thick discharge, epididymitis (can lead to infertility) * S/S women: Mostly asymptomatic, increase vaginal discharge, dysuria, frequency, bleeding after sex, redness/swelling of cervix or urethra. Can cause PID (pelvic inflammatory disease) which can lead to infertility, ectopic pregnancy, chronic pelvic pain
31
Gonorrhea treatment * Culture= * History= * * High dose= * Sexual partners within____days need treatment * HT to abstain from sexual intercourse for _ days after tx
Culture of discharge- NAAT (nucleic acid amplification testing) * History sexual activity * Due high infectiousness, tx started before results of positive culture obtained * High dose 500mg ceftriaxone (Rocephin) IM x1dose * Sexual partners within 60 days need treatment * HT to abstain from sexual intercourse for 7 days after tx
32
Pregnant women same treatment (gonorrhea)
(Ceftriaxone)
33
Newborn
Ophthalmia neonatorum(conjunctivitis)- Erythromycin 50mg/kg po QID x 14 days for newborn
34
Treatment to newborns-
Erthromycin 50mg/kg po QID x 14 days.
34
Chlamydia * Caused by = * Transmitted * Incubation: * Site of infection: * S/S men: * S/S women:
Chlamydia * Most common STI 2 million case/year * Caused by Chlamydia trachomatis bacteria * Transmitted by exposure to sexual fluids * Incubation: 1-3 weeks * Site of infection: urethra-men(urethritis), cervix- women(cervicitis) * S/S men: dysuria, white discharge, swelling testicles/scrotum (epididymitis) * S/S women: mucopurulent discharge(white mucous), bleeding, dysuria, painful intercourse, usually asymptomatic. If untreated, leads to PID (infertility, ectopic pregnancy, chronic pelvic pain)
34
Chlamydia treatment * 7days of _______ * Follow-up testing * High recurrence * Tx all partners within
Chlamydia treatment * Culture of discharge (NAAT) * High prevalence of asymptomatic infection (symptoms will subside w/o tx)- suggest regular screening of high-risk populations * 7days of doxycycline 100mg BID po * Follow-up testing in 3 months is recommended * Abstain from sexual intercourse x 7 days after tx and until all sexual partners have been tx. * High recurrence * Tx all partners within 60 days of diagnosis
35
HPV-Human Papillomavirus * Also known as = * Communicability-can be spread easily through * 100 virus types – 40 types sexually transmitted. HPV type __--and ___ cause genital _______ * Transmitted_____ * Incubation:
* Also known as anogenital warts (Condylomata accuminate) * Communicability-can be spread easily through sexual intercourse. Most people don’t know they’re infected * 100 virus types – 40 types sexually transmitted. HPV type 6 and 11 cause 90% genital warts * Transmitted skin to skin (direct contact vaginal, anal, oral sex) * Incubation: weeks to months to years * May spontaneously resolve within a few years
36
HPV Vaccine *
Quadrivalnt HPV vaccine – targets HPV 6,11,16, 18,5 – Administer to F/M ages 11-12 yrs – 1-2 IM doses given over 6 mos period – Can be given up to age 26, 27-45 years also
37
HPV S&S: Female- Male-  Bleeding may occur after During pregnancy=
HPV S&S: Most are asymptomatic: do not know they are infected Female- inner thighs, vulva, vagina, cervix, perianal area Male-penis, scrotum, anus, urethra Itching with anogenital warts Single or multiple papillary growths (cauliflower-like mass, white to gray, or pink-flesh color, or brownish on darker skin)  Bleeding may occur after defecation with anal warts During pregnancy, multiply & grow rapidly
38
HPV diagnosis
* Visual inspection by health care provider. * Biopsy if warts atypical or not responding to treatment or becoming worse. * Psychosocial distress, removal for cosmetic concerns * HPV infection can persist when warts are not present, virus is. * Tx dependent on wart size, anatomical site, symptoms, cost of tx and client preference
39
HPV- Treatment
 Physician administered: * Chemical or ablative removal: Trichloracetic acid (TCA) – applied directly to wart. Petroleum jelly to surrounding tissue to protect; * Sharp stinging pain initially * Caustic agent destroys wart
40
HPV- Treatment Treatment
HPV- Treatment Treatment Primary goal is to treat visible genital warts Patient applied: * * Imiquimod (Aldara) cream, immune response modifier apply at bedtime, 3x week up to 16 wks. S/E: redness, irritation, ulceration, vesicles may occur. Low risk in pregnancy
41
HPV Not to be used in pregnancy
Podofilox liquid or gel, apply BID x3 days, Can be repeated for up to 4 wks or until warts resolve. S/E: local irritation/pain, Not to be used in pregnancy
42
HPV safe for pregnacy
Imiquimod (Aldara) cream, immune response modifier apply at bedtime, 3x week up to 16 wks. S/E: redness, irritation, ulceration, vesicles may occur. Low risk in pregnancy
43
HPV tx cont’ * *
HPV tx cont’ * Cryotherapy- application of liquid nitrogen>causes necrosis> blistering, use local anesthesia * Surgical tx – physically destroy by electrocautery, use of scissors/scalpel, carbon dioxide laser or curettage. * F/U in several weeks to assess response. * Most respond within 3months of therapy, depends on tx compliance * Recurrence and reinfection are possible, virus is still present.
44
HPV-Control
HPV-Control * Abstinence from sexual contact if warts are present * Use condoms * HPV Vaccine, does not treat active HPV infection. * C-section delivery if warts present .
45
HIV transmission contact with infected * Perinatal transmission during * Exposure to blood during * Puncture wound most common means of work-related HIV transmission
* Sexual transmission (most common) - contact with infected blood, semen, vaginal secretions thru sexual intercourse * Exposure to HIV-infected blood/blood products * Perinatal transmission during pregnancy, delivery, breastfeeding * Exposure to blood during drug-use paraphernalia(needles, syringes, straws) * Puncture wound most common means of work-related HIV transmission
46
Can not be spread through
through hugging, shaking hands, using toilet seats or casual encounters. Not spread in tears, saliva, urine, emesis, sputum, feces, or sweat.
47
Virus replication
leads to massive viremia and wide spread of virus through body’s lymphoid tissues ( CD4 + T cell destruction) * An immune response against the virus provides some protection but ultimately a chronic persistent infection is established.
48
Normal CD4+ T cell count =
800-1200
49
Acute Infection:
* 2-4 wks after exposure, * feels like mononucleosis (fever, swollen glands, sore throat, muscle &joint pain, diarrhea, rash, headache * some neurologic complications(peripheral neuropathy, facial palsy, Guillain-Barre) * lg amt virus present in the blood, (high viral load) * CD4 count drops temporarily then rebound to baseline levels * Most infectious
50
Chronic Infection: – Asymptomatic infection: – Symptomatic infection:
– Asymptomatic infection: many do not know they’re infected, asymptomatic, continue high-risk behavior, infecting others, low level virus in blood but still contagious – Symptomatic infection: CD4+ T cells drop to 500-200, viral load increases, s/s: fever, night sweats, chronic diarrhea, headaches, severe fatigue development of opportunistic infections
51
Opportunistic Infections
* Do not usually occur when immune system is functioning properly -thrush -shingles -Oral Hairy Leukoplakia -Kaposi sarcoma -Pneumocystis jiroveci pneumonia
52
Pneumocystis jiroveci pneumonia
Nonproductive cough, SOB, fever, night sweats, fatigue
53
Acquired Immunodeficiency Syndrome (AIDS)
* Diagnostic CDC criteria – CD4+ T cell count below 200 cells/μl – High viral load, very infectious – Specific opportunistic infection or/+ cancer – Specific opportunistic cancer – Wasting syndrome: lost at least 10% ideal body mass, especially muscle, diarrhea, extreme weakness and fever (not r/t infection)
54
HIV Testing * Window period:
HIV Testing * Confidentiality vs anonymous * Counseling * Window period: time period from initial infection until detectable on screening test, up to several weeks * HIV Antibody/Antigen Testing Table 15- 19 p.253 Lewis * Rapid HIV-Antibody Test: (saliva) results available in 20mins, if positive,need f/u with a standard blood test (Western Blot)
55
Antiretroviral Therapy ART
Antiretroviral Therapy ART * Goals: – Decrease viral load – Maintain or raise CD4+ T cells counts – Prevent HIV-related symptoms and opportunistic diseases – Delay disease progression – Prevent HIV transmission Most effective is simultaneous administration of at least 3 ART drugs from at least 2 different classes used in full dosages and in optimum schedules. Multiple drugs inhibit replication differently, making difficult for virus to recover and minimize drug resistance
56
PrEP
PrEP Preexposure prophylaxis * HIV medication for clients who are not HIV+ * Reduces risk of acquiring HIV * Used in conjunction with other risk prevention interventions * 2 medications in 1 tablet qd = emtricitabine + tenofovir (Truvada or Descovy)

nur 112 (23 decks)

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