STI Flashcards
(76 cards)
1
Q
Bacterial STIs
A
- Chlamydia
- Gonorrhea
- Syphilis
2
Q
S/Sx of Chlamydia (Women)
A
- Often asymptomatic
- Cervix that bleeds easily
- Spotting or post-coital bleeding
- Thin, watery, yellow vaginal discharge
- Dysuria
3
Q
S/Sx of Chlamydia (Men)
A
- Mild to severe dysuria
2. Urethral itching
4
Q
Screening (Chlamydia)
A
All pregnant women should be cultured for chlamydia at 1st prenatal visit
- May be repeated at 36 weeks gestation if
- Previously positive
- Less than 25 years old
- Has a new sex partner or multiple sex partners
5
Q
Chlamydia Diagnosis
A
Culture
6
Q
Chlamydia Complications (Mothers)
A
- Pelvic inflammatory disease
- Ectopic pregnancy
- Tubal factor infertility
- Increased risk for acquiring HIV infection
7
Q
Chlamydia Complications (Baby)
A
Most common cause of ophthalmia neonatorum
- More than half of infants born to mothers with untreated chlamydia will develop conjunctivitis or pneumonia after perinatal exposure to the mother’s infected cervix
8
Q
Chlamydia Treatment for Non-Pregnant Women
A
- Doxycycline 100 mg orally BID for 7 days
2. Azithromycin 1 g PO as a single dose
9
Q
Chlamydia Treatment for Pregnant Women
A
- Azithromycin 1 g PO as a single dose
2. Amoxicillin 500 mg PO TID for 7 days
10
Q
Chlamydia Testing
A
- All exposed sexual partners should be treated
- No need for retesting if treated with recommended or alternative therapy, unless symptoms continue
- Recommended that pregnant women be retested 3 weeks after treatment
11
Q
S/Sx of Gonorrhea (Women)
A
- Often asymptomatic
- Purulent, greenish-yellow vaginal discharge (usually minimal or absent)
- Menstrual irregularities
- Chronic or acute severe pelvic or lower abdominal pain
- Dysuria
- Urinary frequency
12
Q
S/Sx of Gonorrhea (Men)
A
- Most produce symptoms
- Dysuria
- Penile discharge (pus)
- Arthritis
13
Q
Maternal Complications of Gonorrhea
A
- Premature ROM
- Premature birth
- Chorioamnionitis
- Intrauterine growth restriction
- Postpartum sepsis
14
Q
Neonatal Complications of Gonorrhea
A
- Neonatal sepsis
2. Ophthalmia neonatorum
15
Q
Gonorrhea Diagnosis
A
- Must be diagnosed by culture
- All pregnant women should be cultured at the initial prenatal visit
- Infected women and those identified with risky behaviors should be re-cultured at 36 weeks gestation.
16
Q
Gonorrhea Treatment (Pregnant and Non-Pregnant)
A
- Ceftriaxone 250 mg IM in a single dose
2. Concomitant treatment for chlamydia is recommended since co-infection is common
17
Q
Primary Stage of Syphilis
A
- Chancre (primary lesion) appears at point of contact 3-4 weeks after sexual contact
- Chancre is usually a PAINLESS shallow, red, clean ulcer
- May be a single lesion or a group of lesions
- Chancre lasts 1-6 weeks and then spontaneously heals
18
Q
Secondary Stage of Syphilis
A
- Generalized symptoms appear 6-8 weeks after the chancre
- Maculopapular rash that peels on trunk, palms, and soles
- Usually heals without scarring
- Usually heals within 1-3 months
- Can be transmitted by non-sexual contact through the rash
- If not treated, will enter a latent phase that is asymptomatic for most people
19
Q
Generalized Symptoms of Second Stage of Syphilis
A
- Malaise
- Fever
- Generalized lymphadenopathy
- Sore throat
- Headache
- Hair loss
- Loss of appetite
- Painful joints
20
Q
Early Latent Stage of Syphilis
A
Duration of illness up to 1 year from the onset of infection
21
Q
Late Latent Stage of Syphilis
A
Duration of illness greater than 1 year, up to 20 years
- Do not usually transmit the disease
- Pregnant women CAN transmit the infection transplacentally
22
Q
Patient Outcomes of Early Latent Stage of Syphilis
A
- Up to 75% of patient in this stage are asymptomatic, while 25% may have lesions
- 1/3 are spontaneously cured during this stage
- 1/3 never progress beyond this stage
- 1/3 move on to the next stage
23
Q
Tertiary Stage of Syphilis
A
- 25% of patients die
- Diagnosed by lumbar puncture
- Treatment can only slow the progression
- Any damage is irreversible
- Fetus can be infected
24
Q
Complications of Tertiary Stage of Syphilis
A
- Musculoskeletal
- Skin or bone lesions
- Neurologic
- Insanity, paralysis, or death from CNS/spinal cord involvement
- Ataxia and parasthesia often present
- Cardiovascular
- Aneurysms
25
Transmission of Congenital Syphilis
Can be transmitted across the placenta to fetus during pregnancy or delivery
- Risk of infection is greater when mother is in early stages
26
Congenital Syphilis (S/Sx)
Baby may be born dead, die shortly after birth, be born early, or be infected with syphilis
Symptoms Include:
- Saddle nose
- Notched teeth
- Snuffles
- Inflammation of the cornea that may cause blindness
- Neurosyphilis (causes progressive disabling brain changes)
- Deafness
- Bone deformities
27
Treatment for Congenital Syphilis
Treatment with antibiotics can prevent progression but not reverse problems that have already developed
28
Syphilis Screening
- At first prenatal visit
- Early in the third trimester
- Intrapartum, if high risk
- VDRL test
- RPR test
- Can produce false-positive results
- Pregnancy itself can give a false positive result
- Positive screening ALWAYS requires a confirmatory test
- Can always have false negative results in people with early primary syphilis (takes 6-8 weeks after exposure for seroconversion to occur)
29
Syphilis Diagnosis
Darkfield microscopy is the "gold standard" for diagnosing syphilis
- Requires a special microscope
30
Syphilis Treatment for Non-Pregnant Penicillin Allergic Patients
Doxycycline or Tetracycline
31
Syphilis Treatment
ONLY penicillin is used to treat syphilis during pregnancy
| - Penicillin allergic women are desensitized prior to treatment
32
Primary, Secondary, and Early Latent Syphilis Treatment
Benzathine Penicillin G (Bicillin) 2.4 million units IM in a single dose
33
Late Latent or Tertiary Syphilis Treatment
Weekly treatment with Benzathine Penicillin G (Bicillin) 2.4 million units IM X 3 weeks (total dose of 7.2 million units)
34
Pregnancy Syphilis Treatment Complications
- Flu like symptoms, lasting 12-24 hours
- Cause by release of toxins from dead spirochetes
- Preterm labor
35
Syphilis Treatment in Newborns
10-14 days of Procaine Penicillin G IM if + in mom or cord blood
36
Viral STIs
1. Herpes
2. HPV
3. HIV
37
Genital Herpes
- Chronic and recurring disease for which there is no known cure
- Virus is always present but not always active
- Caused by two different subtypes of herpes simplex virus
38
Subtypes of Herpes
1. HSV-1
- Usually transmitted non-sexually
- Associated with fever blisters
2. HSV-2
- Usually transmitted sexually
- Associated with genital lesions
- An association between cervical cancer and HSV-2 has been observed
* * Neither type is exclusively associated with the respective sites
39
Primary Herpes Infection
- Multiple painful, blister-like vesicles that ulcerate, crust, and heal without scarring
- Lesions appear 2-20 days after infection
- May last 2 to 3 weeks
- Women usually have a more severe clinical course than men
40
Common S/Sx of Primary Herpes Infection
1. Tingling or burning before lesions appear
2. Fever and chills
3. Malaise
4. Severe dysuria
5. Itching
6. Lymphadenopathy
7. Cervicitis (heavy watery to purulent vaginal discharge)
41
Recurrent Herpes Infections
- Much more common
- Usually only have local (not systemic) symptoms
- Characteristic prodromal genital tingling is common
- Lesions usually last 5-7 days
42
Common Triggers for Recurrent Infections
1. Stress
2. Menstruation
3. Trauma
4. Febrile illnesses
5. Chronic illness
6. Ultraviolet light
43
Herpes Diagnostics
- May be suspected from findings on history and physical
| - Confirmed by viral culture
44
Pregnancy Complications of Primary Herpes Infection
- Congenital infection is possible, though rare
- Infections during the first trimester have been associated with increased rates of miscarriage
- Neonatal herpes infection
- Risk is highest in babies born to women who have a primary infection near term
45
Prevention of Neonatal Herpes Infection
- Acyclovir late in pregnancy
- Examine and question all women about symptoms at onset of labor
- If visible lesions are not present, vaginal birth is acceptable
- If visible lesions are present, C/S within 4 hours after membranes rupture or labor begins is recommended
46
Is there a treatment for herpes?
- Partially controls symptoms but DOES NOT CURE
| - Does not alter the frequency of recurrences after the medication is stopped
47
Treatment for Herpes for Non-Pregnant Women
1. Treatment with Acyclovir, Famciclovir, or Valacyclovir orally for
- Primary infection
- Recurrent infection
- Suppression
2. Several different regimens that vary in dosage and length of treatment
48
Treatment for Herpes for Pregnant Women
1. Safety of Acyclovir, Famciclovir, and Valacyclovir therapy during pregnancy has not been established
2. Oral Acyclovir is used to treat primary infection and suppression therapy
49
Nursing Management of Herpes
1. Oral analgesics
2. Sitz baths
3. Cotton underwear
4. Keep lesion dry - hairdryer, pat dry, etc.
50
Herpes Patient Teaching
1. No sexual contact from the onset of symptoms until complete healing of lesions
2. Consistent condom use
3. Diet rich in Vitamin C, B-complex vitamins, zinc, and calcium
4. Identify and avoid "triggers"
5. Yearly GYN exams and Pap smears
6. HSV infection is associated with cervical dysplasia
51
S/Sx of HPV
1. Small, soft papillary swellings that appear within 3 months of exposure
2. May occur alone or in clusters
- Infections of long duration may appear as a cauliflower-like mass
3. ENTIRE genital area including cervix and anus may be affected
- Usually painless, but can be uncomfortable if very large or inflamed
4. Chronic vaginal discharge, itching or dyspareunia can occur
52
S/Sx of HPV in Pregnancy
1. Occur more frequently in pregnant than in non-pregnant women
2. Preexisting HPV lesions often enlarge greatly during pregnancy and become friable (bleed easily)
3. Cesarean birth may be performed when extensive growths are present, but is rarely necessary
53
HPV in Neonates
- HPV infection can be acquired by the neonate during birth but the frequency is unknown
- HPV types 6 and 11 can cause respiratory papillomas in infants and children
54
HPV Diagnostics
1. Visible lesions
2. Definitive diagnosis is by histologic evaluation of a biopsy specimen
3. Viral screening and typing for HPV is available
4. Estimate 60 sub-types of HPV virus
- Done in women over 30 to screen for types of HPV that are likely to cause cancer
- Women with abnormal Pap test results
55
What is the goal of treatment of HPV?
Goal of treatment is removal of the warts and relief of signs and symptoms
56
Treatment of HPV in Non-Pregnant Women
1. Client-applied
- Podofilox solution or gel
- Imiquimod crean
2. Provider-applied
- Cryotherapy with liquid nitrogen or cryoprobe
- Podophyllin resin
- Bichloroacetic acid (BCA) or Trichloroacetic acid (TCA)
57
Treatment of HPV in Pregnant Women
1. Provider-applied
- Cryotherapy with liquid nitrogen or cryoprobe
- Bichloroacetic acid (BCA) or Trichloroacetic acid (TCA)
- Surgical removal
2. Imiquimod, podophyllin, and podofilox should not be used during pregnancy
58
HPV Prevention
Gardasil
- Covers several HPV types
- Reduce risk for warts, malignant tumors of vaginal area
** Recommended for females aged 9-26
59
HPV Vaccine (Dosage)
Given as a series of 3 injections over 6 months
60
HPV Vaccine (Side Effects)
1. Pain, swelling, itching, bruising, and redness at the injection site
2. Fever
3. Nausea
4. Dizziness/Fainting
61
HIV Transmission to Newborns
1. Occurs transplacentally at birth
2. Exposure to maternal blood
3. Exposure to vaginal secretions
4. Passed through breast milk
62
Interventions for HIV+
1. Treatment wth HAART
2. Zidovudine (ZDT) PO after 1st trimester IV during L/D
3. Usually used with combination of other antivirals
4. PO for infant starting 8-12 hours after birth, continuing X 6 weeks
63
Will infants test positive for HIV if they have a HIV positive mother?
All infants of HIV + moms will test HIV + due to maternal antibodies. 70% will show seroconversion to negative by age 2.
64
HIV+ Monitoring Throughout Pregnancy
1. Every trimester
- Visual and fundoscopic exam of retina (toxoplasmosis)
2. Weekly NSTs at 32 weeks, serial USGs, BPPs
3. Observe lab and patient for signs of progression
4. Avoid amniocentesis
65
HIV+ Labor and Delivery
1. No invasive procedures after ROM (scalp electrode, scalp pH, vaginal exams), avoid vacuum extraction
2. C-section: decreased risk of vertical transmission but surgery associated with increased risk
- Recommended if viral load, HIV RNA > 1000 copies/mL
66
Trichomoniasis
- Is almost always a sexually transmitted infection
| - Is also a common cause of vaginal infection and discharge
67
S/Sx of Trichomoniasis (Males)
Males are usually asymptomatic
68
S/Sx of Trichomoniasis (Females)
1. Yellow-green or gray, frothy, mucopurulent, copious, malodorous discharge
2. Inflamed vulva and/or vagina
3. Pruritis
4. Dysuria
5. Dyspareunia
6. Discharge worsens during and after menstruation
7. "Strawberry spots" (tiny petechiae) on the cervix and vaginal walls
8. Cervix may bleed easily
69
Trichomoniasis Diagnostics
- Diagnosed by wet smear using normal saline
- See trichomonads using flagella to propel
- Often identified as an incidental finding on Pap smear
70
Trichomoniasis Treatment
- Recommended treatment for both non-pregnant and pregnant women is Metronidazole, 2 g PO in a single dose
- Treat partners
71
Trichomoniasis Treatment Nursing Considerations
1. No alcohol use during treatment or for several days following treatment
- Causes severe abdominal cramping, nausea, vomiting, and headache
2. GI symptoms are common, whether alcohol is used or not
3. Contraindicated during breastfeeding
- Pump/discard milk
- Resume breastfeeding 48-72 hours after taking the last dose
72
Pelvic Inflammatory Disease
Inflammatory state of the upper female genital tract and nearby structures
- Uterine lining, connective tissue, fallopian tubes, etc.
- Caused by ascending infection
- Untreated chlamydia and gonorrhea
73
Complications of PID
1. Ectopic pregnancy
2. Pelvic abscess
3. Subfertility
4. Chronic episodes of disease or abdominal pain
5. Pelvic adhesions
74
High Risk for PID
1. Recent placement of IUD
| 2. Risky sexual practices, early age sex, alcohol/drug usage
75
Criteria to Diagnose PID
1. Lower abdominal tenderness, adnexal tenderness, cervical motion tenderness
2. Supportive signs
76
PID Treatment
1. Doxycycline 100 mg BID for 14 days
2. Pregnant - cefotaxime, azithromycin, metronidazole for 14 days
3. IV or PO
- Tubo ovarian abscess with high fever and severe sickness
- Hospitalized IV pain meds, increased PO/IV fluids bedrest, pain treatment
