OB lecture 5 STI/STD

STD

• biologically sexist

• 30 bacterial, viral, parasitic infections

8 most common std

• 4 treatable

• syphilis

• gonorrhea

• chlamydia

• trichomoniasis

8 most common stds

• 4 untreatable

• hepatitis b

• herpes

• HIV

• HPV

Infections caused by vaginal discharge

• candidiasis

• trichomoniasis

• BV

  • all yeast/fungal infections

Candidiasis

• yeast, fungus

• white cottage cheese dischrge

• tx: miconazole, terconozole, fluconazole

• s/sx: itchy, curd like, burn, uncomfortable

trichomoniasis

• protozoa, parasite

• greenish gray discharge

• strong order

• tx- metronidazole

• left untreated→ causes water to break → preterm labor or endometriosis

Bacterial vaginosis

• Gram Neg Bacillus

• Thin white discharge; odorous

• Tx- Metronidazole

• Most prevalent cause of vaginal discharge

• 50%–75% women asymptomatic

• sx: itching, foul orders (fishy smell typically after sex)

• Untreated: preterm labor or endometriosis; can turn into chorioamnionitis if pregnant

• Risk factors

  • Multiple sex partners

  • Douching

  • lack of vaginal lactobacilli

Nursing management

• teaching preventive measures

  • cotton underwear

  • avoidance of irritants (douching, sprays)

  • good body hygiene

  • avoidance of douching or super absorbent tampons

Infections caused by cervicitis (sister wives)

• chlamydia

• gonorrhea

chlamydia

• most common bacterial STI in US

• majority asymptomatic

• causes scar tissue in fallopian tubes

• doesn’t go through placenta; may infect during delivery (chlamydia pneumonia or conjuctivitis)

• most common infection that causes infertility

• therapeutic management

  • antibiotics (doxycycline, azithromycin) - give to partner as well

  • combination regimen if gonorrhea also present

  • screening

    • TOC - retesting; test of cure

risk factors for chlamydia

adolescence, multiple sex partners, new sex partner, sex without condom, oral contraceptive use, pregnancy, history of another STI

Manifestations of chlamydia

mucopurulent vaginal discharge, urethritis, bartholinitis (infection of small glands on vagina), endometritis, salpingitis(fall tubes), dysfunctional uterine bleeding

Testing for chlamydia

urine testing or swab specimen culture, immunofluorescence, or nucleic acid amplification

Gonorrhea

• 2nd most commonly reported infection in US

• highly contagious and reportable to health departments

• site of infection: columnar epithelium of endocervix

• almost exclusively transmitted via sexual activity

• Pregnancy complications: chorio, preterm labor, PROM, endometriosis

• Newborn complications: ophthalmia neonatorum (conjuctivitis), blindness, joint infections, sepsis

Gonorrhea treatment

• dual antibiotic therapy

  • ceftriaxone and azithromycin or amoxicillin

• TOC test

Nursing assessment for gonorrhea

risk factors

low socioeconomic status, single status, inconsistent use of barrier contraceptives, age <20, multiple sex partners

Nursing assessment for gonorrhea

manifestations

• most asymptomatic, abnormal vaginal discharge, dysuria, cervicitis, abnormal vaginal bleeding, bartholin abscess, PID

• neonatal conjunctivitis if woman gives birth

Nursing management for gonorrhea

• treatment strategies - TOC + antibiotics

• referrals

• preventive measures

• education and counseling

• sexual history

• public education

• safe sex practices

Infections caused by ulcers

herpes and syphilis

Herpes

• recurrent lifelong viral infection

• transmission via contact with mucous membranes or breaks in skin with visible or nonvisible lesions

  • kissing, sexual contact, and vaginal delivery

• 1 in 6 people infected

• viral shedding can take up to 2 weeks with primary episode

• replicates at site of infection and stay dormant until stimuli occurs

• HSV1 (oral/cold sores) and HSV 2 (gavinal/genital)

Herpes therapeutic management

• no cure

• antiretroviral therapy to reduce or repress symptoms, shedding, and recurrent episodes

• Acyclovir

  • Mom needs to take it at least 36 weeks pregnant

• Can pass through placenta

herpes nursing assessment

• primary episode (most severe and prolonged)

  • multiple painful vesicular lesions, mucopurulent discharge, superinfection with candida, fever, chills, malaise, dysuria, headache, genital irritation, inguinal tenderness, lymphadenopathy

• Recurrent infection (more localized and quicker resolution):

  • tingling, itching, pain, unilateral genital lesions

• Diagnosis confirmed via viral culture of fluid from vesicle

Syphilis

• Curable bacterial infection caused by spirochete Treponema pallidum

• Untreated: Serious systemic disease

  • brain, lungs, CNS

• Individuals are infected long before primary lesion occurs

• Crosses the placenta at ANY time

• Moms need treatment at least 3 weeks before delivery

• 5 stages

  • Primary, secondary, early latent, late latent, Tertiary

• Therapeutic management

  • Benzathine penicillin G IM

  • Doxycycline if allergic to penicillin

  • Reevaluation with serologic testing

  • Tx- Pen G IM Q week x 3 wks

• Diagnosis reported to CDC

Syphilis manifestations

• primary

  • chancre, painless bilateral adenopathy (swelling)

• secondary

  • flu like symptoms, rash on trunk, palms, and soles, alopecia, adenopathy

• latency

  • absence of manifestations, positive serology

• Tertiary

  • life threatening heart disease, neurologic disease

• Tests: VDRL and RPR (blood antibody tests), FTA-ABS, TPPA, TPHA

Nursing management for herpes and syphilis

• education

• referral to support group

• coping skills

• options for treatment and rehab

Infections preventable by vaccine

HPV

HAV - HEP A

HBV - HEP B

HPV

• most common viral infection in US

• genital warts or condylomata

• nursing assessment

  • risk factors: multiple sex partners

  • manifestations: most asymptomatic; visible genital warts

  • pap smears; HPV test screen for cancer

HPV management

• therapeutic: primary prevention via vaccine and education; treatment of lesions and warts; secondary prevention via education

  • colposcopy for high risk HPV types

• Nursing management

  • teaching about prevention

  • promotion of vaccines and screening tests

  • education about link between HPV and cervical cancer

HAV (hepatitis A)

• spreads via GI tract

  • Fecal, polluted water, contaminated food handling

HBV

• spreds via

  • saliva, blood, semen, menstrual blood, vaginal secretions

HAV and HBV therapeutic management

• prevention through immunization

  • Dx by IgM antibody presence for HAV & presence of blood test with HBsAG for

    Hep B

HAV: manifestation

flu-like symptoms with malaise, skin rashes, fatigue,

anorexia, nausea, pruritus, fever, and upper right quadrant pain

HBV: manifestations

• like those of hepatitis A, but with less fever and skin involvement

Management: screening, vaccination

HAV and HBV Management

screening, vaccination

HIV

 Virus that causes AIDS

 Public health concern on every continent

 1 in 7 are unaware they are infected

 NO CURE; can only suppress

 Affects CD4 cells by depleting them and impairing remaining ones

 AIDS develops roughly 2-15 years after infection

 Primary infection occurs 2-6 wks after exposure

 Tx- Antiretroviral therapy

HIV others

• transmission

  • AIDS due to HIV infection

• fetal and neonatal effects

  • can be passed to baby during pregnancy and to newborn through breastfeeding

• HIV and adolescents increasing; most exposed via sexual intercourse

HIV manifestation

• acute phase;

  • asymptomatic with viral replication, immunosuppression with opportunistic infections, AIDS

HIV diagnosis and management

• nucleic acid tests (NAT); antigen/antibody tests, and antibody tests

• Therapeutic management: ART (antiretroviral therapy)

  • baby: gets art 6-12 hours after birth; up until 6 weeks

• Nursing management

  • education about drug therapy

  • compliance

  • prevention

  • care during pregnancy and childbirth

  • referrals → reportable

HIV during pregnancy

• crosses placenta → vertical transmission

• don’t rupture membranes before starting AZT/ART

• no fetal scalp electrode

• don’t give metronidazole

• Baby needs treatment (AZT) within 6 hours of birth

• Mom should get AZT either 3 hours before delivery or right away after

Pelvic Inflammatory DIsease

• Result of ascending polymicrobial infection of upper female reproductive tract

• Frequently from untreated chlamydia or gonorrhea

• Complications: Infertility, chronic issues of female reproductive tract, adhesions, peritoneal pain, abscess on ovaries

• Therapeutic management

  • Broad-spectrum antibiotics

  • Oral fluids

  • Bed rest

  • Pain management

PID nursing assessment

• risk factors: hx of sti, lack of consistent barriers, multiple

• Manifestations: lower abdominal tenderness, cervical motion tenderness(painful sexual intercourse), fever, dysmenorrhea, dysuria, dyspareunia(painful sexual intercourse)

• Diagnosis: endometrial biopsy, transvaginal ultrasound, laparoscopic examination

PID nursing management

• hydrations

• analgesics

• education to prevent recurrence

• risk assessment

• sexual counseling

scabies

intensely pruritic dermatitis with lesions

Public lice

pruritis with lice or nits

• crabs

• infection initially asymptomatic

• week later when bites cause pruritus you have symptom

Treatment of public lice, scabies

Treatment: permethrin cream or lindane shampoo; decontamination of bedding and

clothing; treatment of family members and sexual partners

 Three-tiered approach: eradicate infestation, remove nits, prevent spread or recurrence

 Education

zika

Damages fetuses CNS

 Causes Microcephaly, ventriculomegaly, calcifications, placentomegaly, motor abnormalities, epilepsy, hearing loss, neurological impairments, ophthalmologic abnormalities, IUGR and Stillbirth