Sexually Transmitted Infection+ Fetal Development

vaginal cadidiasis (yeast infection) manifestations

-pruritis

-thick, white, curd like discharge

-vaginal soreness

-vulvular burning

-external dysuria

vaginal cadidiasis (yeast infection) risk factors

-pregnancy

-oral contraceptives (with high estrogen content)

-antibiotic use

-diabetes

-obesity

-steroids and immunosuppressive drugs

-HIV infection

vaginal cadidiasis (yeast infection): nursing management

-reduce sugar and soda intake

-cotton underwear

-avoidance of irritants

-remove wet bathing suits promptly

-good body hygiene with mild, unscented soap

-avoidance of douching, vaginal sparays, super- absorbent tampons

vaginal cadidiasis (yeast infection): treatment

-miconazole cream or suppository

-clotrimazole tablet or cream

-terconazole cream or suppository

-fluconazole tablet

trichomoniasis

-parasite

-not always sexually transmitted, can live on damp/wet surfaces, poorly cleaned hot tubes

-visualized under microscope

trichomoniasis risk factors

-sexual intercourse with infection partner

-preterm birth and postpartum endometrtis

-more susceptible to HIV transmission in men and women

trichomoniasis female symptoms

-itching

-malodorous foamy discharge

-heavy yellow/green, gray frothy, or bubbly discharge

-pruritis valvular soreness

-dyspareunia

-bleeding after intercourse

-dysuria

-petechia on cervix

trichomoniasis: male symptoms

-usually asymptomatic

-heavy yellow/green, gray frothy, or bubbly discharge

-pruritis valvular soreness

-dyspareunia

-bleeding after intercourse

-dysuria

-petechia on cervix

trichomoniasis treatment

-metronidazole or tinidazole

^may need multiple treatments

^sexual partners need treatment

-abstinence until therapy is complete and symptom free

bacterial vaginosis

-can increase a women’s susceptibility to other STIs such as HIV, herpes, chlamydia and gonorrhea

-associated with preterm labor, premature rupture of membranes, chorioamnionitis, postpartum endometritis and PID

bacterial vaginosis risk factors

-multiple sex partners

-douching

-lack of vaginal lactobacilli

bacterial vaginosis clinical manifestations

*to diagnose ¾ criteria has to be met

1. thin white vaginal discharge

2. vaginal ph 4.5

3. positive whiff test: secreations mixed with potassium hydroxide creates a fishy smell

4. presence of clue cells under a microscope

chlamydia

-newborns can develop conjunctivitis

-transmitted by vaginal, anal, or oral sex

-highest rates of infection 15-19 years old

chlamydia clinical manifestations

-can be asymptomatic

-dysuria, urinary frequency

-mucus or pus-like discharge

-can cause inflammation of the rectum and conjunctiva

-can infect throat

-females: may lead to PID, ectopic pregnancy, infertility

-males: urethral tingling, sterility

chlamydia treatment

-azithromycin

-doxycycline

-erythomycin

-levofloxacin

-retesting in 3 months to rule out recurrence

gonorrhea

-often coinfected with chlamydia

-transmitted via vaginal, anal, and oral sex

-causes conjunctiva in newborns

-common among teenagers

gonorrhea clinical manifestations

-may be asymptomatic

-dysuria, urinary frequency

-rectal infection: discharge, itching, painful BM with fresh blood

-females: yellow + foul discharge, endocervicitis, PID ectopic pregnancy, infertility

gonorrhea treatment

-dual therapy with ceftriaxone and azithromycin

-re test after 3 months

herpes

-lifelong disease, no cure

1. oral secretions, can be spread to genitals

2. sexual contact with someone shedding virus during outbreak or period with no symptoms

-can be spread to newborns during childbirth

herpes clinical manifestations

-first ep is usually the worse

-itching, tingling, pain in the genital area

-small pustules and blister-like lesions

-dysuria, urine retention, fever, headache, malaise, muscle aches

herpes treatment

-antivirals

-acyclovir

-valcyclovir

-famciclovir

syphillis

-chronic and multi stage if untreated

-sexual conduct

-can be spread to newborn

-stages

^primary, secondary, early latent, late latent, tertiary

syphillis primary

-chancre (painless ulcer) disappears 1-6 weeks without interventions, highly infectious

syphillis secondary

-2-6 months after initial exposure

-flu-like symptoms

-rash on trunk, palms & soles, alopecia last appox 2 years

syphillis early latent

-absence of any symptoms, can last as long as 20 years

syphillis late latent/ tertiary

-life threatening heart disease

-neurologic disease that destroys heary, eyes, brain, central nervous system and brain

syphillis treatment

-penicillin G injection

-if allergic doxyclycline, tetracycline or erythromycin

genital warts (HPV)

-sexual transmission

-could lead to cancer of cervix, vulva, vagina, and anus

-vaccination for prevention

-can’t be cured

-warts can be removed but virus remaines

genital warts treatment

-may disappear without treatment

-can remove by creams, freezing, burning, laser treatment, surgical excision

vaccination recommended starting at 12

pelvic inflammatory disease (PID) risk factors

-teenagers

-multiple sex partners

-early onset sexual activity

-history of PID or STI

-recent. IUD insertion

-recent termination or pregnancy

-smoking

-douching

-unprotected sex

pelvic inflammatory disease (PID) treatment

-maintain hydration

-pain medication

-semi-fowlers

-antipyretic

-antibiotics

hepatitis

A= fecal-oral

^unclean water, uncooked shellfish, poor hand hygiene by infected person

B=saliva, blood, semen, vaginal secretions

^6 weeks to 6 months

^can survive 7 days outside of body

C= injection drug use

herpes symptoms

A&B= flue-like symptoms, skin rash, fatigue, nausea, fever, upper right quadrant pain

C= mostly asymptomatic

ectoparasitic infection

-bedbugs, scabies, crabs

-not always sexually transmitted

-easily passed from person to person

ectoparasitic infection symptoms

-bedbugs: visualize bugs, visualize bites

-scabies: female burrows under skin and lays eggs that hatch, diagnosed by appearance of burrows in the webs of fingers and genitalia but can be whole body

-pubic lice (crabs): visualize lice in pubic hair, axillary hair, eyebrows, beards, rash in pubic area

ectoparasitic infection treatment

-bedbugs: washing linens, clothing, may need pest control

-scabies: permithrin cream, oral invermectin, or benzyl benzoate

-pubic lice: permithrin cream rinse

-clean bedding and clothing with hot water

HIV

-no cure

-antivirals (ART therapy)

-ART given to newborns within 6-12 hrs after birth and continued for 6 weeks

stages of fetal development

-zygotic stage: fertilization of sperm and egg (conception)

-blastocyst stage: zygote divides into a solid ball of cells and attaches to uterus

-embryonic stage: end of second week through eight week

-fetal stage: differentiation and structure specialize by end of the eighth week until birth

ectoderm

-forms the central nervous system, special sense, skin, and glands

mesoderm

-forms skeletal, urinary, circulatory, and reproductive organs

endoderm

forms respiratory system, liver, pancreas, and digestive system

week 3

beginning of brain, spinal cord, heart, GI, neural tube, leg and arm buds

week 5

-heart beats with regular rhythm

week 6

-beginning formation of lungs, fetal circulation established, primitive skeleton forms, CNS forms, brain waves detectable

week 9-12

-sex characteristics develop

week 13-16

-quickening fetal movement felt

oligohydramnios

-too little fluid

polyhydramnios/hydramnios

-too much fluid

triple and quad screening

-performed between 15-18 week

-blood test in second trimester to help identify risk for down syndrome, neural tube defects, and other chromosomal disorders

sex chromosome abnormalities

-klinefilter syndrome

abnormalities of chromosome structure

-cri du chat syndrome

monosomies

-turner syndrome

trisomies

-down syndrome

fetal nuchal translucency

-performed between 10 to 14 weeks

-can detect turner syndrome, cardiac deformities, and for physical anomalies

-if greater than 2.5mm the measurement is considered abnormal.

percutaneous umbilical blood sampling (PUBS)

-performed after 16 weeks gestation

-risk of fetal hemorrhage and risk of infection

chorionic villus sampling

-performed during 10-12 weeks gestation

-complications are

^severe transverse limb defect and spontaneous pregnancy loss

amniocentesis

-usually performed between 15-20 weeks

-results take 2-4

-risk:infection, pregnancy loss, fetal needle injuries