Exam III - STIs

Chlamydia

Cause

* Multiple sex partners
* Unprotected sex

\
Symptoms

* Female
* Most common infection in US women
* Dysuria, urinary frequency, dyspareunia
* May lead to PID, ectopic pregnancy, & infertility
* Maternal infection during pregnancy requires prompt treatment
* If not treated in pregnancy, can cause premature rupture of membranes preterm labor and endometriosis
* Male
* Penile discharge, dysuria, testicular edema/pain
* Neonate
* Can cause conjunctivitis & pneumonia after delivery

\
Diagnosis

* Difficult to diagnose b/c rarely has manifestations
* Endocervical swab of cervical discharge

\
Therapeutic Management

* Antibiotic therapy (doxycycline, azithromycin, amoxicillin) - may decrease effect of oral contraceptives
* Erythromycin ointment to newborn’s eyes after birth
* Reportable to local health dept.

Gonorrhea

Causes

* Multiple sex partners

\
Symptoms

* Female
* Often no manifestations
* If untreated can cause tubal scarring and can lead to PID and infertility
* Male
* dysuria, testicular edema/pain, penile discharge

\
Diagnosis

* endocervical culture for females
* urine cultures
* anal or oral cultures

\
Therapeutic Management

* antibiotic therapy (ceftriaxone and azithromycin) - can decrease effects of oral contraceptives

Syphilis

Cause

* Treponema pallidum
* Oral, vaginal, anal sex

\
Stages:

* Primary
* chancres, ulcerated area
* females: inguinal lymph node edema
* Secondary
* skin rashes on palmar surfaces of hands/feet
* Tertiary
* damage to internal organs
* difficulty with muscle coordination
* blindness

\
Diagnosis

* Serology
* Nontreponemal tests followed by treponemal tests
* Microscopic examination of lesion

\
Therapeutic Management

* Penicillin G IM single dose
* Partners must be treated
* If untreated, can be transmitted to neonate and cause stillbirth/congenital abnormalities
* Reportable to health department

Pelvic Inflammatory Disease

Cause

* Infection induced inflammation of the female reproductive tract

\
Symptoms

* Ascending polymicrobial infection of the female upper reproductive tract
* Caused by untreated chlamydia or gonorrhea

\
Diagnosis

* Wide range of s/s
* Cervical/vaginal discharge, fever, cervical tenderness, elevated sedimentation rate, gonorrhea a=or chlamydial infection, dysmenorrhea, dysuria, nausea, vomiting

\
Therapeutic Management

* Broad spectrum antibiotic therapy
* IV cephalosporin with doxycycline
* Pain management

HPV/Genital Warts

Causes

* Condylomata Acuminata

\
Symptoms

* Common STI in the US
* No cure can remove warts, bur virus remains
* Can lead to cervical cancer, vulvar, vaginal, anal, penile cancer

\
Diagnosis

* Visual inspection: cauliflower like bumps
* Female: pap test

\
Therapeutic Management

* May disappear without treatment
* Most methods of removal rely on chemical or physical destruction of the lesion
* Large warts may require surgical removal
* Vaccination recommended at age 12 and may lead to decrease in CA associated with HPV
* Abstinence during treatment to promote healing

Genital Herpes

Causes

* Lifelong viral disease with no cure

\
Symptoms

* Same in males and females
* Itching, burning, tingling in genital area followed by small pustules & blister-like genital lesions that crust over and heal
* Recurrent
* Dysuria, dyspareunia, fever, malaise, headaches, muscle aches

\
Diagnosis

* Visual inspection of lesion

\
Therapeutic Management

* Antivirals to treat first episode, recurrence, and suppression
* Acyclovir, Valacyclovir, Famcyclovir
* Not a cure, but controls s/s
* Counseling is important to help coping and prevent transmission
* May be asymptomatic or symptomatic

\

Hepatitis A

Symptoms/cause

* Transmitted fecal-oral route after close contact with infected person
* Most common form worldwide acquired from polluted water, eating uncooked shellfish, sewage contaminated H2O, or men who have sex with men (MSM)

\
Diagnosis

* Serologic testing, IgM antibody

\
Therapeutic Management

* Vaccination

Hepatitis B

Symptoms/cause

* Transmitted through saliva, blood, serum, menstrual blood, and vaginal secretions
* MSM at highest risk
* Can result in serious and permanent liver damage

\
Diagnosis

* HBsAG detection

\
Therapeutic Management

* Vaccination

HIV

Causes

* IV drug use
* Multiple sexual partners
* Maternal hx

\
Symptoms

* Fatigue and influenza-like symptoms

\
Can develop AIDS

\
Diagnosis

* Antibody screening test, confirmed by western blot test

\
Therapeutic Management

* Goal = stable CD4 cell counts
* counselling
* antiretroviral therapy
* encourage condom use
* C-section @ 38 weeks for increased viral load
* wear gloves when caring for newborn
* bathe infant after birth before remaining with mother
* advise not to breastfeed

Pubic Lice

Symptoms

* Intense pruritus, may develop secondary infection from scratching

\
Diagnosis

* History of nits (small, shiny, yellow, oval, dew drop like eggs affixed to hair shaft)

\
Therapeutic Management

* permethrin cream
* bedding and clothing washed in hot water to decontaminate
* sexual partners should be treated

Trichomoniasis

Symptoms

* penis-vagina
* vagina-vagina
* females: yellow/green frothy discharge with foul odor, dyspareunia, dysuria
* males: urethral drainage, itching, irritation, dysuria, pain with ejac.

\
Diagnosis

* sample of discharge applied to pH paper, wet mount, whiff test

\
Therapeutic Management

* metronidazole (don’t give during first trimester of pregnancy due to teratogenic effects on fetus
* treat all sexual partners
* educate about safe sex

TORCH infections

Symptoms

* Toxoplasmosis - raw, undercooked meat, cat litter
* Other infections (hepatitis)
* Cytomegalovirus (droplet infection)
* Herpes simplex virus

\
Diagnosis

* prenatal screening

\
Therapeutic Management

* these are a group of infections that can negatively affect a pregnant client
* they can cross placenta and have teratogenic effects on fetus
* rubella can cause miscarriage, congenital anomalies, and death
* HSV can cause miscarriage, preterm labor, and intrauterine growth restriction