Sexually transmitted diseases

Menarch

8-16 yrs old

onset of menstruation

Average age 12.5

Normal cycle data

80-81 ml in monthly cycle

Average cycle is 28 days

Amenorrhea

abscence of menses

Primary: menses has not occured by 16 yrs old

Secondary: when an established menses (3 months) stops coming

Causes of amenorrhea 

Hypothalamic dysfunction

• excessive exercise 

• Eating disorders 

• severe prolonged stress 

Pituitary dysfunction

• low or high levels of prolactin

• may be caused by meds or tumor

Chronic anovulation or ovarian failure

• turners syndrome

• PCOS, thyroid disorders

Anatomic abnormalities

Dysmenorrhea

Painful menstruation 

Primary: cramps without underlying disease 

caused by increased production of prostaglandins 

Ischemia 

Secondary: occurs after menstruation is established 

-associated with underlying condition of the reproductive tract 

• PID, cervical stenosis, ovarian cysts, tumors, IUD placement - copper IUD causes more cramping 

Treatment of primary Dysmenorrhea

Nonsteroidal anti-inflammatory drugs 

-take ibuprofen early so that you dont have prostaglandins being made bc the drug is a prostaglandin synthesis inhibitor 

Oral contraceptives (inhibit ovulation) 

Self care 

Regular exercise and rest 

nutrition 

Treatment of secondary Dysmenorrhea

Continuous oral contraceptive therapy

Hysterectomy - minimally invasive

Removal of affected structure/ organ - can remove ovarian cysts or ovaries

Nutritional self-care for dysmenorrhea

Restriction of methylxanthines: chocolate, cola, caffeine.

Animal fats and red meat salt and sugar

Improve:

-increase intake of complex carbohydrates and protein: vitamin B6 and E, calcium carbonate, magnesium

Premenstrual syndrome 

20-40% 

Luteal phase of menstrual cycle 

PMDD

3-8% of women

marked by 5 or more symptoms

Menopause

Absence of menstruation for 1 full year
 Age of onset influenced by:
 Overall health
 Weight and nutrition
 Lifestyle and culture
 Genetic factors
Psychological Aspects
 “Empty nest”
 Caring for aging parents
 Acceptance or lack of acceptance
 Personal factors affecting ability to cope
 Fatigue from insomnia and/or night sweats

Menopausal changes 

Anovulation
 Irregular menstruation
 Amenorrhea
 Follicle-stimulating hormone (FSH) levels rise to try and get an egg to get released
 Estrogen decreases
 Endometrium thins and myometrium,
fallopian tubes, and ovaries atrophy

Thinning and dryness of vaginal mucosa
 Vaginal pH increases
 Pubic hair thins and turns gray or white
 Labia shrink and lose pigmentation
 Pelvic fascia and muscles atrophy - urinary incontinence 
 Breasts become pendulous- lose their bounce 

Vasomotor symptoms
 Hot flashes
 Night sweats
 Dizzy spells
 Increase in risk for:
 Hypertension
 Coronary artery disease
 Stroke
 Changes in cognitive function
 Musculoskeletal
 Osteoporosis

NOT SURE UNTIL IT HAS BEEN A FULL YEAR

Assessment of
Osteoporosis

Bone mineral density (BMD) testing is
recommended for:
 All postmenopausal women aged 65 or
older
 All postmenopausal women with fractures
 Postmenopausal women younger than
age 65 with one or more risk factors

Bacterial Vaginosis (BV)

Overgrowth of normal vaginal flora
 Thin, watery, white-gray discharge
 “Fishy” odor
 Treatment: Flagyl- DO NOT DRINK ALC

Vulvovaginal Candidiasis
(VVC)

Fungal or yeast infection
 Thick, white vaginal discharge
 Severe itching, dysuria, and dyspareunia
 Treatment: miconazole cream

Trichomoniasis

Bacterial organism:
Trichomonas vaginalis
Transmission: sexual
intimacy
Asymptomatic or mild
symptoms:
Yellow-green,
frothy, odorous
discharge
Vulvar itching
Treatment:
metronidazole

STRAWBERRY SPOTS

Chlamydia

 Bacteria organism: Chlamydia trachomatis
 Transmission: vaginal sex
 Symptoms: 70% of women are
asymptomatic.
 Treatment: azithromycin or doxycycline

Test of cure after 30 days -

Gonorrhea

Bacterial organism: Neisseria gonorrhoeae
 Transmission: vaginal, anal, or oral sex
 80% of women are asymptomatic
 Treatment: antibiotic therapy

Multi drug resistant strain going around that will not respond to antibiotic 

Pelvic Inflammatory Disease
PID

Inflammation of upper female genital tract
 Chlamydia trachomatis and Neisseria
gonorrhoea
 Post infection tubal damage associates with
infertility
 Treatment:
- IV fluids, pain medication, IV antibiotics

Symptoms of PID

Bilateral sharp, cramping pain in the lower
quadrants
 Fever greater than 101F, chills
 Mucopurulent cervical or vaginal discharge
 Irregular bleeding
 Cervical motion tenderness during
intercourse
 Malaise, nausea, and vomiting - fluid replacement IV 

Herpes simplex

Viral organism: HSV-1 and HSV-2
 Transmission:
 Vaginal, anal, or oral sex
 Skin-to-skin contact with an infected site

Can never get rid of it- will always have it

Treatment: oral acyclovir, famcyclovir,
valacyclovir

Herpes primary outbreak

Single or multiple blister like vesicles
Difficult urination and urinary retention
Enlargement of inguinal lymph nodes
Flu like symptoms, genital pruritus, or
tingling

Recurrent 

Same as primary but more subtle at
times

Syphilis

 Bacterial organism: Treponema pallidum
 Transmission:
 Vaginal, oral, or anal sex
 Exposure to exudate from infected
individual
 Transplacental
 Treatment: penicillin G
(Doxycycline/Tetracycline for allergy to PCN)

Symptoms of syphilis: early stage

Chancre appears, fever,
weight loss, malaise

Symptoms of syphilis: secondary stage

Condylomata lata on
vulva, acute arthritis
-Enlargement of liver and
spleen, enlarged lymph
nodes
-Chronic sore throat with
hoarsenes

Genital Warts

Viral organism:
human papilloma
virus (HPV)
 Transmission:
vaginal, oral, or anal
sex
 Symptoms:
 Painless genital warts
 Pruritus
 Treatment: client or
provider therapies for
wart removal

Human Papillomavirus (HPV)

passed on through genital contact—most
often during vaginal and anal sex. HPV may also
be passed on during oral sex.
 There are more than 40 types of HPV that are
passed on through sexual contact.
 If you are 9-26 years of age, there is an HPV
vaccine that can help protect you against the
types of HPV that most commonly cause
problems. The HPV vaccine (Gardasil or
Cervarix) works by preventing four common
HPV types, two that cause most genital warts
and two that cause cancers.

Pediculosis Pubis
“Crabs”; “Pubic Lice”

Parasite: Phthirus
 Transmission: intimate sexual contact, shared
towels and bed linens
 Symptoms:
 Itching in pubic area
 Treatment: 1% permethrin cream; wash and
dry linens, towels, and clothing

Health Teaching

 Planning ahead and developing strategies to
say no to sex
 Limiting the number of sexual contacts and
practicing monogamy
 Using a condom and negotiating condom use
with a partner
 Reducing high-risk behaviors such as used of
alcohol and recreational drugs

Refraining from oral sex if partner has active
sores in mouth, vagina, anus, or on penis
 Seeking care as soon as symptoms are
noticed
 Understanding that disappearance of
symptoms does not mean treatment is
unnecessary
 Taking all prescribed medications completely
 Having more frequent Pap screening for
certain genital infections