reproductive tract infections

No —- because they only protect against pregnancy not to protect against infection, Only latex or plastic condoms do both (no natural skin condoms either)

lambskin condoms

five P assessment for reproductive health, part of primary prevention:

partner, practices, protection, past hx, pregnancy intention

lead to scar tissue/adhesions, infertility, and pelvic inflammatory disease (PID), can also increase risk of ectopic pregnancies because affecting the fallopian tubes

repeated infections

Using spermicide (N-9) can increase risk of acquiring —- because breaks down the epithelium - just better to use condoms

HIV

Lubricated polyurethane sheath with a ring on each end, One end inserted into vagina, Other end covers labia, part of barrier methods

female condoms

CDC recommends starting at preteen - immunity has time to develop, Can receive age 9-26/now ages 9-45 approved, 2-dose schedule for 9-14 years of age, 3-dose schedule for immunocompromised or initiation of series 15-45 years of age, Protects against cancers (even throat/mouth cancers) and warts (HPV)

Gardasil 9

Women are often asymptomatic, Spotting or postcoital bleeding (after intercourse), Mucoid or purulent cervical discharge, Dysuria, If on OCPs, may have break through bleeding

chlamydia

bacterial STIs include:

chlamydia, gonorrhea, syphilis, PID

diagnosis of chlamydia:

nucleic acid amplification test

med for chlamydia if you’re pregnant, Mostly will see this anyway for chlamydia, Doxycycline is contraindicated in pregnancy, other medications are levofloxacin (not recommended but not necessarily contraindicated in pregnancy), and amoxicillin

azithromycin

Test of cure (TOC) 4 wks post tx: Only necessary in pregnancy, If at high risk, retest in 3rd trimester

chlamydia

Aerobic gram-negative diplococcus, Highest rates of infection in 20- to 24- year age group (men & women) and African-Americans, Women are often asymptomatic, Symptoms may be vague, will have irregular periods and painful periods (dysmenorrhea)

gonorrhea

Perinatal complications of —-infection (really for all bacterial infections) include: Prelabor rupture of membranes (Damages placental blood vessels and impairs perfusion, weakens sac), Preterm birth, Chorioamnionitis, Neonatal infection/sepsis–opthalmia neonatorum, Intrauterine growth restriction, Maternal postpartum sepsis

gonorrhea

diagnosis of gonorrhea (can do nucleic tests if this doesn’t pick up):

culture/nonculture tests

tx: Ceftriaxone (Rocephin) IM x 1, PLUS meds for Chlamydia if positive: azithromycin 1 gram p.o. x 1, Or doxycycline 100 mg p.o. BID x 7 d

gonorrhea

needs test of cure (TOC) 1 wk after treatment

gonorrhea

Treponema pallidum, a motile spirochete, can come from cuts, bites, etc, Kind of looks like HSV papules but they are painless unlike HSV (primary), Can have false positives if mom has acute infection, autoimmune disorders, or sometimes just pregnancy, SUD, or after getting certain vaccines = need confirmatory testing, Transplacental transmission may occur at any time during pregnancy, Highest rates among Black women, can lead to serious systemic disease

syphilis

syphilis: Primary lesion/chancre, Appears 5-90 d after infection, Begins as painless moist papule/ulcer at site of inoculation, Then erodes to form nontender, shallow, indurated, clean ulcer several mms to cms in size

primary

syphilis: (6 wks to 6 mos), Maculopapular rash especially on the palms and soles, Condylomata lata – broad, painless, pink-gray, wartlike infectious lesions –Vulva, perineum, anus, Untreated goes to latent phase

secondary

initial screening for syphilis, all pregnant women get screened, if come back positive need confirmatory testing:

VDRL, RPR

confirmatory screening for syphilis:

FTA-ABS, TP-PA

tx for —-: penicillin G is standard, alternative: tetracycline/doxycycline - both contraindicated for pregnancy, Sexual abstinence during treatment, Monthly F/U

syphilis

for syphilis tx: only antibiotics that can cross placenta, if allergic you have to desensitize - oral penicillin challenge, crash cart outside room - after the day you get penicillin shot like everyone else

penicillin G

Infectious process that involves organs of the upper genital tract, From ascending spread of microorganisms from the vagina and endocervix: C. trachomatis, N. gonorrhoeae, wide variety of bacteria, Dyspareunia - pain during sex, Subacute or chronic - dull intermittent pain, Acute - will probably be hospitalized will be extreme pain, UTIs, irregular bleeding too, pyosalpinx, tubo-ovarian abscess, pelvic adhesions

PID

risk factors for acquiring —-: Young age, Nulliparity, Multiple partners, High rate of new partners, History of STIs and —, New IUD placement (at risk up to 3 weeks after insertion)

PID

Increased risk for: Ectopic pregnancy, Infertility, Chronic pelvic pain

PID

Diagnosis – CDC recommends, Physical exam, Temp > 38.3˚C (100.9 ˚F), Abnormal cervical/vaginal discharge, Labs: ↑ Sed Rate, ↑ C-reactive protein, Lab doc. of gonorrhea or chlamydia

PID

viral STIs include:

HPV, herpes, hepatitis, HIV

Most common viral STI, Previously named genital or venereal warts - Condylomata acuminata, Primary cause of cervical neoplasia, lesions will look like broccoli or cauliflower, can be single or in clusters, Most often seen in the posterior introitus, Small – diam=2-3 mms , ht=10-15 mm, Soft, papillary swellings occurring singly or in clusters

HPV

viral STI: Usually painless, Lesions themselves may be uncomfortable - May be large, inflamed, or ulcerated, Dyspareunia, Profuse, irritating vaginal discharge, Itching, Postcoital bleeding, Reports “bumps” on vulva or labia, Extragenital lesions - spread by touch to other parts of the body, Lesions should be cleaned twice a day with saline wash

HPV

Medications: Imiquimod, podophyllin, podofiloxcontraindicated with pregnancy (All of the meds to remove the warts are contraindicated in pregnancy - during pregnancy have to rely on comfort measures), Oatmeal bath, keep clean and dry, Counseling

HPV

Initial infection characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria, Primary infection during first trimester = miscarriage, If no lesions can have vaginal birth, Lesions should be cleaned twice a day with saline wash

HSV

primary infection: Multiple painful lesions, fever, chills, malaise, and severe dysuria, May also be assoc. w/ itching, inguinal tenderness, lymphadenopathy, May have vulvar edema (can be severe).  May have difficulty sitting, Cervicitis, Heavy, watery-to-purulent vaginal discharge (common), Extragenital lesions (spread by touch), Urinary retention; dysuria

HSV

HSV infection: Local symptoms only, less severe, Systemic symptoms usually absent, Prodromal genital tingling, Lesion - unilateral, less severe, Lasts 5-7 days, Begin as vesicles, progress to ulcers, Stress reduction, Avoid excessive heat (hot baths, sun)

recurrent infection

Maternal infection with —-can have adverse effects on both mother and fetus, Neonatal herpes: Most severe complication of HSV, Most mothers lack history of HSV

HSV-2

Management: Systemic antiviral medication: Acyclovir, Valacyclovir (both safe for pregnancy), Famciclovir, Prevention of recurrent episodes, Comfort measures

HSV

Acquired primarily through a fecal-oral route, Vaccination is the most effective means of preventing transmission, Vaccine is recommended for women at high risk for exposure. Safety in pregnancy not known, RUQ pain, will receive immunoglobulin and then vaccine if positive

hepatitis A

hepatitis type: Most threatening to the fetus and neonate, Transmitted parenterally, perinatally, orally, and through intimate contact, Perinatal transmission most often occurs: Mothers w/acute infection in 3rd trimester, During intrapartum or postpartum period - From direct exposure, Has also been transmitted by artificial insemination

hep B

initial test for hepatitis B (if present has current infection or latent infection - surface antigen of disease):

HBsAG

Hep B Management: Pregnant women with known exposure = —-, Begin vaccine series within 14 d

HBIG

Most common blood-borne infection in the United States, Increasing problem, •Main risk factor for pregnant women: history of injecting IV drugs, Other risk factors: STIs (Hep B, HIV), multiple partners, hx of  IV drug use (shared needles), Interferon alfa or ribavirin is main therapy (both contraindicated in pregnancy)

hepatitis C

Transmission occurs primarily through exchange of body fluids, from mother to child can occur throughout the perinatal period, Symptoms include fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash

HIV

screening/diagnostic for HIV:

antibody testing

for HIV: If viral lesions is less than —— you can have a vaginal birth, AZT (antiretroviral prophylaxis) administered prior to C-section (for hours before) - if viral load is more than —- or viral load is unknown, once they cut the cord they can stop the med (IV at hospital, will continue oral meds at home)

1000

meds for HIV positive pregnant women:

AZT, intrapartum zidovudine

HIV positive: Routine gynecologic care q — months, PAP screening

6

Also called abnormal vaginal discharge, Infection caused by: Microorganism (vaginal infection), Or copious amounts of leukorrhea - Causes maceration of tissues, Must distinguish from normal leukorrhea (discharge), Baby will slide out, Doesn’t really have an odor, mild, tx dependent on microorganism

vulvovaginitis

Lactobacilli are replaced with high concentrations of anaerobic bacteria (pH off = more alkaline), Characteristic  “fishy odor”, Discharge – profuse; thin; white, gray, or milky, Mild vaginal irritation or pruritis, Associated with preterm labor and birth

BV

Diagnosis: Microscopic examination: Presence of clue cells in wet smear, “Fishy odor” released when KOH is added to slide, Nitrazine for pH ≥ 4.5

BV

tx for BV (metallic taste, film on tongue) aka flagyl:

metronidazole

aka yeast infection, is second most common type of vaginal infection, Vulvar/vaginal pruritus, Discharge – thick, white, lumpy, cottage cheese-like, Patches on vaginal walls, cervix, labia, risk factors include: Obesity, DM, autoimmune disease, corticosteroids, etc.

candidiasis

tx for yeast infections (candidiasis) that cannot be taken during pregnancy, aka diflucan

fluconazole

Sexually transmitted infection, Common cause of vaginal infection, a protozoa, May be asymptomatic, Vaginal d/c: Yellowish-greenish, frothy, mucopurulent, copious, malodorous, Inflammation of vulva and/or vagina, c/o irritation and pruritis, Dysuria, dyspareunia, Cervix and vaginal walls – “strawberry spots” (petechiae)

trichomoniasis

diagnostic/screening: Wet prep – one celled flagellate trichomonads, NAAT

trichomoniasis

tx for trichomoniasis (safe in pregnancy) aka flagyl:

metronidazole

A part of the normal vaginal flora present in 25% of healthy women, Assoc. w/ poor pregnancy outcomes, Important factor in neonatal morbidity and mortality, Universal screening at 35-37 weeks of gestation - Swab of vagina and rectum, Intrapartum intravenous prophylaxis (mostly PCN G, if allergic clindamycin IVPB)

GBS

GBS loading dose IVPB PCN G:

5 million U

GBS maintenance IVPB dose q 4hrs until birth:

2.5-3 million U

STIs in pregnancy maternal effects:

PROM, preterm labor, PP sepsis, dystocia, miscarriage

fancy name for a difficult or abnormal labor and childbirth, can happen with STIs in pregnancy

dystocia

STIs in pregnancy fetal effects:

preterm, LBW, IUGR, congenital infection, stillbirth

Form group of infections capable of crossing the placenta and adversely affecting the fetus: Toxoplasmosis, Other infections (e.g., hepatitis), Rubella virus, Cytomegalovirus, Herpes simplex virus (HSV)

TORCH