Sexually Transmitted Infections Chapters 5

FACTORS PLACING TEENAGERS AT RISK FOR STIS

-Female anatomy

-Teenagers' feelings of invincibility

-Unprotected intercourse

-Partnerships of limited duration

-Obstacles to using the health care system

Chlamydia: manifestation

-may be asymptomatic

-dysuria

-urinary frequency

-dyspareunia

-cervical discharge

-endocervicitis

-inflammations of the rectum and lining of the eye, can infect throat

gonorrhea manifestations

-may be asymptomatic

-dysuria

-urinaryfrequency

-vaginal discharge

-dyspareunia

-endocervicitis

-arthritis

-PID

-rectal infection

genital herpes manifestation

-blister-like genital lesions

-dysuria

-fever

-headache

-muscle aches

-malaise

when you treat chlamydia you also must treat

ghonorhea

syphilis disease is divided into

4 stages

primary stage of syphilis

-chancre on place of bacteria entrance

-concave sore

secondary stage of syphilis

maculopapular rash, sore throat, lymphadenopathy,flu-like symptoms

Latent stage of syphilis

no symptoms; can be infective first 1-2 years of latency, some will go on to develop tertiary infections

Tertiary stage of syphilis

tumors of the skin, bones, and liver, CNS symptoms,CV symptoms; usually not reversible

CNS syphilis sx include

dementia and memory loss

Trichomoniasis is caused by a

-Trichomonas vaginalis is an ovoid, single-cell protozoan parasite

-sexually transmitted

-can also live on damp/wet surfaces and poorly cleaned/maintained hot tubs, drains, towels, and bathing suits.

Trichomoniasis manifestations

-may be asymptomatic

-dysuria

-urinary frequency

-vaginal discharge

-dyspareunia

-lower abdominal pain

thrichomoniasis has what color discharge

A heavy yellow/green or grayish frothy or bubbly discharge

Trichomoniasis cervix characteristics

-bleeding on contact

-petichiae on cervix

Trichomoniasis vaginal characteristics

-Vaginal pruritus and vulvar soreness

-Vaginal odor described as foul

-Vaginal or vulvar erythema

trichomoniasis tx

-A single 2-g dose of oral metronidazole (Flagyl), tinidazole (Tindamax), or secnidazole for both partners is a common treatment for this infection.

-Multidose therapy, consisting of 500 mg twice a day for 5 to 7 days, is also available and is the preferred treatment in females when using metronidazole

trichomaniasis diagnostic test

nucleic acid amplification tests (NAATs),

genital warts manifestations

-wart-like lesions that are soft, moist, or flesh colored

-appear on the vulva and cervix and inside; also surrounding the vagina and anus

-sometimes appear in cauliflower-like clusters, and are either raised or flat, and small or large

open discussion includes

-Client's sexual habits

-Appropriate anticipatory guidance

-Methods to prevent recurrent STIs

most common causes of vaginitis

-Candida: fungus

-Trichomonas: protozoan

-Gardnerella: bacterium

candida is

fungus

trichamonas is

protazoan

candida is

fungus

VULVOVAGINAL CANDIDIASIS NURSING MANAGEMENT

EDUCATION

Prevention of VULVOVAGINAL CANDIDIASIS

-Cotton underwear

-Avoidance of irritants

-Good body hygiene

-Avoidance of douching or super-absorbent tampons

why do you want to avoid douching

-take out good and bad bacteria

bacterial vagniosis is the most prevalent cause of

vaginal discharge

BV vaginal discharge is

Thin, white/grayish vaginal discharge that adheres to the vaginal mucosa

PH for BV

higher than 4.5

bacterial vaginosis smell

fishy

-(secretion is mixed with a drop of 10% potassium hydroxide on a slide, producing a characteristic stale fishy odor)positive whiff test

_______ women of asymotomatic with bacterial vaginosis

50%-75%

risk factors for bacterial vaginosis

-Multiple sex partners

-Douching

-Lack of vaginal lactobacilli

where can you get good bacteria

-probiotics (yogurt/supps)

BV tx

-treatment for BV typically includes oral or vaginal metronidazole (Flagyl)

- clindamycin (Cleocin) cream.

infections that cause cervicitis are

chlamydia

ghonnorrhea

untreated chlamydia leads to

-cervicitis

-urethritis

-PID

-which leads to infertility

-chronic pelvic pain

-ectopic pregnancies

chlamydia untreated in preganncy

-premature rupture of membranes

-preterm labor

-low-birth-weight newborns

--phthalmia neonatorum, which is an acute mucopurulent conjunctivitis occurring in the first month of birth.

chlamydia is the ______

most common bacterial STI in the US

chlamydia is majorly ____

asymptomatic

chlamydia is caused by

Chlamydia trachomatis (intracellular parasite)

therapeutic management of chlamydia

o Antibiotics (doxycycline, azithromycin)o Combination regimen if gonorrhea also presento Screening

ABX used to treat chlamydia or ghonnorrhea are

doxycycline and azithromycin

-shot in butt

nursing assessment for chlamydia includes

-risk factors

-CM

-lab tests

chlamydia risk factors

-adolescence

-multiple sex partners

-new sex partner

-sex without condom

-oral contraceptive use

-pregnancy

-history of another STI

chlamydia manifestations

-mucopurulent vaginal discharge

-urethritis

-bartholinitis

-endometritis

-salpingitis

-dysfunctional uterine bleeding

chlamydia testing

-Urine testing or swab specimen culture

-immunofluorescence

-EIA

-nucleic acid amplification

second most common STI in the US is

ghonorrhea

careful because ghonnorrhea is _____ and you must _____

-highly contagious

-report to health care organizations

gonorrhea cause is

aerobic gram-negative intracellular diplococcus

site of infection for gonorrhea

-columnar epithelium of endocervix

-almost exclusively gotten through sex

management for gonorrhea is

-ceftriaxone (Rocephin) 500 mg for pregnant and nonpregnant females weighing less than 150 kg (CDC, 2022a).

-If chlamydia has not been ruled out, proper treatment for chlamydia should be started

risk factors for gonorrhea

-low socioeconomic status

-urban living

-single status

-inconsistent use of barrier contraceptives

-age <20 years, multiple sex partners

manifestations of gonorrhea

-most asymptomatic;

-abnormal vaginal discharge

-dysuria

-cervicitis

-abnormal vaginal bleeding

-Bartholin abscess

-PID

if a women gives birth with gonorrhea beware of

neonatal conjunctivitis

-give azithromycin/erythromycin eye drops

ghonnorrhea if untreated can lead to

-organism ascends upward through the endocervical canal to the endometrium of the uterus further on to the fallopian tubes, and out into the peritoneal cavity.

-When the peritoneum and the ovaries become involved, the condition is known as PID

- If gonorrhea remains untreated, it can enter the bloodstream and produce a disseminated gonococcal infection.

-This severe form of infection can invade the joints (arthritis), the heart (endocarditis), the brain (meningitis), and the liver (toxic hepatitis).

NURSING MANAGEMENT:CHLAMYDIA AND GONORRHEA

-Treatment strategies

-Referrals

-Preventive measures

-Education and counseling

-Sexual history

-Public education

-Safe sex practices

genital herpes simplex is a

-Recurrent lifelong viral infection

how do you get genital herpes simplex

-Transmission via contact with mucous membranes or breaks in skin with visible or non visible lesions

-Kissing, sexual contact, and vaginal delivery

with herpes even after tx

you shed the virus, still drink from other ppls cups. Can still spread it

true or false a baby can get genital herpes

true, via vaginal delivery

therapeutic management for herpes

-No cure

- Antiretroviral therapy to reduce or suppress symptoms, shedding,and recurrent episodes16

primary episode herpes

-(most severe and prolonged)

-multiple painful vesicular lesions

- mucopurulent discharge

-superinfection with candida

-fever, chills, malaise, dysuria, headache, genital irritation

-inguinal tenderness

-lymphadenopathy

-vulva, vagina, and perineal areas.

recurrent herpes infection

-more localized and quicker resolution

-tingling

-itching

-pain

-unilateral genital lesions (more localized)

diagnosis of herpes simplex is confirmed by

viral culture of fluid from vesicle

Primary syphilis

chancre, painless bilateral adenopathy

secondary symphilis

-flu-like symptoms

-rash on trunk/palms/soles

-alopecia

-adenopathy

latency syphylis

-absence of manifestations

-positive serology

tertiary syphylis

-life-threatening heart disease

-neurologic disease

tests for syphylis

-DRL and RPR

-FTA-ABS, TPPA

-TPHA

syphylis tx

- An injection of penicillin G can cure primary, secondary, or early latent syphilis.

-Preparation, dosage, and treatment length depend on the disease stage

- For late latent syphilis, three doses of penicillin at weekly intervals are needed.

-Pregnant people should be treated with the same regimen for whichever stage they present with.

-Other medications, such as doxycycline, are available if the patient is allergic to penicillin.

-Patients should be reevaluated at 6 and 12 months after treatment for primary or secondary syphilis with additional serologic testing.

-Patients with latent syphilis should be followed up with clinically and serologically at 6, 12, and 24 months

NURSING MANAGEMENT OF HERPES AND SYPHILIS

- Education

- Referral to support group

- Coping skills

- Options for treatment and rehabilitation

PELVIC INFLAMMATORY DISEASE results from

-Result of ascending poly microbial infection of upper female reproductive tract

-Frequently from untreated chlamydia or gonorrhea

therapeutic management for PID

-Empiric broad-spectrum antibiotics

-Oral fluid

-Bed rest

- Pain management

Nursing management of PID

-RISKS

-CM

-DX

PID manifestations

-lower abdominal tenderness

-adnenal tenderness

-cervical motion tenderness

-fever

-dysmenorrhea

-dysuria

-dyspareunia

PID dx

-endometrial biopsy

-transvaginal ultrasound

-laparoscopic examination

nursing management of PID

-hydration

-analgesics

-education to prevent recurrence

-risk assessment

-sexual counseling

HUMAN PAPILLOMAVIRUS IS THE

most common viral infection in the US

how does HUMAN PAPILLOMAVIRUS manifest

-Genital warts or condylomata

-warts can cause cervical cancer

HPV nursing assessment

-Risk factors.

-Manifestations

- HPV test

HPV manifestations

most asymptomatic; visible genital warts.

HPV diagnostic test

Pap smears

therapeautic management for HPV

-primary prevention via vaccine and education

-at age 11 up until 45

-treatment of lesions and warts

-secondary prevention via education

NURSING MANAGEMENT FOR HPV

-Teaching about prevention to Promotion of vaccines and screening tests

-Education about link between HPV and cervical cancer

HPV tx

none for virus

-only treat warts

hepatitis A spreads via

GI tract

hepatitis B spreads via

body fluids

theraputic management for hep a and b

-prevention through immunization

nursing management hepatitis

-screening/vaccination

how many types of HPV can cause cervical cancer

16 and 18

mursing assessment hepatitis

-blood titers along with clinical manifestations

scabies

-intensely pruritic dermatitis with lesions

pubic lice

pruritus with lice or nits

tx for ectoparasitic infections

-permethrin cream

-lindane shampoo

-decontamination of bedding and clothing

-treatment of familymembers and sexual partners

-3 teared approach

3 teared approach

1. eradicate infestation

2. remove nits

3. prevent spread or recurrence

HUMAN IMMUNODEFICIENCY VIRUS

-causes AIDS

-mostly through sex

-increasing in adolescents

-FETAL/NEONATAL EFFECTS

HIV manifestations

-acute phase; asymptomatic with viral replication

-immunosuppression with opportunistic infection

-AIDS

diagnoses for AIDS

western blot test

therapeutic managaement of HIV

ART (Antiretroviral therapy)