OB Modules: 1 & 2 Contraception/Antepartum Care

What are Sexually Transmitted Infections (STIs)?

Infections of the reproductive tract caused by bacteria, viruses, or parasites transmitted through vaginal, anal, or oral sex.

What is the global impact of STIs?

They are a serious threat to sexual health and overall well-being worldwide, affecting women more than men.

How many main STIs are linked to the highest incidence worldwide?

Eight main infections.

Name the four curable STIs.

Syphilis, Gonorrhea, Chlamydia, Trichomoniasis.

Name the four incurable viral STIs.

Hepatitis B, Herpes Simplex Virus (HSV), HIV, Human Papillomavirus (HPV).

What age group represents nearly half of new STI cases?

Ages 15-24 years.

What proportion of sexually active teen girls have an STI that can cause infertility or death?

: Two in five (40%).

List common complications of STIs in women.

Cervical cancer, infertility, ectopic pregnancy, chronic pelvic pain, death.

What are key prevention strategies for STIs?

Safer sex practices such as limiting sexual partners and consistent use of latex condoms.

What is the primary nursing intervention for candidiasis (yeast infection)?

Take antifungal medications as prescribed (topical creams or oral).

Name three hygiene practices to prevent or manage candidiasis.

Avoid bubble baths and scented products; wash underwear in hot water with unscented detergent and dry in a hot dryer; remove wet bathing suits promptly.

Why should patients avoid douching in candidiasis care?

Because douching destroys protective vaginal mucus.

What type of toilet paper and wiping technique should be used to prevent candidiasis?

Use white, unscented toilet paper and wipe front to back.

What clothing advice is given to patients with candidiasis?

Avoid wearing pantyhose or cut the crotch area for better air circulation.

What type of menstrual product is recommended for candidiasis?

Use pads instead of super-absorbent tampons.

What bacterium causes Bacterial Vaginosis (BV)?

Gardnerella vaginalis, a gram-negative bacillus.

What is the most prevalent cause of vaginal discharge or unpleasant odor?

Bacterial Vaginosis (BV).

What percentage of women with BV may be asymptomatic?

Up to 50-75%.

How does BV differ from vaginitis in terms of inflammation?

BV typically does NOT cause redness, swelling, or pain (no overt inflammation).

What happens to the normal vaginal flora in BV?

Lactobacilli are replaced by anaerobic bacteria.

Name three risk factors for BV.

Multiple sexual partners, douching, and lack of vaginal lactobacilli.

: How does BV affect susceptibility to other infections?

It increases susceptibility to HIV, herpes, chlamydia, and gonorrhea.

What pregnancy complications are associated with BV?

Preterm labor, premature rupture of membranes (PROM), chorioamnionitis, postpartum endometritis, and pelvic inflammatory disease (PID).

What are the primary symptoms of BV?

Thin, white, homogeneous vaginal discharge and a characteristic “stale fish” odor.

What diagnostic criteria must be met for BV diagnosis?

3 out of 4 of the following:

• Thin, white, homogeneous vaginal discharge

• Vaginal pH > 4.5

• Positive “whiff test” (fishy odor with 10% KOH)

• Presence of clue cells on wet-mount microscopy

What should be assessed in clients suspected of having BV?

Symptoms and risk factors.

What education should be provided to clients with BV?

Treatment adherence, prevention methods, avoiding douching and scented products..

What sexual health advice is important for preventing BV reinfection?

Promote safe sexual practices.

What is the most commonly reported bacterial STI in the U.S.?

: Chlamydia (~3 million cases annually).

Which age group has the highest rates of chlamydia infection?

Ages 15-19.

List key risk factors for chlamydia infection.

Adolescence, multiple sex partners, new sex partner, sex without condom, use of oral contraceptives (no barrier method), pregnancy, history of other STIs.

What percentage of women with chlamydia are asymptomatic?

70-80%.

Name common symptoms if a woman with chlamydia is symptomatic.

Mucopurulent vaginal discharge, urethritis, bartholinitis, endometritis, salpingitis, dysfunctional uterine bleeding.

What is the only treatment for chlamydia?

Antibiotics.

What are the CDC recommended antibiotic regimens for chlamydia?

• Doxycycline 100 mg orally twice daily for 7 days

• OR azithromycin 1 g orally in a single dose

Why is combination therapy often prescribed for chlamydia?

Because coinfection with gonorrhea is common.

What is the typical combination therapy for chlamydia and gonorrhea?

Ceftriaxone (for gonorrhea) plus doxycycline or azithromycin (for chlamydia).

: What is the causative organism of gonorrhea?

Neisseria gonorrhoeae, an aerobic gram-negative intracellular diplococcus.

What tissue does gonorrhea primarily infect?

The columnar epithelium of the endocervix.

How is gonorrhea transmitted?

Almost exclusively through sexual contact.

Name four pregnancy complications associated with gonorrhea.

Chorioamnionitis, premature labor, premature rupture of membranes (PROM), postpartum endometritis.

What serious infections can gonorrhea cause in newborns?

Ophthalmia neonatorum (eye infection), which can lead to blindness, joint infection, or life-threatening sepsis if untreated.

List common signs and symptoms of gonorrhea in women.

bnormal vaginal discharge, dysuria, cervicitis, enlarged local lymph nodes, abnormal vaginal bleeding, Bartholin abscess, pelvic inflammatory disease (PID).

What other infections or symptoms can gonorrhea cause?

Neonatal conjunctivitis, mild sore throat (pharyngeal infection), rectal infection (itching, soreness, bleeding, discharge), perihepatitis.

Why is combination therapy recommended for gonorrhea treatment?

Because coinfection with chlamydia is common.

What antibiotics should accompany gonorrhea treatment unless chlamydia is ruled out?

Azithromycin or doxycycline.

: Which antibiotics should NOT be given to pregnant women for gonorrhea?

Quinolones and tetracyclines.

: What is the recommended treatment for pregnant women with gonorrhea?

: Ceftriaxone plus azithromycin or amoxicillin.

What is the prophylaxis for ophthalmia neonatorum in newborns?

Instillation of erythromycin or tetracycline ophthalmic ointment (single legally mandated application).

How is genital HSV transmitted?

Contact with mucous membranes or skin breaks with visible or invisible lesions; also through asymptomatic viral shedding, kissing, sexual contact (including oral sex), and vaginal birth.

Where does the HSV virus remain latent after initial infection?

In the dorsal root ganglia.

What can trigger reactivation of HSV?

Fever, stress, UV radiation, immunosuppression.

What are common systemic symptoms of primary genital HSV infection?

Fever, chills, malaise, headache.

Describe the primary lesions seen in genital HSV infection.

Multiple painful vesicular lesions on vulva, vagina, perineal areas that open, weep, crust, and heal without scarring over about 2 weeks.

What other symptoms accompany primary HSV infection?

Mucopurulent discharge, possible Candida superinfection, dysuria, genital irritation, inguinal lymphadenopathy.

Is there a cure for genital HSV?

No cure, but antiviral medications reduce symptoms, viral shedding, and recurrences.

Name three antiviral medications used to treat genital HSV.

Acyclovir, Famciclovir, Valacyclovir.

What is the typical dosage for Acyclovir in genital HSV treatment?

400 mg orally three times daily for 7–10 days.

How do antiviral treatments help HSV patients?

They improve quality of life by reducing symptom severity, viral shedding, and frequency of recurrence.

What causes syphilis?

Treponema pallidum, a spirochete bacterium.

How is syphilis transmitted?

Sexually or congenitally from mother to fetus.

What is the hallmark lesion of primary syphilis?

Chancre — a painless ulcer at the infection site.

How long does a primary syphilis chancre take to heal without treatment?

1 to 6 weeks.

What symptom commonly accompanies the primary chancre?

Painless bilateral lymphadenopathy.

When does secondary syphilis typically appear?

2 to 6 months after initial infection.

What are key signs of secondary syphilis?

Flu-like symptoms, maculopapular rash (including palms and soles), alopecia, adenopathy, pharyngitis, weight loss, fatigue.

How long does the secondary stage of syphilis usually last?

About 2 years.

What characterizes latent syphilis?

No symptoms but positive serology; can last up to 20 years.

What are serious complications of tertiary syphilis?

Cardiovascular disease, neurosyphilis, skin lesions, eye damage.

What risks does congenital syphilis pose?

Severe complications in newborns, including disability and death.

What is the preferred treatment for syphilis?

Benzathine penicillin G (IM or IV).

What is the Benzathine penicillin G dosing for syphilis infection less than 1 year?

2.4 million units IM in a single dose.

How is syphilis treated if infection is longer than 1 year or duration is unknown?

2.4 million units IM once weekly for 3 weeks.

What alternatives exist for patients allergic to penicillin?

Doxycycline or other antibiotics.

What is the most common viral infection in the U.S.?

Human Papillomavirus (HPV).

Approximately what percentage of sexually active people get HPV at some point?

: About 80%.

What does HPV commonly cause?

Genital warts (condylomata).

How many people in the U.S. are currently infected with HPV?

Estimated 80 million.

How many new HPV cases are estimated annually in the U.S.?

About 14 million. 5

Name some risk factors for HPV infection.

Multiple sexual partners, age 15–25 years, sex with males who have multiple partners, early sexual debut (≤16 years).

What additional factors increase risk for cervical cancer linked to HPV?

Smoking, few/no cervical screenings, weakened immunity, nulliparity, long-term contraceptive use (>2 years), coinfection with other STIs, pregnancy, nutritional deficiencies.

How are HPV warts typically identified?

Visible fleshy papules with warty, granular surfaces diagnosed by inspection.

How can HPV lesions affect pregnancy?

Lesions can grow large, affecting urination, defecation, mobility, and fetal descent.

What is the shape and appearance of large HPV wart clusters?

Cauliflower-like clusters that may bleed easily.

Is there a medical cure for HPV infection?

, there is no cure for the infection itself.

What is the primary focus for HPV management?

Prevention through HPV vaccination and education.

What are the CDC vaccine recommendations for HPV?

Start at ages 11–12 (two doses if vaccinated before 15); three doses if vaccinated at older ages.

Should adults aged 27–45 receive the HPV vaccine?

They should discuss vaccination with their healthcare providers.

How is Hepatitis B Virus (HBV) transmitted?

Via saliva, blood, semen, menstrual blood, and vaginal secretions.

What is the incubation period for HBV?

6 weeks to 6 months.

How long can HBV survive outside the body?

t least 7 days.

Which groups have the highest transmission rates of HBV?

Heterosexual partners and men who have sex with men.

How many people worldwide have been infected with HBV?

Approximately 257 million.

What are common symptoms of HBV infection?

Flu-like symptoms such as malaise, fatigue, anorexia, nausea, pruritus, fever, and right upper quadrant pain.

How is HBV diagnosed?

Blood tests detecting hepatitis B surface antibody (HBsAb) and viral proteins.

How do HBV symptoms compare to Hepatitis A symptoms?

HBV symptoms are similar but usually have less fever and skin rash.

How do most HIV-infected adolescents acquire the virus?

Through sexual contact—heterosexual or homosexual.

Among HIV-infected adolescent males, what is the most common transmission route?

Sex with other males.

Among HIV-infected adolescent females, what is the most common transmission route?

Heterosexual contact.

What percentage of adolescent HIV infections is due to injected drug use?

A smaller percentage compared to sexual transmission.