STD's

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jsullivan
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18533
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STD's
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2010-05-09 22:34:26
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STD\'s
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wk 11/12 std lecture
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  1. What are the chief complaints of a person w/ an STD?
    itching, burning, dysuria, pain
  2. What is a VDRL?
    • VDRL= Veneral Disease Research Lab
    • -blood test for syphillis, flourescent treponemal antibody test
  3. What is a gram stain used for?
    • Gram stain: urethral in males and cervical in females
    • Gram negative diploc = GC (ghonnerea). The exclusion of GC= chlymadia
    • -enzyme-like immunoassay and direct flourescent antibody tests
  4. Define Genetial Herpes
    • -acute, recurring, incurable viral disease
    • a) HSV-1: classis cold sore caused from heat, sun, or fever, often referred to as "fever blisters"
    • b) HSV-2: genetal herpes
  5. what are the s/sx of HSV?
    • -initial and recurrent outbreaks w/ the same symptoms
    • -burning sensation of skin or prickly like pins/needles
    • -small itchy or painful red bumps
    • -bumps become fluid filled vesicles, painful
    • -fluid goes from clear to thick and yellow in a few days, they break open w/ very painful sores
    • -females may be more painful (due to warm, moist areas)
  6. What is the course of genital herpes?
    • -blisters crust over and crusts fall off in 10 days
    • -may have swollen lymph glands in groin and other areas
    • -50% fever, muscle aches, HA. Most women have vaginal discharge
    • -30% males have sores inside urethra causing painful urination
    • -firs infection may be mild and go unnoticed until reoccurance, or be severe
  7. Discuss reoccurence in regards to HSV
    • -may be q 2 wks to 6 mo.
    • -usually less severe. May accompany local trauma (i.e. menses, infection, other STDs, anxiety, stress, poor nutrition
    • -outbreaks may become fewer over the years but HSV is incurable.
    • -anything over 4 outbreaks/year is considered severe and treated w/ continuout prophylactic meds all year
  8. What are the complications of HSV?
    • -spread from initail site by hands, mouth, and can go to other open sores or the eyes causing infection/blindness
    • -can go to fingers/fingernails= Herpatic Whitlow - a former occupational hazard when med staff didn't wear gloves, esp. when working in mouth (dentists and anesthesiologist
  9. Discuss pregnant women and HSV
    • -should inform MD if they have HSV.
    • -if HSV in inactive phase the pt can deliver vaginally, or CS needed to prevent spread to newborn
    • -babies of active mother have a 25-40% chance of becoming infected, and 60% of infected babies die
  10. How is HSV transmitted?
    • -during viral shedding (type I and type II)
    • -just before and during the active outbreak via direct contact genital to genital or mouth to genital
    • -virus enters through small cracks/abrasions in skin but virus can also survive outside the body in warm moist environ for a short period of time
    • -chlorine kills the virus-you can't get it from swimming pools
  11. What is the Tx for HSV?
    • -no cure
    • -virus lies dormant in nerve ganglia until body becomes stressed then it comes out again
    • we treat the symptoms:
    • -astringent compresses (i.e. Burrow's soak for cooling and pain relief)
    • -and meds to decr. severity, promote healing and decr. frequency of outbreaks
  12. What are the ANTIVIRAL meds for Herpes?
    • *Acyclovir (Zovirax or Avirax)
    • -used orally 7-10 days
    • -s/e: N/V
    • *Famiciclovir (Famvir)
    • -used orally 7-10 days
    • -educ: start w/in first 48hr of sx
    • *Valacyclovir (Valtrex)
    • -used orally 7-10 days
    • -s/e: GI distress, HA, dizziness
  13. Discuss Tx for HSV
    • -avoid touching active blisters and avoid sexual activity
    • -used condoms at all times
    • -Use cold compresses to reliefve symptoms, avoid hot bc it incr. inflammation
    • -wear ventilated clothing, dry blisters w/ powder, corn starch, cool hair dryer
  14. What is considered the "classic STD?"
    Syphillis
  15. Discuss Syphillis: cause and incidence
    • cause: Treponema pallidum spirochete (slender, spiral shape)
    • incidence: fewer cases d/t use of PCN and better public health educ.
  16. Discuss the PRIMARY phase of Syphilis
    • -chancre (pronounced "shank-are") at site of inoculation in genitals, about 3wks after exposure
    • -Highly infectous- 1st small papule w/in 3-7 days then it breaks down into characteristic painless, indurated, smooth, weeping lesion
    • -if no Tx chancre disappears in 6wks and organism disseminates throughout bloodstream, leading to secondary phase
  17. Discuss SECONDARY Syphilis
    • -6wks to 6mo after primary syphilis
    • -Systemic disease
    • -s/sx: malaise, low-grade fever, HA, muscle-ache/pain and sore throat
    • -grneralized rash involves papules to squamous papules and pustules
  18. Discuss the LATENT STAGES of Syphilis
    • Early Latent: first year after infection
    • Late Latent: more than a year duration after infection. Noninfectous except to fetus of pregnant woman.
    • Tertiary or Late (can cause extreme damage in body systems): highly variable s/sx, period for 4-20 years
    • -sx: benign lesions, skin and mucous memb., bones, aortitis (inflammation of aorta), aneurysms (from weakened vessels), and neurosyphilis (affects whole nervous system and pt can become psychotic)
  19. How is Syphilis diagnosed?
    • -incubating Syphilis can NOT be detected w/ lab tests
    • -primary can be Dx by microscope identification (spirochetes from oozing canchre looked at under microscope and diagnosed)
    • -later stages: VDRL blood test
    • -FTA-ABS (flourescent treponemal antibody absorbtion)
    • -RPR (rapid plasma reagin-detects 2 types of antibodies)
    • -tests can give false neg/false pos even after pt had adequate tx, retreatment may be only choice
  20. What is the Tx for Syphilis?
    • Primary Prevention: SAFE SEX!
    • Secondary: early Tx, prevntion of complications
    • Tertiary: treat complications, notify partners
    • *Syphilis is completely curable by using PCN AB (but remember it doesn't provide immunity, you can get the disease again)
  21. Discuss GC
    • -Gm neg. diplococcus, transmitted by sexual contact or in an to a neonate via an infected birth canal
    • -initail symptoms 3-10 days after contact or non-symptomatic
  22. What are the s/sx of GC in MALES?
    • -dysuria
    • -penile discharge, profuse yellow-green, clear or scant
    • -GC is referred to as the "drip"
    • -rectal bleeding, pain w/ defication, pharyngitis (sore throat from incocculation in oral area)
    • -most common- urethra then spread to prostate, seminal vesicles and epididymis
  23. What are the s/sx of GC in FEMALES?
    • -change in vaginal discharge, odorus
    • -urinary frequency, dysuria
    • -anal itch, irritation, bleeding
    • -pain w/ defication
    • -pharyngitis
    • -most commmon: cervix or urethra and spreads up causing PID, endometritis, salpinfitis, pelvis peritonitis
  24. What is the Tx for GC?
    • -completely curable
    • -must be seen by MD
    • -prob w/ incr. resistant strains
    • -AB: ceftriaxone (Rocephin) AB of choice- want to mix w/ lidocaine if you give it IM-painful shot, one dose of Rocephin can cure GC
  25. Discuss Chlymadia
    • -C. trachomatis most common transmitted bacteria
    • -US: 4 million infected annually
    • - invades columnar epithelial tissues in reproductive tract w/ manifestations similar to GC
    • -incubation 1-3 wks or months/years
    • -many w/o sx, (usually picked up on pap screening)
  26. What are the sx for MALES with Chlamydia
    • -urithritis
    • -dysuria
    • -frequency of urination
    • -mucoid discharge (more h2o, less copious than GC)
    • -complications: epididymitis, prostatitis, infertility, Reiter's syndroms (arthrytis)
  27. What are the sx for WOMEN with chlymadia
    • -75% asymptomatic
    • - mucopurulent cervicitis, change in vaginal discharge
    • -dysuria, frequency
    • -soreness of infected area
    • -COMPLICATIONS: salpingitis, PID, ectopic preg and infertility
    • -TX choice: azithromycin (Zithromax) or doxycycline
    • -educ: treat partner
  28. Discuss PID
    • Pelvic Inflammatory Disease:
    • -process involves one or more pelvic structures
    • -most common in fallopian tubes = leading cause of infertility
    • - acute PID-complex lower genital tract organism that migrates to endocervix through endometrail cavity and fallopian tubes
    • -PID can lead to: endometritis, peritonitis, salpingitis, oophoritis, parametritis, adhesions, strictures that can lead to a bowel obstruction.
    • PID most often caused by STD- GC, chlymadia, mycoplasma
  29. What is the Tx for PID?
    • nonsurgical:
    • -analgesia, sitz baths, heat on lower back/abdomen, bedrest in semi-fowlers
    • -AB as ordered

    • surgical:
    • -laproscopic or abdominal laparotomy to remove abscesses, masses
    • Teach: meticulous perineal hygiene, treat partners for STDs, provide counseling and educ. about infertility, ectopic preg, chronic pain

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