Sexually Transmitted infections

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  1. What are STI's
    reproductive tract infections caused by microorganisms transmitted primarily thru close initimate contact

    • Complications
    • female- cervical cancer (HPV), infertility (bc scaring in fallopian making it hard for the eggs to pass), ectopic pregnancy, chronic pelvic pain (PID) bc of adhesion that form, death (not treated)

    Males- mouth, anal, throat cancer (from HPV)

    Transmission in utero to fetus or during childbirth to newborns
  2. Risk Factors
    • Groups at high risk for STI's
    •  African americans and hispanic youth
    • abuse youths
    • homeless youths- prositutions
    • young men having sex with me (MSM)
    • LGBTQ
  3. Factors that place teenagers at risk
    female anatomy- columnar epithelial cells on their cervix (cells outside their cervix) 

    teens feel invincibly 

    unprotected intercourse

    partnerships of limited duration

    obstacles to using the health care system- embrassed, fear, no money, dont want their parents to know, no transportation
  4. Reportable STI
    HIV, gonnerhea, chamidia, syphllis- PID (pelvic inflammatory disease, hep A/B, herpes (neotal herpes), gonnerhea (opthamia neonatorum)- gonnerhea in baby's eye
  5. Pregnancy and STI
    • Transmission during pregnancy- before, during or after the baby's birth
    • can occur anytime

    STI's can that can cross plancenta- syphillis and HIV (reason why we screen for these)

    STI's acquired during vaginal delivery: gonnorhea, chlamydia, hep b, HSV2 (herpes simplex virus 2) genital herpes, HIV

    Breast feeding- HIV can cross thru breast milk esp breastfeeding > 24 months
  6. Pregnancy and STI complication
    • Complications:
    • early onset of labor- baby at risk
    • premature rupture of membrane (PROM)
    • uterine infection after delivery- sti can infect the uterus
  7. Pregnancy and STI NB
    • harmful effects on the NB
    • still birth
    • low birth weight (less than 5lbs)
    • gonnorhea in the eyes- conjunctivitis
    • pneumonia
    • neonatal sepsis (less than 3 mons)
    • neuro damage- blindness, deafness
    • infection of meniges- menigitis
    • liver disease
    • acute hepatitis
    • chronic liver disease-cirrihosis
  8. patient education
    • Prevention- safe sex practices
    • - reduce the number of sexual partners
    • - knowledge of partner- ask how many they had
    • - avoid casual sex
    • - condom: barrier method
    • - discuss sexual history
    • - birth control and spermicide don't protect against STI
    • female condoms
    • latex v non latex condom
    • non latex does not protect against all sti.
    • COMMUNICATION between sexual partners is essential

    • express feelings and fears role playing
    • - abstinence: most effective prevention method
  9. more patient education
    • Proper and consistent condom use
    • latex is protective against STI
    • use new condom with each sexual intercourse never reuse
    • proper storage
    • apply condom to erect penis before genital contact, ensure space at the tip for semen collection, withdraw while penis still erect
    • ensure adequate lubrication, use only water base lubricants
    • latex allergy- polyurethane male and female condoms available or use natural skin condom with latex condom over
  10. Cervicitis
    Chlamydia and Gonorrhea

    inflamed cervix, friable (sensitive- can cause cervix to bleed)
  11. Chlamydia
    • silent infection
    • common bacterial sti in US
    • most common between 15-19 yrs old
    • cause: chlamydia trachomatis (intracellular parasite)- test: urine
    • complication:
    • NB neonatal conjunctivitis
    • pneumonia- respiratory problems
    • males- urethritis (inflammation of urethra)
    • females- cervicitis, salpingitis, ectopic pregnancy (rupture), PID, infertility
  12. Chlamydia cont
    • Transmission: vaginal, anal, oral sex, childbirth
    • treatable

    • Therapeutic Management
    • Antibiotics: (doxycycline (twice a day for week), azithromycin- single dose)
    • common to have co infection with gonorrhea: use combination medication regimen if gonorrhea also present- doxy or azithromycin with ceftriaxone (rocephin)
    • sexual partners need testing and treatment if positive
    • abstitence
    • retest test 3-4 for recurrence (annual screening)

    older people more at risk for catching infection
  13. Chlamydia: nursing assessment
    • Assess for
    • Risk factor: adolescence multiple sex partners, mulitiple sex partners, new sex partners, oral conceptive, pregnancy, hx of other sti

    • manifestation both female and male maybe asymptomatic
    •  female- mucopurulent vaginal discharge, dysuria, frequent urination, may lead to PID, infertility, ectopic pregnancy
    •  male- urethral itch or tingling, penile discharge, male lead to sterility

    urine testing, urethral swab culture in males and endocervical swab in female, conjunctival secretions in neonates
  14. Gonorrhea
    • 2nd highest bacteria in US
    • reportable
    • highly contagious
    • cause- Neisseria gonorrhea bacteria
    • transmission: almost exclusively transmitted thru sexual activity: vaginal, anal, oral sex also thru childbirth
    • increase the risk for: PID, inferitility/sterility, ectopic pregnancy, and acquiring or transmitting HIV
    • often co infected with chlamydia
  15. Gonorrhea 2 NB, symptoms management
    • Risk to the NB- Opthalmia neonatorum gonorrhea infection transmitted during birth to eye can lead to blindness
    •  prevention: instill erythromycin in both eyes

    • GC symptoms- both male and female may be asymptomatic
    • female- dysuria, frequency vaginal discharge (yellow/foul), may lead to PID, ectopic preg, infertility
    • male- penile discharge pus, dysuria

    • Therapeutic management: antibiotic therapy
    • - single dose of ceftriaxone, ciprofloxacin, cefiximine
    • do not use cipro if < 18 years old or pregnant- problems with joints and children
    • co treatment for chlamydia : doxy
  16. Nursing Management chlam and gon
    • Education and counseling:
    •  Risk factors: single women, women < 25 years old, african american or hispanic women and history of STI, new or mulitple sex partners, inconsistent barrier, contraception use, living in community with high infection rate
    • Preventive measures and safe sex practices. emphasize importance of seeking treatment and informing partners.
    • Complete medication treatment regimens as recommended
  17. Infections characterized by genital ulcers
    • genital herpes and syphilis
    • genital ulcers increase the risk of acquiring HIV infection bc of the break in the skin
  18. Herpes type II: Genital herpes
    • HSV2
    • no cure for this...
    • this virus lays dorment in skin nerve cells and something happens like stress, menses, sexual intercourse, > 50% is unknown can cause outbreak

    • Viral genital herpes is the most prevalent genital ulcer infection
    • lifelong infection
  19. Genital Herpes
    • Transmission via contact with mucous membranes or breaks in skin with visible or nonvisible lesions
    • - kissing, sexual contact, and vaginal delivery

    Complications: neonatal herpes simplex viral infection= high mortality and morbidity

    • Therapeutic management
    • no cure
    • anti-viral therapy- to reduce or suppress symptoms, shedding and reoccuring episodes
    • - acycolvir (zovirax) 400mg PO TID for 7-days
    • - Valacyclovir (valtrex) 1 gram PO BID for 7-10 days
  20. Genital Herpes: Nursing Assessment
    • Primary episode (most severe and prolonged)
    •  - muliple painful vesicular lesion located on the vulva, vagina, and or perineal areas
    •  - mucopurulent discharge, superinfection with candida, fever, chills, malaise, dysuria, headache, genital irritation, inguinal tenderness and lymphadenopathy

    • Recurrent infection (more localized and quicker resolution)
    •  - fewer lesions, less painful
    •  - tingling, itching, pain, unilateral genital lesions (more localized)

    diagnosis confirmed via viral culture of fluid from vesicle 
  21. Syphilis
    Curable bacterial infection caused by spirochete Treponema pallidum

    serious systemic disease: can lead to disability and death if untreated

    can last in the body for many yrs if not treated

    -spirocete rapidly penetrates intact mucous membranes or microscopic lesion in the skin, then enters lymph system and bloodstream within hours

    - crosses placenta to fetus at any time during the pregnancy. 1:10,000 infants born with congenital syphilis 

    starts out like an ulcer- called chancre
  22. Syphilis and pregnancy
    • complications:
    • Spontaneous abortion- miscarriage
    • prematurity- born early
    • stillbirth

    newborn: multisystem failure of heart, lungs, spleen, liver, pancreas, and bone damage, CNS involvement, mental retardation
  23. Syphllis: Nursing Assessment
    • 4 stages:
    • - Primary: chancre, and painless bilateral adenopathy (ingunial lymph nodes). highly contagious. lasts up to 2 months

    • - secondary: appears 2-6 months after initial exposure, flu like symptoms, maculopapular rash on trunk, palms, and soles, alopecia, adenopathy fever, pharyngitis, weight loss, fatigue. last about 2 years
    • - Latency: absence of manifestations of diease, positive serology. can last up to 20 years 
    • - if not treated- tertiary: life-threatening heart disease. slowly destroys the heart, eyes, brain, CNS, and skin

    • Screening: 
    • clients dx with HIV and other STI's
    • all pregnant women

    Diagnostic tests: VDRL and RPR
  24. Syphilis: therapeutic management
    for all stages

    preferred drug: benzathine penicillin G given IM/IV. dose dependent on infection duration 

    1 dose single dose-  if had for a long time then pt will get 3 doses

    • if allergic give doxycylie
    • reevaluation with serologic testing at 6-12 months after treatment
  25. Nursing management: genital ulcers
    • Education re caring for genital ulcers
    • - abstai for sexual intercourse when lesions present
    • - wash hands with soap and water
    • - comforts measure 
    • no constricting clothing
    • cotton underwear
    • urinating in water if urination is painful
    • sitz bath
    • air drying lesions

    • avoid extremes in temperature exposure and steriod creams, gel or sprays
    • use condoms with non infected partners
    • inform heath care providers or diagnosis
    • Referral to support group
  26. Human Papilloma Virus: HPV
    • The most common viral STI: 20 mllion new cases annually
    • The body;s immune system clears most HPV naturally within two yrs though some infections persist
    • no treatment for the virus
    • most active men and women will get HPV at some point in their lives
    • everyone is at risk and many may benefit from vaccine
    • HPV vaccine: routinely recommended for 11 or 12 yr old boys and girls
    • CDC recommendation: Gardisil or Cervarix
    •  Immunize all teens girls and women thru 26
    •  Immunize all teen boys and men thru 21 (thru 26 of age if gay, bisexual or men who have sex with men)
    • HPV most affective if given before an individual has sex
  27. HPV
    • Most prebalent in young women between 15-24 yrs
    • transmission: vaginal, anal, or oral sex. can pass even when an infected person is not showing any signs and symptoms
    • Cause of essentially all cervical cancers: 4th common cancer in women in the US
    • - types HPV, 16, 18, 31, 33 and 35 strongly associated with cervical cancer
    • Genital warts or condylomata: caused by HPV 6 or 11 consider low risk for cervical cancer
  28. HPV nursing assessment
    • Collect heath hx
    • Assess for risk factors
    • manifestation: most asymptomatic; visible genital warts that are soft, moist or fleshed colored, appear on the vulva, cervix and inside and around vagina, anus, scrotum, or clusters
    • Dx: pap smear with HPV test
    • May disappear without treatment. treatment aimed at removing lesions with chemicals or physical destruction but not treating infection
    •  - freezing, burning, laser treatment, surgical removal
  29. Pelvic Inflammatory Disease (PID)
    definition: inflammation of the upper female genital tract. results from ascending polymicrobial infection to upper female reproductive tract. commonly it is due to untreated chlamydia or gonorrhea

    • complications- ectopic pregnancy, pelvic abscess, infertility, recurrent or chronic episodes of PID pr abdominal pain, pelvic adhension and depression
    • (accurate dx is critical)

    • Risk Factor: 
    • - sexually active in childbearing years
    • - under 25 yrs
    • cervix of teen girl and young women not fully mature
    • - douching, multiple sex partners, IUD contraception device
  30. PID therapeutic management
    therapeutic management- effective against n gonnorgorea and c trachmatis treat sexual partners

    • Outpatient: mild to moderate severe acute PID, broad spectrum antibiotics
    •   PO and IM
    •       cefraizone 250mg IM and Doxy 100 mg PO BID
    •       if no improvement in 72 hrs admit to hosp

    • Hospitalized
    • - IV broad spectrum antibiotic ( cefoxitin 2g IV every 6 hrs PLUS Doxy 100mg PO)
    • - oral fluids
    • - bed rest
    • - pain management
    • - outpatient f.u essential: retest 3-6 months and offer HIV testing 
  31. PID nursing assessment s/s
    Complete health hx

    • S/S
    • - oral temp > 101 f (>38.3c)
    • - abnormal cervical or vaginal mucopurulent discharge (green pus)
    • - pressence of abundant numbers of WBC on saline microscopy of vaginal fluid
    • - lower abdominal tenderness, ovarian and cervix tenderness, painful intercourse, N/V (really sick- scarring can happen so be careful)
    • - Labs: increased ESR + GC or chlamydia

    Definitive Dx- endometrial biopsy, transvaginal u/s, laparoscopic examination
  32. Infections characterized by vaginal
    • Vuvovaginal candidiasis- yeast infection
    • trichomoniasis
    • bacterial Vaginosis
  33. Vulvovaginal Candidiasis
    • Fungal infection of the vagina
    • cause: yeast or monilla
    • most common cause of vaginal discharge
    •  (not considered STI as yeast is normal flora of vagina)- it over grows

    • Therapeutic management: Vaginal suppositories or creams, miconazole, clotrimazole 
    • PO: fluconazole (diflucan) 150mg tab single

    the first yeast infection should be treated by the md
  34. Nursing assessment vulvovaginal candidiasis
    • curd type discharge
    • Predisposing factors
    • Pregnancy, oral contraceptives, antibiotics, DM, obesity, steriods, immunosuppressives, HIV, and tight restrictive clothing, nylon underwear, trauma to vaginal mucosa from chemical irritants, douching or bubble baths

    • Manifestations: Pruritis, thick, white, curd like vaginal discharge, vaginal soreness, vulvar burning, erythema, dyspareunia, external dysuria 
    • PE: speculum + white placques on vaginal wall
    • wet smear: hyphae and spores, pH normal
  35. Bacterial vaginosis
    • Third common infection of the vagina
    • - cause: bacteria Gardnerella vaginatis
    • - sexually associated infection characterized by alterations in vaginal normal flora. Lactobacilli replaced with high concentration of anaerobic bacteria
    •    multiple sex partners
    •    douching with decreases normal lactobacilli
    • Associated with preterm labor, PROM, chorioamnionitis, PP endometritis and PID
    • Therapeutic management: PO metronidazole (flagyl) or clindamycin cream
    • Nursing Assessment
    • think white vaginal discharge with "stale fishy odor"
    • Dx: vaginal pH > 4.5, positive, "whiff test" clue calls on wet mount microscopic exam

    alteration of the normal flora in vag
  36. Nursing management teaching prevention
    • use condoms consistently
    • cotton underwear
    • avoidance of irritants
    • good body hygiene wipe front to back
    • avoidance of douching or super absorbent tampons
    • choose to lead a healthy lifestyle
  37. Trichomoniasis
    Definition: StI caused by single cell protozoan parasite trichomonas vaginalis. men asymptomatic carrier

    • Nursing Assess.
    • S/S: heavy yellow/green or gray frothy bubbly discharge, vaginal pruritis, vulvar soreness, cervical bleeding, strawberry looking cervix
    • Vaginal pH greater than 4.5

    Therapeutic management: single 2 gram dose of oral metronidazole (flagyl) for both partners

    • Implications of trick
    • without treatment u are at increase risk fo HIV
    • pregnant women increase risk deliver premature, low birth weight NB

    parasite- looks like a flagllum 
  38. Trich Nx Management
  39. Pregnancy test prior treatment with flagyl
    • avoidance of sex until both client and partner complete therapy and are symptom free
    • no intake of alcohol with drug therapy- N/V
    • complete full antibiotic regimen
  40. Preventing STI's
    • Education about safer sex practices
    • behavior modication
    • contraception
    • vaccination
Card Set:
Sexually Transmitted infections
2014-11-11 03:48:54

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