Essentials of Maternity, Newborn, and Women's Health Nursing, 3rd Edition Chapter 5 Sexual Transmitted Infections

Genital warts disease

*(condylomata acuminata) *One of the most common STIs in the United States *Could lead to cancers of the cervix, vulva, vagina, anus, or penis *No cure; warts can be removed but virus remains

Assess the client for clinical manifestations of trichomoniasis which include;

*A heavy yellow/green or gray frothy or bubbly discharge *Vaginal pruritus and vulvar soreness *Dyspareunia *A cervix that may bleed on contact *Dysuria *Vaginal odor,described as foul *Vaginal or vulvar erythema *Petechiae on the cervix

Symptoms of gonorrhea might include

*Abnormal vaginal discharge *Dysuria *Cervicitis *Abnormal vaginal bleeding *Bartholin's abscess *PID *Neonatal conjunctivitis in newborns *Mild sore throat (for pharyngeal gonorrhea) *Rectal infection (asymptomatic) *Perihepatitis

Genital herpes treatment

*Acyclovir (Zovirax) *Other antivirals *DOES NOT CURE, just control symptoms *Sexual partners benefit from evaluation and counseling. If symptomatic , they need treatment. If asymptomatic, offer testing and education

Preventing Vaginitis

*Avoid douching to prevent altering the vaginal environment *Use condoms to avoid spreading the organism *Avoid tight, nylon underpants, and tight clothes *Wipe from front to back after using the toilet *Avoid powders, bubble baths, and perfumed vaginal sprays *Wear clean cotton underpants *Change out of wet bathing suits as soon as possible *Become familiar with the signs and symptoms of vaginitis *Choose to lead a healthy lifestyle

Assess the health history for significant risk factors for chlamydia, which may include

*Being an adolescent *Having multiple sex partners *Having a new sex partner *Engaging in sex without using a barrier contraceptive (condom) *Using oral contraceptives *Being pregnant *Having a history of another STIs

Genital herpes female symptoms

*Blister-like genital lesions *Dysuria *Fever, headache, muscle aches

Genital herpes male symptoms

*Blister-like genital lesions *Dysuria *Fever, headache, muscle aches

Syphilis diagnostic testing

*Blood tests *Venereal Disease Research Laboratory (VDRL), Rapid Plasma Reagin (RPR),and treponemal tests (e.g., fluorescent treponemal antibody absorbed [FTA-ABS]) can lead to a presumptive diagnosis *Dark-field examination and direct fluroescent antibody tests or lesions exudate or tissue provide definitive diagnosis of early syphillis

Chlamydia effects on fetus or newborn

*Can be infected during delivery *Eye infections (neonatal conjunctivitis), pneumonia, low birth weight, preterm birth, stillbirth

Gonorrhea effects on fetus or newborn

*Can be infected during delivery *Rhinitis, vaginitis, urethritis, inflammation of sites of fetal monitoring, chorioamnionitis, preterm birth, IUGR *Ophthalmia neonatorum can lead to blindness and sepsis (including arthritis and meningitis)

Syphilis effects on fetus or newborn

*Can be passed in utero *Can result in fetal or infant death *Congenital syphilis symptoms include skin ulcers, rashes, fever,weakened or hoarse cry, swollen liver and spleen. jaundice and anemia, various deformations

Infections characterized by cervicitis

*Chlamydia *Gonorrhea

Condoms during nonpenetrative sexual activity

*Condoms have been advocated for use during fellatio; unlubricated condoms may prove best for this purpose due to the taste of the lubricant *Other barriers, such as dental dams or an unlubricated condom, can be cut down the middle to form a barrier; these have been advocated for use during certain forms of nonpenetrative sexual activity (e.g., cunnilingus and anolingual sex)

Genital herpes effects on fetus or newborn

*Contamination can occur during birth *Intellectual disability, blindness, seizures, premature birth, low birth weight, death

Gonorrhea disease

*Curable STI *Client is often co-infected with Chlamydia trachomatis

Chlamydia disease

*Curable STI *Seen frequently among sexually active adolescents and young adults *Sexually active adolescents should be screened at least annually

Condom decreases sexual pleasure (sensation) Note: Often perceived by those who have never used a condom

*Encourage client to try *Put a drop of water-based lubricant or saliva inside the tip of the condom or on the glans of the penis before putting on the condom *Try a thinner latex condom or a different brand or more lubrication

Infections characterized by genital ulcers

*Genital herpes simplex *Syphilis *Pelvic inflammatory disease (PID) *Human immunodeficiency virus (HIV)

Genital herpes transmission mode

*Having sexual contact (vaginal, oral, or anal) with someone who is shedding the herpes virus wither during an outbreak or during a period with no symptoms *Can be transmitted through close skin-to-skin contact

Vaccine-preventable STIs

*Hepatitis A *Hepatitis B *Human papillomavirus (HPV)

Condoms decreases spontaneity of sexual activity

*Incorporate condom use into foreplay *Remind client that peace of mind may enhance pleasure for self and partner

CDC classifications of STIs

*Infections characterized by vaginal discharge *Infections characterized by cervicitis *Infections characterized by genital ulcers *Vaccine-preventable STIs *Ectoparasitic infections

Genital herpes disease

*Lifelong recurrent viral disease *Most people have not been diagnosed *These is no cure

Syphilis secondary infection female symptoms

*Maculopapular rash (hands & feets) *Sore throat *Lymphadenopathy *Flu-like symptoms

Trichomoniasis female symptoms

*Many women have symptoms but may be asymptomatic *Dysuria *Urinary frequency *Vaginal discharge (yellow, green, or gray, and foul odor) *Dyspareunia *Irritation or itching of genital area

Chlamydia male symptoms

*May be asymptomatic *Dysuria *Penile discharge (mucus or pus) *Urethral tingling *May lead to epididymitis (inflammation of the epididymis, the tubular structure that connects the testicle with the vas deferens) and sterility *Can cause inflammation of the rectum and lining of the eye (conjunctivitis) *Can infect the throat from oral sexual contact with an infected partnet

Chlamydia female symptoms

*May be asymptomatic *Dysuria *Vaginal discharge (mucus or pus) *Endocervicitis *May lead to pelvic inflammatory disease, ectopic pregnancy, and infertility *Can cause inflammation of the rectum and lining of the eye (conjunctivitis) *Can infect the throat from oral sexual contact with an infected partner

Gonorrhea female symptoms

*May be asymptomatic or no recognizable symptoms until the serious complications such as pelvic inflammatory disease *Dysuria *Urinary frequency *Vaginal discharge (yellow, foul) *Dyspareunia *Endocervicitis *Arthritis

Trichomoniasis treatment

*Metronidazole (Flagyl) *Sexual partners need evaluation, testing, and treatment also

Treatment of candidiasis include one of the following medications

*Miconazole (Monistat) cream or suppository *Clotrimazole (Mycelex) tablet or cream *Tercinazole (Terazol) cream or intravaginal suppository *Fluconazole (Diflucan) oral tablet

Trichomoniasis male symptoms

*Most infected men are asymptomatic *Dysuria *Penile discharge (watery, white)

Gonorrhea male symptoms

*Most produce symptoms but can be asymptomatic *Dysuria *Penile discharge (pus) *Arthritis *May lead to epididymitis and sterility *Symptoms of rectal infection include discharge, and itching, and occasional painful bowel movements with fresh blood

Clinical manifestations of chlamydia include

*Mucopurulent vaginal discharge *Urethritis *Bartholinitis *Endometritis *Salpingitis *Dysfunctional uterine bleeding

Syphilis latent infection female symptoms

*No symptoms *No longer contagious *Many people if not treated suffer no further signs and symptoms *Some people will go on to develop tertiary or late syphilis

Ectoparasitic infections

*Pediculosis pubis *Scabies

Syphilis treatment

*Penicillin G injected (if penicillin allergy, doxycycline or erthromycin) *Sexual partners need evaluation and testing

Allergy to latex

*Polyurethane male and female condoms are available *A natural skin condom can be used together with a latex condom to protect the man or woman from contact with latex

Assess the client's health history for predisposing factors for vulvovaginal candidiasis, which include

*Pregnancy *Use of oral contraceptives with high estrogen content *Use of broad-spectrum antibiotics *Obesity *Use of steroid and immunosuppressive drugs *HIV infection *Wearing tight, restrictive clothes and nylon underpants *Trauma to vaginal mucosa from chemical irritants or douching

Assess the client for clinical manifestations of genital/vulvovaginal canndidiasis. Typical symptoms, which can worsen just before menses, include:

*Pruritus *Vaginal discharge (thick, white, curd-like) *Vaginal soreness *Vulvar burning *Erythema in the vulvovaginal area *Dyspareunia *External dysuria

Teach the following preventive measures to women with frequent vulvovaginal candidiasis infections

*Reduce dietary intake of simple sugars and soda *Wear white, 100% cotton underpants *Avoid wearing, tight pants or exercise clothes with spandex *Shower rather than taking tub baths *Wash with a mild, unscented soap and dry the genitals gently *Dry underwear in a hot dryer to kill the yeast that clings to the fabric *Remove wet bathing suits promptly *Practice good body hygiene *Avoid vaginal sprays/deodorants *Avoid wearing pantyhose (or cut out the crotch to allow air circulation) *Use white, unscented toilet paper and wipe from front to back *Avoid douching (which washes away protective vaginal mucus) *Avoid the use of superabsorbent tampons (use pads instead)

Condoms require prompt withdrawal after ejaculation

*Reinforce the protective nature of prompt withdrawal and suggest substituting other postcoital sexual activities

Condoms are embarrassing, juvenile, "unmanly"

*Remind client that it is "manly" to protect himself and others

Condoms are a poor fit (too small or too big, slips off, uncomfortable)

*Smaller and larger condoms are available

Gonorrhea diagnostic testing

*Staining samples directly for the bacterium, detection of bacterial genes or DNA in urine, and growing the bacteria in laboratory cultures *More than one test may be used

To diagnose bacterial vaginosis, three of the following four criteria must be met:

*Thin, grayish white homogeneous vaginal discharge *Vaginal pH> 4.5 *Positive "whiff test" (secretion is mixed with a drop of 10% potassium hydroxide on a slide, producing a characteristic stale fishy odor) *The presence of clue cells on wet-mount examination

Proper Condom Use

*Use latex condoms *Use a new condom with each act of sexual intercourse. Never reuse a condom *Handle condoms with care to prevent damage from sharp objects such as fingernails and teeth *Ensure condom has been stored in a cool, dry place away from direct sunlight. Do not store condoms in wallet or automobile or anywhere they would be exposed to extreme temperatures *Do not use a condom if it appears brittle, sticky, or discolored. These are signs of aging *Put condom on before any genital contact *Put condom on when penis is erect. Ensure it is placed so it will readily unroll *Hold the tip of the condom while unrolling. Ensure there is a space at the tip for semen to collect, but make sure no air is trapped in the tip *Ensure adequate lubrication during intercourse.If external lubricants are used, use only water-based lubricants such as KY-jelly with latex condoms. Oil-based or petroleum-based lubricants, such as body lotion, massage oil, or cooking oil can weaken latex condoms *Withdraw while penis is still erect, and hold condom firmly against base of penis

Gonorrhea treatments

*Usually a single does of one of the following: *Cefixime (Suprax) *Ciprofloxacin (Cipro) *Ofloxacin (Floxin) *Levofloxacin (Levaquin) **NO FLOXIN or CIPRO if < 18 YR OLD or PREGNANT**

Trichomoniasis transmission mode

*Vaginal intercourse with an infected partner *May be picked up from direct genital contact with damp or moist objects, such as towels, wet clothing, or a toilet seat

Genital warts diagnosis testing

*Visual inspection *Abnormal Pap smear may indicate cervical infection of HPV

Genital herpes diagnostic testing

*Visual inspection and symptoms or culture *Virologic and type-specific serologic tests can tell if herpes simplex virus II is present but does not confirm genital herpes, though most providers will assume a positive HSV II means genital herpes

Infections characterized by vaginal discharge

*Vulvovaginal candidiasis *Trichomoniasis *Bacterial vaginosis

Genital warts male symptoms

*Wart-like lesions that are soft, moist, or flesh colored and appear on scrotum or penis *Sometimes appear in clusters that resemble cauliflower-like bumps, and are either raised or flat , small or large

Genital warts female symptoms

*Wart-like lesions that are soft, moist, or flesh colored and appear on the vulva and cervix and inside and surrounding the vagina and anus *Sometimes appear in clusters that resemble cauliflower-like bumps, and are either raised or flat, small or large

Fear of condom breakage may lead to less vigorous sexual activity

*With prolonged intercourse, lubricant wears off and the condom begins to rub. Have a water-soluble lubricant available to reapply

Chlamydia treatment

*azithromycin (Zithromax) *doxycycline (Vibramycin) *erythromycin (EES) *ofloxacin (Floxin) *Sexual partners need evaluation, testing, and treatment also

Syphilis tertiary infection female symptoms

*tumors of skin, bones, and liver *CNS symptoms *CV symptoms *Usually not reversible at this stage

Syphilis secondary, latent, and tertiary male symptoms

All similar to female symptoms

Syphilis primary infection male symptoms

Chancre on place of entrance of bacteria (usually penis but can develop in other parts of the body)

Syphilis primary infection female symptoms

Chancre on place of entrance of bacteria (usually vulva or vagina but can develop in other parts of the body)

Chlamydia causative organism

Chlamydia trachomatis (bacteria)

Gonorrhea maternal effects

Chorioamnionitis, preterm birth, PROM, intrauterine growth restriction (IUGR), and postpartum sepsis

Genital herpes causative organism

Herpes simplex virus II (HSV II)

Genital warts causative organism

Human Papillomsvirus

Genital warts

May develop warts in the throat (laryngeal papillomatosis); uncommon but life threatening

Trichomoniasis diagnosis testing

Microscopic evaluation of vaginal secretions or culture

Gonorrhea causative organism

Neisseria gonorrhoeae (bacteria)

Trichomoniasis effects on fetus or newborn

Premature rupture of membranes, preterm birth, low birth weight

Syphilis causative organism

Treponema pallidum (spirochete bacteria)

Trichomoniasis causative organism

Trichomonas vaginalis (protozoan)

Primary symptom of bacterial vaginosis

are a thin, white homogenous vaginal discharge and a characteristic "stale fish" odor

sexually transmitted infections (STI)

are infections of the reproductive tract caused by microorganisms transmitted through vaginal, anal, or oral sexual intercourse

Genital herpes fetal effects

birth anomalies and transplacental infection

Candidiasis fetal effects

can acquire thrush in the mouth during birthing process if mother is infected

Hepatitis B fetal effects

can become chronic carrier of hepatitis B, which may lead to liver cancer or cirrhosis

Syphilis fetal effects

congenital syphilis, leading to multisystem organ failure and structural damage, and intellectual disability

Chlamydia fetal effects

conjunctivitis, which can lead to blindness; low birth weight, and pneumonitis

Chlamydia diagnostic testing

culture fluid from urethral swabs in males or endocervical swabs for females and conjunctival secretions in neonates

Gonorrhea fetal effects

eye infections (gonococcal ophtalmia) , which can cause blindness

Trichomoniasis maternal effects

has been implicated in causing the premature rupture of membranes (PROM) and preterm births

Bacterial vaginosis maternal effects

increase risk for spontaneous abortion, PROM, chorioamnionitis, postpartum endometritis, and preterm labor

genital/vulvovaginal candidiasis

is one of the most common causes of vaginal discharge

Human paillomavirus (HPV) maternal effects

may cause dystocia if large lesions

Hepatitis B maternal effects

may cause preterm birth; can be transmitted to fetus if active in last trimester

Human paillomavirus (HPV) fetal effects

none known

Chlamydia maternal effects

postpartum endometritis, PROM, and preterm birth

Candidiasis maternal effects

resistant to treatment during pregnancy; uncomfortable localized genital itching and discharge

Bacterial vaginosis fetal effects

risk of neonatal sepsis

Trichomoniasis fetal effects

risk of prematurity

Syphilis transmission mode

sexual contact with an infected person

Genital herpes maternal effects

spontaneous abortion, intrauterine infection, preterm labor, PROM, and IUGR

Syphilis maternal effects

spontaneous abortion, preterm birth, and stillbirth

Genital warts transmission mode

vaginal, anal, or oral sex with an infected partner

Gonorrhea transmission mode

vaginal, anal, oral sex, and by childbirth

Chlamydia transmission mode

vaginal,anal,oral sex, and by childbirth