Maternity Exam #3: Common Gynecological Infections

A woman has been diagnosed with trichomoniasis and asks the nurse when it would be safe to resume sexual activity. How should the nurse respond?

"After treatment you must be symptom free to resume sexual activity."

A client diagnosed with genital herpes asks the nurse about future sexual experiences. Which response by the nurse is appropriate?

"If you plan to have future sexual relationships, you need to let your partner know of your history prior to intercourse."

A client with genital herpes asks the nurse about what to expect with the infection. Which response by the nurse is appropriate?

"You have to be extremely careful in the future. Even if you do not have symptoms, you could still spread the infection to others."

Normal vaginal pH

3.8-4.5; protects it by being acidic

what accounts for the most cases of vaginitis?

BV, candidia, & trichomoniasis

syphilis

a bacterial STI caused by treponema pallidum that occurs in 4 primary stages involving a painless canchre, systemic rash, and multiple CNS and organ system effects; also known as the "great pretender" since it has varying manifestations and similarities to other diseases.

Hepatitis C

a bloodborn viral infection that has a low risk of sexual transmission that presents risks for liver cirrhosis, failure, and cancer but has nonspecific symptoms such as fatigue --> acute or chronic

what medication is used for treatment of herpes symptoms?

acyclovir; does not treat just suppresses symptoms

Rapid Plasma Reagin (RPR)

blood test for syphilis

urinary tract infections

infections that occur as a result of bacterias ascending into the urethra, bladder, and kidneys

how is HPV infection screend for?

pap smear and HPV test

colposcopy

the biopsy of abnormal cervical cells in the diagnosis and screening for cervical cancer

cystitis

the most common form of a UTI that is limited to the bladder and consist of symptoms such as urinary frequency, urinary urgency, a sensation of incomplete emptying, pain with urination, and sometimes hematuria

A client who has been treated for recurring gonorrhea visits the sexual health clinic reporting dysuria, urinary frequency, and whitish-yellow vaginal discharge. A pelvic examination reveals cervicitis. How would the nurse interpret these findings?

the possibility of a chlamydia infection

primary infection of HSV

.occurs in a person with no preexisting antibodies to either HSV1 or HSV2

which types of HPV cause the most cases of cervical cancer?

16 and 18

annual screening is done for chlamydia under which age?

25

what is the incubation period for HPV?

3 weeks to 3 years

which types of HPV cause the most cases of visible genital warts?

6 and 11

Whiff test

A test for bacterial vaginosis (BV). A positive result occurs when a strong, fishlike odor is released after one to two drops of KOH are added to the slide (or a cotton swab soaked with discharge).

CVA tenderness

Costo-vertebral Angle tenderness; tenderness over the kidney's

When describing sexually transmitted infections and testing, the nurse explains that a client is typically tested for chlamydia, gonorrhea, and syphilis at the same time for which reason?

It is not unusual for clients to have concurrent infections with more than one sexually transmitted infection (STI).

A nurse is caring for a client undergoing treatment for bacterial vaginosis. Which instruction should the nurse give the client to prevent recurrence of bacterial vaginosis?

Practice monogamy.

During a routine physical examination, the client is noted to have a Bartholin cyst abscess. The nurse recognizes the need to obtain testing to rule out:

STI.

Strawberry cervix

Trichomonas vaginalis; the cervical mucosa may reveal punctate hemorrhages with accompanying vesicles or papules

pyelonephritis

a UTI that as ascended to the kidneys that includes symptoms such as fever, chills, flu-like symptoms, and back pain or CVA tenderness; can have long-term consequences such as infection, kidney failure, shock, multiple organ dysfunction, sepsis, and death if the right antibiotic is not prescribed

chlamydia

a bacterial STI that can cause urethritis in males and cervicitis, PID, periphepatitis, or reactive arthritis in females but is often assymptomatic and therefore can cause infertility and ectopic pregnancy long term due to inflammation of the fallopian tubes, ovaries, and endometrium that results in scarring that, in turn, increases the risk for both infertility and ectopic pregnancy

Gonorrhea

a bacterial STI that can cause urethritis in men and cervicitis in women and left untreated can cause infertility, ectopic pregnancy, and pelvic pain that often is asymptomatic After the microorganism disseminates throughout the body, the client may manifest a skin rash, fever, and painful joints. Other symptoms such as infections of the urinary tract or vagina, sore throat, intermenstrual bleeding due to cervicitis, and painful urination are associated with the organism's invasion of those structures, depending on the nature of the sexual contact.

pelvic inflammatory disease (PID)

a condition that is most commonly caused by chlamydia and gonorrhea in the upper female genital tract that causes fever, pain, chills, vaginal discharge, bleeding, and malaise that most commonly presents with abdominal tenderness; can ultimately cause infertility and ectopic pregnancy, sepsis and even death; on exam seen with thick yellow discharge from the cervix, numerous WBC and cervical motion tenderness

preexposure prophylaxis (PrEP)

a daily medication that almost eliminates transmission of the HIV virus among people engaging in high risk sexual behaviors or working with high risk populations; but costs a lot of money so that is a large barrier

A nurse is presenting a program for a local women's group about STIs. When describing the information, the nurse would identify which infection as the most common cause of vaginal discharge?

candidiasis

Candidia albicans

cause of yeast infections that appears as a spagetti (pseudohyphae) and meatballs (spores) appearance

what is the treatment for syphilis?

penicillin G

antiretroviral therapy (ART)

therapy that reduces the mortality and progression of HIV to AIDS by reducing viral load

azithromycin or doxycycline

treatment for chlamydia

Ceftriaxone IM and azithromycin PO

treatment for gonorrhea since penacillin no longer works since the bacterium has created new strains resistant to antibiotics

Metrionidazole

treatment for trichomoniasis - can prevent scarring

fluconazole and OTC vaginal preparations

treatment for yeast infections

most conditions that affect the vagina have less to do with _______________ and more to do with ______________

true infection; overgrowth of naturally occuring microbes

Bacterial Vaginosis (BV)

type of vaginosis that is associated with a higher than normal pH (>4.5) in the vagina with decreased lactobacilli due to pregnancy, intercourse, tampons, antibiotics, contraception, bleeding, menopause, feminine hygiene products that allows certain bacteria to become dominant and cause symptoms such as fishy vaginal odor and thin white/grey vaginal discharge, is positive for a whiff test, & clue cells are present.

candidiasis vulvovaginitis (yeast infection)

type of vaginosis that is itchy and associated with high glucose environments (diabetes), antibiotics, restrictive clothing, and underear made with artificial fibers that causes a thick cottage cheese-like discharge or acute vaginal dryness and an inflammed vulvua; caused often by C.albicans, C. glabrata and C.tropicalis which appear often as pseudohypae, spores, lactobacilli, & squamous epithelial cells.

gardisil

vaccine for the most dangerous types of HPV (6, 11, 16, 18) that is given to females

cervarix

vaccine for the most dangerous types of HPV (6, 11, 16, 18) that is given to males

How is HSV detected?

viral culture

Lymphogranuloma venereum (LGV)

an STI that consists of a painless ulcer at first that progresses to adenopathy and absesses

pubic lice

an ectoparasitic infection transmitted sexaully that consists of pruritis with lice or hits of the genitals

scabies

an ectoparasitic infection transmitted sexually that consists of intensely pruritic dermatitis with lesions of the genitals

hepatitis B immunglobulin

an injection given to those who have been exposed to hepatitis B that are not immune or their immunization status is unknown

A client has been diagnosed with condylomata acuminata and requires treatment for the condition. What would be the treatment of choice?

cryotherapy it can penetrate deeper than other forms of therapy to eliminate the lesion. The client would be encouraged to stop sexual contact until the lesions are resolved.

A client with primary syphilis is allergic to penicillin. The nurse would expect the primary care provider to prescribe which agent?

doxycycline

sulfamethoxazole/trimethoprim

first line antibiotic to treat simple cystitis in which many individuals have an allergy

A nurse is caring for clients who have a history of genital herpes infection. The client most at risk for an outbreak of genital herpes is the client who reports:

genital pruritus and paresthesia.

HSV2

herpes virus that is most commonly associated with genital herpes; associated with more frequent outbreaks

HSV1

herpes virus that is most commonly associated with oral herpes

latent stage

stage of syphilis that consists of an asymptomatic period that can last for years; retesting needs to be done at 6 months, 12 months, and 24 month as well as testing for HIV

tertiary stage

stage of syphilis that may affect multiple organ systems including the brain, nerves, and joints

primary stage

stage of sypilis that consists of a single painless genital canchre or multiple unconfortable lesions; after treatment will need to be retested at 6 and 12 months

urine culture

a test to identify any bacteria present in a urine sample that is much more accurate than a point of care urinalysis but takes several days to complete

hepatitis B vaccine

a vaccine that is administered in 3 doses (the second one 1 month after the first and the 3rd 6 months after the 1st) that is recommended to be started at birth and prevents hepatitis B infection

viral hepatitis

inflammation of the liver caused hep A,B or C in which only Hep B is really transmitted during intercourse

vaginitis

inflammation of the vagina

what HIV viral load is considered high and contraindicates vaginal delivery?

more than 1000 copies/mL

recurrent infection HSV

periodic manifestations of a preexisting infection

vaginosis

refers to any abnormality of the discharge of the vagina.

nonprimary infection HSV

refers to the acquisition of HSV1 in someone who already has antibodies to HSV2, or acquisition of HSV2 in someone who already has antibodies to HSV1.

acquired immunodeficiency syndrome (AIDS)

stage of HIV infection in which one's CD4 count falls below 200 cells/uL or when the patient becomes diagnosed with an AIDS-defining condition

acute infection

stage of HIV infection that consists of the first 6 months after contraction characterized by flu-like symptoms, fever, headache, sore throat, enlarged lymph nodes and rash

secondary stage

stage of syphilis that consists of a systemic rash Other symptoms may also occur, which means that the infection has spread throughout the body such as a sore throat and flu like symptoms; after treatment will need to be retested at 6 and 12 months

Nitrofurantoin

a first line antibiotic used to treat simple cystitis

point of care urinalysis

a test that is used to assess for UTIs that assess for leukocytes, nitrates, and blood in the urine that can be innacurate especially with use of urinary analgesics but results are immediate

pap smear

a test that screens for cellular abnormalities of the cervix and endocervical canal that is used for the detection of cervical cancer; recommended to begin at age 21 or within 3 years of becomming sexually active

trichomoniasis

a type of vaginosis that is sexually transmitted and causes a frothy, yellow or green copious discharge, fishy odor, vulvular irritation, "strawberry cervix", dysuria, urinary frequency, and off schedule bleeding that can lead to pelvic inflammatory disease, cystitis, cellulitis, infertility, preterm birth, premature rupture of membranes and infection of infant at birth if untreated; caused by protozoan T. vaginalsis and is diagnosed via motile trichomonads, a very high pH (5.0), & copious white blood cells, positive for whiff test

molluscum contagiosum

a very infectious STI that is also common in children that consists of a large DNA virus causing round, firm, shiny, white papules with an indented center

human papillomavirus (HPV)

a viral STI that consists of genital warts or condylomata and is the primary cause of cervical cancer

herpes simplex virus (HSV1 and HSV2)

a viral STI that is transmitted by skin-to-skin contact, usually of the mucosa, that is contagious just prior, during, and after an outbreak and consits of vesicular lesions of the mouth or genitals

human immunodeficiency virus (HIV)

a viral infection that can be transmitted sexually, contaminated blood products, and IV drug use that consists of 3 stages of infection and destroys the body's ability to fight infection, allowing for an opportunistic infection to destroy the immune system; The risks for sexual transmission include STIs that cause skin breakdown, such as HSV and syphilis, the presence of other STIs, the lack of penile circumcision, receptive vaginal or anal sex, multiple sexual partners, and the lack of condom use.

Hepatits B

a virus transmitted perinatally, sexually, or through IV drug use that consists of upper right quadrant pain, discomfort, nausea, vomiting, anorexia, jaundice, and fatigue that places one at risk for cirrhosis, liver failure, liver cancer, and death --> acute or chronic

Hepatitis A

a virus transmitted the fecal-oral route that has an incubation period of 28 days and is a risk in those with illicit drug use, living in a residential facility, exposure to day care centers, and homosexual activity between man and man and consists of symptoms such as abdominal pain, flu-like symptoms, nausea, vomiting, anorexia, jaundice, and pruritis; generally self-limiting with a full recovery in 2-3 months --> acute

Phenazopyridine

an over the counter urinary analgesic for pain of cystitis that does not cure a UTI and changes the color of urine to bright orange; should not take more than 2 days because it can mask the symptoms of a UTI

ciprofloxacin

antibiotic used to treat pyelonephritis; can be used to treat simple cystitis as well but is not first line because of concerns about building antibiotic resistance

chronic HIV without AIDS

asymptomatic stage of HIV infection that begins 6 months after infection and lasts until the CD4 count falls below 200; can last for less than a decade if treatment is not obtained

what is the most commonly diagnosed bacterial STI in the US?

chlamydia

After teaching a group of young adult women on preventing pelvic inflammatory disease, the nurse determines that the teaching was successful when the group identifies which method as effective?

having infected sexual partners receive treatment preventing pelvic inflammatory disease include advising sexually active females to insist their partners use condoms, discouraging routine vaginal douching, encouraging regular sexually transmitted infection screening, and emphasizing the importance of having each sexual partner receive treatment if infected.

AIDS defining illnesses

illnesses that are commonly not seen in healthy individuals and consist of cadidiasis of the esophagus, bronchi, trachea, or lungs, invasive cervical cancer, cytomegalovirus disease, encephalopathy, kaposi sarcoma, lymphoma, recurrent pneumonia, recurrent salmonella septicemia, toxoplasmosis of the brain, and wasting syndrome

condyloma acuminatum

lesion that appears as a result of human papilloma virus; on the skin, lesions appear as cauliflower-like warts, and on mucous membranes, they have a flat appearance; also known as venereal or genital warts

what CD4 count is diagnostic of AIDS?

less than 200 cells/uL

postpartum antiretroviral (ARV) drugs

medications given to newborns who were prenatally exposed to HIV to reduce the risk of perinatal transmission of HIV

what is the treatment for PID?

multiple antibiotics; intramuscular (IM) ceftriaxone as a single dose and doxycycline twice daily for 14 days. Depending on the clinical picture, metronidazole twice daily for 14 days may also be prescribed.

A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect which finding once the microorganism disseminates throughout the body?

painful joints