OB chapter 7 : STIs and other infections

TORCH infections

- A group of organisms capable of crossing the placenta. - affect a pregnant woman and her fetus - infections provide influenza-like symptoms in the mother , but fetal and neonatal effects are more serious

Group B streptococcus

- May be considered a part of normal vaginal flora in a woman who is not pregnant and is present in about 25% of healthy pregnant woman. - infection has been associated with poor pregnancy outcomes - recommended that all women be screen at 35 to 37 weeks of gestation - treatment: penicillin G

Syphilis

- earliest described STIs - can be transmitted through kissing, biting, or oral-genital sex - transplacental transmission can occur at any time during pregnancy - complex disease that can leas to serious systemic disease and even death when untreated

Hepatitis A

- flulike symptoms with malaise,. Fatigue. Anorexia, nausea, pruritus , fever and right upper quadrant pain - fecal-oral-route by ingestion of contaminated food - can be transmitted during sexual activity

Prevention/identification/ management of toxoplasmosis

- good hand washing - avoid eating raw or rare meat, and exposure to litter used by infected cats - toxoplasmosis tiger should be checked if there are cats in the house - if tiger is rising during early pregnancy, therapeutic abortion may be considered an option

Trichomoniasis

- i almost always an STI and is also a common cause of vaginal infection - yellowish to greenish, frothy mucopurulent , copious, malodorous discharge - inflammation of the vulva, vagina, or both - management: metronidazole

Hepatitis B

- infection, disease of the liver and if often a silent infection -The virus most threatening to the fetus and neonate - people at risk are heath care workers and public safety workers exposed to blood on the workplace

Hepatitis C

- most people are asymptomatic, or have general influenza-like symptoms Risk factors: having STIs, multiples sexual partners, history of blood transfusion, and * history of IV drugs use* Transmission: readily transmitted through exposure to blood and less efficiently through semen, saliva, or urine

Physical inspection of HPV

- rotate speculum blades until all areas are visualized ( vagina exam) - Diagnose based of characteristics ( papillary swelling singly or in clusters, multiple lesions, multiple fine finger Iike projections, flat tipped papules.) - gloves should be changed between vaginal and rectal examinations to avoid potential spread

Human papilloma virus (HPV)

- the most common viral STI in ambulatory health care setting - also called genital warts - lesions in women are commonly seen in the posterior part of the introitus; however lesions also are found on the buttocks, the vulva, vagina, anus, and cervix. - there's is a link between some types of this infection and cervical cancer

Chlamydia

- the most commonly reported STI in American women - these infections are often silent and highly destructive ; their sequelae and complications can be very serious - untreated infections can lead to acute salpingitis or pelvic inflammatory disease - ages 15 - 24 have the highest rates of infection - highest in black women

Gonorrhea

- the oldest communicable disease in the United States, second to chlamydia in reported cases - highest among sexually active teenagers, young adults, and blacks - reportable communicable disease ***

Genital herpes simplex virus

-Infection that can result in painful recurrent genital ulcers and is caused by two different antigen subtypes . - recurrent episodes less every than the initial infection -can have adverse gene to on the mother and fetus during pregnancy -

Bacterial vaginosis

-The most common cause of vaginal symptoms . - associated with preterm labor and birth - women complain of "fishy odor" - discharge profuse, think, white or gray, or milky

The most common STIs in women are

1. Chlamydia 2.Gonorrhea 3. Human pappillomavirus 4. Herpes simples virus (type 2) 5. Syphillis 6. Human immunodeficiency virus (HIV)

Perinatal complications of gonorrhea

1. Premature rupture of memebranes 2. Preterm birth 3. Chorioamnionitis 4. Neonatal sepsis 5. Intrauterine growth restriction 6. Maternal postpartum sepsis 7. Amniotic infection syndrome (manifested by placental, fetal & umbilical cord inflammation after premature rupture of membranes 8. Ophthalmia neonatorum (highly contagious , if untreated can cause blindness to newborn )

Physical barrier

A condom is an example of what type of barrier. ?

AROM

Artificial rupture of membranes

Primary syphilis

Characterized by a lesion, the chancre

Secondary syphilis

Characterized by a symmetric maculopapular rash on the palms and soles, generalized lymphadenopathy. The individual may experience fever*, headache* , and malaise*.

Ophthalmia neonatorum

Chlamydia is teh most common infectious cause of _______ ________.

Risk reduction measures

Essential component of primary prevention 1. Knowledge of her partner 2. Reduction of the number of partners 3. Low risk sex 4. Avoid the exchange of bodily fluids 5. Vaccination

FSE

Fetal scalpel electrode

Rubella

German measles virus. Maternal effects: rash, fever, mild symptoms such as headache , malaise, myalgias, and arthralgias, postauricular lymph nodes may be swollen Fetal effects: deafness, eye defects, central nervous sys defects, and cardiac defects

Pelvic Inflammatory Disease (PID)

Is an infectious process that most commonly involves the uterine (fallopian) tubes ( salpingitis), uterus (endometriosis) , and more rarely, the ovaries and peritoneal surfaces.

HSV-1

Is transmitted non sexually. More commonly associated with gigivostomatitis, and oral labial ulcers

HSV-2

Is usually transmitted sexually ; associated with genital lesions

Culture

Laboratory diagnosis of chlamydia is by __________ ( expensive and labor intensive)

Azithromycin or amoxicillin

Management if woman is pregnant with chlamydia

Herpes

Management: acyclovir

Hepatitis B management

Management: no specific treatment ; vaccine available ; avoid sharing saliva through kissing, or sharing of silverware or dishes

Syphilis

Management: penicillin G

Toxoplasmosis

Maternal effects: most infections asymptomatic; woman immune after first episode Fetal effects: congenital infection sis most likely to occur when maternal infections develops during the third trimester. The risk of fetal injury, however, is greatest when maternal infection occurs during the first trimester.

Conjunctivitis or pneumonia

More than half of infants born to mother with chlamydia will develop _______ or _________ after perineal exposure to themother's infected cervix

Chlamydial

Past _________ infections are associate with ectopic pregancy and tubal factor infertility

PROM

Premature rupture of memebranes

Maternal infection with HSV-2

Primary infection during the first trimester have been associated with increased miscarriage rates. The most severe complication of ______ infection is neonatal herpes, a potentially fatal of severely disabling disease.

Secondary prevention

Prompt diagnosis and treatment of current infections, can also prevent personal complications and transmission to others.

Chemical barriers

Provide dual contraceptive and protection against bacterial STIs; ex. Nonoxynol-9 (N-9) spermicides.

PID (pelvis inflammatory disease )

Risk factors for acquiring _________ 1. Young age 2. Nulliparity 3. Multiple partners 4. High rate of new partners 5. History of STIs and PID

Gonorrhea

S/s of women : 1. Purulent endocervical discharge 2. Menstrual irregularities ' 3. Pain ( pelvic or lower abdominal ; longer more painful menses) 4. Dysuria, vague abdominal pain, low backache

SROM

Spontaneous rupture of memebranes

Toxoplasmosis, Other infections, Rubella, cytomegalovirus (CMV), herpes

TORCH stands for ...?

Primary prevention

The most effective way of reducing the adverse consequences of STIs for women and for society.

Pelvis inflammatory disease

The most serious complications of chlamydia infections.

HIV

Treatment of _________- infected women with the triple-drug antiretroviral therapy (ART) or highly active antiretroviral therapy (HAART) during pregnancy has been proven to decrease the mother-to-child transmission to 1% -2% . - no cure - cesarean birth are recommended

HPV

Untreated ________ infection resolves spontaneous in young women because their immune system may be strong enough to gift the infection. No therapy has been showing to eradicate it.

Tertiary syphilis

Will develop in about one third of the infected women if untreated. Neurological, cardiovascular , musculoskeletal, or multi organ system complications can develop in this stage.

PID

Women who have had _______ are at increase risk for - ectopic pregnancy - infertility *** - and chronic pelvic pain

Candidiasis

Yeast infection , the second most common type of vaginal infection in the U.S. Management: miconazole & clotrimazole