Chapter 7
Condylomata lata (secondary syphilis)
(broad, painless, pink-gray wart-like infectious lesions) may develop on the vulva, perineum, or anus
What medication should a person diagnosed with hepatitis A virus avoid
(e.g., acetaminophen, ethyl alcohol) Medications and other ingested substances that might cause liver damage or are metabolized in the liver
Transmission of HIV
- Exchange of bodily fluid -blood, semen, vaginal secretions, breast milk -Sexual contact, shared needles, contact with blood, mother to baby
Systemic antiviral medications used to partially control the symptoms and signs of HSV infections:
-Acyclovir -Valacyclovir -Famciclovir
When to screening for syphilis
-All women who were diagnosed with another STI or have HIV -Screen all pregnant women at the first prenatal visit, third trimester, and again before birth
Candidiasis (yeast infection) risk factor
-Antibiotic therapy -Diabetes -Pregnancy -Obesity -Diets high in refined sugars -Use of corticosteroids and hormones Immunosuppressed states
Vaginal Infections
-Bacterial vaginosis -candidiasis -trichomoniasis
Those with Pelvic Inflammatory Disease (PID)
-Ectopic pregnancy -Infertility -Chronic pelvic pain
STI risk reduction measures
-Knowledge of partner -Reduction of the number of partners -Low-risk sex -Avoiding exchange of body fluids -Vaccination
Tertiary stage of syphilis
-Neurologic -cardiovascular -musculoskeletal -multiorgan-system complications can develop in this stage
gonorrheal infection symptoms in woman
-Purulent endocervical discharge, but this is more often minimal or absent. -Menstrual irregularities may be the presenting symptom -pain—chronic or acute severe pelvic or lower abdominal pain or longer, more painful menses. -dysuria -vague abdominal pain -low backache prompts a woman to seek care. Gonococcal rectal infection may occur in women after anal intercourse. Individuals with rectal gonorrhea may be completely asymptomatic or, conversely, have severe symptoms with profuse purulent anal discharge, rectal pain, and blood in the stool. Rectal itching, fullness, pressure, and pain are also common symptoms, as is diarrhea. A diffuse vaginitis with vulvitis is the most common form of gonococcal infection in prepubertal girls. There may be few signs of infection; on the other hand, vaginal discharge, dysuria, and swollen, reddened labia may be present.
TORCH infections include
-Toxoplasmosis -Other infections (e.g., hepatitis) -Rubella, cytomegalovirus -Herpes simplex
Nontreponemal tests for syphilis
-Venereal Disease Research Laboratories (VDRL) -Rapid plasma reagin (RPR) test
Candidiasis other comfort measures
-Women who have extensive irritation, swelling, and discomfort of the labia and vulva can take sitz baths -Adding colloidal oatmeal powder to the bath -Not wearing underpants to bed -avoid using tampons during menses because the tampon will readily absorb the medication -avoid intercourse during treatment
Bacterial Vaginosis (BV) risk factors
-Women with new or multiple sexual partners -those who douche or do not use condoms -those who lack vaginal lactobacilli are at higher risk for infection. -(women who have never been sexually active are rarely affected)
To decrease the risk of neonatal GBS infection
-all women should be screened at 35 to 37 weeks of gestation using a rectovaginal culture -intravenous antibiotic prophylaxis (IAP) be offered during labor to all who test positive.
Hepatitis B Virus (HBV) symptoms
-arthralgia (joint pain) -arthritis, -lassitude, -anorexia, -nausea, -vomiting, -headache, -fever, -mild abdominal pain
Zika virus transmission
-bites from the Aedes mosquito. -via sexual contact by semen
Later Hepatitis B Virus (HBV) symptoms the woman may have
-clay-colored stools, -dark urine, -increased abdominal pain, -jaundice
Over the counter candidiasis Prevention/treatment
-dairy products [yogurt] or powder, tablet, capsule, or suppository supplements) -garlic
Risk factors for neonatal GBS
-infection include positive prenatal culture for GBS in the current pregnancy -preterm birth of less than 37 weeks of gestation -prelabor rupture of membranes for a duration of 18 hours or more -intrapartum maternal fever higher than 38°C (100.4°F) -a positive history of early-onset neonatal GBS
Primary syphilis
-is characterized by a primary lesion the chancre that appears 5 to 90 days after infection. This lesion often begins as a painless papule at the site of inoculation and then erodes to form a nontender, shallow, indurated, clean ulcer several millimeters to centimeters in size
Ophthalmia neonatorum
-is the most common manifestation of neonatal gonococcal infection -it is highly contagious -if untreated, it may lead to blindness of the newborn
Syphilis transmission
-kissing -biting -oral-genital sex. -Transplacental transmission can occur at any time during pregnancy; infected mother to her unborn child through the placenta, bacterium enters the body through any openings in the skin or mucous membranes
Trichomoniasis vaginalis symptoms
-may be asymptomatic -frothy yellowish to greenish discharge -mucopurulent, copious, and malodorous -Inflammation of the vulva, vagina, or both -pruritus -Dysuria and dyspareunia -Typically the discharge worsens during and after menstruation -cervix and vaginal walls will demonstrate the characteristic "strawberry spots" or tiny petechiae, and the cervix may bleed on contact -In severe infections, the vaginal walls, cervix, and occasionally also the vulva may be acutely inflamed.
Group B Streptococcus (GBS)
-may be considered a part of the normal vaginal flora in a woman who is not pregnant -has been associated with poor pregnancy outcomes
Group B Streptococcus (GBS) and neonatal
-morbidity and mortality -usually resulting from vertical transmission from the birth canal of the infected mother to the infant during birth
Bacterial Vaginosis (BV) symptoms
-overgrowth of normal vaginal flora -Profuse, thin, watery, white-gray discharge -"fishy" odor -mild irritation or pruritus
Perinatal complications of gonococcal infection include
-prelabor rupture of membranes -preterm birth -chorioamnionitis -neonatal sepsis -intrauterine growth restriction -maternal postpartum sepsis.
Risk factors for hepatitis A include
-sexual and household contacts with others who have hepatitis A -children as well as caregivers exposed to hepatitis A in nursery, daycare, or preschool; -men who have sex with men (MSM); -IDUs -international travelers -persons exposed to a common-source food or water outbreak.
Alternative measures that may increase comfort when HSV-2 lesions are active include:
-warm sitz baths with baking soda -keeping lesions dry by blowing the area dry with a hair dryer -set on cool -patting dry with a soft towel; -wearing cotton underwear and loose clothing; -using drying aids such as hydrogen peroxide -Burow solution, or oatmeal baths; -applying cool, wet black teabags to lesions -applying compresses with an infusion of cloves or peppermint oil and clove oil to lesions.
Candidiasis symptoms
-white creamy or cottage cheese discharge -vulvar and possibly vaginal pruritus -red and swollen vulvar
Age range that has the highest rates of Gonorrhea infection
20- to 24-year age group among both men and women
human immunodeficiency virus (HIV)
A virus that causes severe depression of the cellular immune system characterizes AIDS
Trichomoniasis vaginalis transmission
Almost always sexually-transmitted
Ophthalmia Neonatorum treatment/prevention
An antibiotic ointment (e.g., erythromycin) applied to the eyes of all newborns soon after birth
pelvic inflammatory disease (PID)
An infectious process that most commonly involves the: -uterine (fallopian) tubes (salpingitis) -uterus (endometritis) -and, more rarely, the ovaries and peritoneal surfaces Can be acute, subacute, or chronic
HIV screening and diagnosis
Antibody testing
HIV treatment
Antiretroviral therapy (ART)
HPV screening and diagnosis
Both the Papanicolaou (Pap) test & Physical examination are used in making a diagnosis.
During delivery if visible lesions are present
Cesarean birth is recommended
Hepatitis C Virus (HCV) prevention
Currently there is no preventative vaccine.
viral hepatitis
Five different viruses hat causes inflammation of the liver (hepatitis viruses A, B, C, D, and E) account for almost all cases of viral hepatitis in humans. (Hepatitis D and E viruses are common among users of intravenous (IV) drugs and recipients of multiple blood transfusions)
Candidiasis (yeast infection)
Fungal infection, both yeast and mold qualities Entry via overcomin host barriers via adhesins Strict aerobe, favors moist surfaces second most common type of vaginal infection
HSV treatment
Has no cure Systemic antiviral medication Cleaning lesions twice a day with saline helps prevent secondary infection
Primary cause of cervical neoplasia.
Human Papilloma virus (HPV)
Most common viral STI seen in ambulatory health care settings
Human Papillomavirus (HPV)
Chlamydia trachomatis symptoms
Infections are usually asymptomatic, but some women may experience: -spotting or postcoital bleeding -mucoid or purulent cervical discharge -dysuria. - Bleeding results from inflammation and erosion of the cervical columnar epithelium
vulvovaginitis
Inflammation of the vulva and vagina various causes
Genital herpes simplex virus (HSV)
Is a chronic and recurring viral infection resulting in painful recurrent genital ulcer and there is no known cure two antigen subtypes
Bacterial Vaginosis (BV)
Is the most common cause of vaginal symptoms today caused by bacterial microorganisms can increase susceptibility to STIs such as chlamydia, gonorrhea, genital herpes, and HIV is associated with preterm labor and birth
Gonococcal Rectal Infection
May occur in women after anal intercourse. Individuals may be completely asymptomatic or have severe symptoms: -profuse purulent anal discharge -rectal pain common symptoms, -blood in the stool. -Rectal itching -fullness/pressure -pain -diarrhea.
Hepatitis C Virus (HCV) symptoms
Most clients are asymptomatic or have general influenza-like symptoms similar to those of HAV
Pelvic Inflammatory Disease (PID) causes
Most commonly caused by chlamydia and gonorrhea infection in upper female genital tract Most results from ascending spread of microorganisms from the vagina and endocervix to the upper genital tract. This spread most frequently happens at the end of or just after menses following reception of an infectious agent also can develop after a miscarriage or an induced abortion, pelvic surgery, or birth
Trichomoniasis vaginalis screening and diagnosis
NAAT test recommended: most sensitive Speculum examination with wet mount: not as accurate
HPV treatment
No therapy has been shown to eradicate. Removal of warts and relief of symptoms is typically the goals of treatment for HPV.
herpes simplex virus 1 (HSV-1)
Nonsexually transmission is more commonly associated with gingivostomatitis and oral labial ulcers (fever blisters/cold sores)
Secondary syphilis
Occurs 6 weeks to 6 months after the appearance of the chancre (a painless ulcer) and is characterized by a widespread symmetric maculopapular rash on the palms and soles and generalized lymphadenopathy. The infected individual may also experience: -fever -headache -malaise. If the woman is untreated, she enters the latent phase (Tertiary stage of syphilis)
Syphilis treatment
Penicillin G is the preferred drug for treating syphilis It is the only proven therapy that has been widely used to treat neurosyphilis, congenital syphilis, or syphilis during pregnancy.
STI risk reduction measures
Physical barriers: Condoms: male and female Chemical barriersNonoxynol-9: -Research now shows that N-9 lubricated condoms and spermicides are NOT recommended for the prevention of HIV & STIs Communication: -Expressing feelings and fears -Attention to partner's response -Nurses must suggest strategies to enhance women's condom negotiation and communication skills. Vaccination: -Hep B -HPV
HPV lesions in women are most commonly seen in the
Posterior part of the introitus They can also found on the: buttocks vulva vagina anus cervix are often painless but may be uncomfortable, particularly when they are very large, inflamed, or ulcerated. Chronic vaginal discharge, pruritus, or dyspareunia can occur.
Preventing infection (secondary prevention)
Prompt diagnosis and treatment of current STIs can also prevent personal complications and transmission to others.
Hepatitis C Virus (HCV) risk factor
STIs such as HBV and HIV, multiple sexual partners, history of blood transfusions, history of intravenous drug use
how to diagnose Hepatitis A Virus (HAV)
Serologic testing to detect the immunoglobulin M (IgM) antibody is done to confirm acute infections. antibody is detectable 5 to 10 days after exposure can remain positive for up to 6 months.
What factors trigger herpies Simplex virus outbreaks
Stress trauma period fever ultraviolet light
Hepatitis C Virus (HCV) screening
The CDC does not recommend routine testing in pregnant women unless they are considered to be at high risk.
Hepatitis C Virus (HCV) treatment
The U.S. FDA has approved several drugs for the treatment
Neonatal herpes
The most severe complication and is a potentially fatal or severely disabling disease
How many types of HPV are there?
There are approximately 100 types of HPV, which is a double-stranded DNA virus.
Hepatitis B Virus (HBV) treatment
There is no specific treatment; recovery is usually spontaneous within 3-16 weeks
diffuse vaginitis with vulvitis gonococcal infection
There may be few signs of infection on the other hand present symptoms include: -vaginal discharge -dysuria -swollen, reddened labia
herpes simplex virus 2 (HSV-2)
Transmitted sexually Initial infection characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria may last 2 to 3 weeks
latent phase secondary syphilis
Usually asymptomatic Latent infections lack clinical manifestations but are detected by serologic testing If the infection was acquired in the preceding year, the infection is termed an early latent infection.
Effective means of preventing HAV transmission
Vaccination
HPV prevention
Vaccine (Gardisil vs HPV 6,11,16,18) -3 doses w/in 6 mo (0, 2, 6mo); -For boys & girls
When may a woman need to be hospitalized
Women who become dehydrated from nausea and vomiting or who have fulminating hepatitis A
Hepatitis B Virus (HBV) risk factor
Women who have a history of -acute or chronic liver disease, -multiple blood transfusions -receive treatment in a dialysis unit, have -household or sexual contact with a hemodialysis client Who work or live -in institutions for the mentally challenged Health care workers and public safety workers exposed to -blood in the workplace are at risk. -needlesticks. Behaviors such as -having multiple sexual partners -a history of intravenous drug use increase the risk of contracting HBV infections. -Share needles
Hepatitis B Virus (HBV) is caused by
a large DNA virus and is associated with three antigens and their antibodies: -Hepatitis B surface antigen (HBsAg), -HBV antigen (HBeAg), -HBV core antigen (HBcAg), -antibody to HBsAg (anti-HBs), -antibody to HBeAg (anti-HBe), -antibody to HBcAg (anti-HBc).
Human Papillomavirus (HPV)
a virus that can cause genital warts Most infections are asymptomatic and most appear to resolve spontaneously within a few years.
How many types cause cancer?
about 40 of these types have been found to be causes of anogenital infections. Two specific types (16 and 18) that pose highest risk for causing cancers of the cervix, vagina, vulva, penis, and oropharyngeal area.
Untreated Chlamydia infection often lead to
acute salpingitis or pelvic inflammatory disease (PID)
Gonococcal infection screening
all sexually active women younger than 25 years of age who are at risk for gonorrhea due to multiple sex partners or a new sex partner All pregnant women should be screened at the first prenatal visit, and infected women and those not infected but identified with risky behaviors should be rescreened at 36 weeks of gestation.
Syphilis
an STD that attacks many parts of the body and is caused by a small bacterium called a spirochete is a complex disease that can lead to serious systemic disease and even death when untreated.
Pharmacologic measures that may increase comfort when HSV-2 lesions are active include:
analgesics such as aspirin, acetaminophen, or ibuprofen may be used to relieve pain and systemic symptoms associated with initial infections A thin layer of lidocaine ointment or an antiseptic spray may be applied to decrease discomfort, especially if walking is painful. topical agents should be used with caution. Nonantiviral ointments, especially those containing cortisone, should be avoided.
Women with gonorrheal infection
are often asymptomatic
Chlamydia trachomatis treatment
azithromycin or doxycycline
Gonococcal infections in pregnancy
can affect mother and fetus.
Herpies Simplex virus (HSV-2) and pregnancy
can have adverse effects on both the mother and fetus. congenital infection is possible though rare Primary infections during the first trimester have been associated with increased rates of miscarriage
Gonococcal infection Diagnosis
cannot be diagnosed reliably by clinical signs and symptoms alone Cultures should be obtained from the endocervix, rectum Thayer-Martin cultures are recommended to diagnose women
chlamydial infection of cervix
causes inflammation, which results in microscopic cervical ulcerations and that may increase the risk of acquiring HIV infection. infants born to mothers with chlamydia will develop conjunctivitis or pneumonia after perinatal exposure to the mother's infected cervix
Human Papilloma virus (HPV) is also know by these names
condylomata acuminate, or genital warts
Most common form of gonococcal infection in prepubertal girls.
diffuse vaginitis with vulvitis
Alternative treatments for penicillin-allergic clients
doxycycline, tetracycline, and erythromycin Tetracycline and doxycycline are contraindicated in pregnancy, and erythromycin is unlikely to cure a fetal infection
human immunodeficiency virus (HIV) Symptoms include
fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, rash.
Hepatitis A virus (HAV) is characterized by
flulike symptoms with malaise, fatigue, anorexia, nausea, pruritus, fever, right upper quadrant pain
TORCH infections
form a group of organisms capable of crossing the placenta
Because coinfection is common, any woman suspected of having gonorrhea should
have a chlamydial culture and a serologic test for syphilis if one has not been done in the previous 2 months
Hepatitis A virus (HAV)
infection is acquired primarily through a fecal-oral route by ingestion of -contaminated food, -particularly milk -shellfish -polluted water -person-to-person contact
Hepatitis B Virus (HBV)
is a disease of the liver and often a silent infection the virus most threatening to the fetus and neonate.
Gonorrhea
is almost exclusively transmitted by sexual contact. The principal means of transmission is genital-genital contact; it is also spread by oral-genital and anal-genital contact. In females, there is also evidence that infection can spread from vagina to rectum.
Trichomoniasis vaginalis
is an STI and is also a common cause of vaginal infection
methods used to diagnose Herpies simplex virus
laboratory studies: A viral culture is obtained by swabbing exudate during the vesicular stage of the disease. Type-specific serologic tests for HSV-2 antibodies are also available
Bacterial Vaginosis (BV) treatment
metronidazole (Flagyl) orally is most effective
Trichomoniasis vaginalis treatment
metronidazole or tinidazole orally in a single dose Partner should also be treated
Perinatal transmission of Hepatitis B Virus (HBV)
most often occurs in infants of mothers who have acute hepatitis infection late in the third trimester during the intrapartum or postpartum period from exposure to HBsAg-positive vaginal secretions, blood, amniotic fluid, saliva, and breast milk
Transmission HIV from mother to child
occur throughout the perinatal period. Exposure may occur to the fetus through: -the maternal circulation as early as the first trimester of pregnancy, -to the infant during labor and birth by inoculation or ingestion of maternal blood and other infected fluids, -to the infant through breast milk
Candidiasis treatment
over the counter/prescritions oral, IV, or topical treatment fluconazole pill or vaginal suppositories Full course of treatment must be completed
The most serious complication of chlamydial infections, and past chlamydial infections are associated with an increased risk of ectopic pregnancy and tubal factor infertility.
pelvic inflammatory disease (PID)
recommended treatment for Group B Streptococcus (GBS)
penicillin G
Intramuscular benzathine penicillin G is used to treat
primary, secondary, and early latent syphilis
Woman with HPV lesions may complain of symptoms such as a
profuse irritating vaginal discharge itching dyspareunia postcoital bleeding "bumps" on her vulva or labia
Chlamydia screening: women
screening for chlamydia in sexually active women age 24 years or younger and older women at increased risk for infection. All pregnant women should be screened for chlamydia at the first prenatal visit. Screening late in the third trimester (36 weeks) may be repeated if the woman was positive previously or if she is younger than 25 years, has a new sex partner, or has multiple sex partners.
Chlamydia trachomatis
the most commonly reported STI in American women ages 20 to 24 years have the highest rates of infection These infections are often silent and highly destructive Harder to diagnose is woman
Preventing infection (primary prevention)
the most effective way of reducing the adverse consequences of STIs for women and for society
Hepatitis B Virus (HBV) transmission
through blood, saliva, sweat, tears, vaginal secretions
Hepatitis C Virus (HCV) transmission
through exposure to blood and much less efficiently via semen, saliva, or urine
Treponemal tests for syphilis
—fluorescent treponemal antibody-absorbed (FTA-ABS) —T. pallidum passive particle agglutination (TP-PA) assay —are used to confirm positive results.
bacteria STIs (curable)
• Chlamydia • Gonorrhea • Syphilis Pelvic inflammatory disease (PID)
Sexually Transmitted Viral Infections
• Human immunodeficiency virus • Herpes simplex virus types 1 and 2 • Cytomegalovirus • Viral hepatitis types A and B • Human papillomavirus
HIV management
•Prevention of transmission through contraceptive education (condoms) •Preventative health care measures (smoking cessation, hand washing, nutrition) •Suicide prevention •Financial & health care assistance •Pregnancy can cause adverse health risk(copper intrauterine device (IUD) and levonorgestrel-releasing intrauterine system (LNG) IUD) •Antiviral therapy during pregnancy & no breastfeeding in infected mothers •Death & dying
Risk factors for acquiring Pelvic Inflammatory Disease (PID)
•Young age •Nulliparity (uncountable Never having completed a pregnancy beyond 20 weeks) •Multiple partners •High rate of new partners •History of STIs and PID