OB EXAM 1- STI's

Urinary Health

8-12 (16 oz.)glasses of water per day Frequent voiding Encourage post-coital voiding Decrease caffeine, carbonated beverages and alcohol (bladder irritants) Encourage tea, cranberry juice as fluids After toileting, wipe from front to back

Hepatitis A

A----> ANUS Spread by oro-fecal route Oral or anal sexual contact can predispose someone to Hep A. Best prevention is HANDWASHING especially after using toilet Hep A vaccine can be given in pregnancy Perinatal transmission is rare Breastfeeding is safe

Promoting Vaginal Health

Avoid douching, feminine "hygiene sprays" Avoid perfumed soaps and cleansers Wear cotton underwear Avoid nylon panties or stockings Avoid scented/lubricated condoms Lubricate for sex with intended products Keep perineal area clean and dry Avoid excessive tampon use

Human Immunodeficiency Virus (HIV)and AIDS

Caused by HIV which is a retrovirus Transmission through exposure to an infected person's body fluids such as: blood, vaginal fluid, semen, breast milk DIAGNOSIS/ TX: HAART: Highly active anti-retroviral therapy, PREG: All pregnant women should be offered testing, Antibody testing may not help in testing infant/young siblings because maternal antibodies can persist up to 18 months, having a vaginal birth can increase the risk of transmission NEWBORN: W/o treatment, 15-25% of infants born to HIV-infected mothers will acquire HIV (Source: CDC) 12%--14% more infected by breastfeeding where HIV-infected women breastfeed their infants into the second year of life.

Listeriosis: Infectious Teratogens

Caused by gram (+) motile bacteria found in shellfish, birds, spiders, and mammals. Transmitted by ingesting contaminated meat, dairy products, etc. CDC found undercooked chicken and soft cheeses were significant sources of disease NEWBORN: Fetal infection acquired through placenta is usually fatal. Newborn infections acquired through exposure in the birth canal result in meningitis and encephalitis. May cause neonatal sepsis - Use antibiotics if sepsis is suspected in newborns

Patient education with an STI

Etiology and course of the infection How to use the prescribed medication Expected side effects of prescribed medications Teaching on vaginal health Need for partner treatment How to obtain partner treatment

Hepatitis C

Inflammation of the liver caused by hepatitis C virus - an RNA virus Spread by direct contact with blood or blood contaminated items; can spread sexually as well. Leading indication for liver transplant 80% of persons have no S/S of infection

TORCH - Cytomegalovirus (CMV)

Most common cause of congenital infection in US Transmission requires direct contact with infected body fluids PREG: No treatments that are safe in pregnancy, Avoid kissing children under age 6 on the mouth NEWBORN: CMV can cause symptoms at birth or in later life Most babies born with CMV never develop problems

Human Papilloma Virus (HPV)

Of these, 74% occur among those aged 15--24 years. Gardasil 9 against 9 strains 6, 11, 16, 18, 31, 33, 45, 52, and 58 Vaccine almost 100% effective PATHO: Visible genital warts usually are caused by HPV types 6 or 11. HPV types 16, 18, 31, 33, and 35 commonly cause cervical neoplasia (cancer precursors) DIAGNOSIS: External warts have a "cauliflower-type" appearance, or resemble skin tags PREG: Tx during pregnancy aimed at keeping bulk of the condyloma from complicating delivery NEWBORN: Pediatric provider must be notified of the condyloma as babies have increased risk of laryngeal papillomatosis otherwise know as recurrent respiratory papillomatosis (RRP) C.Section does not eliminate this risk

TORCH - Rubella (German Measles)

PATHO: Acute onset of generalized maculo-papular rash, Rash & posterior cervical lymphadenopathy, temp >99.0 DIAGNOSIS: Vaccination and reduction of potential contacts PREG: In early preg: stillbirth, miscarriage, fetal anomalies, Most rubella in preg among foreign-born mothers NEWBORN: If maternal rubella contracted prior to 8th wk of pregnancy, 85% chance of congenital rubella syndrome (CRS), CRS commonly causes cataracts, cardiac defects, deafness, glaucoma, microcephaly, CNS defects

TORCH - Parvovirus "Fifth disease" "Slap cheek disease"

PATHO: Airborne or droplet spread infection, Diagnosed by seeing the facial and truncal rash on exam DIAGNOSED: With severe anemia caused by parvovirus B19 infection, patient may need hospitalization and blood transfusions. Treat joint pain/swelling with rest, limited activities PREG: Not considered serious in pregnancy, No treatment for parvovirus in pregnancy NEWBORN: Both mother and baby may have mild disease 5% of fetuses w/ parvovirus develop anemia

Gonorrhea

PATHO: Caused by N. gonorrhoeae, women mostly asymptomatic S/S :Low abdominal pain Urethritis, dysuria Purulent discharge from Skene's, Bartholin's, urethra, or vagina; inflammation in those areas DIAGNOSED: Most diagnosed by DNA probe (urine or swab) TX: ceftriaxone, No unprotected sex until after BOTH are treated & symptom free PREG/NEWBORN: Delivery with (+) gonorrhea can cause neonatal gonorrheal opthalmia (ophthalmia neonatorum)and blindness, blood or joint disease, disease late in pregnancy can ascend and cause postpartal endometritis, salpingitis, oophoritis, or peritonitis

Herpes Simplex II (HSV II)

PATHO: HSV-2 usually a genital infection, incubation period 3-7 days, infection occurs via inoculation of virus into susceptible mucosal surfaces or through small cracks in the skin. More common and more severe symptoms in women with acute dysuria and or cervicitis lesions usually heal on their own PREG: More easily passed to fetus (transmission rate of 50%), Cesarean recommended for active lesions, Prophylactic antivirals are recommended for last 4-6 weeks of pregnancy to suppress disease.

TORCH - Varicella-zoster virus (VZV)

PATHO: Primary infection causes chicken pox, Virus is established in dorsal root ganglia, Rash has characteristic maculo papular/ vesicular lesions that open, then crust, Rash highly pruritic DIAGNOSIS: Rash from scalp to trunk, then extremities, Lesions also can occur on mucous membranes of the oropharynx, respiratory tract, vagina, conjunctiva, and cornea. PREG: Herpes zoster (shingles) rare in pregnancy; no known effects, Varicella during pregnancy affects mother, fetus/infant, Greatest risk of congenital varicella in the first 20 weeks NEWBORN: Prior to 20 weeks, fetus can develop Congenital Varicella Syndrome (CVS): cataracts, chorioretinitis, limb hypoplasia, hydronephrosis, microcephaly, mental retardation, dermatome lesions, and cutaneous scars. Varicella in mother from 6 days prior to 2 days after birth can be passed to newborn

Trichomoniasis

PATHO: Protozoal STI caused by Trichomonas vaginalis, May see punctuate hemorrhages -"strawberry cervix" S/S: May present with frothy, malodorous, copious discharge with pruritus. TX: Metronidazole, no sex until partners are treated and are both asymptomatic

Chlamydia

PATHO: STI caused by Chlamydia trachomatis, Most frequently reported bacterial STI in the US, Implicated in infertility (even in men), ectopic pregnancy, PROM and PTL S/S: can mimic a UTI TX: Azithromycin, Doxycycline, Abstain from sexual activity until one week after all partners are treated NEWBORN: Chlamydia can be passed to infant during vaginal birth, ophthalmia neonatorum Infection not reliably prevented with ophthalmic erythromycin Consider chlamydia in any baby with conjunctivitis under 1 month of age

Syphilis

PATHO: STI caused by the spirochete T. pallidum PRIMARY STAGE: Characterized by chancre that is filled with spirochetes, highly infectious, painless - can be missed easily SECONDARY: 4 weeks - 6 months after primary disease, Papular rash: palms and soles, alopecia at eyebrows, eyelashes, and head LATENT: after 1st year, until tertiary stage develops TERTIARY: Can appear from 1-2 years up to 30 years later, Associated with high morbidity and mortality DIAGNOSIS/TX: Darkfield exam that show spirochetes is definitive test, TX: Benzathine penicillin, or Doxycycline PREG: Congenital syphilis is the worst outcome NEWBORN: congenital symptoms- Babies can have non-immune hydrops, jaundice, hepatosplenomegaly, rhinitis, skin rash, and/or pseudoparalysis of an extremity

Pelvic Inflammatory Disease

PATHO: Usual organisms - C. Trachomatis, N. Gonorrhea, Increases risk of tubal scarring and infertility DIAGOSIS: Woman presents with low abdominal pain, mucopurulent discharge, possible urethritis, fever and N/V NEWBORN: high risk for maternal and fetal morbidity and preterm delivery, pregnant women who have suspected PID should be hospitalized and treated with parenteral/IV antibiotics.

Bacterial Vaginosis (BV)

PATHO: actobacillus specioes in the vagina with high concentrations of anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis *most common cause of vaginal discharge/malodor TX: metronidazole: no alcohol, with hold breast feeding 24hrs

Urinary Tract Infection(UTI)

Predominantly caused by E. coli S/S: Dysuria, urgency,↑ frequency of voids TX: may treat on symptoms of UTI alone up to 40% of untreated uti becomes pyelonephritis NEWBORNS: Don't use Bactrim after 36 weeks; nitrofurantoin after 38 weeks, Don't give nitrofurantoin to breast feeding mothers of babies < 1 month

TORCH - Toxoplasmosis

Protozoan spread by contact with infected raw meat or cat feces 50% of human exposure through raw or undercooked meat, usually pork PREG: Miscarriage likely in early pregnancy, Maternal treatment reduces fetal effects NEWBORN: In neonates, complications such as obstructive hydrocephalus, and intracranial calcifications associated with mental retardation, seizure activity, and motor and developmental delays can occur. Chorioretinitis can lead to blindness. But may have no symptoms at birth

Herpes Simplex I (HSV I)

The most common herpes simplex virus Herpes labialis (cold sores)is the most common HSV-1 infection The virus spreads to nerve cells and stays in the body for the rest of a person's life DIAGNOSIS: Culture/scrape lesion for virus - best method, intermittently reactivates and causes symptoms, or flares/outbreaks TX: acyclovir, valacyclovir

Vulvovaginal Candidiasis (VVC)

Usually caused by C. albicans. TX: Treated with 7 day topical/vaginal cream- miconazole - most preferred in pregnancy also can be treated with antifungals S/S: pruritus, vulvar erythema, +/- discharge

Hepatitis B

Viral inflammation of the liver caused by hepatitis B virus (HBV) Transmitted primarily through sexual contact - about 30% to 70% of new cases. Spread by direct contact with blood and body fluids, perinatal transmission to fetus Vaccine is a three-dose series: Initial, one month later, and six months later Giving HBV vaccine and immunoglobulin to the baby at birth prevents 85-95% of infants born to HBV positive moms from contracting the disease. Baby MUST be bathed prior to invasive tests to ↓ percutaneous exposure to mom's blood