Sexually Transmitted Infections
Prevalence
# of people with an infection at a given point in time
Incidence
# of positive tests in a period of time
Nursing Roles
-Education about safe sex practices including using latex condoms and being mutually sexually exclusive -Provide education about STI transmission -Offer vaccines when available -Provide screening
Herpes Simplex: Symptoms
-Initial infection characterized by multiple painful lesions -fever -chills -malaise -severe dysuria -Infection remains dormant in nerve cells resulting in recurrent, periodic outbreaks
Trichomonas vaginalis: screening and diagnosis
-Motile trichomonad on wet prep -cervix may bleed on contact -petechiae on the cervix "strawberry cervix" -pH > 4.5 -many white blood cells on microscopy - "too many to count"
Human Papilloma virus: screening/diagnosis & treatment
-Pap smear with co-testing for HPV -If high risk HPV, colposcopy recommended -No therapeutic management, prevention is key -HPV vaccine starting at 9 years of age -Treatment of warts with topical agents, laser -Cervical dysplasia with LEEP and conization
Candida albicans: screening and diagnosis
-SSE vulvar redness -white patches on vaginal walls -wet smear with pseudohyphae -spores -lactobacilli -rarely WBCs
Herpes Simplex: Perinatal Infection
-Spontaneous abortion -preterm labor -microcephaly -low birth weight -microphthalmia -chorioretinitis -neonatal HSV infection
Nursing Care for genital ulcers
-abstain from intercourse during prodromal period and when lesions are present -wash hands after touching -comfort measures such as light, breathable garments, sitz baths -avoid extreme temperatures -use condoms
Candida albicans: management
-antifungal (topical or oral) -avoid douching -tub baths -scented soaps -reduce sugars
Risk of infection
-based on individual behaviors AND probability of encountering someone with an infection -certain communities have higher prevalence and therefore higher statistical likelihood of infection despite the same sexual activity
Infections can result in tremendous human suffering
-cancer -infertility -ectopic pregnancy -chronic pelvic pain -liver disease -death
Organisms resulting in vaginitis
-candida, a fungus -trichomonas, a protozoa -gardnerella, a bacterium
Vaginal health
-complex balance of microbiologic organism in the vagina is a key element in the maintenance of health -subtle shifts in the vaginal environment may allow organisms with pathologic potential to proliferate, causing infectious symptoms
Pelvic Inflammatory Disease: Symptoms
-discharge -fever -cervical motion tenderness -dysmenorrhea -dysuria -dysuria -MAY BE ASYMPTOMATIC
HIV: symptoms
-fever -headache -night sweats -malaise -generalized lymphadenopathy -myalgias -nausea -diarrhea -weight loss -sore throat -rash
Trichomonas vaginalis: common symptoms
-inflammation of the vagina and/or vulva -dyspareunia -dysuria -odor -yellow/green or grey frothy discharge -men are asymptomatic carriers
Trichomonas vaginalis: therapy
-metronidazole -2g orally in a single dose -both partners must abstain during treatment -avoid EtOH- causes N/V
Trichomonas vaginalis: perinatal risks
-preterm birth -premature ROM -LBW infant -increased risk of HIV infection
Pelvic Inflammatory Disease: Risk Factors
-recent intrauterine device -smoking -douching -hx of STI -multiple sex partners
Syphilis - Treponema pallidum: perinatal implications
-spontaneous abortion -low birth weight -fetal growth restriction -prematurity -stillbirth -multi-system failure of the heart, lungs, spleen, liver, and pancreas, as well as structural bone damage and nervous system involvement and mental retardation
Bacterial Vaginosis - Gardnerella: Symptoms
-thin, white homogenous vaginal discharge -"stale fish" odor -not associated with swelling or pain OFTEN ASYMPTOMATIC
Candida Albicans: common symptoms
-vulvar and vaginal pruritus -thick, creamy, white vaginal discharge -vaginal soreness -burning -erythema -dyspareunia (genital pain before, during, or after sex)
Why do STIs put women at the greatest risk
-women are more likely to acquire infection -greater risk of complications -vertical transmission in pregnancy
Neisseria gonorrhoeae
2nd most common STI; Often coinfected with chlamydia Rising rates of antibiotic resistance
Bacterial Vaginosis - Gardnerella
Alterations in vaginal flora in which lactobacilli is replaced with anaerobic bacteria increases risk of acquiring other STIs
Pelvic Inflammatory Disease
Ascending vaginal infection of upper reproductive tract (endometritis, parametritis, salpingitis, peritonitis) Complications include ectopic pregnancy, pelvic abscess, chronic pain, infertility
Syphilis - Treponema pallidum: therapy
Benzathine penicillin G, IM or IV weekly x 3 wks ; reevaluate in 6 and 12 months
Trichomonas vaginalis
Can be sexually transmitted or live on damp/wet surfaces and poorly cleaned hot tubs -single cell protozoan parasite
Herpes Simplex: Diagnosis & Therapy
Diagnosis: clinical s/sx , viral culture IgG/IgM Therapy: Antiviral drugs (ie valtrex), Cesarean section
Preventing STIs
Federal, state, and local jurisdictions require communicable diseases be reported when diagnosed by doctors or laboratories. Reportable diseases are those considered to be public health concerns (contagious and can cause serious harm if undiagnosed or untreated. All bacterial STIs are reportable (syphilis, gonorrhea, chlamydia, chancroid), HIV, viral hepatitis Reporting of diseases allows for ensuring appropriate testing and treatment of infected individuals, collection of data regarding disease trends, and tracking outbreaks.
A 24 year old client presents with a 3 day history of painful sores in the genital area. She reports fever and headaches, and pain when urinating. She is sexually active with a new partner. On exam, vital signs are WNL with the exception of a temperature of 100.9 F, tender lymphadenopathy, and multiple labial ulcers. She denies any prior history of lesions, is not currently on medication or supplements. What is the likely infection?
Herpes Simplex
Neisseria gonorrhoeae: symptoms
May be asymptomatic -PID -dysuria -vaginal discharge (yellow green) -dyspareunia -endocervicitis -arthritis -endocarditis -meningitis -hepatitis INFECTION IN PREGNANCY: can result in chorioamnionitis, PPROM, PTL, endometritis, opthalmia neonatorum
Bacterial Vaginosis - Gardnerella: Therapy
Metronidazole orally or clindamycin cream
Chlamydia trachomatis
Most common STI -highest risk factors: -age < 25 yrs -new/multiple sex partners -not using barrier contraceptive -poor socioeconomic conditions
Human Papilloma virus
Most common viral infection (80% of sexually transmitted infections) Cervical, vulvar, vaginal, penile, anal, and oropharyngeal cancers
Syphilis - Treponema pallidum: screening/diagnosis
Nontreponemal test - IgM and IgG - Rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) Treponemal test: detect treponemal specific IgA, IgM, IgG, EIA, FTA-ABS Dark field microsopic exam
HIV: perinatal & postnatal
Offer screening in pregnancy - reduces risk of transmission from ~ 25% to less than 2% when treated with HAART Cesarean when viral load > 1,000 copies/ml Currently breastfeeding is US is discouraged to reduce transmission PrEP - Pre exposure prophylaxis can reduce the risk of infection in high risk individuals
Pelvic Inflammatory Disease: Prevention
Prevention of STI is key -barrier contraception -discourage douching -encouraging STI screening and treatment of infection
Herpes Simplex
Recurrent, lifelong viral infection More common in females than males Herpes simplex virus 1 (HSV-1)/Herpes simplex virus 2 (HSV-2) Infects dorsal root ganglia and may remain dormant until triggered - stress, immunosuppression
HIV
Retrovirus that attacks and causes destruction of T lymphocytes AIDS: Severe depression of the cellular immune system
Human Papilloma virus: RF & symptoms
Risk factors include multiple sex partners, < 25 years of age Often asymptomatic, may have visible genital warts
Hepatitis A and B
Sexually transmitted virus infections resulting in chronic liver disease that can progress to cirrhosis or liver failure Symptoms include malaise, anorexia, nausea, fever, RUQ pain, rash Vaccines available for Hep A and B
Syphilis - Treponema pallidum
Systemic disease that can lead to disability and death if untreated Chronic, multistage, curable bacterial infection Infection manifests itself in distinct stages (primary, secondary, latency, and tertiary)
Bacterial Vaginosis - Gardnerella: Diagnosis
Three of four criteria must be met: -thin grayish white homogenous discharge which adheres to vaginal mucosa -vaginal pH > 4.5 -Positive "whiff test" -presence of clue cells on wet mouth
HIV: transmission, counseling, treatment
Transmission: primarily through exchange of body fluids (sexual contact, IVDA, vertical transmission) Pre and post counseling with testing - HIV antibodies, nucleic acid tests (NAT), antibody/antigen (p24) Treatment with highly active antiretroviral therapy (HAART) Refer the client for a mental health consultation, legal assistance, and financial resources.
Neisseria gonorrhoeae: transmission, diagnosis, therapy
Transmission: vaginal, anal, oral sex or childbirth Diagnosis: Cultures, NAA, EIA from urine, urethra, endocervical Therapy: dual therapy with ceftriaxone IM and oral azithromycin/doxycycline
Chlamydia trachomatis: transmission, diagnosis, therapy
Transmission: vaginal, anal, oral sex or childbirth Diagnosis: cultures from urine urethra, endocervical, conjunctival secretions in neonate Therapy: azithromycin, doxycycline , antibacterial ointment (erythromycin) in neonate. Treat for gonorrhea concurrently. Test of cure (TOC) 3-4 weeks post tx in pregnancy
Herpes Simplex: Transmission
Transmitted by contact of mucous membranes or breaks in skin with lesions May be unaware of infection Kissing, sexual contact, vaginal delivery
A woman comes to the local women's health clinic for an evaluation. The woman is diagnosed with chlamydia. Which action(s) by the nurse would be important? Select all that apply. [mark all correct answers] a. report the condition to public health authorities b. teach the woman how to use the intravaginal medication c. instruct the client to avoid alcohol with treatment d. explain that there is no cure for the infection e. discuss the need for treatment for gonorrhea as well
a & e a. report the condition to public health authorities e. discuss the need for treatment for gonorrhea as well
A client reports genital ulcers and a diagnosis of syphilis. Which nursing interventions should the nurse implement when caring for the client? Select all that apply. [mark all correct answers] a. Have the client urinate in water if urination is painful. b. Suggest the client apply ice packs to the genital area for comfort. c. Instruct the client to wear nonconstricting, comfortable clothes. d. Instruct the client to wash her hands with soap and water after touching lesions.
a. Have the client urinate in water if urination is painful. c. Instruct the client to wear nonconstricting, comfortable clothes. d. Instruct the client to wash her hands with soap and water after touching lesions.
A nurse is assisting with a pelvic exam on a client who is suspected of having trichomoniasis. Which findings would the nurse note as helping to confirm this diagnosis? Select all that apply. [mark all correct answers] a. cervical bleeding when touched b. cervical petechiae c. vaginal erythema d. curd-like discharge in the vagina
a. cervical bleeding when touched b. cervical petechiae c. vaginal erythema
A 22-year-old woman comes to the clinic for an evaluation. Assessment findings are as follows: Age of first intercourse: 15 years Intrauterine contraception inserted 2 months ago Monogamous partner Use of condoms for sexual activity Cigarette smoking since age 16; approximately 1/2 to 1 pack per day The woman is diagnosed with pelvic inflammatory disease (PID). Which information from the woman's assessment would the nurse evaluate as increasing the woman's risk for this condition? Select all that apply. a. intrauterine contraceptive device insertion b. age of first intercourse c. monogamous partner d. cigarette smoking e. use of condoms
a. intrauterine contraceptive device insertion b. age of first intercourse d. cigarette smoking
Vaginosis
any abnormality of the discharge of the vagina
A 24 year old client presents with a 3 day history of painful sores in the genital area. She reports fever and headaches, and pain when urinating. She is sexually active with a new partner. On exam, vital signs are WNL with the exception of a temperature of 100.9 F, tender lymphadenopathy, and multiple labial ulcers. She denies any prior history of lesions, is not currently on medication or supplements. The nurse reviews the teaching plan for this client diagnosed with genital ulcers. Which instructions would the nurse include in this teaching plan? Select all that apply. a. "Apply ice packs to the area for 20 minutes every few hours." b. "Use a condom when having sexual intercourse with any noninfected partner." c. "Avoid having sex when any ulcers are present." d. "Try using sitz baths to help relieve the discomfort." e. "Air dry any lesions with a hair dryer on the low setting."
b. "Use a condom when having sexual intercourse with any noninfected partner." c. "Avoid having sex when any ulcers are present." d. "Try using sitz baths to help relieve the discomfort." e. "Air dry any lesions with a hair dryer on the low setting."
A community health nurse is conducting a class on sexually transmitted infections (STIs). She states that "STIs are discriminatory." What would the nurse most likely use to support this statement? a. "All individuals are susceptible if exposed to the infectious organism." b. "Women are diagnosed with two thirds of the new cases of STIs annually." c. "After only a single exposure, women are less as likely as men to acquire STIs." d. "Women are equally diagnosed over men as they will seek treatment first."
b. "Women are diagnosed with two thirds of the new cases of STIs annually."
A 33-year-old client presents to the office with complaints of vaginal discharge, itching, and vulvar burning. The client reports the discharge is white, like cottage cheese, and has no odor. The client recently was seen in the office for a sinus infection and finished a one week course of antibiotics. On exam, the vaginal walls are covered by white plaques. There is erythema noted in the vulva. Which of the following treatments would be recommended? a. antibiotic such as metronidazole b. antifungal such as clotrimazole c. antiviral such as valacyclovir
b. antifungal such as clotrimazole
A college student is seen at the sexual health clinic reporting dysuria, mucopurulent vaginal discharge with bleeding between periods, conjunctivitis, and a painful rectal area. What sexually transmitted infection would the nurse suspect? a. syphilis b. chlamydia c. herpes d. gonorrhea
b. chlamydia
Pelvic Inflammatory Disease: Treatment
broad spectrum antibiotics May require hospitalization
A 33-year-old client presents to the office with complaints of vaginal discharge, itching, and vulvar burning. The client reports the discharge is white, like cottage cheese, and has no odor. The client recently was seen in the office for a sinus infection and finished a one week course of antibiotics. On exam, the vaginal walls are covered by white plaques. There is erythema noted in the vulva. What is the likely diagnosis based on the clinical presentation and exam findings? a. trichomoniasis b. bacterial vaginosis c. candida albicans
c. candida albicans
A 24 year old client presents with a 3 day history of painful sores in the genital area. She reports fever and headaches, and pain when urinating. She is sexually active with a new partner. On exam, vital signs are WNL with the exception of a temperature of 100.9 F, tender lymphadenopathy, and multiple labial ulcers. She denies any prior history of lesions, is not currently on medication or supplements. The client, who has been newly diagnosed with herpes simplex virus (HSV) ask the nurse how long it will take for the "sores" to go away. How should the nurse respond? a. "The first outbreak takes about 3 weeks to heal with medication." b. "The pain should go away in a few days once the 'sores' crust over." c. "Once you start the medication it will take about 1 week." d. "It will take about 2 weeks for the outbreak to fully heal."
d. "It will take about 2 weeks for the outbreak to fully heal."
Vaginitis
inflammation and infection of the vagina; may be due to infectious or non infectious triggers
Infections of reproductive tract are caused by
microorganisms transmitted through vaginal, anal or oral sexual intercourse -includes more than 30 sexually transmitted infectious organisms (bacteria, viruses, Protozoa, and ectoparasites)
Candida albicans
most common cause of vaginal discharge -predisposing factor: antibiotic therapy, diabetes, pregnancy, obesity, immunosuppression
Cervicitis
presence of inflammation or infection of the cervix
Epidemiology
study of incidence, distribution, determinants of health related states and events in a population
Chlamydia trachomatis: symptoms
typically asymptomatic -dysuria -vaginal discharge -endocervicitis -postcoital bleeding/spotting -PID, ectopic pregnancy -infertility -inflammation of rectum -conjunctivitis -throat infection -men urethritis can cause newborn conjunctivitis
