STD's WH - NSFW. Lots of pictures, just for you. You're welcome.

Syphilis Management

Transplacental at any time during pregnancy. Screen during 1st prenatal visit. Dx : +VDRL, +RPR. Penicillin, doxyclycline. Reevaluate after treatment. Sexual abstinence during treatment. *Jarisch-Herxheimer reaction may occur within 1st 24 hours - hypotension, HA, myalgias.* May be necessary to rescreen because 1/3 of people in early primary syphilis may have noreactive serologic tests. Rescreen in 1-2 months if suspicious lesions are present.

Gonorrhea Management

Treat with cefixime 400mgx1 or ceftriazone 125mg IMx1. Treat partner.

Hepatitis A Management

Vaccination to prevent HAV transmission. Self-limiting disease, no chronic infection.

Scabies S/S

*Intensely pruritic* dermatitis with lesions.

Syphilis S/S

3 stages. Primary (1-6 weeks) - painless chancre. Secondary (2-6 months) - rash on palms and soles, alopecia, adenopathy, fever, fatigue. May develop condylomata lata (broad, painless, pink-gray wart-like infectious lesions on the vulva, perineum, or anus. There's a picture. You're welcome.) Latency - no symptoms, positive serology. Tertiary - cardiac and CNS dysfunction.

Candidiasis Management

Dx by physical exam, vaginal pH, wet smear. Don't wear tight fitting clothing/underwear or pantyhose made of nonabsorbent materials. Antifungals to treat infection: OTC: miconazole, clotrimazole. PO: fluconazole Newborns can develop thrush during vaginal birth. Use sitz baths. Avoid tampons.

Bacterial vaginosis management

Dx: wet prep with *clue cells*, pH >4.5. Treat with Flagyl. Pt is more susceptible to other STIs. Associated with preterm labor, PROM, chorioamnionitis, and PID. Avoid irritatns such as powder, bubble bath, perfumed sprays, douching, super-absorbent tampons, tights, nylon underwear, tight clothes. Use good body hygiene by wiping front to back, changing out of wet bathing suits asap, wearing clean cotton underwear. Use condoms.

Trichomoniasis Management

Dx: wet prep. One-celled protozoan with flagella. Treat with metronidazole (Flagyl) Must treat sexual partners. Can cause preterm birth/labor and postpartum endometritis

Scabies Management

Eradicate infestation, remove nits, prevent spread or recurrence. Permethrin cream or lindane shampoo. Decontamination of bedding and clothing - wash with hot water. Vacuum carpets. Treat family members and sexual partners.

Pubic Lice Management

Eradicate infestation, remove nits, prevent spread or recurrence. Permethrin cream or lindane shampoo. Decontamination of bedding and clothing - wash with hot water. Vacuum carpets. Treat family members and sexual partners. (Same as scabies management)

Hepatitis A S/S

Fecal oral route. Flu-like symptoms: Malaise Fever Anorexia Nausea RUQ pain

Herpes S/S

Initial infection: Multiple painful lesions fever chills malaise severe dysuria Subsequent episodes: More localized milder shorter in duration May have prodromal tingling. Recurrent painful vesicles and itching.

Chlamydia S/S

Most common bacteria STI. *Asymptomatic* or cervicitis.

Hepatitis C S/S

Most common blood-borne infection in U.S. transmitted usually through blood,. Much less efficient in other body fluids. Asymptomatic, flu-like symptoms.

Human Papilloma Virus (HPV) S/S

Most common viral infection. Highly contagious. *genital warts. * Flesh-colored, painless, cauliflower-like lesions.

Group Beta Strep Management

Mother screened with cervical swab at 36-37 weeks gestation. IV antibiotic prophylaxis (erythromycin) if positive or unknown during labor. Two doses needed 4 hours apart.

Human Papilloma Virus (HPV) Management

There is no therapy that will eradicate HPV. Goal of treatment is removal of warts and relief of symptoms. High incidence of recurrence. Topical application of podofilox 0.5% solution or gel (not during pregnancy.) Check partners for HPV even if asymptomatic. Use latex condoms and vaginal spermicide to decrease transmission. Prevention: Vaccine (guradisil, cervidex) x 3 doses (initial, one month, six months). Routine pap smears

Review patient education associated with sexually transmitted infections.

Abstinence of activities with fluid exchange Knowledge of partner Decrease number of partners Condom use - male compliance, storage away from high heat, use only once and with every sexual encounter, latex is best. Avoid - anal-oral, anal-genital intercourse, practices that increase tissue damage, direct contact with lesions. If taking medication for STI... Complete entire prescribed drug therapy Refrain from sex until infection is completely gone. Have partner examined and treated to prevent re-infection. Avoid strong soaps, perfumes, or creams. Cool or tepid sitz baths to relieve itching. Genital hygiene, avoid douching. Void before and after intercourse. Limit time spent in damp clothes.

Group Beta Strep S/S

Asymptomatic.

Hepatitis B S/S

Can be transmitted through intimate contact. Found in all fluids. Initially asymptomatic. Eventually: Jaundice hepatomegaly Flu-like symptoms

Bacterial vaginosis S/S

Caused by imbalance of normal vaginal flora. *Fish odor* *profuse, thin, white, gray, or milky discharge* *Irritation and/or pruritus*

Gonorrhea S/S

Chlamydia's best friend. 45% have coexisting chlamydial infection. Highly communicable high reinfection rate. *Women are often asymptomatic*. May have purulent d/c. Menstrual irregularities, pelvic pain, dysuria.

Herpes Management

No cure. Establish if pt is pregnant. Diagnosis confirmed by viral culture of fluid from vesicle. Suppression of virus with systemic antivirals.: acyclovir, valacyclovir, famciclovir. C-section with active lesions. Education: Avoid triggers. No sex from prodrome to complete healing. Hand hygiene after touching lesions. Nonconstrictive clothing. Cotton underwear. Lukewarm sitz bath. Air-dry lesions with low heat hairdryer. Avoid ice or heat packs. Avoid steroid creams, sprays, or gels. Use condoms.

Candidiasis S/S

One of the most common causes of vaginal discharge. *Extreme itching* *Redness* *Cottage cheese discharge* Painful urination Lesions Common risk factors are: Antibiotic therapy Diabetes Obesity Diets high in refined sugars Immunocompromise and corticosteroid use.

Pelvic Inflammatory Disease (PID) S/S

Pain Increased WBC's Increase ESR Fever Lower abdominal, adnexal, and cervical motion tenderness. Sub acute: dull, cramping, and intermittent. Acute: severe, persistent, and incapacitating. *Pain when touching cervix!* May complain of intermenstrual bleeding. Pelvic tenderness bilaterally.

Pubic Lice S/S

Pruritus with lice or nits.

PID Management

R/O ectopic pregnancy and appendicitis. Endometrial biopsy. Transvaginal ultrasound Laparoscopic exam. Teach prevention. Broad spectrum antibiotics, possible hospitalization. Pain management. Education. Avoid sex until treatment completed.

Chlamydia Management

Screen during first prenatal visit. DX with vaginal culture or urine screen. May cause *neonatal conjunctivitis or neonatal pneumonia*. Use doxycylcine for 7 days (cheaper but less compliance). or azithromycin for 1 day (More expensive, no need for compliance.) If <25, screen annually for chlamydia. Partner should also be treated.

Hepatitis B Management

Screening for the presence of HBsAg on all women at the first prenatal visit. Give newborn immunoglobulin if mom has Hep B. No specific treatment. Vaccinations in a series of three doses over a 6 month period.

Review safe sex practices and behaviors associated with increased risk of acquiring a sexually transmitted infection.

Sexual Risk: Number of partners Previous diagnosis of STD Use of barrier contraceptives Anal Intercourse Female anatomy predisposed them to STI's (columnar epithelial cells sensitive to invasion.) Teenage feeling of invincibility Unprotected intercourse Partnerships of limited duration Obstacles to using the healthcare system Drug Related Risk: Injection with shared needles Partner who uses drugs Sex while intoxicated Exchange sex for drugs/money/shelter Blood-related Risk: Received blood transfusion/Sex with recipient of transfusion Shared equipment for tattoo/body piercing.

Trichomoniasis S/S

Sexually transmitted. *Yellow-green, frothy, copious malodorous discharge.* *Dysuria* *Pain after sex* *Friable cervix*