NUR 236: Chapter 41 Sexually transmitted infections

Trichomoniasis. Diagnosis

-A sample of the discharge is used for application to pH paper, and whiff test is performed -Wet mount saline prep indicates the presence of trichomonads -Pap smear can detect the presence of trichonomads

Syphilis. Patient education

-Abstain from sexual contact until sores have completely healed. -Partners need to be tested and treated -After treatment report: headache, fever, tachycardia, and myalgia. This could be indicative of Jarisch-Herxheimer reaction and should be reported to the provider -If left untreated or undiagnosed, can be transmitted to the neonate and cause stillborn birth or congenital abnormalities -Infection of the eyes (leading to blindness), or nervous system (headache, numbness, paralysis, dementia)

Genital herpes. Medications

-Acyclovir (started at 36 weeks gestation to prevent outbreaks) -Valacyclovir -Famciclovir

Gonorrhea. Treatment

-Administer erythromycin to all infants following delivery. This is the medication of choice for ophthalmia neonatorum -Ceftriazone IM -Azithromycin PO or doxycycline to address any confection with chlamydia

Gonorrhea. Anal lesions symptoms

-Anal itching -Rectal bleeding -Diarrhea -Painful defecation

Hepatitis B. Symptoms

-Anorexia -Malaise -Vomiting -Abdominal pain -Dark urine -Jaundice -Skin rashes -Arthritis

Pelvic inflammatory disease. Treatment includes

-Antibiotics -Bed rest -Hospitalization

Hepatitis B. Education

-Appropriate handling of all blood or body fluids to prevent transmission of infection -Prevention of needle stick injuries -Universal vaccination

Bacterial vaginosis. Patient education

-Avoid alcohol while taking metronidazole due to a disulfiram-like reaction (severe nausea and vomiting) -Take all medications as prescribed -Understand the possibility of decreasing effectiveness of oral contraceptives -Treatment of partner is not routinely recommended -Adhere to safe sex practices

Candidiasis. Patient education

-Avoid tight-fitting clothing, and wear cotton-lined underpants -Remove damp clothing as soon as possible -Avoid douching -Increase dietary intake of yogurt with active cultures -If infections are recurrent or frequent, diabetes should be ruled out

Pelvic inflammatory disease. Chronic PID symptoms

-Backache -Feeling of pelvic heaviness -Disturbances in menstruation

Human Papilloma Virus (HPV). Symptoms

-Bumps in the genital area that might not itch or hurt, vaginal discharge, dyspareunia, and bleeding after intercourse -Small warts or a group of warts in the genital area that can have a cauliflower-like appearance -Abnormal changes to the cervix that can be detected by a Pap test

Genital herpes. Secondary/ recurrence symptoms

-Burning genital pain -Possible numbest and tingling/shooting pain 24 hr before lesions appear, vesicles

Pelvic inflammatory disease. Complications

-Can cause ectopic pregnancy -Can lead to infertility -Can cause chronic pain in abdominal area

Hepatitis B. Infection may be persistent and result in a chronic carrier state and may develop

-Chronic active hepatitis -Cirrhosis -Hepatocellular carcinoma -Hepatic failure -Death

Human Papilloma Virus (HPV). Treatment for genital warts

-Client applied creams, such as bicloroacetic acid (BCA) which is safe for use during pregnancy, and imiquimod, which is recommended for individuals age 13 and older who are not pregnant -Provider administered therapy, such as tricloroacetic acid (TCA) and application -For precancerous changes on the cervix, the provider can perform treatments including laser therapy or cone biopsy

Human Papilloma Virus (HPV). To prevent you want to

-Consider abstinence -Safe sex practices such as mutual monogamy, correct and consistent condom use

Candidiasis. The pH of the vagina can be altered by

-Diabetes -Oral contraceptives -Some systemic antibiotic use -Frequent douches

Chlamydia. Modes of transmission

-Direct sexual contact -May be transmitted to newborn during vaginal delivery -Very common STI in the US

Chlamydia. Medications

-Doxycycline -Azithromycin or amoxicillin -Erythromycin

Gonorrhea. Male symptoms

-Dysuria -Testicular edema or pain -Penile discharge (white, green, yellow, or clear) sometimes profuse

What are some prevention strategies for STIs

-Early education of adolescents on abstinence and safer sex practices. -Education and counseling of people at risk on ways to prevent STIs through changes in sexual and lifestyle behaviors. -Identification of asymptomatically infected people and of symptomatic people unlikely to seek diagnostic and treatment services. -Effective diagnosis and treatment of infected people. -Evaluation, treatment, and counseling of sexual partners of people who are infected with an STI. -Pre-exposure vaccination of patients at risk for vaccine-preventable STIs such as hepatitis B and HPV. -Follow-up of patients at risk or under treatment to ensure compliance.

Gonorrhea. Diagnosis

-Endocervical culture preferred for female clients -Urine cultures -Anal or oral cultures

Chlamydia. Diagnosis

-Endocervical swab culture of cervical discharge -Urine culture specimen as alternative

Genital herpes. Primary/initial symptoms

-Fever -Malaise -Myalgia, body aches -Burning genital pain -Dysuria (female) -Painful intercourse -Painful blisters -Enlarged body aches -Vesicles in genital area that ulcerate, crust over, and resolve spontaneously in about 2 weeks

Transmission of STIs. STIs are primarily based through some type of intimate contact such as

-Genital to genital -Mouth to genital -Genital to rectum

Human Papilloma Virus (HPV). Some types can cause

-Genital warts and cervical cancers

Prevention of HPV. Gardasil 9 provides protection against

-HPV types 6 and 11, which cause genital warts -HPV 16 and 18, the cancer-causing strains

Pelvic inflammatory disease. Acute PID is treated with

-IV antimicrobals, symptom relief, and patient support and treatment

Trichomoniasis. Treatment

-Identify and create all sexual partners -Reinforce safe sex practices with the client -Metronidazole or tinidazole: Orally -Partners should also be treated

Genital herpes. Education

-Keep lesions clean and dry to prevent secondary infection -Increased fluids will dilute urine for greater comfort -Topical anesthetics and oral analgesics may help manage pain -Encourage use of condoms with spermicide -If pregnant, infant should be delivered by cesarean section

Genital herpes. Diagnosis

-Lesions usually early identified by clinician -Can be confirmed by viral cultures of fluid from vesicles

Human Papilloma Virus (HPV). Vaccines are recommended to protect against

-Low risk types of HPV that cause genital warts -High risk types of HPV that cause cancer

Pelvic inflammatory disease. Acute PID Symptoms

-Lower severe abdominal pain -Unpleasant odor -Painful intercourse/urination -Yellow, green vaginal discharge -Fever, chills, nausea, vomiting

Chlamydia. Female symptoms

-Many females has no symptoms -Urinary frequency -Dysuria -Spotting or postcoital bleeding -Vulvar itching -Gray-white discharge

Bacterial vaginosis. Medications

-Metronidazole -Clindamycin -Probiotic lactobacilli used for prevention

Human Papilloma Virus (HPV). Risk factors

-Multiple partners -Unprotected sexual practices

Syphilis. Risk factors

-Multiple partners -Unprotected sexual practices

Chlamydia. Risk factors

-Multiple sex partners Unprotected Sex

Gonorrhea. Risk factors

-Multiple sexual partners -Unprotected sexual practices -Age younger than 25, if sexually active

Bacterial vaginosis. Risk factors

-New or multiple sex partners -Unprotected sexual practices

Chlamydia. Male symptoms

-Often asymptomatic -Penile discharge -Dysuria -Frequency of urination -Testicular edema or pain

Gonorrhea. Female symptoms

-Often no manifestations -Dysuria -Vaginal bleeding between periods -Dysmenorrhea -Yellowish-green vaginal discharge -Early induced endocervical bleeding

Syphilis. Transmitted through

-Oral -Vaginal -Anal -To an unborn child

Human Papilloma Virus (HPV). It is spread through

-Oral sex -Vaginal sex -Anal sex Most commonly vaginal or anal routes

Human Papilloma Virus (HPV). Diagnosis

-Pap test with or without HPV co-testing -Genital warts are diagnosed by provider based on appearance during physical examination -Based on the Pap test result, colposcopy and biopsy can be performed to diagnose cervical precancerous and cancer

Syphilis. Medications

-Penicillin G IM in a single dose. If the duration of the syphilis is unknown, three doses are recommended. Safe during pregnancy -Doxycycline or tetracycline orally, if allergic to penicillin as alternative therapy. Do not administer if pregnant

Candidiasis. Risk factors

-Pregnancy -Diabetes -Oral contraceptives -Recent antibiotic treatment -Obesity -Diet high in refined sugars

Gonorrhea. What are some perinatal complications if left untreated

-Premature rupture of membranes -Preterm birth -Postpartum sepsis and endometritis -Chorioamnionitis -Neonatal sepsis -Intrauterine growth restriction

Chlamydia. If not treated during pregnancy, chlamydia can cause

-Premature rupture of membranes -Preterm labor -Postpartum endometriosis

Trichomoniasis. Pregnant clients who have trichomoniasis are more likely to have

-Preterm delivery -Premature rupture of membranes

HIV. Treatments

-Preventing and screening is key as there is no cure -Medications include antiretroviral therapy (HAART) -Goal is to keep CD4 cell counts greater than 500 cells/mm3

STIs have a major impact on

-Reproduction -Sexuality -General health

Bacterial vaginosis. Diagnostics

-Sample of the vaginal discharge applied to pH paper, a pH greater than 4.5 -Saline and potassium hydroxide (KOH) wet smear test, wet mount saline prep, which indicated presence of clue cells -Positive whiff test with release of a fishy odor

Hepatitis B. Diagnosis

-Serologic testing for HBV infection gives definitive diagnosis

Hepatitis B. Transmission via

-Sexual contact -Blood contact -Fetus via the placenta in an infected mother

Mode of transmission include

-Sexual intercourse -Contact with the genitals -Rectum -Mouth

Chlamydia. If continued sexual activity is desired, be aware of the

-Sexually transmitted infection status of any sexual partners -Use a barrier contraceptive each time you have sex

Risk factors for transmission of STIs. STIs can have long-term reproduction in the form of

-Sterility -Complicated pregnancy -Neonatal infection

Reporting STIs. What are some current reportable diseases

-Syphilis -Gonorrhea -Chlamydia

Reporting STIs. In some status, screening for some STIs such as ___________, is required for a marriage license

-Syphilis -Gonorrhea -Pelvic inflammatory disease -Chlamydia -Lymphogranuloma

Bacterial vaginosis. Symptoms

-Thin, white, or gray discharge with a fish-like odor, especially after sex

Candidiasis. Medications

-Topical therapies recommended for use in pregnant clients -Miconazole or clotrimazole for 3 to 7 days, this is an OTC treatment, provider should diagnose candidiasis initially -Fluconazole can be prescribed as a single low dose to clients who are not pregnant or lactating

Gonorrhea. Females frequently have no manifestations. If gonorrhea is left untreated, it can cause

-Tubal scarring and can lead to pelvic inflammatory disease which can cause infertility

Gonorrhea. Oral lesions symptoms

-Ulcerations of the lips, tender gums, pharyngitis

Trichomoniasis. Male symptoms

-Urethral draining, itching, or irritation -Dysuria or pain with ejaculation -Can lead to prostate infections

Syphilis. Diagnosis

-VDRL -Rapid plasma reagin

Genital herpes. Female symptoms

-Vulva -Vaginal surface -Buttocks -Cervix

Candidiasis. Symptoms

-Vulvar and vaginal pruritus (itching) -Painful urination due to the excoriation from itching -Thick, creamy, white, cottage cheese (curd) like vaginal discharge -Vulvar and vaginal erythema and inflammation -White patches on the vaginal wall

HIV. Symptoms

-Weight loss -Fatigue -Recurring vaginal yeast infection -Diarrhea/flu like symptoms -Oral thrush

Trichomoniasis. Female symptoms

-Yellow-green, frothy vaginal discharge with foul odor -Dyspareunia and vaginal itching -Dysuria -Strawberry spots on the cervix (tiny petechiae) -A cervix that bleeds easily

HIV. Vaginal birth can be an option of a client who has a viral load of less than

1,000 copes/mL at 36 weeks of gestation

HIV. Review plan for scheduled cesarean birth at 38 weeks for maternal viral load of more than

1,000 copies/mL

Prevention of HPV. The recommended routine HPV vaccine for all girls and boys is

11 to 12 years old through 18 to 26 years

Bacterial vaginosis. It is the most common vaginal infection in females aged

14 to 49 years of age

Human Papilloma Virus (HPV). Routine screening for females ages

21 to 65 years

Gonorrhea. Repeat culture within ____________ to monitor for medication effectiveness

3 to 4 weeks

Gonorrhea. This has a high reoccurrence rate so repeat culture at

3-6 months

Genital herpes. How long do blisters last

7 to 21 days

Human Papilloma Virus (HPV). The vaccine is indicated for ages

9 to 26, though ideally given at age 11 to 12

Prevention of HPV. The HPV vaccine can be given to boys and girls as young as

9, and to women up to 26

Gonorrhea. What is this

A bacteria infection that is primarily spread by genital-to-genital contact. It can also be spread anal-genital or oral-genital contact. I can also be transmitted to a newborn during delivery

HIV. Give newborn what before shots and blood draws

A bath

Candidiasis. It is caused by

A change in the vaginal pH, which allows the yeastlike fungus Candida albicans to grow

Pelvic inflammatory disease. Can be

Acute or chronic

The largest population groups affected by STIs are

Adolescents and young adults

Trichomoniasis. While taking Metronidazole or tinidazole you want to avoid

Alcohol while taking the medication and for 3 days after treatment to avoid disulfiram-like reaction that occurs (severe nausea, vomiting)

Risk factors for transmission of STIs. Types of contraceptive used based on reproduction choices may influence a woman's increased risk of STIs because the use of oral contraceptives

Alters the cervical secretions, resulting in alkaline environment in the vagina and thus a more favorable setting for growth of organisms that cause STIs

Genital herpes. _______________ medications can shorten and prevent outbreaks

Antiviral

Pelvic inflammatory disease. This refers to the

Any inflammation in the pelvic cavity

Hepatitis B. Acute infection may be

Asymptomatic

Gonorrhea. At pregnant clients at risk should be screened

At the first prenatal visit and prescreened in the third trimester if at continued rest risk

Chlamydia. How often should pregnant clients be screened

At the first prenatal visit and rescreened in the third trimester if younger than 25 years and/or high risk

Pelvic inflammatory disease. Several different _______________ can cause PID

Bacteria

Pelvic inflammatory disease. How does bacterial travel

Bacteria travels into peritoneal cavity, ovaries, Fallopian tubes through the uterus

Chlamydia. Chlamydia is a

Bacterial infection caused by Chlamydia trachoma's and is the most commonly reported STI in American females

Syphilis. This is an STI caused by the

Bacterium Treponema pallidum

These are microscopic tissue examinations perfumed on a sample taken from the affected area and are usually done to differentiate between benign and malignant tissues but can also provide a differential diagnosis for diseases that have specific cellular changes or organisms present

Biopsies

Reporting STIs. Bloodborne infections may be transmitted to a fetus before

Birth

Reporting STIs. Newborns are at risk for contracting any STI that may reside in the vagina at the time of

Birth

STIs can also be transmitted via

Blood contact and to a fetus via the placenta or to a newborn during the birthing process

HIV. After pregnancy you want to avoid

Breastfeeding

Genital herpes. If active lesions are present during the last 2 weeks before delivery what is indicated

C-section

HIV. Transmission

Can be passed by sexual contact and contaminated needles

Prevention of HPV. Both vaccines are highly efficacious against

Cervical, vaginal, vulvar, and anal cancers, are well tolerated and are considered safe

Gonorrhea. CDC recommends treatment for ________________ as well for those who test positive for gonorrhea

Chlamydia

Pelvic inflammatory disease. Many cases have been due to

Chlamydia and gonorrhea

Hepatitis B. Infants born infected are at a high risk for

Chronic Hepatitis B infection

Agglutination

Clumping together of cells in a variety of characteristic patterns

Human Papilloma Virus (HPV). When large, widespread, or occluding the birth canal, genital warts can

Complicate a vaginal delivery, a cesarean section can be recommended

People with multiple sexual partners are at high risk for

Contracting an STI

Human Papilloma Virus (HPV). For a pregnant client with an abnormal Pap that requires further follow-up, further evaluation and treatment are usually

Deferred until after birth

Genital herpes. This is spread by

Direct contact, not limited to only sexual contact. Transmission most commonly occurs from infected partner with no visible lesions

Candidiasis. Diagnosis

Discharge is treated for pH and wet mounted to observe for yeast buds, hyphae, and pseudo-hyphae

Candidiasis. During pregnancy, candidiasis is treated to relieve

Discomfort and prevent oral thrush in the neonate

Risk factors for transmission of STIs. Biologically, young, sexually active women have a large portion of columnar epithelium lining of the cervix and a vaginal pH that can be altered by frequent

Douching

Chlamydia. _________________ might reduce the effectiveness of oral contraceptives

Doxycycline

Human Papilloma Virus (HPV). Routine screening can provide

Early detection

Human Papilloma Virus (HPV). Females 21 to 29 years old should have a Pap test

Every 3 years

Human Papilloma Virus (HPV). During pregnancy, the lesions can

Expand and obscure the birth canal, which can interfere with the descent of the fetus and the clients ability to urinate and defecate

Lesions of STIs. Lesions can also be found far from the

Genital area. For example, lesions of syphilis include a classic rash on the palms of the hands and soles of the feet

Chlamydia. Erythromycin is an antibiotic that is both bacteriostatic and bactericidal, and thus provides prophylaxis against

Gonorrhea and chlamydia

If the gram stain loses the stain but accepts the counter stain they are considered

Gram negative

If the gram stain retains the initial stain it is

Gram positive

People aged 50 years and older constitute 45% of Americans living with

HIV

Reporting STIs. What infections can be passed through blood contact, sharing of needles, or rarely through transfusion with contaminated blood, needle or sharps injuries or by direct contact with open wounds or body fluids

HIV or hepatitis B

Human Papilloma Virus (HPV). Pre-teens can get the

HPV vaccine

Bacterial vaginosis. This is a bacterial infection most commonly caused by

Haemophilus vaginalis or Gardnerella vaginalis

Hepatitis B. This is cause by

Hepatitis B virus

Genital herpes. This is caused by

Herpes simplex virus types 1 and 2

Risk factors for transmission of STIs. An alteration of vaginal pH can place the woman at

Higher risk for an STI

HIV. What therapy is initiated before delivery to decrease the risk of transmission to infant

IV HAART therapy 3 hours before

Bacterial vaginosis. If BV is left untreated, it can

Increase a client's chances of developing PID, which can lead to infertility

Goals of Healthy People 2030 include to

Increase access to resources that prevent STIs and to decrease the incidence of gonorrhea and syphilis

Risk factors for transmission of STIs. The use of long-acting oral contraceptives may contribute to a reduced use of condoms, thus

Increasing the risk of exposure to STIs in both partners

Pelvic inflammatory disease. PID can result from an

Infection after pelvic surgery or childbirth and is not always an STI

Pelvic inflammatory disease. The most common reproductive complication is

Infertility from damage to the fallopian tubes

Bacterial vaginosis. It is related to reduction in the

Lactobacilli in the vaginal flora

Genital herpes. Male symptoms

Lesions may appear on -Glans penis -Shaft of penis -Prepuce -Scrotal sac -Inner thighs

Syphilis. This can have ______ _______ complications if not adequately treated

Long term

Bacterial vaginosis. BV is associated with

Minor vaginal tissue trauma, often caused by frequent sexual activity or douching

Human Papilloma Virus (HPV). HPV is the

Most common STI

Lesions of STIs. Lesions around the _____________ of either sex can occur in cases of oral sexual practices

Mouth

Risk factors for transmission of STIs. Women aged 15 to 24 are diagnosed with STIs at a

Much higher rate than men

Risk factors for transmission of STIs. The ___________ ________ in the cervix of women becomes more permeable around the menstrual period, which can result in an increased risk during this time for infections in the upper genital tract, such as PID

Mucus plug

Gonorrhea. What is the causative of agent of gonorrhea

Neisseria gonorrhoae

Hepatitis B. Treatment

No specific therapy is available. HBIG is given after exposure

Human Papilloma Virus (HPV). Females older than than 65 years who have had regular screening with normal results should

Not be screened for cervical cancer, unless they have cervical precancer, in which they should continue to be screened for 20 years after the precancer diagnosis

Risk factors for transmission of STIs. Men seek earlier health care intervention because the signs and symptoms are more

Obvious and distressing

Pelvic inflammatory disease. Infection of the ovary is called

Oophoritis

Chlamydia. Erythromycin is administer to all infants following delivery to prevent

Ophthalmia neonatorum within 1 hour of birth

Gonorrhea. If left untreated, the neonate experiences

Ophthalmia neonatorum, which can cause blindness

Gonorrhea. There is a possibility of this decreasing effectiveness of

Oral contraceptives

Trichomoniasis. Metronidazole and tinidazole may decrease the effectiveness of

Oral contraceptives

Pelvic inflammatory disease. The organisms causing the infection are usually introduced from the

Outside, traveling through the uterus to infect pelvic organs

Human Papilloma Virus (HPV). Females 30 to 65 years old should have both a

Pap test and an HPV test every 5 years, it is also acceptable to get a Pap test alone every 3 years

Chlamydia. If chlamydia is left untreated in females, it can lead to

Pelvic inflammatory disease (PID)

Trichomoniasis. If left untreated in females, it can lead to

Pelvic inflammatory disease, which can cause infertility

Pelvic inflammatory disease. Infection of the pelvic peritoneum is called

Pelvic peritonitis

Trichomoniasis. Transmitted by

Penis-to vagina, or vagina-to-vagina

Reporting STIs. Depending on the organism, such exposure can lead to a variety of serious problems for the infant, including

Pneumonia and blindness

Chlamydia. Doxycycline is used as a treatment, but is contraindicated during

Pregnancy

HIV. You want to screen for HIV during

Pregnancy

Human Papilloma Virus (HPV). Screening should occur, even during

Pregnancy

Lesions of STIs. In men, the lesions related to STIs may appear under the

Prepuce, on the head or body of the penis, or on the scrotum, perianal area, rectum, anus, or inner thighs

Bacterial vaginosis. Treatment is especially important for pregnant clients because it can cause

Preterm labor and preterm birth

Syphilis. During the _________ stage, -The client can notice a chancre, which is a painless papular lesion at the site of infection (genitals or mouth) -Chancers can progress to an ulcerated area -Female report of inguinal lymph node edema can indicate internal lesions (vaginal or cervical)

Primary

Trichomoniasis. This is an STI caused by the

Protozoan parasite Trichomonas vaginalis.

Pelvic inflammatory disease. If the infection is in the Fallopian tubes, it is called

Salpingitis

Candidiasis. It is the ___________ most common type of vaginal infection in the US

Second

Syphilis. During the _________ stage, -The client can notice skin rashes, such as maculopapular rash on the palmar surface of the hands and the soles of the feet -Flu-like symptoms

Secondary

Pelvic inflammatory disease. Treatment is based on

Severity

Pelvic inflammatory disease. It is more common in

Sexually active women, particularly women with multiple sexual partners

This is taken directly from the site, ex vaginal, cervical, or urethral swabs

Smears and cultures

The term sexually transmitted infection refers to

Specific infections spread by intimate physical contact

____________ _______________ differentiate organisms by using dyes that have been found to stain some bacteria in specific ways

Staining procedure

Reporting STIs. STIs must be reported to the local public health agency in accordance with

State and local statutory requirements

Chlamydia. This can lead to _____________ in men

Sterility

Gonorrhea. This can lead to male _____________

Sterility

Syphilis. During the __________ stage, -Damage to internal organs can occur for which clients can notice the manifestations including difficulty coordinating muscle movement and blindness -Neurologic and cardiovascular infections

Tertiary

Bacterial vaginosis. All clients who have manifestations should be

Tested

Trichomoniasis. All females who have clinical findings should be

Tested

Syphilis. All pregnant clients should be screed at

The first prenatal visit and prescreened in the third trimester if at high risk (live in areas with high numbers of syphilis cases, not previously tested, or had positive test in the first trimester)

Trichomoniasis. Metronidazole is not given during

The first trimester of pregnancy due to the teratogenic effects on the fetus

Human Papilloma Virus (HPV). If therapy is deferred until after delivery of baby, remember that

The lesions are infectious

Prevention of HPV. How many doses are required

Three

Human Papilloma Virus (HPV). How many doses of the vaccine are received during a 6 month period

Three doses

Genital herpes. There is no cure, so symptoms are

Treated

Risk factors for transmission of STIs. What is the first signs of an STI in men

Urinary tract infections associated with sexual activity

Pelvic inflammatory disease. Only ___________ can get PID

Women

Risk factors for transmission of STIs. During and after the sexual act, male secretions and semen are in contact with female mucous membranes for longer than female secretions are in contact with male mucous membranes, therefore

Women have an increased risk for STIs

Chlamydia. The CDC recommends screening how often

Yearly for sexually active females younger than 25 years, as well as older females who have risk factors such as new or multiple partners

Candidiasis. This is a _____________ ____________

Yeast infection

Gonorrhea. The CDC recommends yearly screenings for all sexually active females aged

Younger than 25 years as well as older females who have risk factors of new or multiple partners