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