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Chapter 7

Copyright 2016 by Elsevier Inc. All rights reserved.

Sexally !rans"itted # $ther In%ections&all 201'

(ove"ber 1)* 201'


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2Copyright 2016 by Elsevier Inc. All rights reserved.

+earning $b,ectives

-escribe prevention o% sexally trans"itted in%ections

in o"en* inclding ris/ redction "easres. -i%%erentiate signs* sy"pto"s* diagnosis* and

"anage"ent o% nonpregnant and pregnant o"en

ith selected sexally trans"itted bacterial in%ections

chla"ydia* gonorrhea* syphilis. Exa"ine the care o% nonpregnant and pregnant

o"en ith selected sexally trans"itted viral

in%ections h"an i""node%iciency virs 3I45hepatitis A* * and C h"an papillo"avirs genital

herpes.


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)Copyright 2016 by Elsevier Inc. All rights reserved.

+earning $b,ectives Cont.

Co"pare and contrast signs* sy"pto"s* and

"anage"ent o% selected vaginal in%ections in

nonpregnant and pregnant o"en. -iscss the e%%ect o% grop streptococci 8S on

pregnancy and "anage"ent o% pregnant o"en ith

8S. Identi%y the e%%ects o% !$9C3 in%ections on

pregnancy and the %ets. -escribe the health conse:ences e.g.* ectopic

pregnancy* in%ertility %or o"en ho are in%ected

ith reprodctive tract in%ections. 9evie principles o% in%ection control %or 3I4 and

blood;borne pathogens.


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'Copyright 2016 by Elsevier Inc. All rights reserved.

=revention Cont.

9is/ redction "easres >noledge o% partner 9edction o% the n"ber o% partners

+o;ris/ sexAvoiding exchange o% body %lids 4accination


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=revention Cont.

9is/ redction "easres =hysical barriers

? Condo"s Che"ical barriers

? (onoxynol;@ Co""nication

? Expressing %eelings and %ears? Attention to partners response? (rses "st sggest strategies to enhance a o"ans

condo" negotiation and co""nication s/ills. 4accination


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acterial Sexally !rans"itted

In%ections

Chlamydia trachomatis Bost co""on and %astest spreading S!I

? In%ections o%ten silent and highly destrctive? -i%%iclt to diagnose

? Sexally active o"en ages 1' to 2< years have thehighest rates o% in%ection* ith o"en ages 1 to 20

years having the highest rates C-C* 2012e. Screening and diagnosis

? Asy"pto"atic and pregnant o"en

? Co"parisons o% diagnostic procedres


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Copyright 2016 by Elsevier Inc. All rights reserved.


In%ections Cont.

Chla"ydia Banage"ent

? -oxycycline? ADithro"ycin

? All exposed sexal partners shold be treated. =erinatal trans"ission

? Antibiotic oint"ent


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(or"al Cervix

Source Claire E. Stevens, Seattle STD/HIV Prevention Training Center


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Chla"ydia Cervicitis

Source St. +ois S!-F3I4 =revention !raining Center


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Bcoprlent Cervicitis

Source Seattle S!-F3I4 =revention !raining Center

-rip

s


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In%ections Cont. 8onorrhea

Aerobic gra";negative diplococcs $ldest co""nicable disease in the Gnited States

Second to chla"ydia in reported cases 3ighest rates a"ong teenagers* yong adlts* and

A%rican;A"ericans Ho"en o%ten asy"pto"atic


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In%ections Cont. 8onorrhea

Screening and diagnosis? C-C reco""ends screening all o"en at ris/.? !esting per%or"ed dring %irst tri"ester and at )6 ee/s

o% pregnancy? Is a reportable disease

Banage"ent? Antibiotic therapy ce%ixi"e or ce%triaxone? Conco"itant treat"ent %or chla"ydia

? =erinatal co"plications o% gonococcal in%ection


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1


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1'Copyright 2016 by Elsevier Inc. All rights reserved.


In%ections Cont.

Syphilis Treponema pallidum* a "otile spirochete

? Earliest described S!I? !rans"ission by entry into sbctaneos tisse throgh

"icroscopic abrasions that can occr dring sexalintercorse

? Also trans"itted throgh /issing* biting* or oral;genitalsex

!ransplacental trans"ission "ay occr at any

ti"e dring pregnancy.


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acterial Sexally !rans"itted In%ections

Cont.

Syphilis Can lead to serios syste"ic disease and even

death hen ntreated

In%ection "ani%ests in distinct stages? =ri"ary ' to @0 days a%ter exposre? Secondary 6 ee/s to 6 "onths? !ertiary develops in one third o% o"en in%ected


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In%ections Cont.

Syphilis Screening and

diagnosis? =regnant o"en

? Serologic tests? &alse;positive reslts

Banage"ent? =enicillin? Sexal abstinence

dring treat"ent


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=ri"ary Syphilis

Source Centers %or -isease Control and =revention


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=ri"ary Syphilis Chancre

Source &lorida S!-F3I4 =revention !raining Center


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Secondary Syphilis 9ash

Source Cincinnati S!-F3I4 =revention !raining Center


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In%ections Cont.

=elvic in%la""atory disease =I-An in%ectios process that "ost co""only

involves the %allopian tbes* ters* and

occasionally the ovaries and peritoneal sr%aces Bltiple organis"s have been %ond to case =I-.


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In%ections Cont. =elvic in%la""atory disease =I-

9is/ %actors %or ac:iring =I-? ong age? (lliparity

? Bltiple partners? 3igh rate o% ne partners? 3istory o% S!Is and =I-

!hose ith =I- are at increased ris/ %or? Ectopic pregnancy? In%ertility

? Chronic pelvic pain


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2'Copyright 2016 by Elsevier Inc. All rights reserved.

4iral Sexally !rans"itted In%ections

3"an papillo"avirs

3=4 Condylo"ata ac"inata A%%ects 20 "illion

A"ericans Bost prevalent viral S!I

seen in a"blatory

health care settings =reviosly na"ed genital

or venereal arts Bore %re:ent in

pregnant o"en


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=erianal Hart



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3=4 Cervical Harts



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3=4 Harts on the !high



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Cont.

3erpes si"plex virs 3S4 3erpes si"plex virs 1 3S4;1

? !rans"itted nonsexally 3erpes si"plex virs 2 3S4;2

? !rans"itted sexally

Initial in%ection characteriDed by "ltiple pain%l lesions*%ever* chills* "alaise* and severe dysria


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Cont. 3erpes si"plex virs 3S4 Cont.

Chronic and recrring disease %or hich there isno /non cre

Syste"ic antiviral "edications partially control the

sy"pto"sJ Baternal in%ection ith 3S4;2 can have adverse e%%ects

on "other and %etsJ (eonatal herpes

Bost severe co"plication o% 3S4 Bost "others lac/ history o% 3S4

S


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8enital 3erpes Si"plex

)2

Sor

es

Source &lorida S!-F3I4 =revention !raining Center


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8enital 3erpes Si"plex in &e"ales

Source Centers %or -isease Control and =revention


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)


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Cont. 4iral hepatitis Cont.

3epatitis virs 34? Bost threatening to the %ets and neonate? -isease o% the liver and o%ten a silent in%ection

? !rans"itted parenterally* perinatally* and* rarely* orally asell as throgh inti"ate contact

? 4accination series available? (o speci%ic treat"ent recovery is sally spontaneos

ithin );16 ee/s


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Cont. 4iral hepatitis Cont.

3epatitis C virs 3C4? Bost co""on blood;borne in%ection in the Gnited States? I"portant health proble" as increasing n"bers ac:ire

disease? 9is/ %actor %or pregnant o"en is history o% in,ecting I4

drgs

? Inter%eron;al%a or ribavirin is "ain therapy %or 3C4in%ection

? E%%ectiveness o% treat"ent varies


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Cont.

3"an i""node%iciency virs 3I4


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Cont.

3"an i""node%iciency virs 3I4 Cont. Severe depression o% the celllar i""ne syste"

associated ith 3I4 in%ection characteriDes AI-S Sy"pto"s %ever* headache* night seats*

"alaise* generaliDed ly"phadenopathy* "yalgias*

nasea* diarrhea* eight loss* sore throat* and

rash


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4aginal In%ections Cont.

!richo"oniasis Cased byTrichomonas vaginalis $%ten considered an S!I Co""on case o% vaginal in%ection

In%la""ation o% the vagina andFor vlva Screening and diagnosis

? Specl" exa"ination? =ap test

Banage"ent

? BetronidaDole? !he ris/ %or sexal trans"ission "st be co""nicatedto in%ected o"en.


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4aginal In%ections Cont.

8rop streptococci 8SA part o% the nor"al vaginal %lora* present in 20K

to )0K o% healthy o"enAssociated ith poor pregnancy otco"es I"portant %actor in neonatal "orbidity and

"ortality Screening at )6;)7 ee/s o% gestation Intrapart" intravenos prophylaxis


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Baternal and &etal E%%ects o%

Sexally !rans"itted In%ections S!Is in pregnancy are responsible %or

signi%icant "orbidity and "ortality =regnancy e%%ects

? =re"atre rptre o% "e"branes? =re"atre labor? =ostpart" sepsis? -ystocia? Biscarriage


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')Copyright 2016 by Elsevier Inc. All rights reserved.

Baternal and &etal E%%ects o% Sexally

!rans"itted In%ections Cont.

S!Is in pregnancy are responsible %or

signi%icant "orbidity and "ortality. &etal e%%ects

? =reter" birth? =ne"onia? Syste"ic in%ection? Congenital in%ection? Stillbirth


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'


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''Copyright 2016 by Elsevier Inc. All rights reserved.

Baternal and &etal E%%ects o% Sexally

!rans"itted In%ectionsCare Banage"ent

Assess"ent and nrsing diagnoses 3istory

? As/ abot li%estyle behaviors that place clients at ris/ %orS!Is

=hysical exa"ination? Ensre co"%ort dring exa"ination

+aboratory tests


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Baternal and &etal E%%ects o% Sexally !rans"itted

In%ectionsCare Banage"ent Cont.

Expected otco"es o% care &ocs on physical and psychologic needs ith

e"phasis on avoidance o% rein%ection and har"%l

se:elae In%ection control

=lan o% care and interventions Banage"ent dring pregnancy

Evalation


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In%ection Control

Interrpting the trans"ission o% in%ection is

crcial to S!I control Bany S!Is are reportable all states re:ire

that these S!Is be reported to pblic healtho%%icials 8onorrhea Syphilis

Chancroid +y"phogranlo"a venere" 8ranlo"a inginale


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'Copyright 2016 by Elsevier Inc. All rights reserved.

>ey =oints

9eprodctive tract in%ections inclde S!Is and

co""on genital tract in%ections. 9is/;redction sexal practices are /ey S!I;

prevention strategies. 3I4 is trans"itted throgh body %lids*

pri"arily blood* se"en* and vaginal

secretions.


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>ey =oints Cont.

=revention o% "other;to;neborn 3I4

trans"ission is "ost e%%ective hen the

o"an receives antiretroviral drgs dring

pregnancy and labor and birth* and the in%antreceives the drgs a%ter birth.

3=4 is the "ost co""on viral S!I. Syphilis has ree"erged as a co""on S!I*

a%%ecting A%rican;A"erican o"en "ore thanany other ethnic or racial grop.


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>ey =oints Cont.

Chla"ydia is the "ost co""on S!I ino"en in the Gnited States and the "ostco""on case o% =I-.

4iral hepatitis has several %or"s o%trans"ission 34 in%ections carry thegreatest ris/.

ong* sexally active o"en ho do notpractice ris/;redcing sexal behaviors andhave "ltiple partners are at greatest ris/ %orS!Is and 3I4.


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>ey =oints Cont.

S!Is are responsible %or sbstantial "ortality

and "orbidity* great personal s%%ering* and

heavy econo"ic brden in the Gnited States.

S!Is and vaginitis are biologic events %orhich all individals have a right to expect

ob,ective* co"passionate* and e%%ective

health care.


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>ey =oints Cont.

=regnancy con%ers no i""nity against

in%ection* and both "other and %ets "st be

considered hen the pregnant o"an

contracts an in%ection. ecase history and exa"ination cannot

reliably identi%y everyone ith 3I4 or other

blood;borne pathogens* blood and body;%lid

precations shold be sed consistently %oreveryone all the ti"e.


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Oestion

1. A nrse is providing discharge instrctions toa client ho has ,st been diagnosed ithh"an papillo"avirs 3=4 on her cervix.Hhat is the "ost i"portant dischargeinstrction %or this clientN

a. !a/e a "ltivita"in every day.b. Chec/ %or external lesions arond the vagina

every "onth.

c. 3ave =ap tests done as reco""ended by herprovider.d. Avoid sing an intraterine device IG-.

chapter_007 powerpoint for nov 13

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