1. STIs BY: Diana Blum MSN Metropolitan Community College

2. Statistics Each year more than 100,000 women are left sterile 19 million infections occur in USA each year Mostly in 15-24 year olds Drug Abuse and multiple sex partners are risk factors Highest in African Americans, Hispanics, and Caucasians

3. Nursing Know your feelings Don’t be judgmental Provide quality care Reporting is Mandatory: HIV/AIDS, Gonorrhea, Syphilis, Chlamydia, viral Hepatitis Get list of sexual partners This slows transmission They need treatment as well

4. Diagnostics Serologic Tests: done to detect infection Smears and Cultures: many have discharges/lesions that need identification and treatment options

5. Chlamydia Chlamydia Infection-caused by virus like bacteria “chlamydial trachomatis” Symptoms usually take 1-3 weeks after infected S/s Men – penile discharge – Painful and frequent urination S/s woman – Vaginal discharge & lower abdominal pain – No symptoms may be experienced

6. Assessment & Treatment Contact transmission by MM in the mouth eyes, urethra, vagina, rectum Take sexual hx Chlamydial antigen test Cell tissue culture Treatment-single dose azithromyacin-Zithromax, or 7 day course of Vibramyacin(doxycycline), no sex til cured Complications: newborns get eye infection or infant pneumonia, sterility, sperm duct obstruction, PID, Ectopic Pregnancy, 5x’s more likely to get HIV

7. chlamydia

9. Chlamydia Vaginitis

10. Gonorrhea Caused by neissara gonorrhoeate S/s female – Vaginal discharge – Redness swelling of external genitalia – Burning on urination – Abdominal pain – Abnormal menstruation – Rectal infection can cause: discharge, anal itch, soreness, bleeding, painful defecation, sore throat S/s male – d/c from penis that is white or green – Burning on urination

11. Transmission can occur from mom to baby Can not get from toilet seat, door knob, towel It is possible to be asymptomatic Symptoms occur 2days to 3 weeks after exposure the disappear Men are usually more syptomatic Complications: Sterility, damage to heart, damage to joints, PID, increase risk of HIV

12. Treatment Single dose of Rocephin IM, Cipro IM or Orthoflex IM followed by 7 days of oral vibromyacin If untreated, can cause sterility Person remains infectious if untreated, even though symptoms disappear after 3-4 weeks PCN not used because of resistance issues F/U with MD Care plan page 1167

13. Gonorrhea

14. Syphillis Caused by a spirochete Treponoma Pallidum. 9756 cases in 2006 in USA Can be passed through placenta causing congenital syphilis S/s progress in 4 stages Page 1158

15. First stage Chancre-may last from 1 to 5 weeks Disappears and becomes a painless red ulcer that may last from 1-5 weeks then it moves to the blood Highly contagious Chancre usually noticed 1-12 weeks after initial contact

16. Primary syphilis-chancre

18. Primary syphyilis

19. Second Stage Contagious Occurs 6 weeks from contact Rash on extremities palms of hands, soles of feet and trunk then pustules develop S/S: fever sore throat, general ache

20. Third Stage-Latent stage No Symptoms Disease may be spread by blood contact not by sex act itself Major organs being invaded

21. Fourth Stage-Late stage Usually 3 years after initial contact S/s: BLINDNESS – MENTAL ILLNESS – PARALYSIS – HEART DISEASE – ARTHRITIS – NUMB EXTREMITIES – ULCERS ON SKIN AND ORGANS – PAIN – EASIER CHANCE OF GETTING HIV

22. Diagnosis and Treatment Dx based on blood confirmation of organism Treatment of choice Pen G injections patients allergic to penicillin may be treated with doxycycline 300mg daily for 21 days or oral amoxycillin 3gm twice daily with 1 gm of probenecid for 2 weeks. F/U with Doctor No sex for 1 month after treatment

23. Herpes Simplex Type II – transmitted by sexual contact – Can be transferred by hand contact – Virus that causes cold sores (HSV1) – Avoid Direct Kissing S/s – Painful itching sores around genitals – Rash,then blisters – Flu-like symptoms and burning on urination – Appearance and lab tests used to dx

24. Herpes Simplex WomenMen

25. Treatment for Herpes No cure May keep in check with antivirals Wash towels/ personal items Complications: cervical cancer and need for c-sections

26. Trichomoniasis Caused by the parasite Trichomonas Vaginalitis 7 million new cases each year Usually transmitted sexually but can live on damp clothes and towels If found the partner will also need to be treated even if no symptoms present

27. S/s women blood spotting in vaginal discharge heavy, yellowish-green or gray, frothy vaginal discharge infection in the urethra – the tube that carries urine from the bladder out of the body itching, burning or pain in the vagina lower abdominal pain musty vaginal odor pain and/or burning when urinating pain or discomfort during sexual intercourse (dyspareunia) swelling in the groin swollen and irritated vagina and cervix urinating more than usual vaginal or vulval redness worsening symptoms when menstruating

28. Trichomoniasis S/s men – Few or no symptoms – infection of the urethra or prostate gland, which is involved in semen production – painful and/or difficult urination – thin, whitish discharge from the penis – tingling inside the penis – Treatment Flagyl is drug of choice Diagnostics by microscopic study and cultures

29. Trichomoniasis

30. Condylomata Acumulata Venereal warts Caused by HPV (pap smears are highly important) Incubation is 3 weeks to 8 months Warts are pink or red and soft with cauliflower like appearance BX done for diagnosis High reoccurrence rate Pregnancy Stimulates large growth Treatment-removing visible parts of warts for symptom relief via surgery, cryotherapy, acid burn off or interferon injection

31. Condylamata

32. Condylamata

33. Vulva

34. Bacterial Vaginosis Caused by Gardenella Vaginalis Associated with multiple sex partners and douching S/s are grey discharge and fishy odor, itching Treatment is Flagyl Client teaching-no alcohol when taking meds as can have a rx with vomiting, tachycardia and hypotension  Note! Flagyl is contraindicated during pregnancy so a menstrual history or pregnancy test should be obtained before administration

35. Vaginitis  Etiology:  bacteria  protozoa  viruses  yeasts

36.  The acidic environment (pH less than 5.0) of the vagina inhibits the growth of many pathogens. Several factors increase risk for infection.

37. Factors that increase Risk Skin diseases Skin irritation Perfumes Nylon underwear antibiotics

38.  Diagnosis made from description of symptoms and identification of pathogens in sample of vaginal discharge

39.  Types of vaginitis  candidiasis caused by Candida albicans, a fungus (cottage cheese like discharge)  trichomoniasis, caused by Trichomonas vaginalis, a protozoan

40. Ways to decrease risk Avoidance or irritants-chemicals, dyes, soaps Cotton underwear, nonrestrictive clothing Frequent cleansing with neutral agents Heat in the form of sitz baths or irrigation Avoid sexual intercourse during course of treatment Review box 49-2 and condom use on page 1170