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STIs

STIs. BY: Diana Blum MSN Metropolitan Community College. 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

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STIs

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  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. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

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

  14. 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

  15. 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

  16. 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

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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. Vaginitis • Etiology:  bacteria  protozoa  viruses  yeasts

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

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

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

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

  28. 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

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