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Sexuality: Sexually Transmitted Infections

Sexuality: Sexually Transmitted Infections. Perry pp. 96-106. STIs--Overview. Transmission—intimate sexual contact, blood, body fluids, transplancental

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Sexuality: Sexually Transmitted Infections

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  1. Sexuality: Sexually Transmitted Infections Perry pp. 96-106

  2. STIs--Overview • Transmission—intimate sexual contact, blood, body fluids, transplancental • Epidemiology—frequent sexual contact with multiple sex partners; heterosexual women is fastest growing group; females under 20 especially vulnerable—cx is highly susceptible • Contributing factors—unprotected sex, antibiotic resistance, tx delay from ignorance or embarassment • Positive results for one STI may indicate need for other STI screenings

  3. Sexual hx STD hx Contraceptive use Med use Menstrual irreg Vaginal d/c Itching Lesions Urinary sx Lymphadenopathy Sore throat General Assessment of STIs

  4. Diagnostics • History and Physical • Serum tests • Enzyme immunoassay (chlamydia, HIV) • Nucleic acid amplification (chlamydia) • Western blot (HIV-confirms + EIA results) • VDRL, RPR (syphilis) • Antibody assays (syphilis-confirms + RPR) • Cervical cultures (gonorrhea, chlamydia) • Lesion cultures (syphilis, herpes) • PAP and bx (HPV)

  5. Bacterial Infections: Chlamydia • Most common, fastest spreading • Men and women are usually asymptomatic • High risk for PID if not tx early • Long term consequences of infertility and tubal pregnancy • Treated with doxycycline or azithromycin; if pregnant, erythromycin or amoxicillin

  6. Bacterial: Gonorrhea • Men are symptomatic with dysuria and epidydimytis, 1/3 women asymptomatic—many first present with PID or menstrual irregularities • May have oral sx if engaged in oral sex • High risk of infertility if not tx early • Can cause complications with pregnancy & baby • Treated with Rocephin + doxycycline due to high incidence of concurrent chlamydia

  7. Bacterial: Syphilis • Primary stage—chancre 5-90d after exposure, heals spontaneously after 3-4 wk • Secondary—6 wks-6 months after chancre disappears. Rash on palms, soles; wart-like lesions in genital area, lymphadenopathy, flu sx • Latency—up to 20 years • Tertiary—multi-organ system complications caused by inflammatory lesions, manifested as dementia, psychosis, MI, stroke, meningitis, etc. • Tx with PCN, doxycycline; if pregnant, PCN or erythromycin.

  8. Viral Infections: Human Papilloma Virus (HPV) • Over 30 different strains; 8 may have potential to cause cervical cancer • Most common viral infection • Unlike other STDs, condoms are no protection • 2 major types present as either painless, fleshy clusters on external genitalia, or microscopic lesions on cx (asymptomatic). Cx kind carry high risk of developing into cx cancer.

  9. HPV cont’d • Incubation: 1-9 months • Most infections will clear within 24 mos. • Only 10% will have persistent infection • Takes about 3 yrs from time of exposure to abnormal cx changes • Incurable—fleshy lesions can be topically treated with podophyllin (not during pregnancy) or cryotherapy; cx lesions tx with laser • C-section not necessary

  10. HPV Vaccine • Gardasil—prevents HPV 6, 11, 16, 18; 3/$360 • Vaccine to prevent infection by other strains is in developmental stages • Potential target population is 9-26 yrs • Data for men is not available • Potential elimination of up to 60% of cx lesions, 70% of cx cancers, 90% of warts • Should it be required vaccine? • May be better accepted if it is promoted as an anti-cancer vaccine

  11. Herpes genitalis (HSV-2) • Viral infection affecting genital area--? link to cx cancer. • Recurrent, incurable; latent in nerve cells • Not a reportable disease so incidence is hard to determine • Begins with systemic sx; manifests later as vesicular lesions. • First outbreak is worst—successive outbreaks are less severe.

  12. HSV-2 cont’d • Dangerous during pregnancy. C-section recommended for visible lesions. May tx newborn • Treated with antivirals (i.e., acyclovir) and lysine either daily or for outbreaks. Does not cure, but decreases severity of sx and length of course of breakout--?safety during pregnancy

  13. Human Immunodeficiency Virus: Stats • 1.5 million affected in U.S.; 34.3 worldwide; >800,000 dx; 40,000 new cases anually—26% being women and 66% of those women are African American • Death rate has fallen dramatically (mostly in U.S.) d/t advances in tx of those living with infection • ½ are IV drug users; ½ are sexual contact (usually heterosexual worldwide) • Risk of infection greater in partner who receives semen

  14. HIV cont’d • Caused by retrovirus (replicates backward from RNA to DNA) and has mutated into subtypes • Spread by infected blood, seminal, vaginal, amniotic fluids, and breast milk • Seroconversion will usually occur within 6-12 weeks after infection (window period) • Attacks immune system & destroys T cells (CD4 count) • 4 stages are based on hx, PE, lab evidence of immune dysfunction, opportunistic infections and malignancies.

  15. HIV and Pregnancy • HIV+ women should use contraception • If pregnant, transmission is likely if woman is untreated • Treatment with zidovudine is preferred during pregnancy, labor, and in newborn • Breastfeeding is highly discouraged because of high transmission

  16. HIV Stages • Primary (Acute) Infection • From infection to development of antibodies. • Seroconversion will occur during this period. • Pt is asymptomatic except for initial flu-like sx, but virus is rapidly reproducing until a viral set point is reached (infected cells=viral clearance).

  17. HIV Stages cont’d • Early Chronic Infection: • Cell counts >500 • Pt feels well, altho a persistent lymphadenopathy may exist. • Body still fighting off other infections. • Virus is at a set point. • 8-10 years may pass before complications develop.

  18. HIV Stages cont’d • Intermediate Chronic Infection: • Cell counts 200-499 • Infections/conditions begin to develop such as Pneumocystis carinii pneumonia (PCP), candida esophagitis, cytomegalovirus, Kaposi’s sarcoma, and wasting syndrome • Late Chronic Infection: • Cell counts <200 • Above infections and other conditions develop

  19. Oral Candida Infection

  20. Kaposi’s Sarcoma

  21. Pneumocystis carinii Pneumonia (PCP)

  22. Education • Universal precautions for healthcare workers • Contraceptive counseling with OC and male or female condoms or sterilization • Vag exam & PAP q6mo • Testing for other STIs • Importance of pharm mgmt, and mgmt of opportunistic infections and other conditions • Emotional support, grief support

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