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Chapter 7 - Sexually Transmitted and Other Infections
 Half of people infected are between ages 15 and 24
Prevention
 Primary prevention
 Primary prevention the most effective way of reducing STIs in women
 Individual activities aimed at determining infection
 Risk free options include
 Complete abstinence
 Secondary prevention
 Prompt diagnosis and treatment can prevent personal complications and
transmission to others
 Ask about the five P’s (Box 7-2)
 Partners, Prevention of Pregnancy, Protection from STIs, Practices, and
Past history of STIs
 A critical first step is for the nurse to ask questions about….
 Her sexual history
 Risky sexual behaviors
 Drug related risky behaviors
 Risk reduction measures
 Knowledge of partner
 Reduction of the number of partners
 Low-risk sex – Table 7-1
 Avoiding exchange of body fluids
 Vaccination
 Physical barriers
 Condoms
 Chemical barriers
 Nonoxynol-9
 Communication
Bacterial Sexually Transmitted Infections:
Chlamydia trachomatis
Most common and fastest spreading STI
Silent and highly destructive
Symptoms in Women:
 Usually asymptomatic
 Abnormal vaginal discharge
 Pain during sex
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Can Lead to PID
Spotting
Easily detected by a urine test or a swab
Easily cured with antibiotics
Infants born to mothers with this will develop conjunctivitis or pneumonia
Bacterial Sexually Transmitted Infections: Gonorrhea
 Can cause rupture of membranes
o Premature birth
 Aerobic gram-negative diplococcus
 Highest rates among teenagers, young adults, and African-Americans
 Usually asymptomatic
 Painful urination
 Abnormal vaginal bleeding
 Pain during sex
 A mother can pass gonorrhea to her baby during childbirth
 Blindness in the newborn
Screening and diagnosis
 CDC recommends screening all women at risk.
 Testing performed during first trimester and at 36 weeks of pregnancy
 Is a reportable disease
Management
 easily detected by a urine test or swab; and easily cured with antibiotics; but any
damage to the body cannot be repaired.
Syphilis
Primary Stage
 A painless sore called a chancre may be located on the genitals, lips, anus, or other area
of direct contact
 The chancre will last 1-5 weeks and heal without treatment
 The person can easily pass it on to sex partners
Secondary Stage
 Skin rashes lasting 2 – 6 weeks (average of 4 weeks) on the palms of the hands, bottoms
of the feet, or any part of the body
 Other symptoms include fever, swollen lymph glands, headache, hair loss, and muscle
ache
 Symptoms will go away without treatment
 The person may be able to pass it on to sex partners
Late Stage Syphilis- cross into brain
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 Ulcerating Gumma
Congenital Syphilis
 A mother can pass syphilis on to her unborn child
 Transplacental transmission may occur at any time during pregnancy.
 Testing & Treatment for Syphilis
 Easily detected by a blood test;
 Venereal Disease Research Laboratories VDRL or rapid plasma regain RPR are used
as screening tests.
Easily cured with antibiotics
 Penicillin
 Sexual abstinence during treatment
 Any damage done to the body cannot be repaired.
Pelvic inflammatory disease (PID)
 An infectious process that most commonly involves the fallopian tubes, uterus,
and occasionally the ovaries and peritoneal surfaces
 Multiple organisms have been found to cause PID.
 Frequently happens at the end of just after menstrual period
 Risk factors for acquiring PID
 Those with PID are at increased risk for
 Ectopic pregnancy
 Infertility
 Chronic pelvic pain
 Diagnosis can be difficult
 Pain during intercourse
 Pus in the urine
 Pelvic adhesions
 Pain is common
 Management – prevention; broad spectrum antibiotics.
 Should be on bedrest in a semi fowler position
 Refrain from sexual intercourse till treatment is complete
 Barrier method of protection
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Viral Sexually Transmitted Infections: Human Papillomavirus (HPV)
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Affects 20 million Americans
Most prevalent viral STI seen in ambulatory health care settings
Previously named genital or venereal warts
More frequent in pregnant women (than non-pregnant)
Profuse irritating vaginal discharge, itching, postcoital bleeding
Bumps on the vulva
Screening and diagnosis
 History of known exposure
 Physical inspection
 Pap test
 Viral screening and typing for HPV are available but not standard
practice.
Management
 Removal (Cryotherapy, freezing)
 Medications (Gardasil vaccine- wait 20 min because of fainting)
 Counseling
Herpes simplex virus (HSV) (pg.157 how to clean and dry out lesions)
 Herpes simplex virus 1 (HSV-1)
 Transmitted nonsexually
 Herpes simplex virus 2 (HSV-2)
 Transmitted sexually
 Initial infection characterized by multiple painful lesions, fever, chills, malaise, and
severe dysuria
 Chronic and recurring disease for which there is no known cure
 Systemic antiviral medications partially control the symptoms
 Maternal infection with HSV-2 can have adverse effects on mother and
fetus
 Reoccurring
 Neonatal herpes
 Most severe complication of HSV
 Most mothers lack history of HSV
 C-section if visible lesions are present!
 Cleaning lesions
 Twice a day with saline
 Warm sitz bath with baking soda
 Keep lesions dry by blowing a hair dryer set on cool or patting with a dry
soft towel
 Can apply cool wet black tea bags
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Viral Sexually Transmitted Infections: Viral hepatitis
 Hepatitis A virus (HAV)
 Acquired primarily through a fecal-oral route
 Hepatitis B Virus (HBV)
 All women should be screened if pregnant
 Get the vaccines if infected and did not have them in the past
 Good personal hygiene and tell healthcare workers
 Can lead to liver disease
 No specific treatment
 Hepatitis C Virus (HCV)
 Ribavirin therapy
 Can lead to liver cancer
Viral Sexually Transmitted Infections: HIV
 Transmission of HIV occurs primarily through exchange of body fluids
 Counseling the woman for testing:
 Risk assessment and testing
 Follow up with results
 HIV and Pregnancy
 Stays on her ART or HAART
 Receives all vaccines
 Cesarean birth to prevent vertical transmission (viral loads are monitored)
 Infants treated with oral zidovudine for 6 weeks after birth (must be
started within 12 hours)
 Precautions
 Universal precautions
 Protect eyes/wear gloves
Vaginal Infections
 Vulvovaginitis
 Inflammation of the vulva and vagina
 Many different causes
 Bacterial vaginosis (BV)
 Associated with preterm labor and birth
 Treatment with metronidazole orally
 Candidiasis
 Predisposing factors
 Antibiotic therapy
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 Diabetes
 Higher sugars
 Pregnancy
 Obesity
 Diets high in refined sugars
 Use of corticosteroids and hormones
 Immunosuppressed states
 Trichomoniasis (parasite)
 Caused by Trichomonas vaginalis
 Often considered an STI
 Metronidazole
 The risk for sexual transmission must be communicated to infected
women.
 Group B streptococci (GBS)
 A part of the normal vaginal flora, present in 20% to 30% of healthy women
 Associated with poor pregnancy outcomes
 Important factor in neonatal morbidity and mortality
 Screening at 36-37 weeks of gestation
 Intrapartum intravenous prophylaxis
Maternal and Fetal Effects of Sexually Transmitted Infections
 Pregnancy effects
 Premature rupture of membranes
 Premature labor
 Postpartum sepsis
 Dystocia
 Miscarriage
 Fetal effects
 Preterm birth
 Pneumonia
 Systemic infection
 Congenital infection
 Stillbirth
Infection Control
 Interrupting the transmission of infection is crucial to STI control
 Many STIs are reportable; all states require that these STIs be reported to public health
officials
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 Teaching should include:
 Take your medicine as directed
 Comfort measures
 Keeping appointments and having partner tested as appropriate
 Communicate with sexual partners
 Safe sex
Neonatal Infections Chapter 35: pages 858-868
Neonatal Infections – Sepsis (table 35-2)
 Interventions
 Breastfeeding
 Medication administration
 Preventive measures
 Handwashing
 Standard Precautions
 Antibiotic instillation into the eyes
 Transplacental infections
 TORCH infections: an acronym that is often used to describe maternal infections
during early pregnancy associated with various congenital malformations and
disorders
 Toxoplasmosis (cats)
 Gonorrhea
 Syphilis
 Varicella-zoster
 Rubella
 Hepatitis B virus (HBV)
 Bacterial infections
 Group B streptococci (GBS)
 A leading cause of neonatal morbidity and mortality in the United
States
 Escherichia coli
 Staphylococcus aureus
 Listeriosis (mothers who don’t have treated water)
 Chlamydia infection
Fungal infections
 Candidiasis—Candida albicans
 Thrush
 Diaper dermatitis
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 Treatment is an antifungal ointment, such as nystatin (Mycostatin)
or miconazole 2% (Monistat), applied three times a day for 7 to 10
days