Chapter 5 - STIs STI’S What are the most common STIs in women? Chlamydia, HPV, Gonorrhea, HSV-2, Syphilis and HIV Who’s at risk? - African Americans Abused, homeless youth Young men having sex w/ men LGBT youths Multiple partners Unprotected sex What factors place teenagers at risk for STIs? - Female’s anatomy (columnar epithelial cells sensitivity to invasion) Feeling of invincibility Unprotected intercourse Partnerships of limited duration Obstacles to use HCS What are some of the teaching guidelines? Pg 152 - Use latex condoms New condom w/ each act of sex Handle condoms w/ care to prevent damage from sharp objects (fingernails/teeth) Keep condom in cool, dry place away from direct sunlight Don’t store condoms in wallets, cars or anywhere exposed to high temp. Don’t use brittle, sticky or discolored condoms Put condom on prior to genital contact Put condom when penis is erect Hold the tip of the condom while unrolling (ensure space at the tip to collect semen w/out air trapped) What happens if an STI is left untreated? - PID = infertility Adverse pregnancy outcomes Anogenital/cervical cancers Increase likelihood of both transmitting & acquiring HIV. What are some of the nursing assessments? - Assess adolescent sexual behavior and STI risk Screen asymptomatic infection during clinic visits Counsel adolescents on STI risk reduction Role: detection, prevention & tto of STIs in adolescents What are some Nursing Management? 1 Chapter 5 - STIs - Encourage pt. to complete ABX Adapt content info to the pt. developmental level Identify risk factors/behaviors Guide pt. to develop specific individualized actions of prevention Teach adolescents about sexual development Encourage adolescents to postpone initiation of sexual intercourse as long as possible Encourage need of using barrier methods If sexually active: Refer to clinic, explain contraceptive methods INFECTIONS CHARACTERIZED BY VAGINAL DISCHARGE What’s vaginitis? Inflammation/infection of the vagina. Mostly caused by Candida, trichomonas or Gardnerella What’s a primary prevention for vaginitis? - Changing the sexual behaviors that placed the women at risk Assessing females for s/s and risk factors Avoid/prevent recurrence by ED prevention methods How one can prevent vaginitis? - AVOID douching, tights, nylon underpants and tight clothes Use condom Wipe from front to back Wash only w/ hypoallergenic bar soaps (no liq. Soap/body washes) AVOID powders, bubble baths & perfumed vaginal sprays Wear clean cotton underpants Change out wet bathing suits ASAP Recognize s/s of vaginitis Healthy lifestyle 2 Chapter 5 - STIs Candidiasis 2nd most common type of vaginal infection. Known as: monilia, yeast and fungal infection. NOT STI - Candida is a bacterium that lies in the vagina; becomes pathological if environment is altered. Causative Organism: Candida albicans Mode of transmission: vaginal, anal, oral sex and childbirth Fetal effects: Thrush Maternal Effects: genital itching/discharge What are the risk factors? - ABX DM Pregnancy Obesity Diet high in refined sugar Corticosteroids Immunosuppressed states What are the s/s? - Pruritus (itch) - Discharge: thick, white, lumpy & cottage cheese like - Vaginal soreness - Vulvar burning - Dyspareunia - External dysuria What are the Diagnostic Testing? - Physical exam: white plagues on the vaginal walls Vaginal pH Wet smear – reveal hyphae/spores What’s it the treatment? Mostly used for 3-7 days - Miconazole (Monistat) – cream/suppository Clotrimazole (Mycelex) – TB/cream Terconazole (Terazol) – cream/intravaginal suppository Fluconazole (Diflucan) – 150 mg TB x1 What are the nursing Assessments? - - Health History o Pregnancy, DM, Obesity, HIV o Use of oral contraceptive w/ high estrogen o ABX (broad-spectrum) o Steroid, immunosuppressant o Vaginal mucosa trauma (chem. Irritants/douching) o Wear tight clothes and nylon underwear Assess s/s (see above 3 Chapter 5 - STIs What are the Nursing Managements? - OTC agents Methods of comfort Preventable measures o Healthy lifestyle: know s/s o Good hygiene Mild unscented soap/toilet paper Dry gently, wipe front to back o AVOID: spray, deodorant douches, superabsorbent tampons, bubble baths or scented bath products o Change wet bathing suit ASAP 4 Chapter 5 - STIs Trichomoniasis What is it? Common type of vaginal infection and discharge. Increase the risk of HIV transmission. More common in females. Can be asymptomatic or symptomatic. Males are symptomatic carriers. Causative Organism: Trichomonas vaginalis Mode of transmission: Mostly sexually transmitted and childbirth What are the effects on females? Infertility, PPE What are the effects on fetus/newborn? PROM, PTB, LBW S/S: - Discharge: yellowish-greenish, frothy, mucopurulent, copious, malodorous Vulva/vaginal inflammation Irritation, pruritus, dysuria, dyspareunia “strawberry spots” – cervix/vaginal wall Cervical bleeding on contact Diagnostic Test: - Microscope – presence of trichomonad (confirms) OSOM trichomonas rapid test and Affirm VPIII Vaginal pH > 4.5 Treatment: both partners! - Metronidazole 2g PO x1 Tinidazole (Tindamax) What are the Nursing Assessments? - Health history and s/s o Pregnancy, DM, obesity, HIV o Use of oral contraceptive w/ high estrogen o ABX (broad spectrum) What are the Nursing Management? - AVOID sex until cured, OH during tto. (nausea/vomiting) Provide info about causes and transmission, effect on reproductive organs and fertility Importance of partner notification and tto. 5 Chapter 5 - STIs Bacterial Vaginosis (BV) What is it? Most common type of vaginitis (vaginal discharge). Associated with preterm labor and birth. Infection characterized by alteration of vaginal flora – lactobacilli is replaced w/ anaerobic bacteria. Etiology: unknown - Excess anaerobic bacteria = alteration of the normal acidic pH of the vagina – charact: fishy odor Causative Organism: G. vaginalis Mode of transmission: Sexual contact – not always! What are the effects on fetus/newborn? PTL, PROM and Chorioamniotitis * Risk Factors: - Multiple sex partners Douching ABX Lack of vaginal lactobacilli ↓ estrogen production S/S: - Discharge - profuse, thin, white/gray or milky appearance - 50% females: asymptomatic - Lead to: PID, PPE What’s the Diagnostic testing? - Wet mount nitrazine for pH (presence of clue cells) Discharge adherent to vaginal wall (+) whiff test – add KOH = fish odor pH > 4.5 What’s the treatment? - Metronidazole – PO o AVOID OH! Clindamycin (Cleocin) – cream In males isn’t beneficial to prevent recurrence since sexual transmission hasn’t been proven. What are the Nursing Assessment? S/S & risk factors (see above) What are the Nursing Management? - Primary Prevention: Good hygiene behavior Education: see “preventing vaginitis” above 6 Chapter 5 - STIs Chlamydia Most common bacterial STI in US. Majority is asymptomatic. Curable and frequent among active adolescents and young adults Causative Organism: Chlamydia trachomatis Mode of transmission: vaginal/anal/oral sex and childbirth What happens if left untreated? PID, infertility, partners transmission and PROM Effect on female: Ectopic pregnancy and Postpartum endometritis Effects on the fetus/newborn: Infected during delivery, PROM, Neonatal conjunctivitis, Ophthalmia neonatorum, Pneumonia, LBW, Preterm and stillbirth Risk Factors: adolescence, multiple sex partners, unprotected sex, pregnancy, History of STI, use of oral contraceptive, poor socioeconomic condition and single status. Non-white S/S: - Mucopurulent vaginal discharge Bartholinitis* Urethritis (male) Endometritis (female) Salpingitis* (female) – inflammation of fallopian tube Dysfunctional uterine bleeding Female: cervicitis, acute urethral syndrome, PID, infertility, chronic pelvic pain Male: urethral tingling, sterility and Epididymitis Diagnostic Testing: - Culture: urine test or swab Immunofluorescence Enzyme immunoassay (EIA) Nucleic acid amplification by PCR Treatment: - - ABX: o Doxycycline: 100mg PO BID x7 days o Azithromycin: 1g PO x1 Combination regimen if gonorrhea is present: o Ceftriaxone (Rocephin) + Doxycycline or Azithromycin Other ABX: Erythromycin (EES) and Ofloxacin (Floxin) 7 Chapter 5 - STIs Nursing Assessment: Health history, risk factors and s/s Nursing Management: - Good hygiene behavior Prevention intervention: o Raising awareness o ↑ screening coverage o Enhancing partner services o Encourage annual screening o Maximize use of effective partner tto services o Rescreen infected females/males 3 months after tto. If pregnant, adherence in question, symptoms persist or suspect reinfection 8 Chapter 5 - STIs Gonorrhea It’s a serious and severe bacterial infection. The 2nd most reported infection in US. Develop resistance to multiple ABX classes. Highly contagious and is a reportable infection. Increases the risk for PID, infertility, ectopic pregnancy and HIV acquisition/transmission Causative agent: Neisseria Gonorrhoeae Site of infection: Columnar epithelium of the endocervix Mode of Transmission: sexual activity and childbirth - Infection is self-limiting. However, it can ascend through the endocervical canal to endometrium of the uterus on to the fallopian tubes and out into the peritoneal cavity – Known as PID. The scarring of the fallopian tubes is permanent = infertility Untreated: enter bloodstream = disseminated gonococcal infection = invade joints (arthritis), heart (endocarditis), brain (meningitis) and liver (toxic hepatitis) Effects on the fetus/newborn: Infected during birth, Neonatal conjunctivitis, intellectual disability, seizures, PML LBW, death. - Ophthalmia neonatorum o Blindness/sepsis o Arthritis/meningitis o TTO: erythromycin or tetracycline eye ointment (prophylactic) Risk Factors: - Low socioeconomic status - Urban living - Single status - Unprotected sex - Age < 25 yrs. - Multiple sex partners or new Diagnostic Testing: - Culture - Nucleic acid hybridization test (GenProbe) S/S: Mostly asymptomatic - Abnormal vaginal Discharge/bleeding o Female: yellow, foul o Male: pus - Dysuria, Cervicitis, PID - Bartholin’s abscess - Enlarged lymph nodes (local) - Mild sore throat (pharyngeal gonorrhea) - Perihepatitis * Females: - Urinary frequency - Dyspareunia (painful intercourse) - Endocercivitis Male: - Sterility - Epididymitis - Rectal infection: discharge, anal itch and painful BM w/ fresh blood. 9 Chapter 5 - STIs Treatment: Dual therapy: prevent resistance Uncomplicated infections: - Ceftriaxone: 250 mg IM x1 Azithromycin: 1g PO x1 or Doxycycline 100 mg PO x7 days Other ABX: Cefixime: 400 mg PO x1 Concomitant tto for chlamydia due to common coinfection. Contraindications: NO Quinolones or tetracycline to pregnant women Nursing Assessment: - Health history Comprehensive sexual history (# of partners and use safe sex techniques) Assess s/s and newborn for neonatal conjunctivitis Nursing Management: - Rescreening in 3 months from tto. Educate about risk factors Recognize high risk groups Emphasize importance of tto and informing sex partners Teach safer sex practices Pregnant women: Screen 1st visit & at 36 wks o AVOID quinolones/tetracyclines (prevent irreversible tooth discoloration & enamel hypoplasia in newborn) 10 Chapter 5 - STIs INFECTIONS CHARACTERIZED BY GENITAL ULCERS Nursing Management for Herpes and Syphilis - - Referral to support group Education Address psychosocial aspects o coping skills o acceptance of lifelong nature of herpes o tto option/rehab. Provide safe, accurate, sensitive and supportive care teaching guidelines: - - - Abstain from sex during prodromal periods and when lesions are present Wash hands w/ soap/water after touching lesions to avoid autoinoculation Comfort measures: o nonconstructive clothes o cotton underwear o urinate in water if painful o lukewarm sitz bath o air-dry lesions w/ hair dryer (low heat) AVOID extreme temps: o ice pack/hot pads, o steroid creams, sprays or gels Use condoms Inform HCP Genital Herpes Simplex (HSV-2) It’s a recurrent lifelong viral infection. More common in females than males. After primary outbreak, virus remain dormant in the nerve cells = recurrent outbreaks. Females should be tested for all common STIs What triggers outbreaks? Emotional stress, menses, UV exposure, illness, surgery, fatigue, genital trauma, immunosuppression and sexual intercourse. More than half occurs w/out a precipitating cause. Causative agent: Herpes Simplex Virus Mode of Transmission: contact w/ mucous membranes or breaks in skin w/ visible or nonvisible lesions. Kissing, sexual contact and vaginal delivery What are the effects on pregnancy? Spontaneous abortion, PTL, chorioretinitis, What are the effects on the fetus/newborn? LBW, microphthalmia, microcephaly and neonatal HSV infection. 11 Chapter 5 - STIs Risk Factors: - Unprotected sex - Multiple sex partners - Low socioeconomic status - History of STIs - Increasing age Diagnostic Testing: - Viral culture of vesicle fluid. - Clinical s/s - IgG/IgM antibody testing (screening purpose) - Pap smear (insensitive/nonspecific) Nursing Assessment: s/s & risk factor S/S: Asymptomatic Primary Episode (most severe/prolonged) - Multiple painful vesicular lesions - Mucopurulent discharge - Superinfection w/ candida - Fever, chills, malaise - Dysuria - Headache - Genital irritation - Inguinal tenderness - Lymphadenopathy Recurrent infection (localized & fast) - Tingling, itching, pain - Unilateral genital lesions *** Viral shedding takes up to 2 wks. *** Treatment: No cure! Antiretroviral therapy - reduce/suppress symptoms, shedding and recurrent episodes. Safety in pregnancy hasn’t been establish. TTO usually from 7-10 days: - Acyclovir (Zovirax) 400mg PO TID Famciclovir (Famvir) 250mg PO TID Valacyclovir (Valtrex) 1g PO BID Suppressive therapy: 6 or more recurrence/yr. Nursing Management: - Psychosocial consequences (emotional distress, isolation, fear of rejection or transmission, loss of confidence, altered interpersonal relationships Counseling Risk of sexual and perinatal transmission Methods to prevent spread Provide information o Reading materials and referral to websites o Another knowledgeable staff o # of herpes support groups o Educate pt. to abstain from sex until lesions resolve o Good hand hygiene o Educate pt. there’s no cure, and practice safer sex. o Encourage pt. to inform partners 12 Chapter 5 - STIs Syphilis It’s a curable bacterial infection. It’s a serious systemic disease, can lead to disability and death if untreated. Congenital syphilis when an infected mother directly infects the fetus. Pregnant women should be screened on the first visit and then on the 3rd trimester. In high-risk cases, serology testing may be repeated in the 3rd trimester and at birth. Causative agent: Treponema pallidum Mode of Transmission: sexual and birth. It can penetrate intact mucous membranes or microscopic lesions and enter the lymphatic system and bloodstream = w/in hrs = systemic infection Site of entry: vaginal, rectal or oral. Can cross the placenta after 9 wks of gestation. Untreated: life-threatening complications: hepatitis, stroke and nervous system damage What are the effects on pregnancy? Spontaneous abortion, stillbirth What are the effects on the fetus/newborn? LBW, prematurity, IUGR (intrauterine growth restriction), multisystem failure (heart/lung/spleen/liver/pancreas), structural bone damage, NS involvement and intellectual disability Diagnostic Testing: Use 2 serologic test - - Nontreponemral test: o RPR (rapid plasma regain) o VDRL (venereal disease research lab) Treponemal Test: detect IgA, IgM & IgG o EIA o FTA-ABS (fluorescent treponemal antibody absorption) o TPPA (T pallidum agglutination assay) o TPHA (T pallidum hemagglutination assay) Nursing Assessment: s/s, Screen pregnant women 1st visit Nursing Management: - Reevaluation w/ serologic testing - Reevaluate at 6-12 months after tto. For primary/secondary syphilis - Referral to support group S/S: Primary: - Chancre (painless ulcer) - Painless bilateral adenopathy Secondary: 2-6 months after initial exposure - Flu-like symptoms 13 Chapter 5 - STIs - Rash on truck, palms and soles - Alopecia - Adenopathy - Fever, pharyngitis, weight loss, fatigue *** last about 2 yrs *** Latency: last up to 20 yrs. - Absence of manifestations - Positive serology Tertiary: life-threatening - Heart disease o Inflammation of aorta, eyes, brain, CNS and skin - Neurologic disease Congenital s/s: - Skin ulcers - Rash, fever - Weakened/hoarse cry - Swollen liver/spleen - Jaundice and anemia - deformations Treatment: Benzathine Penicillin G (2.4 units IM/wk x3) – adherence challenging - o Doxycycline or Erythromycin (500 mg PO TID x7 days) - (if allergic to penicillin) Azithromycin (Z-pack) 1g PO x1 Ceftriaxone 250mg IM x1 Ciprofloxacin 500mg PO BID x 3 days (Contraindicated: pregnant/lactating) 14 Chapter 5 - STIs PID – Pelvic Inflammatory Disease PID is an inflammatory state of the upper female tract (involves fallopian tubes, ovaries or peritoneum), endometriosis may be present. Results of an ascending polymicrobial infection of upper female reproductive tract. Frequently from untreated Chlamydia or Gonorrhea. Uncommon in pregnancy. What are the effects on women? Infertility, ectopic pregnancy, pelvic abscess formations and chronic pelvic pain What are the complications? Fibrosis, scarring, loss of tubal function, ectopic pregnancy, pelvic abscess, infertility, recurrent or chronic episodes, chronic abdominal pain, pelvic adhesions and depression What are the risk factors? - Age < 25 Inner city Multiple sex partners IUC (intrauterine contraceptive) History of STI or PID Unprotected sex Douching Non-white female OH/Drugs/Smoking Nulliparity * What are the S/S? - Lower abdominal tenderness - Adnexal tenderness - Cervical motion tenderness What is the Diagnostic Test? - Endometrial Biopsy - Transvaginal Ultrasound - Laparoscopic exam (standard criterion) What’s the treatment? - Empiric Broad-spectrum ABX o Ceftriaxone: 250 mg IM x1 + Doxycycline 100 mg PO BID x14 days w/ or w/out Metronidazole 500 mg PO BID x14 days o Cefoxitin 2g IM x1 + Probenecid 1g PO x1 + Doxycycline 100 mg PO BID x14 days w/ or w/out Metronidazole 500 mg PO BID x14 days Ambulatory: single dose Injectable ABX Hospitalized: - IV ABX PO fluids bed rest (semi-fowler if acute PID) pain management: Analgesics Follow up is needed! If Pregnant: Cefotaxime + Azithromycin + Metronidazole x 14 days- AVOID tetracyclines and quinolones! What are the Nursing Assessments? 15 Chapter 5 - STIs - - - Health History for risk factors (see above) Physical exam (s/s) – minimal criteria for diagnosis o Discharge o PO temp > 101 F (38.3 C) o Cervical motion tenderness o Prolonged menstrual bleeding o Dysmenorrhea o Dysuria o Acute lower abdominal Pain o Painful sex intercourse o Nausea, vomiting Labs o ↑ erythrocyte sedimentation rate (inflammatory process) o ↑ C-reactive protein level o N. Gonorrhoeae or C. trachomatis DNA probes/cultures o WBC on saline vaginal smear Diagnostic tests (see above) What are the Nursing Managements? - Hospitalized: (see above under tto) Education to prevent recurrence Risk assessment Explain various diagnostic tests Discuss implications of PID and risk factors Sexual counseling o Safe sex o Limit # sex partners o Contraceptive barriers use o AVOID douching o Complete ABX o Explain untreated sequelae Teaching to prevent PID? - Use condom Discourage douching = bacterial overgrowth STI screenings Emphasize importance of having e/a sexual partner receive ABX tto. Vaccine Preventable STIs 16 Chapter 5 - STIs (HPV) – Genital Warts Most common viral infection in US. Most frequent in pregnant women where incidence increase from 1st trimester to the 3rd. Lesions enlarged greatly during pregnancy. HPV mediated oncogenesis is responsible for cervical squamous cell carcinomas and preinvasive cervical neoplasm HPV can cause? Genital warts or Condylomata = Cervical cancer (4th common type of cancer). What are the effects on pregnant women? Affect urination, defecation, mobility and descent of the fetus. Csection not indicated unless Pelvic outlet is obstructed by warts. What are the effects on fetus/newborn? Acquired by neonate during birth. What are the risk factors? - Age (15-25) Inner city Multiple sex partners First intercourse at 16 Cervical cancer risk factors o No screening o contraceptive use > 2yrs o Coinfection w/ STI o Pregnancy o Nutritional deficiency What are the S/S? - mostly asymptomatic - HPV lesions (Condylomata acuminata) - frequent in post. introitus - buttocks, vulva, vagina, anus cervix - painless but uncomfortable - Chronic vaginal discharge - Pruritus or dyspareunia What is the Diagnostic Test? - - Pap smear – detect cellular changes HPV test – determine specific strain o Discriminate btw low and high risk o High risk: Colposcopy – visual exam of cervix using magnification and simple staining solutions (acetic acid and Lugol’s solution) Biopsy – confirm cervical abnormality Direct visualization of the growths What’s the treatment? No tto or medical cure. Focus on prevention HPV vaccine - 3 types of vaccines to prevent Cervical Cancer - Cervarix: HPV 16, 18, 31, 33 and 45 (causes of adenocarcinoma – can’t screen adequately) o Efficacy: 6.4 yrs Gardasil: HPV 16, 18 and 31 (squamous cell cancer) & HPV 6 and 11 (genital warts and resp. papillomatosis. Efficacy: 5 yrs Gardasil 9 - Prevent cervical, vulvar, vaginal and anal cancers Vaccine administration: IM deltoid or anterolateral area of the thigh. 3 – 0.5 mL doses 17 Chapter 5 - STIs - 1st dose: 9-26 yrs old 2nd dose: 2 months after 3rd dose: 6 months after initial dose Vaccine S/E: pain, fainting, redness, swelling @ injection site; fatigue, headache, muscle/joint aches and GI distress Serious A/E: blood clots (heart, lungs, legs), Guillain-Barre Syndrome and < 30 deaths. What are the Nursing Assessments? - - - Health History for risk factors (see above) o Vaginal discharge, itch, dyspareunia or bleeding after intercourse o Visible genital wart (type 6 and 11) Cervix, vagina, urethra, anus and mouth Painful, friable and pruritic (itch) Physical exam (s/s) o Visible warts – fleshy papules w/ warty, granular surface o Pap Smear Labs: HPV test Diagnostic tests (see above) What are the Nursing Managements? - - Teaching prevention methods o Primary prevention: vaccine and education, lesion/warts tto o Secondary prevention: education Promotion of vaccines and screening tests o Pap Smears and H ED about link btw HPV and cervical cancer Teaching for those affected w/ Genital Warts o HPV remains and viral shedding may occur after removal of warts o Transmission and duration of infectivity after tto. Unknown o Recurrence w/in first few months after tto is common (indicates recurrence not reinfection) What are some Prevention methods? - Long-term monogamous relationship Abstinence and vaccination Hepatitis A 18 Chapter 5 - STIs Sexually transmitted viral infection. Inflammation of the liver. Highly contagious. Doesn’t require any specific diet or restriction. Meds that might cause liver damage or that are metabolized in the liver should be used w/ caution Causative Agent: Hepatitis A virus (HAV) Mode of Transmission: fecal-oral route (primarily), ingestion of contaminated food (milk, shellfish, polluted water) or person-person contact. Preventable measures? Vaccination Risk Factors: S/S: influenza-like symptoms w/ malaise, fatigue, anorexia, nausea, pruritus, fever and URQ pain Diagnostic test: Serologic test: detect IgM (confirm acute infection) Treatment: HAV vaccine and IG – IM (prevent Hep. A infections) – 2 doses, 6 months apart Nursing Management: - Encourage vaccination for children 12-23 months, 1 yr or older if traveling to other countries with high Hep. A prevalence and those w/ chronic liver disease Hepatitis B Sexually transmitted viral infection. Most threatening to fetus and neonate. Is a Liver disease, often a silent infection. HBsAg is found in blood, saliva, sweat, tears, vaginal secretions and semen. Causative Agent: Hepatitis B virus (HBV) Mode of Transmission: Parenterally, perinatal (infants of mom w/ acute Hep infection in late 3rd trimester), Oral (rare) and via sex, artificial insemination Preventable measures? Vaccination series Risk Factors: multiple sex partners, unprotected anal intercourse, history of STIs Who’s at risk? Drug users , Healthcare workers S/S: Like Hep. A – arthritis, anorexia, nausea, vomiting, headache, less fever, mild abdominal pain, arthralgia* and lassitude* What are the effects on fetus/newborn? Late 3rd trimester or during intrapartum/postpartum periods from exposure to vaginal secretions, blood, amniotic fluid, saliva and breast milk Diagnostic Test: Blood test – HbsAg (look for proteins and antibodies made by the virus) Treatment: HBV vaccine (recommended to those w/ multiple sex partners in the last 6 months) Nursing Management: 19 Chapter 5 - STIs - Pap smear and HBV screening (1st prenatal visit and repeat on 3rd trimester) Explain Hep. B vaccines are given to infants after birth (series of 3 injections given w/in 6 months) Hepatitis C Most common chronic bloodborne infection in US. Responsible for chronic viral hepatitis. Attacks the liver and leads to inflammation Causative Agent: Hepatitis C virus (HCV) Mode of Transmission: not sexual but it can be transmitted that way. Risk Factors: Pregnant women w/ history of IV drug use, STIs (HBV/HIV), multiple sexual partners, history of blood transfusion. Perinatal transmission is rare except in those immunocompromised (HIV/AIDS) Diagnostic Test: Treatment: no vaccine Nursing Management: - Safe sex Prevention of infection: education and improve health outcomes for those infected. Ectoparasitic Infections 20 Chapter 5 - STIs Common cause of skin rash and pruritus. Include scabies and pubic lice. Nursing care for women w/ lice and scabies: 3 step approaches - Eradicating infestation Removing nits Preventing spread or recurrence regimens using pyrethrin and permethrins. Minimize spread of scabies and lice: - Use meds as instructed Remove nits w/ fine-toothed nit comb Don’t share personal items Treat objects, clothes and bedding – wash in hot water Vacuum carpets to prevent recurrence of infestation. Scabies: intensely pruritic dermatitis w/ lesions caused by a mite. Transmitted by direct skin-to-skin contact. Female mite burrows under the skin and deposit eggs, which hatch. Lesions start as small papules that reddens, erodes and crust (sometimes). Diagnosis: history and appearance of linear burrows in the webs of the fingers, elbows, axillae, buttocks and genitalia Treatment: Permethrin, crotamiton or ivermectin, and ABX if a 2nd infection is present Pubic lice – pruritus w/ lice or nits. Can be found in the head, body or pubic areas. Infection is asymptomatic until after a wk. or so. Diagnosis: history and presence of nits on hair shafts or lice Treatment: - Medications: topical anti-louse agents: Permethrin shampoos, malathion, Spinosad or ivermectin Control measures: wash clothes/bedding in hot water and dried using a hot setting. Sealing clothes in plastic bags for 2 wks. to decontaminate them. HIV/AIDS 21 Chapter 5 - STIs Severe depression of the cellular immune system associated w/ HIV characterizes AIDS. HIV seroconversion occurs w/in 6-12 wks. It’s asymptomatic or flu-like symptoms (fever, headache, night sweats, malaise, lymphadenopathy, myalgia, nausea, diarrhea, weight loss, sore throat and rash). HIV in adolescents is increasing, mainly exposed via sexual intercourse AIDS: breakdown in the immune function caused by HIV. Sufficient amount of viruses must be transferred to infect the person. Continuous activation of immune system and is the driven force for CD4 T cell depretlion and progression to AIDS. Infected person develops opportunistic infections that become fatal . HIV progress to AIDS in about 11 yrs. After infection. Mode of Transmission: sex, sharing needles for IV drug use, mother to fetus, breastfeeding, blood transfusion. Who’s at risk? Homosexuals, multiple sex partners, African americans, unprotected sex Fetal/Neonatal effects: perinatal transmission, Preterm birth, LBW, HIV(+), Intrauterine fetal death, miscarriage Diagnostic Testing: - ELISA (initial screening) Western blood test (to confirm if ELISA (+)) Screening o Rapid HIV: results in 10-20 mins. o Confirmatory: Western blot or IFA Treatment: HAART (3 ART drugs BID) Goal: lower HIV viral load, restore body’s ability to fight off pathogens, improve quality of life and lower HIV morbidity/mortality. HIV in Pregnancy: - - TTO Prenancy: o Mon takes PO ZDV (ART) wk 14-34 continued until labor o Labor: IV ZDV until delivery (3 hrs prior c-section) o Neonate: ART syrup w/in 12 hrs. after birth. And continued for 6 wks. S/E: bone marrow suppression C-section sched @ 38 wks (Viral Load > 1000 copies/mL) o Vaginal may be option if Viral load < 1000 at 36 wks, ROM or declines c-section Avoid breastfeeding (formula instead) Nursing Management: - Education about drug therapy o Identify barriers to adherence Don’t understand link btw drug resistance & nonadherence Fears revealing HIV status by being see taking meds Not emotionally adjusted to HIV diagnoses Don’t understand drug regimen 22 Chapter 5 - STIs - Unpleasant S/E Feel anxious/depressed Compliance Prevention Referrals: HIV medical care services, mental heath services, social services substance abuse services. 23
