Chapter 05 Promoting Reproductive Health Through an Understanding of Sexually Transmitted Diseases

Screening Recommendations CDC – opt-out testing, all patients ACOG – routine for women ages 19–64 Provide and document post-test counseling Conform to HIPAA regulations http://www.webmd.com/sexual- conditions/ss/slideshow-std-pictures-and- facts

HIV + Women: Special Concerns Psychosocial issues Gynecologic problems related to immunocompromise Vulvovaginal candidiasis Human papillomavirus Herpes simplex virus

Chlamydia Trachomatis Most common bacterial STD Leading cause of preventable infertility Complications include ectopic pregnancy, pelvic inflammatory disease Usually asymptomatic in women http://www.youtube.com/watch?v=Eww8tGk qGRw&feature=relmfu

Chlamydia Trachomatis (cont’d) Diagnosis Culture Direct immunofluorescence Nucleic acid hybridization/amplification (NAAT) Enzyme immunoassay Treatment Antibiotics (e.g., doxycycline, azithromycin)

Gonorrhea Causative bacterium: Neisseria gonorrhoeae Second most commonly reported STD Women often asymptomatic May progress to pelvic inflammatory disease

Gonorrhea (cont’d) USPSTF, CDC: Annually screen all sexually active women ages 25 and younger Testing: culture, nucleic acid hybridization, NAAT (cervical or urine sample) Treatment: antibiotics (cefixime, ceftriaxone); include partners

Trichomoniasis Causative protozoan: Trichomonas vaginalis Most common curable STD in U.S. May be asymptomatic Symptoms: frothy vaginal discharge (gray, green) with foul odor

Trichomoniasis (cont’d) Diagnosis Wet mount (+ motile trichomonad parasites) Rapid trichomoniasis test, affirm VP III test Treatment Metronidazole; tinidazole Treat partners simultaneously

Pelvic Inflammatory Disease Acute infection of uterus, fallopian tubes May cause scarring, adhesions, blockage Common causative organisms: C. trachomatis, N. gonorrhoeae Symptoms: pain, bleeding, N & V Treatment: combined drug therapy

Human Papillomavirus Cause of condylomata acuminata Over 100 viral types identified Usually asymptomatic, sub-clinical Vaccine available for certain types Treatment of external warts: topical chemical agents, cryotherapy, laser surgery, electrosurgery http://www.webmd.com/cancer/cervical- cancer/slideshow-cervical-cancer-overview

Herpes Simplex Virus 1 and 2 HSV-1 associated with cold sores HSV-2 associated with genital lesions Occurs more frequently in women Primary infection: flu-like symptoms, pain, appearance of multiple blister-like lesions Recurrent outbreaks less severe Transmission possible during viral shedding

Herpes Simplex Virus (cont’d) Diagnosis: viral culture, serum testing Treatment goal: hasten healing, reduce symptoms Antiviral medications Complementary care measures Patient education

Syphilis Causative spirochetal bacterium: Treponema pallidum Transmission: sexual intercourse, transplacental (maternal-fetal) Increased incidence since 2001 Understanding Syphilis (STDs #1) You tube

Syphilis (cont’d) Primary: chancre Secondary: fever, rash, malaise, headache, weight loss, condylomata lata Tertiary: gummas, joint disease, neurosyphilis, C-V syphilis Treatment: penicillin G, doxycycline, tetracycline

Hepatitis Leading cause of liver cancer Most common reason for liver transplantation May be caused by Hepatitis A virus (HAV), Hepatitis B virus (HBV), or Hepatitis C virus (HCV)

Hepatitis B Virus Highest incidence in persons 20–49 years More contagious than HIV Causes liver disease, may be fatal Transmission: sexual intercourse, blood-to- blood contact, maternal-fetal transfer You tube Hepatitis B

Practice Question A nurse is providing discharge instructions to a client who has just been diagnosed with human papillomavirus (HPV) on her cervix. Which of the following is the most important discharge instruction for this client? a. Take a multivitamin every day. b. Check for external lesions around the vagina every month. c. Have Pap smears done as recommended by her practitioner. d. Avoid use of the intrauterine device (IUD). c

Practice Question Which of the following sexually transmitted infections can be cured with antibiotics? a. Human papillomavirus b. Chlamydia c. Herpes simplex virus d. Hepatitis B B