Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Chapter 05 Promoting Reproductive Health Through an Understanding of Sexually Transmitted Diseases

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Human Immunodeficiency Virus/ AIDS  HIV – entry via percutaneous/genital routes  Plasma viremia → organ dissemination  Progression → acquired immunodeficiency syndrome (AIDS)  Most women infected by exposure to infected men

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint 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

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint HIV + Women: Special Concerns  Psychosocial issues  Gynecologic problems related to immunocompromise  Vulvovaginal candidiasis  Human papillomavirus  Herpes simplex virus

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Chlamydia Trachomatis  Most common bacterial STD  Leading cause of preventable infertility  Complications include ectopic pregnancy, pelvic inflammatory disease  Usually asymptomatic in women

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Chlamydia Trachomatis (cont’d)  Diagnosis  Culture  Direct immunofluorescence  Nucleic acid hybridization/amplification (NAAT)  Enzyme immunoassay  Treatment  Antibiotics (e.g., doxycycline, azithromycin)

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Gonorrhea  Causative bacterium: Neisseria gonorrhoeae  Second most commonly reported STD  Women often asymptomatic  May progress to pelvic inflammatory disease

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint 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

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Trichomoniasis  Causative protozoan: Trichomonas vaginalis  Most common curable STD in U.S.  May be asymptomatic  Symptoms: frothy vaginal discharge (gray, green) with foul odor

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Trichomoniasis (cont’d)  Diagnosis  Wet mount (+ motile trichomonad parasites)  Rapid trichomoniasis test, affirm VP III test  Treatment  Metronidazole; tinidazole  Treat partners simultaneously

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint 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

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint 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

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint 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

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Herpes Simplex Virus (cont’d)  Diagnosis: viral culture, serum testing  Treatment goal: hasten healing, reduce symptoms  Antiviral medications  Complementary care measures  Patient education

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Syphilis  Causative spirochetal bacterium: Treponema pallidum  Transmission: sexual intercourse, transplacental (maternal-fetal)  Increased incidence since 2001

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint 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

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint 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)

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Hepatitis A Virus  Formerly known as “infectious hepatitis”  Incidence highest in developing countries  In U.S., primarily contracted during overseas travel to affected countries  No specific treatment  Vaccine available

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint 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

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Hepatitis B Virus (cont’d)  Symptoms: fever, fatigue, anorexia, jaundice, N & V, dark-colored urine  Most adults recover completely; 25% become chronically infected  Screen all pregnant women, individuals at high risk  Vaccines available

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Hepatitis C Virus  Most common bloodborne infection in U.S.  Formerly called “non-A, non-B hepatitis”  Primarily transmitted via blood-blood contact  Most infected individuals progress to chronic viral hepatitis

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Hepatitis C Virus (cont’d)  Newly acquired infection often asymptomatic  Various serum screening tests available  After diagnosis, evaluate liver functioning  Consider Hepatitis B vaccination  Combination therapy for chronic infection

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Hepatitis D Virus  Only occurs in individuals already infected with HBV  Clinically indistinguishable from other hepatitis types  Transmitted via body fluids  Perinatal transmission rare

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Women With Chronic Hepatitis: Nursing Implications  Education, counseling  Maintain excellent hygiene  Avoid contact with all blood sources  Intimate partners use condoms  Nutritional strategies  Avoid alcohol, tobacco, hepatotoxic medications  Referrals

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Chancroid  Causative streptobacillus: Haemophilus ducreyi  Symptoms: painful lesion on labia, dysuria, dyspareunia, inguinal adenopathy  Diagnosis: culture or biopsy  Treatment: antibiotics

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Lymphogranuloma Venereum  Causative bacterium: Chlamydia trachomatis  Stage 1 – painless genital ulcer  Stage 2 – lymphadenopathy  Symptoms: cervicitis, salpingitis, fever  Treatment: doxycycline, erythromycin

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Granuloma Inguinale  Causative bacterium: Klebsiella granulomatis  Symptoms: painless ulcerative lesions on labia, perineum (no lymphadenopathy)  Diagnosis: history, tissue biopsy  Treatment: doxycycline

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint Pthirus Pubis  Primarily spread through sexual contact  Typically found attached to pubic hair  Do not transmit disease  Feed on human blood  Treatment: permethrin lotion  Teach patients strategies for lice control

Shelton Hisley The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint The Women’s Health Companion aternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint to Maternal-Child Nursing Care: Optimizing Outcomes For Mothers, Children and Families: Enhanced, Revised Reprint STD Education and Counseling  Create a therapeutic environment  Provide information appropriate to patient circumstances (e.g., age, drug use)  Include partners when possible  Teach strategies to promote genital health