Rebecca is visiting the clinic seeking birth control pills. She had sexual intercourse for the first time 8 weeks ago. Subjective data:  Her partner does not use a condom or spermicide with intercourse  Her last menstrual period was 2 weeks ago  Denies any symptoms other than frequent urination and some dysuria.  Interested in using oral contraceptives  Very nervous Rebecca, a 16 year old white female

The Health Care provider after talking with her does a physical exam including a pelvic exam. Lab work is also drawn.

Objective data obtained from examination and lab results: ◦ Cervical ectopy noted during Pap test ◦ Mucopurulent cervical discharge ◦ Urine pregnancy test is negative ◦ Nucleic acid amplification test is suspect for Chlamydia and gonorrhea.

 After gathering this data, what conclusions can be drawn?  Why did she not suspect that she might have a STD?   What risk factors were present?  What do you think is the next step? Explain.

 Endocervical Culture is completed – came back positive for Chlamydia and gonorrhea.  Why was a endocervical culture done?  Explain why smears, the nucleic acid amplification test and EIA tests are not used in confirming the diagnosis in a female.

Health Care Providers Orders: ◦ Doxycycline 100mg bid for 7 days ◦ Ceftriaxone 250mg IM once  When you see above medications ordered, what did this tell you?  What are the side effects of these medications?  What medication would be ordered if Rebecca only had gonorrhea?

 What does she need to know about other STD’s What other testing would you recommend.  What is important to teach regarding Health Prevention?  What complications can occur is she does not follow the health teaching?

 What symptoms might her sexual partner exhibit of chlamydia or gonorrhea?  Where is the initial site of infection in the male?  Why does the male seek medical care early?  How is the male diagnosis confirmed?  Does the partner need to be treated? Explain.

a. doxycycline (Vibramycin) b. Cefixime (Suprax) c. levofloxacin (Levaquin) d. ceftriaxone (Rocephin) e. ciprofloxacin (Cipro) f. Amoxicillin (Ampicillin) g. acyclovir (Zovirax)

 Primary stage  When does this occur?

◦ In what stage does this Bilateral symmetric rash on trunk, extremities, and palms appear? ◦ What other symptoms will the patient exhibit?

 Occur mostly in late syphilis  Gummas can produce irreparable damage to bone, liver, or skin  Aneurysm may press on structures such as intercostal nerves, causing pain  Scarring of aortic valve  Neurosyphilis  Tabes dorsalis  Sudden attacks of pain  Loss of vision and sense of position

 Nonspecific antitreponemal Tests used for screening: ◦ VDRL ◦ RPR  Specific treponemal Tests for confirmation: ◦ Fluorescent treponemal antibody absorption (FTA-Abs) All these tests – tests for antibodies Even Better - presence of spirochetes on dark field microscopy

 Mr. L., 61 years old, was admitted to the hospital for pre-operative preparation for surgery. His pre- operative blood work included a VDRL test and it came back positive.  What would be most important for the nurse to ask the patient?  Why?  What would be different in this situation if the patient was 16?

 Drug therapy ◦ Benzathine penicillin G (Bicillin) ◦ Aqueous procaine penicillin G ◦ **Be sure they complete full course of therapy  Contact Isolation o Lesions of primary and secondary syphilis are highly infective. o Gloves should be worn in direct contact o Good Handwashing after removal of gloves

Which of the following is NOT a symptom of syphilis? a. a hard chancre sore b. a rash on the skin including the palms and soles. c. a thick, yellowish discharge d. large ulcers called gummas.

 What causes a patient with genital herpes to seek medical care?

 Primary (initial) episode ◦ Burning or tingling at site ◦ Small vesicular lesion appear on penis, scrotum, vulva, perineum, perianal areas, vagina, or cervix ◦ Primary lesions present for 17 to 20 days ◦ New lesions sometimes continue to develop for 6 weeks ◦ Lesions heal spontaneously

 When are they most contagious?

 Recurrent genital herpes ◦ Occurs in 50% to 80% in following year ◦ Triggers  Stress  Fatigue  Sunburn  Menses ◦ Prodromal symptoms of tingling, burning, itching at lesion site ◦ Symptoms are less severe and lesions heal within 8 to 12 days ◦ With time, lesions will occur less frequently

 How is the diagnosis confirmed?

 What is the major treatment for genital herpes?

 Drug therapy ◦ Inhibit viral replication ◦ Suppress frequent recurrences  Acyclovir (Zovirax)  Valacyclovir (Valtrex)  Famciclovir (Famvir)  Given several times /day for 7-10 days.

 Do the antiviral medications eradicate the disease?

 Symptomatic care ◦ Genital hygiene ◦ Loose-fitting cotton underwear ◦ Lesions clean and dry ◦ Sitz baths ◦ Barrier methods during sexual activity ◦ Drying agents ◦ Pain  Dilution of urine with water  Local anesthetic

 A primary Herpes Simplex virus (HSV) infection differs from recurrent HSV episodes in that: a.Only primary infections are sexually transmitted b.Systemic manifestations such as fever and myalgia are more common c.It is of shorter duration than recurrent episodes d.Transmission of the virus to a fetus is less likely during primary infection.

 What causes genital warts?  Who is most likely to get this condition?

 How is this condition diagnosed?

 What is the Primary goal in the treatment of genital warts?  Treatment includes a course of therapy rather than one treatment. Explain.

 With removal of genital warts infectivity is decreased? Explain

 Treatments ◦ Chemical  Trichloroacetic acid (TCA)  Bichloroacetic acid (BCA)  Podophyllin resin  For small external genital warts ◦ Patient managed  Podofilox (Condylox/Condoylox gel)  Imiquimod (Aldara)  Immune response modifier

 Treatments ◦ If warts do not regress with previously mentioned therapies  Cryotherapy with liquid nitrogen  Electrocautery  Laser therapy  Use of α -interferon  Surgical excision

 Recurrences and re-infection possible  Careful long-term follow-up advised  Health Preventive Measures ◦ Vaccine to prevent cervical cancer, precancerous genital lesion, and genital warts due to HPV ◦ Gardisal vaccine Gardisal vaccine

The age group that seems particularly susceptible to HPV infections is: a.students of college age b.teenagers c.middle-aged adults d.senior citizens

Human papilloma viruses (HPVs) are associated with: a.cancer of the cervix b.skin cancer c.lung cancer d.spontaneous abortions