1. Sexually Transmitted Infections Jeannie Harper, PhD, RN

2. Prevention  Education  Make better decisions  Common assumptions  Empowerment  Use of safe  Assessment for high risk behaviors  History of Sexual activity  Drug Use  History of blood transfusions  Abstinence  Condoms

3. Bacterial Infections: Chlamydia trachomatis  Most common & fastest spreading in US  Leads to acute salpingitis or PID  Increases risk for HIV  CDC Treatment for urethral, cervical, rectal infections  Doxycycline 100 mg BID xs 7 days  Azithromycn 1 g po (more expensive)  If pregnant, Erythromycin or amoxicillin  Often asymptomatic = non-compliance of medicine use

4. Bacterial Infections: Gonorrhea  Neisseria gonorrhoeae : Reportable  Oldest communicable disease in US  Drug resistant strains to pennicillin (PPNG)  Almost exclusive to sexual contact  Age most important risk factor  Sexually active teens  Young adults  Most prevalent among African Americans  Often asymptomatic  CDC Treatment= Ceftriaxone 125 mg IM  Partner contact testing and treatment required

5. Bacterial Infections: Syphillis  Treponema pallidum- motile spirochete  Rates are high in southern states  Sypmtomatic  Primary lesion, chancre  Secondary rash with fever, HA, lymphadenopathy, condylomata  Pregnant women screened in 1 st and 3 rd trimesters  Penicillin G 2.4 million units IM  Doxycycline, 100 mg for Penicillin allergy  Penicillin is only drug to be used during pregnancy  Desensitization to Penicillin required  Treatment may result in jarish-Herxheimer reaction and preterm labor or birth

6. Viral Infections: Human papillomavavirus (HPV)  Primary cause of cervical neoplasia  Causes genital warts or condylomata acuminata  May require a c/s delivery  Symptom may be a “bump” on the vulva or labia  Papanicolaou (Pap) test used to make diagnosis  No therapy for treatment  Prevention: Gardasil® vaccination for women beginning during age 11 ( types 6, 11, 16, 18)  http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-young- women.htm

7. Viral Infections: Herpes Simplex Virus (HSV)  Transmission is sexually and non-sexual  HSV-1=Fever blisters  HSV-2 =labial ulcers  Not reportable  Chronic and recurring  Treatment  Antiviral medication- Acyclovir, 400mg orally tid xs 4 days  Diet and stress reduction can limit outbreaks  In pregnancy an active outbreak requires a c/s delivery

8. Viral Infection: Viral Hepatitis  Hepatitis B (HBV)  Most threatening to fetus and neonate  Screen for active or chronic disease states or immunity  Prevention through immunization  Hepatitis C (HCV)  Most common blood-borne disease  IV drug use is most common risk factor  Treatment- Interferon alfa-2b with or without Ribaviran

9. Viral Infection: Human Immunodeficiency Virus (HIV)  Women fastest growing population  Leads to acquired immunodeficiency syndrome (AIDS)  Transmission is by body fluids  Can be transmitted to fetus in pregnancy (18-26%)  Antibodies remain in child for 18 months (see study guide for SDIs in pregnancy)

10. Vaginal Infections  Bacterial vaginosis (BV)  Characterized by fishy odor  Treatment- Flagyl (metronidazole)  Pump and dump for breast feeding moms taking Flagyl  Trichomaoniasis  Almost always sexually transmitted  Most common cause of vaginal infection (25%)  One-celled protozoan  Yellowish to greenish, frothy, malodorous discharge  Irritation and pruritus

11. Group B Streptococcus  Normal flora in 9-23% of women  Associated with poor pregnancy outcomes  Protocol for labor  Penicillin G- 5 MU IV loading dose then  Penicillin G- 2.5 MU maintenance q 4 hrs  Alternative to Penicillin is:  Ampicillin 2 g IV loading then  Ampicillin 1 g IV 1 4 hrs