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

2. 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
conditions/ss/slideshow-std-pictures-and- facts

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

4. Chlamydia Trachomatis
Most common bacterial STD
Leading cause of preventable infertility
Complications include ectopic pregnancy, pelvic inflammatory disease
Usually asymptomatic in women
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5. Chlamydia Trachomatis (cont’d)
Diagnosis
Culture
Direct immunofluorescence
Nucleic acid hybridization/amplification (NAAT)
Enzyme immunoassay
Treatment
Antibiotics (e.g., doxycycline, azithromycin)

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

7. 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

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

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

10. 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

11. 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
cancer/slideshow-cervical-cancer-overview

12. 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

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

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

15. 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

16. 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)

17. 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

18. 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

19. 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