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Lisa Heelan , FNP

Lisa Heelan , FNP. Family Health Promotion 1 Commonly Occurring Infections. Learning Objectives. Summarize modes of transmission, treatments and descriptions of the most commonly occurring sexually transmitted infections (STI’s)

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Lisa Heelan , FNP

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  1. Lisa Heelan, FNP Family Health Promotion 1 Commonly Occurring Infections

  2. Learning Objectives • Summarize modes of transmission, treatments and descriptions of the most commonly occurring sexually transmitted infections (STI’s) • Summarize the health teaching that a nurse needs to provide to a woman with an STI • Relate the implications of pelvic inflammatory disease (PID) for future fertility to its pathologic origin, signs and symptoms and treatment

  3. Compare the different types of hepatitis • Compare vulvovaginal candidiasis and bacterial vaginosis • Discuss acquired immunodeficiency syndrome (AIDS), including care of the pregnant woman with HIV/AIDS, neonatal implications and ramifications for the childbearing family

  4. Normal Vaginal Flora

  5. VulvovaginalCandidiasis (Yeast) Thick, white vaginal discharge Severe itching, dysuria and dyspareunia Treatment: Miconazole cream

  6. Clinical Thinking in Action Maria is a 24 year old woman who is coming to the clinic for the 4th time this year with complaints of vaginal itching and thick cottage cheesy discharge which started again yesterday. Maria denies any change in her sexual partner, but loves to run five miles per day. cells and a negative Wiff test Her wet mount shows a +KOH with no WBC’s, no clue.

  7. If a woman experiences frequent recurrences of monilial vaginitis, what should she be tested for?

  8. What about a pregnant woman who has a yeast infection? Can this be a serious condition for the newborn?

  9. The client being given discharge instructions with a diagnosis of vulvovaginal candidiasis demonstrates understanding when she states, “I need to: • Wear nylon panties • Apply the miconazole (Monistat) for 10 days • Consider taking acidophilus daily • Douche daily 0

  10. Bacterial Vaginosis Overgrowth of normal vaginal flora Thin, watery, white-grey discharge “Fishy” odor Treatment: Flagyl

  11. Increased risk of pelvic inflammatory disease (PID) • Abnormal cervical cytology (pap) • Increased risk for premature rupture of the membranes (PROM) • Preterm labor • Postcesareanendometritis

  12. Trichomoniasis Transmission: Sexual intimacy Symptoms: asymptomatic or mild * yellow-green frothy, odorous discharge *Vulvar itching Treatment: Metronidazole

  13. Critical Thinking in Action Ann is a 31 year old woman who now has a new sexual partner. She has been inconsistent with using condoms. She presents to the clinic with some vaginal itching and a bad odor that she says she has never had before. On exam, the wet mount shows: –wbc’s, -clue, +wiff and Trichomonas vaginalis. Her pregnancy test is +.

  14. Ann understands why she can’t drink alcohol, because she is pregnant, but she can’t understand why her boyfriend can’t drink alcohol if he takes flagyl. What do you tell her?

  15. What are pregnant women with trichomoniasis at increased risk for? Can they be treated with metronidazole (flagyl)?

  16. Ann can’t understand that if she is treated, and her boyfriend has started treatment, why they have to abstain from sex. What do you tell her?

  17. A nonpregnant woman reports a fishy smelling, thin, white watery vaginal discharge. She is diagnosed with BV. The client reports an allergy to sulfa. What will the nurse adminster? • Metronidazole (flagyl) 500 mg po bid for a week • Penicillin G (Bicillin) 2 million units IM x 1 • Doxycycline (Vibramycin) 100mg po bid for a week • Zithromax (Azithromycin) 1 mg po bid for 2 weeks 0

  18. Chlamydial Infection Most common STI in the United States Transmission: Vaginal, anal & oral Symptoms: 70% of women have no symptoms Treatment: Azithromycin or Doxycycline http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm

  19. Gonorrhea…. • Transmission: vaginal, anal, or oral sex • Symptoms: 80% of women are asymptomatic • Treatment: Ceftriaxone IM

  20. Symptoms of chlamydia and/or gonorrhea…. Men Discharge from the penis Burning sensation while urinating Tender or swollen testicles Women Burning sensation while urinating Abnormal vaginal discharge Abdominal pain Unusual vaginal bleeding Men and Women Anal itching Soreness Bleeding Painful bowel movements Eye infections Blood infections

  21. On a wet mount….increased white blood cells

  22. Critical Thinking in Action Cherelle, age 18, was just diagnosed with gonorrhea by the nurse practitioner at the clinic where you work. Although she had been asymptomatic, she had come in for evaluation after her boyfriend was diagnosed with gonorrhea and started on antibiotics. Cherelle is treated with ceftriaxone IM plus doxycycline bid x 1 week.

  23. Cherelle asks you why she received two medications, when she only had gonorrhea? How would you reply?

  24. Cherelle asks you whether she is now immune to gonorrhea. Is she?

  25. Cherelle asks whether she can now have sex with her boyfriend. Can she do so?

  26. While Cherelle is not pregnant, what might happen to her fetus if she was pregnant and had a chlamydial infection that was not treated?

  27. Pelvic Inflammatory Disease What are the symptoms of PID? When should a woman be hospitalized? http://www.cdc.gov/std/PID/STDFact-PID.htm

  28. Which of the following diagnostic tests would the nurse question when ordered for a client diagnosed with pelvic inflammatory disease (PID)? • Throat culture for Strep tococcus A • CBC (complete blood count) • Culture for Neisseria gonorrhea • RPR (rapid plasma reagin) 0

  29. The nurse’s discharge teaching plan for the woman with PID should reinforce which of the following potentially life threatening complications? • Involuntary infertility • Chronic pelvic pain • Depression • Ectopic pregnancy 0

  30. Primary episodes most severe Vesicles may appear within a few hours up to 21 days after exposure Flu-like symptoms, genital tingling or pruritus Lesions heal on own within 2 weeks Herpes Genitalis HSV 1?, HSV 2?

  31. Herpes…. • Transmission: vaginal, anal or oral • Skin to skin contact • 50 million people in US have it • Treatment: Oral acyclovir

  32. Can increase spontaneous abortion if primary infection occurs in first trimester • Intrauterine growth restriction and neonatal infection in 2nd or 3rd trimester • Risk to fetus varies and is dependent on route of birth and whether lesions present at delivery are recurrent or primary

  33. Symptomatic newborns with Herpes • Fever • Jaundice • Seizures • Poor feeding • ½ develop herpetic lesions • Treated with acyclovir

  34. Syphilis…. Bacterial Organism: Treponemapallidum Transmission: *Vaginal, oral or anal *Exposure to exudate from infected individual * Transplacental Symptoms: Early stage: Chancre, fever weight loss, malaise

  35. Syphilis….. Symptoms of second stage: *Condylomatalata on vulva, acute arthritis *Enlargement of liver and spleen, lymph nodes *Chronic sore throat

  36. Critical Thinking in Action Mary is a 24 year old pregnant woman, 19 weeks gestation. She recently noticed a sore in the vulva area that didn’t hurt or itch, but it has been persisting for about 2 weeks now. Mary is concerned because the father of the baby had been in prison, and a friend of hers told her that men in prison have sex with other men. Now, Mary wants to be checked for everything, and isn’t sure she wants to remain in the current relationship.

  37. Mary’s RPR titer turns out to be + for syphilis. She needs to be treated, and will be given Penicillin G. Mary asks about what effect this disease may have on her fetus. You reply?

  38. Why is testing done at the initial prenatal screening, and repeated in the 3rd trimester on all pregnant women?

  39. HPV • In the US, 20 million men & women are infected • 2.3% of women ages 14-59 are infected with cancer causing strains HPV type 16 or 18

  40. Genital Warts…. • Viral organism: HPV • Transmission: Vaginal, oral, or anal sex • Symptoms: Painless Pruritus • Treatment: Client or provider therapies for wart removal

  41. Women with HPV • Should have paps or thin preps every 6 months depending on their age • May need colposcopies • Instructed in safer sex practices and screened for other STI’s

  42. A woman with HPV is likely to present with which nursing assessment finding? 10 • Profuse, pus-filled vaginal discharge • Clusters of genital warts • Single painless ulcer • Multiple vesicles on genitalia

  43. Men with HPV • Prevalent in both heterosexual and homosexual men • HIV+ men had higher rates of anal cancer

  44. Anal Cancer • Affects 4,600 men & women each year • 700 people die

  45. Approved by FDA in June 2006 • 3 injections over 6 months at a cost of $150/injection • For use in males & females starting at age 9 to 26 • Protects against HPV strains 16 & 18 that causes 70% of all cervical cancers and types 6 & 11 which causes 90% of genital warts

  46. Gardasil Vaccine • Doesn’t contain mercury, thermosol or live or dead virus, only virus like particles • Questionable length of protection---may need to be revaccinated within 5 years of receiving initial vaccine • Will continue to need annual paps • Side effects—no long term studies

  47. Cervarix • Protects against HPV strains 16 & 18 • FDA approved in October 2009 • Manufactured by GlaxoSmithKline • Approved for use in females age 10-25

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