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126 Cards in this Set
- Front
- Back
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What is the most common viral STI seen in ambulatory health care settings?
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Human papillovirus (HPV) infections
also known as CONDYLOMATA ACUMINATA or GENITAL WARTS |
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What is HPV the primary cause of?
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Cervical neoplasia/cancer
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Where are HPV lesions frequently seen in women?
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In the posterior part of the introitus; however, lesions are also found on the buttocks, the vulva, the vagina, the anus, and the cervix
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What is the appearance of HPV lesions?
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1. Infections of long duration may appear as a cauliflower-like mass.
2. In moist areas such as vaginal introitus, the lesions may appear to have multiple, fine, fingerlike projections 3. Flat-topped papules, 1 to 4 mm in diameter, are seen most often on the cervix. Often, then lesions are visualized only under magnification 4. Warts are usually fleshed colored or slightly darker on Caucasians, black on African-Americans, brown on Asians |
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What clinical manifestations are present with HPV?
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1. Usually painless, but may be uncomfortable, particularly when very large, inflamed, or ulcerated
2. Chronic vaginal discharge, pruritus, or dyspareunia can occur |
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What is pruritus?
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Itching
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What is dyspareunia?
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Painful sexual intercourse, for either gender
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What causes preexisting HPV lesions to enlarge during pregnancy?
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Relative state of immunosuppression during pregnancy
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What type of delivery is recommended for women with active HPV lesions?
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Cesarean birth
(unless all of the growth derives from one stalk, making it possible to push the large lesion to the side, allowing the baby to pass through vaginally) |
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What is the transmission rate of HPV to the neonate?
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Unknown
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What is the preventive value of cesarean birth against HPV?
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Unknown
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What are the symptoms of HPV?
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1. Profuse, irritating vaginal discharge
2. Itching 3. Dyspareunia 4. Postcoital bleeding 5. "Bumps" on the vulva or labia |
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What physical assessments are required whenever HPV lesions are suspected or seen in one area?
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Inspection of the vulva, perineum, anus, vagina, and cervix
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What methods are used to diagnose HPV?
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1. Evaluation of signs and symptoms
2. Papanicolaou (Pap) test 3. Physical examination 4. Viral screening and typing for HPV (but not part of standard practice) |
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What is condylomata lata?
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A form of secondary syphilis and generally are flatter and wider than genital warts
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How is HPV treated?
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1. Usually difficult to treat
2. No therapy has been shown to eradicate HPV 3. The goal of treatment therefore is removal of warts and relief of signs and symptoms, not the eradication of HPV 4. Clients often must make multiple office visits 5. Eradication of the virus is not considered conclusive even after no visible evidence of wart tissue is present because of the high incidence of recurrence |
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What pharmacological treatments should not be used during pregnancy?
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1. Imiquimod
2. Podophyllin 3. Podofilox |
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What methods are recommended for removal of HPV lesions during pregnancy?
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Cryotherapy or other surgical techniques
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What remedies can provide relief from discomfort caused by HPV lesions?
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1. Bathing with oatmeal solution and drying the area with a cool hair dryer
2. Keeping the area clean and dry, which also decreases the growth of the warts 3. Cotton underwear and loose-fitting clothes that decrease friction and irritation 4. Maintaining a healthy lifestyle to aid the immune system 5. Diet, rest, stress reduction, exercise |
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What should clients with HPV be counseled for?
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1. Information on how the virus is transmitted
2. That no immunity is conferred with infection 3. That requisition of the infection is likely with repeated contact 4. Partners should be checked even if they are asymptomatic 5. The infection is highly contagious 6. Concurrent vaginitis and STIs should be emphasized 7. Annual check-ups for recurrences and screenings for cervical cancer 8. Have regular Pap tests |
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What are the preventive strategies against transmission of HPV?
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1. Abstinence from all sexual activity
2. Staying in a long-term relationship 3. Prophylactic vaccination |
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What is HSV?
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Herpes simplex virus
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How many people in the US are infected with HSV?
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About 50 million people (although it is not a reportable disease)
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What are the characteristics of an initial HSV genital infection?
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1. Multiple painful lesions
2. Fever 3. Chills 4. Malaise 5. Severe dysuria 6. May last 2 to 3 weeks |
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Which gender generally has a more severe clinical course of HSV infections?
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Women
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What are the clinical manifestations of women with HSV infections?
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1. Lesions that progress from macules to papules, then forming vesicles, pustules, and ulcers that crust and heal without scarring
2. Itching, inguinal tenderness, and lymphadenopathy 3. Sever vulvar edema 4. Cervix may appear normal or be friable, reddened, ulcerated, or necrotic 5. Heavy, watery-to-purulent vaginal discharge 6. Systemic symptoms are usually absent, although the characteristic prodromal genital tingling is common |
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What are the complications of HSV during pregnancy?
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1. Neonatal herpes (most severe)
2. Increased miscarriage rates during first trimester |
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How is HSV managed?
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Directed toward specific treatment during primary and recurrent infections, prevention, self-help measures, and psychologic support
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What antiviral medications provide clinical benefits against HSV?
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1. Acyclovir
2. Valacyclovir 3. Famiciclovir |
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What measures help increase comfort in women with active genital herpes?
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1. Warm baths with baking soda
2. Keeping lesions dry by blowing the area with a hair dryer set on cool or patting dry with a soft towel 3. Wearing cotton underwear and loose clothing 4. Using drying aids, such as hydrogen peroxide, Burow's solution, or oatmeal baths 5. Applying cool, wet, black tea bags to lesions 6. Applying compresses with an infusion of cloves or peppermint oil and clove oil to lesions 7. Oral analgesics such as aspirin and ibuprofen may be used to relieve pain |
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What can help prevent recurrences of HSV breakouts?
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A diet rich in vitamin C, B-complex vitamins, zinc, and calcium
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When is transmission of HSV most likely to occur?
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When there is viral shedding (so women should refrain from sexual contact until complete healing of lesions)
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What can trigger a breakout of genital herpes?
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1. Stress
2. Menstruation 3. Trauma 4. Febrile illnesses 5. Chronic illness 6. UV light |
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What method of delivery is recommended for HSV?
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If visible lesions are not present at onset of labor, vaginal birth is acceptable. Cesarean birth within 4 hours after labor begins or membranes rupture is recommended if visible lesions are present.
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Why are women encouraged to have annual Pap tests and gynecological exams?
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Because HSV infections may be associated with cervical dysplasia
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Which viruses account for all cases of viral hepatitis in humans?
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Hepatitis viruses A, B, C, D, and E
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Which hepatitis viruses are common among users of IV drugs and recipients of multiple drug transfusions?
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Hepatitis D and E viruses
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How are Hepatitis A virus infections acquired?
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Primarily through a fecal-oral route by ingestion of contaminated food, particularly milk, shellfish, or polluted water, or person-to-person contact
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What are the characteristics of an HAV infection?
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Flu-like symptoms with malaise, fatigue, anorexia, nausea, pruritus, fever, and right upper quadrant pain
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Which antibody is detected in acute HAV infections?
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Immunoglobulin M (IgM), which is detectable 5 to 10 days after exposure and can remain positive for up to 6 months
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Does an HAV infection cause liver damage?
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NO, because HAV infection is self-limited and does not result in chronic infection or chronic liver disease, and treatment is usually supportive
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What should be avoided during HAV infection?
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Medications and substances that might cause liver damage or that are metabolized in the liver
(e.g. ACETAMINOPHEN or ETHYL ALCOHOL) |
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What is recommended during HAV infection?
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A well-balanced diet
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Which hepatitis virus is the most threatening to the fetus and neonate?
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Hepatitis B virus (HBV)
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What causes HBV infections?
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Large DNA virus and is associated with three antigens and their antibodies
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Which populations are at risk of HBV infection?
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1. Women of Asian, Pacific Island (Polynesian, Micronesian, Melanesian), or Alaskan-Eskimo descent and women born in Haiti or sub-Saharan Africa
2. Women who work or live in institutions for the mentally challenged 3. Women with a history of multiple blood transfusions 4. Health care workers and public safety officers exposed to blood in the workplace |
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Which group has a greater risk of HBV infection?
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1. Women who have a history of acute or chronic liver disease, or work or receive treatment in a dialysis unit, or who have a household or sexual contact with a hemodialysis client
2. People with a history of multiple sexual partners and a history of IV drug use |
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Where can the hepatitis B surface antigen (HBsAg) be found?
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In blood, saliva, sweat, tears, vaginal secretions, and semen
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How does perinatal transmission occur?
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From exposure to HBsAg-positive vaginal secretions, blood, amniotic fluid, saliva, and breast milk
(occurs most often in infants of mothers who have acute hepatitis infection late in the third trimester or during the intrapartum or postpartum periods) |
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What is HBV infection?
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A disease of the liver and is often a silent infection
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What are the symptoms of HBV infection?
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1. Arthralgias
2. Arthritis 3. Lassitude 4. Anorexia 5. N/V 6. Headache 7. Fever 8. Abdominal pain 9. Clay-colored stools 10. Dark urine 11. Jaundice |
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When is screening for HBsAg recommended?
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On all women at the first prenatal visit, regardless of whether they have been tested previously, and should be repeated later in the pregnancy or on admission for labor and birth for women with high risk behaviors
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What is the "window phase"?
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The time period in which a person may continue to be infectious of HBV even though HBsAg cannot be detected in the serum
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What components of the history should be obtained when hepatitis B is suspected?
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1. Inquiry about symptoms of the disease
2. Risk factors |
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What physical assessments should be done when hepatitis B is suspected?
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1. Inspection of the skin for rashes
2. Inspection of the skin and conjunctiva for jaundice 3. Palpation of the liver for enlargement and tenderness 4. Weight loss, fever, and general debilitation should be noted |
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What is the management for HBV infection?
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1. Women should be advised to increase bed rest; eat a high-protein, low-fat diet; and increase fluid intake
2. Avoid medications metabolized in the liver 3. Avoid alcohol 4. Vaccination during pregnancy |
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What is the most common blood-borne infection in the United States?
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Hepatitis C virus (HCV)
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What are the risk factors for HCV?
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1. IV drug use
2. STIs, such as hepatitis B and HIV 3. Multiple sexual partners 4. History of blood transfusions |
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What is the most common risk factor for HCV for pregnant women?
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History of injecting IV drugs
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How does sexual activity relate to the transmission of HCV?
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Studies have shown a positive correlation between sexual activity and HCV transmission, particularly with increasing numbers of sexual partners, failure to use a condom, history of STI such as hepatitis B and HIV, heterosexual sex with a male intravenous drug user, and sexual activities involving trauma
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What are the symptoms of hepatitis C?
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1. Can be asymptomatic
or 2. Flu-like symptoms similar to hepatitis A. About 10% have fatigue, nausea, and anorexia. |
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How is HCV infection confirmed during lab testing?
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By the presence of anti-C antibody
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What is HIV?
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Human immunodeficiency virus, a retrovirus
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How is HIV transmitted?
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Exchange of bodily fluids (semen, blood or, less commonly, vaginal secretions)
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What is the most common means of transmission of HIV in women?
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Heterosexual sex
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What are the characteristics of HIV?
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1. Severe depression of the cellular immune system associated with HIV infection characterizes AIDS
2. Once HIV enters the body, seroconversion to HIV positivity usually occurs within 6 to 12 weeks |
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Which diseases are most opportunistic with HIV infections?
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1. Pneumocystis carinii pneumonia (PCP)
2. Candida esophagitis 3. Wasting syndrome 4. HSV 5. Cytomegalovirus |
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What are the symptoms of HIV?
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1. Fever
2. Headache 3. Night sweats 4. Malaise 5. Generalized lymphadenopathy 6. Myalgias 7. Nausea 8. Diarrhea 9. Weight loss 10. Sore throat 11. Rash |
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When can transmission of HIV from the mother to the fetus occur?
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Throughout the perinatal period
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Which hepatitis virus currently has no preventative vaccine?
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Hepatitis C
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What other diseases should HIV-positive women be screened for?
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1. Syphilis
2. Gonorrhea 3. Chlamydia 4. Other vaginal infections |
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What type of therapy should all HIV-infected women be treated with?
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Zidovudine or HAART during pregnancy, regardless of their CD4 counts
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What should HIV-positive women be vaccinated for?
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1. Hepatitis B
2. Pneumococcal infection 3. Haemophilus influenzae type B 4. Viral influenza |
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What is recommended to support a pregnant woman's immune system?
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1. Optimal nutrition
2. Sleep 3. Rest 4. Exercise 5. Stress reduction |
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What is the most common gynecological complaint?
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Vaginal discharge
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What is normal vaginal discharge?
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Leukorrhea is normally clear to cloudy in appearance, and may turn yellow after drying. The discharge is slightly slimy, nonirritating, and has a mild, nonoffensive odor. Normal vaginal secretions contain lactobacilli and epithelial cells.
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What is the normal pH of vaginal secretions?
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Acidic, ranging from pH 4 to 5
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What is the most common type of vaginitis?
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Bacterial vaginosis (BV)
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What is the etiology of BV?
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Unknown
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What is bacterial vaginosis (BV)?
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A syndrome in which normal H2O2-producing lactobacilli are replaced with high concentrations of anaerobic bacteria (Gardnerella & Mobiluncus)
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What happens during BV?
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With proliferation of anaerobes, the level of vaginal amines is increased, and the normal acidic pH of the vagina is altered. Epithelial cells slough, and numerous bacteria attach to their surfaces (clue cells). When the amines are volatilized, the characteristic odor of BV occurs.
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What is the characteristic BV discharge?
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1. "Fishy" smell in the vaginal area
2. Profuse; thin; and white, gray, or milky in appearance 3. Mild irritation or pruritus (itching) |
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What is the most effective treatment of bacterial vaginosis?
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Oral metronidazole (Flagyl)
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What are the side effects of metronidazole?
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1. Sharp, unpleasant metallic taste in the mouth
2. Furry tongue 3. Central nervous system reactions 4. Urinary tract disturbances 5. Abdominal distress 6. N/V 7. Headache |
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What is a contraindication of metronidazole?
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Breastfeeding
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What is Vulvovaginal candidiasis?
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Yeast infection, the second most common type of vaginal infection
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What is the most common cause of yeast infections?
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Candida albicans
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What factors predispose women to yeast infections?
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1. Antibiotic therapy
2. Diabetes, especially uncontrolled 3. Pregnancy 4. Obesity 5. Diets high in refined sugars or artificial sweeteners 6. Use of corticosteroids or exogenous hormones 7. Immunosuppressed states |
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Which antibiotics predispose women to yeast infections?
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1. Ampicillin
2. Tetracycline 3. Cephalosporins 4. Metronidazole |
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What can create a environment ideal for vaginal fungal growth?
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Tight-fitting clothing and underwear or pantyhose made of nonabsorbent materials
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What are the symptoms of yeast infections?
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1. Itchiness
2. Feeling of dryness 3. Painful urination 4. Excoriations resulting from scratching 5. Thick, white, lumpy, and cottage cheese-like discharge 6. Redness and swelling of the vulva, labial folds, the vagina, and the cervix |
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What is the most common symptom of yeast infections?
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Vulvar and vaginal pruritus (itchiness)
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What test is conducted for Trichomoniasis?
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Saline wet smear
(vaginal secretions mixed with normal saline on a glass slide) |
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What test is conducted for Candidiasis?
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Potassium hydroxide (KOH) prep
(vaginal secretions mixed with KOH on a glass slide) |
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What test is conducted for bacterial vaginosis?
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1. Normal saline smear
2. Whiff test (vaginal secretions mixed with KOH) |
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What is the vaginal pH with a yeast infection?
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Normal
(between 4 to 5) |
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What is the vaginal pH with trichomoniasis?
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pH greater than 4.5
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What is the vaginal pH with bacterial vaginosis?
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pH greater than 4.5
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What is the management of vulvovaginal candidiasis?
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1. Exogenous Lactobacillus
2. Miconazole (Monistat) 3. Clotrimazole (Gyne-Lotrimin) 4. Sitz baths 5. Avoid use of tampons |
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What are the prevention measures of genital tract infections?
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1. Practice genital hygiene
2. Choose underwear of hosiery with a cotton crotch 3. Avoid tight-fitting clothing (especially tight jeans) 4. Select cloth car seat covers instead of vinyl 5. Limit time spent in damp exercise clothes (especially swimsuits, leotards, and tights) 6. Limit exposure to bath salts or bubble bath 7. Avoid colored or scented toilet tissue 8. If sensitive, discontinue use of feminine hygiene deodorant sprays 9. Use condoms 10. Void before and after intercourse 11. Decrease dietary sugars 12. Drink yeast-active milk and eat yogurt (with lactobacilli) 13. Do not douche |
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What the most common cause of vaginal infection?
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Trichomoniasis
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What organism causes Trichomoniasis?
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Trichomonas vaginalis, an anaerobic one-celled protozoan with characteristic flagellae
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What are the characteristics of Trichomoniasis?
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1. Yellowish to greenish, frothy, mucopurulent, copious, malodorous discharge
2. The cervix and vaginal walls will demonstrate "strawberry spots" or tiny petechiae, and the cervix may bleed on contact |
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What is the recommended treatment for Trichomoniasis?
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Metronidazole, 2 g orally
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What is group B streptococcus (GBS) considered as?
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Normal part of vaginal flora
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What is recommended to decrease the risk of neonatal GBS infection?
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1. Screening at 36 to 37 weeks of gestation with a rectovaginal culture
2. IV antibiotic prophylaxis |
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What are TORCH infections?
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1. T = Toxoplasmosis
2. O = other infections (such as hepatitis) 3. R = Rubella virus 4. C = Cytomegalovirus (CMV) 5. H = Herpes simplex |
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What is toxoplasmosis?
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A protozoan infection associated with the consumption of infested raw or undercooked meat and with poor handwashing after handling infected cat litter
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How is toxoplasmosis determined?
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Through blood studies although laboratory diagnosis is difficult
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What is the treatment for toxoplasmosis?
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Spiramycin, sulfadine, or a combination of pyrimethamine and sulfadiazine. Although pyrimethamine may be potentially harmful to the fetus, treatment of the parasite is essential
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What are the "other" infections of TORCH?
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GBS, varicella, and HIV
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What is rubella?
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A viral infection transmitted by droplets (such as from an infected person's sneeze)
also known as GERMAN MEASLES or 3-DAY MEASLES |
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What signs and symptoms are seen in the rubella infected mother?
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Rash, muscle aches, joint pain, and mild lymphedema
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What are the consequences of a rubella infection on the fetus?
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1. Miscarriage
2. Congenital anomalies (known as congenital rubella syndrome) 3. Death |
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Why is the rubella vaccine contraindicated in pregnant women?
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Because the women may develop a rubella infection from the live vaccine
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What is cytomegalovirus (CMV)?
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Mononucleosis-like syndrome
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How is CMV transmitted?
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By close contacts but also has been isolated from semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and banked blood
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How is maternal CMV diagnosed?
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In urine or in serum
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What are the consequences of a fetal CMV infection?
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1. Microcephaly
2. Eye, ear, and dental defects 3. Mental retardation |
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What is the treatment for CMV?
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No treatment is available during pregnancy
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What are the potential pregnancy effects of primary genital herpes infection (from herpes simplex virus)?
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1. Miscarriage
2. Preterm labor 3. IUGR |
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Should mothers with HSV have cesarean births?
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Not recommended for all mothers with HSV, only the ones with clinical eveidence of active lesions should have C-sections
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What are the methods of self-care for STIs?
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1. Take medications as directed
2. Use comfort measures for symptom relief as suggested by the health care provider 3. Keep appointment for repeat cultures or checkups to make sure infection is cured 4. Inform sexual partners of the need to be tested or treated, if necessary 5. Abstain from sexual intercourse until treatment is complete 6. Use safer sex practices when sex is resumed 7. Call health care provider immediately if bumps, sores, rashes, or discharges appear 8. Keep all future appointments with the health care provider, even if everything appears normal |
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What are the recommended preventive measures of STIs?
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Complete abstinence from sexual activities that transmit semen, blood, or other body fluids or that allow skin-to-skin contact
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What is the primary physical barrier promoted for the prevention of sexual transmission of HIV and other STIs?
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Condom (male and female)
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What is the female condom?
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A lubricated polyurethane sheath with a ring on each end that is inserted into the vagina
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