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37 Cards in this Set
- Front
- Back
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Consequences of STD's
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20-50% of chlamydia and 10-40% of Gonarrhea untreated which causes PID, resulting in infertility, ectopic pregnancy and chronic pelvic pain
A 2-5 fold increase in HIV lifelong infection with HSV |
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STD Trends
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GC at an all time low
Chlmydia remains the most commonly reported (bacterial) infectious disease up %5 from last yr. syphillis up 19%-big coinfection with HIV 65 million living with virial STD <50% of providers rountinely screen for STDS |
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Prevelence of the problem
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HPV and HSV tend to be silent- ie subclinical
est. that up to 75% of college woman are infected with HPV and up to 50% with HSV |
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Risk factors for STDS
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sexually active
young noncontracepting substance abuse internet partner sex for money or drugs >1 partner in last 60 days NO SAFE SEX ONLY SAFER SEX |
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HERPES
incubation |
HSV 1 or 2, 2 is usually geneitial
2-10D most cases subclinical shedding decreases after 3-5yrs |
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HERPES
Assessment |
asymptomatic
primary: multiple lesions, +/- lymphadenopathy and systemic sx recurrent: fewer lesions and shorter duration |
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HERPES
DIAGNOSIS |
culture-usually need new lesion
serologic test available(3 mo after primary outbreak)need to differeniate HSV 1&2 |
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HERPES
TREATMENT |
NO CURE
antivirials: acyclovir, famciclover and valacyclovir help delay symptoms and heal and feel better quicker |
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PRIMARY HERPES, FEMALE
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RISK IN PREG IS WITH PRIMARY OUTBREAK. IF INFANT EXPOSED AND GETS VIRUS IT INCREASED MORTALITY AND THOSE WHO LIVE HAVE NEURO DAMAMGE
GOAL IS < FREQ AND < SEVERE OF SX |
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CONDYLOMA ACUMINATA
GENETIAL WARTs |
Assessment-usually withour other sx
DX Physical Exam or colposcopy for cervical lesions TX: podophyllin (not with preg) TCA-burns them off imiquimod liuid nitrogen laser |
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Genital wart female
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only 60-80% response with 30-40% recurrence
complications -1/2 of sexually active womaen have HPV virus HPV 6&11 cause warts. 16,18,31,33,35 cause cervical dysplasia, often infected with more than one type vaccine available |
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HPV vaccine
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for high risk HPV-esp 16 and 18
studies show efficacy at 100% after 17mo will not prevent currently developing CA will take 10-20yr to show effect |
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GONORRHEA
s/s |
Incubation 1-14D
female- often silent discharge, spotting, pain, sysparunia(painful sex) Male-generally NOT silent creamy discharge, dysuria |
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Gonorrhea
diagnosis |
PCR urine or swab, culture by swab, also rectal or throat. can occur anywhere sex occurs ie mouth, anus
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Gonococcal cervicitis
treatment |
floxin 400mg once or phocephin 125mg IM
resistence to floxin is usually with males so use rhocephin |
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Gonococcal cervicitis
complicaitons |
PID with resulting infertility and or chronic pelvic pain
rare systemic sepsis |
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what type of infections are gonarrhea dn chylmdia?
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Cervical infections in woman that can ascend upward and urethral in men and generally don't ascend
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CHLAMYDIA
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most common bacterial STD 50% no s/s
incubation 7-21D |
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CHLAMYDIA
assessment |
woman-none, discharge
PE: clear cervical discharge, raw friable cervix male: none, dysuria, discomfort, clear sischarge |
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CHLAMYDIA
treatment |
zithromax 1gm po once or doxycline 100mg bid x7d
only time ovre use of ABX accepted |
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CHLAMYDIA
Complications |
silent PID with resulting infertility
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Syphilis
causitive agent incubations period |
treponema pallidum
9-90D rare but increasing co-infection with HIV |
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Primary syphilis-
chancre |
primary stage
chancre-painless indurated ucler at site of infection |
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Syphilis Secondary
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skin rash, mucus patches, condylomata lata (flat lesions on mouth and/or palms, very infectious
OCCURS ANYTIME AFTER 3 MONTHS |
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lATE SYPHILIS
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LATENT STAGE-no clincial sx, can last 6mo or 20yrs
TERIARY- may affect the heart, CNS, skin (gumma-nasty lesion)bones |
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Syphilis
dx and rx |
dx- serological test. treponemal test-usually remain + even after tx
Nontreponemal tests- 3mo to be +, four fold change in titer indicates active disease, usually returns to normal RX- depends on stage and duration primary, secondary and early latent-benzathine PCN 2.4 mil u IMx1 Late latent and teriary-7.2mil u in 3 doses, 1 wk apart |
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syphilis in a newborn
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congenital has no problem in infant is tx is given before 18 mo of age.
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STD vaginal infections
trichomoniasis |
caused by protoza avg. incubation 7d
assess; Male none Female-perineal itching, discharge, strawberry red cervix |
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diagnosis of trichomoniasis
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trich in wet prep or by culture
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tx of trichomoniasis
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metronidazole 2gm TREAT PARTNERS
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Bacterial vaginosis
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NOT AN STD
ASSESS-foul smelling discharge +/- puritius |
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Bacterial vaginosis
dx |
white smooth discharge coating vaginal walls
clue cells on microscopic exam +wiff test-fishy |
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bacterial vaginosis
treatment |
metronidazole 500mg bid x7d
metrogel vaginal jelly qd x7d |
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bacterial vaginosis
cause and complications |
an imbalance vs pathogen
complications include PID, PROM (co-factor),premature labor |
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Chancroid Male-regional adenopathy
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highly contagious-seen mostly in tropical seaports
caused by haemophilis ducreyi sx-start as papules progressing to ulcers >transmission of HIV RX- zithromax 1gmx1 incubation 4-7D |
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counseling guidelines for patients with STD
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all sexually active people nn information
privacy/confidentiality non-judgemental written reference material active listening address psychological impact of dx personal responsability |
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Interventions
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individual focused ex outreach, counseling 1:1
condom distribution community focused; screening exams, sexual risk factor hx, peer outreach Health communications ex; mass media towrds specific populations Policy focused: increased funding for drug, etoh, and sex education programs |
