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37 Cards in this Set

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Consequences of STD's
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
STD Trends
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
Prevelence of the problem
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
Risk factors for STDS
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
HERPES
incubation
HSV 1 or 2, 2 is usually geneitial
2-10D
most cases subclinical
shedding decreases after 3-5yrs
HERPES
Assessment
asymptomatic
primary: multiple lesions, +/- lymphadenopathy and systemic sx
recurrent: fewer lesions and shorter duration
HERPES
DIAGNOSIS
culture-usually need new lesion
serologic test available(3 mo after primary outbreak)need to differeniate HSV 1&2
HERPES
TREATMENT
NO CURE
antivirials: acyclovir, famciclover and valacyclovir help delay symptoms and heal and feel better quicker
PRIMARY HERPES, FEMALE
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
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
Genital wart female
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
HPV vaccine
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
GONORRHEA
s/s
Incubation 1-14D
female- often silent discharge, spotting, pain, sysparunia(painful sex)
Male-generally NOT silent creamy discharge, dysuria
Gonorrhea
diagnosis
PCR urine or swab, culture by swab, also rectal or throat. can occur anywhere sex occurs ie mouth, anus
Gonococcal cervicitis
treatment
floxin 400mg once or phocephin 125mg IM
resistence to floxin is usually with males so use rhocephin
Gonococcal cervicitis
complicaitons
PID with resulting infertility and or chronic pelvic pain
rare systemic sepsis
what type of infections are gonarrhea dn chylmdia?
Cervical infections in woman that can ascend upward and urethral in men and generally don't ascend
CHLAMYDIA
most common bacterial STD 50% no s/s
incubation 7-21D
CHLAMYDIA
assessment
woman-none, discharge
PE: clear cervical discharge, raw friable cervix
male: none, dysuria, discomfort, clear sischarge
CHLAMYDIA
treatment
zithromax 1gm po once or doxycline 100mg bid x7d
only time ovre use of ABX accepted
CHLAMYDIA
Complications
silent PID with resulting infertility
Syphilis
causitive agent
incubations period
treponema pallidum
9-90D
rare but increasing co-infection with HIV
Primary syphilis-
chancre
primary stage
chancre-painless indurated ucler at site of infection
Syphilis Secondary
skin rash, mucus patches, condylomata lata (flat lesions on mouth and/or palms, very infectious
OCCURS ANYTIME AFTER 3 MONTHS
lATE SYPHILIS
LATENT STAGE-no clincial sx, can last 6mo or 20yrs
TERIARY- may affect the heart, CNS, skin (gumma-nasty lesion)bones
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
syphilis in a newborn
congenital has no problem in infant is tx is given before 18 mo of age.
STD vaginal infections
trichomoniasis
caused by protoza avg. incubation 7d
assess; Male none
Female-perineal itching, discharge, strawberry red cervix
diagnosis of trichomoniasis
trich in wet prep or by culture
tx of trichomoniasis
metronidazole 2gm TREAT PARTNERS
Bacterial vaginosis
NOT AN STD
ASSESS-foul smelling discharge +/- puritius
Bacterial vaginosis
dx
white smooth discharge coating vaginal walls
clue cells on microscopic exam
+wiff test-fishy
bacterial vaginosis
treatment
metronidazole 500mg bid x7d
metrogel vaginal jelly qd x7d
bacterial vaginosis
cause and complications
an imbalance vs pathogen
complications include PID, PROM (co-factor),premature labor
Chancroid Male-regional adenopathy
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
counseling guidelines for patients with STD
all sexually active people nn information
privacy/confidentiality
non-judgemental
written reference material
active listening
address psychological impact of dx
personal responsability
Interventions
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