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GYN presentation- STIs
Transcript of GYN presentation- STIs
Pelvic Inflammatory Disease, HPV Sexually Transmitted Infections
and Pregnancy Chlamydia is caused by the gram-negative bacteria Chlamydia trachomatis which can establish long-term associations with the host cell
Chlamydia is a curable bacterial infection mainly affecting the urinary tract in both men and women.
It is transmitted through genital, oral, or anal sex.
Most common STI with an estimated 3 million new cases each year in the US according to the CDC.
Higher prevalence among young females, sexually active and under 25 years old.
Untreated chlamydia increases the risk of HIV, other STI’s, and uterine infection postpartum
Risk factors: no or infrequent use of condoms, multiple sex partners within the past year, history of prior STIs. Pelvic Inflammatory Disease Caused by vaginal intercourse with an infected partner
Infection begins in the cervix and ascends to the upper genital tract
Infection is usually bacterial – gonorrhea and chlamydia are the most common agents.
Epithelial damage caused by gonorrhea and chlamydia can allow other opportunistic microorganisms entry.
Infection can be spread by instrumentation of the cervix such as in a D&C or insertion of an IUD
Infection is thought to be caused by direct entry of into the endometrial cavity following disruption of the protective cervical barrier. Syphilis Syphilis: Treatment Human Papillomavirus Genital human papillomavirus is the most common sexually transmitted infection. There are more than 40 types of HPV that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat.
HPV can cause serious health problems, including genital warts and certain cancers. There is no certain way to tell who will develop health problems from HPV and who will not. In most cases HPV goes away by itself before it causes any health problems, and most people who become infected with HPV do not even know they have it. Gonorrhea Pathology and A&P Can lead to pelvic inflammatory disease (PID) in women, starting from the cervix and leading to the uterus or fallopian tubes; 15% of women.
PID can cause damage to the reproductive system in females, including the ovaries, uterus, fallopian tubes, and cervix. Chlamydia: Signs and Symptoms Chlamydia does not usually present with symptoms, 75% of women and 50% of men infected are asymptomatic
Symptoms that may occur are:
general genital pain
lower abdominal pain
discharge from penis
increased vaginal discharge
tender or swollen testicles
and/or possible spotting.
Usually begin one to three weeks after exposure
Anal intercourse can cause inflammation of the rectum and oral sex can lead to infection in the throat. Chlamydia:Diagnosis and Treatment Diagnosis either by a swab of possible affected areas or a urine test.
If positive, testing for other STIs is usually performed.
Treatment is with antibiotics; either a one-time dose, or a 5-10 day dose
Infection typically resolves in one to two weeks
Sex should be abstained from during this time
Sexual partner or partners should be tested and treated as well. Chlamydia and Pelvic Inflammatory Disease Chlamydia: Implications for Pregnancy During pregnancy, chlamydial infection can result in:
higher rates of preterm birth
infection of the amniotic sac and fluid
50% of infants born vaginally to mothers with untreated chlamydia contract the infection.
25-50% of these babies develop conjunctivitis within a few days to a few weeks post birth
***Erythromycin is not conducive for conjunctivitis caused by chlamydia.
5-10% develop pneumonia a few weeks to several months after birth.
Prompt administration of antibiotics used to treat these infections.
Antibiotic treatment before delivery is the best prevention.
Obstruction and scarring in the fallopian tubes may cause infertility. Chlamydia: Recommendations During Pregnancy Pregnant women should/will be tested during their first prenatal exam.
If at high risk or under age of 25, testing may be repeated in the third trimester.
In pregnant women, CDC recommends retesting 3-4 weeks post treatment to guarantee free of infection.
Treatment of chlamydia during pregnancy is with a single dose or week long course of pregnancy safe antibiotics.
Partner should be treated also and sex should be abstained from for a week after completing treatment to ensure that re-infection does not occur. References http://www.nlm.nih.gov/medlineplus/chlamydiainfections.html#cat1 (page last updated 5 February 2013)
http://www.mayoclinic.com/health/chlamydia/DS00173/METHOD=print (April 29, 2011)
Euerle, B. (2012, January 6). Syphilis. Retrieved from http://emedicine.medscape.com/article/229461-overview
( Euerle, 2012)
Syphilis - cdc fact sheet. (2013, February 11). Retrieved from http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm
(Syphilis - cdc, 2013)
Syphilis. (2003). Retrieved from http://catalog.nucleusinc.com/displaymonograph.php?MID=87 (Syphilis, 2003)
Centers for Disease Control and Prevention. (2013, Febuary 11). Gonorrhea - cdc fact sheet. Retrieved from http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm
Mayo Clinic Staff. (2011, January 8). Gonorrhea: Treatments and drugs. Retrieved from http://www.mayoclinic.com/health/gonorrhea/DS00180/DSECTION=treatments-and-drugs
"Genital HPV Infection - Fact Sheet." Center for Disease Control and Prevention. National HPV and Cervical Cancer Prevention Resource Center American Sexual Health Association (ASHA), 18 Mar 2013. Web. 31 Mar 2013. <http://citationmachine.net/index2.php?reqstyleid=1&reqsrcid=MLAWebDocument&srcCode=11&more=no&mode=form>. Chlamydia A chronic infection caused by the sporochete, Treponema pallidum.
It is usually transmitted by vaginal, oral, or anal sex, but it can be transmitted by nonsexual exposure to exudate, such as an infected sore touching someone’s skin.
The central nervous system (CNS) is invaded early in the infection; during the secondary stage, examinations demonstrate that more than 30% of patients have abnormal findings in the cerebrospinal fluid (CSF).
These sores are located on the external penis, the vagina. And in the rectum. They can also be located on the lips or in the mouth.
It is important to know that syphilis cannot be spread through contact with toilet seats , doorknobs , shared clothing , or eating utensils. The infected sore has to come in direct contact with the individual’s skin. Syphilis: Pathology T pallidum rapidly penetrates intact mucous membranes or microscopic dermal abrasions and, within a few hours, enters the lymphatics and blood to produce a systemic infection.
The incubation period is 10 to 90 days even if there are no sores present.
Each sore contains spirochetes, a very contagious and infectious bacteria.
There are 3 phases of syphilis called the primary, secondary, and latent phase, which show different signs and symptoms..... Syphilis: Primary Phase Syphilis: Secondary Phase Syphilis: Latent Phase A chancre sore, a painless ulcer with raised edges, appears at the site where the bacteria entered through the skin.
Signs and symptoms:
These chancre sores arises approximately 3 weeks to 3 months after the infection, and it persist for approximately 3 to 6 weeks.
During this phase placental transmission is about 95% to the fetus. In about 6 weeks to 6 months the secondary symptoms will start to appear.
Signs and symptoms:
Condylomata lata, which are highly infectious wart-like plaques that appear on the vulva.
Liver and spleen enlargement
Non-tender lymph node enlargement
Patchy hair loss
Chronic sore throat with hoarseness
Brown rash that can be all over the body, but is usually on the palms of the hands and soles of the feet
*During this phase placental transmission is about 95% to the fetus. The latent phase begins when the secondary symptoms disappear.
The bacteria damages the heart, eyes, brain, nervous system, bones, joints, or almost every other part of the body.
This stage can last for years and even decades.
Signs and symptoms:
Difficulty coordinating muscle movements
This phase can result in mental illness, blindness, other neurologic problems, heart disease, and death.
During this phase placental transmission is about 10% to the fetus. Syphilis: Signs and Symptoms for the Baby Some infants with congenital syphilis may have symptoms at birth, but most develop symptoms between 2 weeks and 3 months later.
These symptoms may include:
Weakened or hoarse crying sounds
Swollen liver and spleen
Various deformities Syphilis: Diagnosis “Great Imitator,” because it’s s/s in the primary stage are very similar to those of other infections
Syphilis can be diagnosed through:
recognition of the signs and symptoms
simple blood test
examination under a microscope.
Shortly infection with syphilis, the body starts to form antibodies that can be detected by an accurate, safe, and inexpensive blood test.
There is a chance that the test may give false-negative results, not show signs of an infection despite its presence, for up to 3 months after infection.
There also a chance the test can show a false-positive result, showing signs of an infection when it is not present.
***Therefore, two blood tests are usually used. During pregnancy, the only antibiotic that is safe to treat syphilis successfully is penicillin by injection
With neurosyphilis (infection of the brain or spinal cord), the individual will need to obtain a spinal tap
If the patient is allergic to penicillin, then they will have to be desensitized (receive small by increasing doses) to the drug so that they can receive it.
**With penicillin, syphilis will be cured, but it will not reverse the damage already done.
Individuals being treated for syphilis must abstain from sexual contact with new partners until the syphilis sores are completely healed
Partners should be notified, tested, and treated if necessary. Syphilis: Treatment cont. During pregnancy, treatment of syphilis can cause temporary reactions that include:
muscle and joint aches (which typically appear several hours after treatment and go away in 24 to 36 hours)
After treatment, routine blood tests will ensure the infection has cleared and there is no reinfection.
There will be an ultrasound to verify fetal health Serious but curable bacterial infection of Neisseria Gonorrhoeae
Considered an STI, but can be transmitted by contact without sex as well.
Effects both males and females
Most often affects the urethra, rectum, throat and cervix
Can also affect the eyes, skin and joints
***Babies will get the infection in their eyes if the mother is infected
The incubation period is 2-10 days
Highly infectious with 820,000 cases annually (13,200 are pregnant women) Gonorrhea: Common Signs and Symptoms Gonorrhea: Diagnosis Simple gram stain is easiest for cervical, urethral and join infections
A culture is an absolute 100% diagnosis for all infection types
Ligase Chain Reaction (LCR) DNA test is a useful screening method
***40% of women who are diagnosed with Gonorrhea also have Chlamydia, so they should get tested for both Gonorrhea: Treatment Adults: Antibiotics
CDC recommends one IM dose of Ceftriaxone in combination with either one 1g dose PO Azithromycin for one week OR BID 100mg dose PO of Doxycycline for a week.
If mother is positive, the baby will be treated prophylatically with an antibiotic eye ointment (usually erythromycin)
The US Preventative Service Task Force strongly suggests that all babies get eye ointment prophylactically.
If the baby develops Gonorrhea, it will be treated with antibiotics Gonorrhea: Effects on Pregnancy Increased risk of:
infected amniotic fluid
Treatment in pregnancy:
partner must be treated as well and abstain from sex until regimen is complete Genital Tract:
pus discharge from penis
pain/swelling of testicles
increased vaginal discharge
vaginal bleeding between periods and after intercourse
abdominal pain and pelvic pain
Rectum: itching, pus discharge and right red bleeding
Eyes: pain, sensitivity to light and pus discharge
Throat: pain and swollen lymph nodes
Joints: extreme pain, warm, red and swollen (arthritic) HPV: Pathology and A&P HPV targets the squamous epithelium found beneath the foreskin of the penis (illustrated), the scrotum, vulva, vagina, cervix, anus or bladder.
HPV is passed on through genital contact
HPV can be passed on between straight and same-sex partners—even when the infected person has no signs or symptoms.
A person can still have HPV, even if years after sexual contact with an infected person.
It is also possible to get more than one type of HPV.
***In rare circumstances, a pregnant woman with genital HPV can pass the HPV on to her baby during delivery.
HPV is so common that nearly all sexually-active men and women get it at some point in their lives.
This is true even for people who only have sex with one person in their lifetime. HPV: Treatment There is no treatment for the virus itself, but there are treatments for the health problems that HPV can cause:
Genital warts can resolve on their own but may be removed for cosmetic reasons
A special acid solution that can be used, the warts freeze off with a liquid nitrogen solution, or they can be removed by laser, by electrocautery, or surgically.
***NEVER TREAT GENITAL WARTS WITH DRUGSTORE MEDICATIONS MEANT FOR COMMON WARTS!!
Cervical cancer (and other HPV-related cancers) is most treatable when it is diagnosed and treated early. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. HPV: Diagnosis HPV tests are available to help screen women aged 30 years and older for cervical cancer (concerning Pap smear)
There is not an approved HPV test to find HPV in the mouth or throat
The Pap test (or Pap smear) helps find cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
*Women should start getting the Pap test at age 21 years, and then every three years after that.
Negative HPV and Pap test mean a very low risk of cervical cancer and patients can wait 5 years to get re-tested HPV: Signs and Symptoms
Genital warts usually appear as a small bump or group of bumps in the genital area
small or large
raised or flat, or shaped like a cauliflower.
Warts can appear within weeks or months after sexual contact(even if the infected partner has no s/s)
Left untreated, genital warts might go away, remain unchanged, or increase in size or number.
*The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.
Cervical cancer usually does not cause symptoms until it is quite advanced. *For this reason, it is important for women to get regular screening
Recurrent respiratory papillomatosis (RRP)
Warts grow in the throat--can occur in children and adults
These growths can sometimes block the airway, causing a hoarse voice or trouble breathing. HPV: Implications for Pregnancy HPV is unlikely to affect your pregnancy or your baby’s health.
HPV vaccines are not recommended; however, pregnancy testing is not needed before vaccination; if a woman is found to be pregnant after vaccination is started, no intervention is needed, but the remainder of the 3-dose series should be delayed until completion of pregnancy
If you have genital warts, they may grow faster during pregnancy, possibly from extra vaginal discharge that provides the virus with a moist growing environment, hormonal changes, or changes in your immune system. In most cases, the warts won’t pose any problems for you or your baby. HPV: Implications for Pregnancy It IS possible for you to pass the virus to your baby, but this is RARE and he/she is likely to overcome it on their own without any symptoms or problems.
If child does get the type of HPV that causes genital warts, he may develop warts on his vocal cords and other areas sometime in infancy or childhood. This is RRP and it is very serious.
There are two prescription products that women/men can apply themselves to treat genital warts, but are generally not recommended during pregnancy. HPV: The Vaccine HPV vaccines are recommended for 11- or 12-year-old boys and girls.
safe and effective, and protect males and females against the most common types of HPV that lead to disease and cancer.
three shots over six months; it is important to get all three doses to get the best protection
Girls and women:
Gardasil: also protects against most genital warts, and has been shown to protect against anal, vaginal, and vulvar cancers.
Either vaccine is recommended for 11- and 12-year-old girls, and can also be given to girls beginning at 9 years of age.
Boys and men:
(Gardasil) is available to protect males against most genital warts and anal cancers. Gardasil is recommended for 11 and 12 year-old boys: Gay, bisexual, and other men who have sex with men should receive the vaccine through age 26 years
A person can lower their risk of
Genital warts by using condoms all the time and the right way.
Cervical cancer by getting routine screening if they are a woman aged 21–65 years (and following up on any abnormal results);
Oropharyngeal cancers by avoiding tobacco and limiting alcohol intake; and PID: Diagnosis PID is difficult to diagnose because symptoms are often mild and go undetected.
There are no specific tests to diagnose it.
If sexually active and experiencing lower abdominal pain, a culture of the cervix is likely to be done to test for chlamydia or gonorrhea.
An ultrasound or surgery may be necessary for diagnosis in some cases. PID: Common Signs and Symptoms Often only mild pain/discomfort or no symptoms at all.
Lower abdominal pain or pelvic pain
Unusual vaginal bleeding
Nausea and vomiting
Fever PID: Anatomy Can affect any of the female internal reproductive organs
Scar tissue can block the fallopian tubes or partially block them, which can lead to infertility or ectopic pregnancies. This can cause rupture of the fallopian tubes.
Scarring can affect ovaries. PID: Treatment Treated with antibiotics, usually broad-spectrum antibiotics.
A culture and sensitivity can be done as well, BUT it is best to get started on antibiotics immediately
You and your partner should be treated so you don’t become re-infected.
Rest and analgesics are often also indicated.
Refrain from any kind of sex until the course of treatment has been completed. Gonorrhea and Pelvic Inflammatory Disease In women, gonorrhea can spread into the uterus (womb) or fallopian tubes (egg canals) and cause pelvic inflammatory disease (PID). The symptoms may be mild or can be very severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled pockets that are hard to cure) and chronic (long-lasting) pelvic pain. PID can damage the fallopian tubes enough that a woman will be unable to have children. It also can increase her risk of ectopic pregnancy. Prevention Abstain!!!
The most effective way to avoid STIs is to abstain from sex
Long-term mutually monogamous relationship with a partner who isn't infected.
Getting vaccinated early, before sexual exposure, is also effective in preventing certain types of STIs
Wait and verify.
Avoid vaginal and anal intercourse with new partners until you have both been tested for STIs. Oral sex is still risky, so use a latex condom or dental dam
Use a new latex condom or dental dam for each sex act, whether oral, vaginal or anal.
Keep in mind that while condoms reduce your risk of exposure to most STIs, they provide a lesser degree of protection for STIs involving exposed genital sores, such as human papillomavirus (HPV) or herpes. Also, non-barrier forms of contraception, such as oral contraceptives or IUDs don't protect against STIs.