Sexually Transmitted           Infections   By: Maria Carmela L. Domocmat, RN, MSN                            Nurse Instru...
1.   Diseases Characterized by       3.   Diseases Characterized by     Ulcerations                          Vaginal Disch...
Chlamydial infectionsGonorrhea      Maria Carmela L. Domocmat, RN, MSN
CHLAMYDIAL INFECTIONS
Chlamydia one of the most common STDs Known as the silent STD Known as the “great sterilizer” Most important cause of PID ...
bacterial infection caused by pathogenChlamydia trachomatis Non-motile gram negative bacteriaIncubation Period of Chlamydi...
mainly passed through sexual activity:   Intimate sexual contact   vaginal or anal sex with an infected partner   oral sex...
NOT from simple kissing, sharing baths, towels, cups, or from toilet seats.Mode of transmission (MOT)                    M...
people can infect other when they have symptoms & some times when they do not, the partner is infected in approximately 33...
70% of women and 50% of men who have chlamydia – asymptomatic – that’s why usually goes untreated.Signs and Symptoms of Ch...
Chlamydia Symptoms in Women:  Yellow, mucopurulent vaginal discharge  Urethritis with dysuria (pain or a burning on  urina...
Chlamydial cervicitis               Maria Carmela L. Domocmat, RN, MSN
Chlamydia Symptoms in Men:  Clear to mucopurulent (white/cloudy, watery)  discharge from penis  Urethritis with dysuria  t...
Chlamydia - Symptoms             Maria Carmela L. Domocmat, RN, MSN
Both gender  Proctitis (inflammation of the rectum)  PharyngitisSigns and Symptoms of Chlamydia                       Mari...
culture swab of the cervical mucus Tissue culture from urethra, endocervix, rectum Rapid nonculture detection test on urog...
culture swab or swab test of the cervical mucus    can be done in conjunction with a Pap test.   about 90% accurate. Tissu...
a swab test collecting fluid from the penis or vagina.   Swab test is obtained by briefly placing a swab  in the opening o...
Direct fluorescent antibody (DFA)microscopy ELISA Nucleic acid amplification test Monoclonal antigen-antibody tests Should...
Recommended Regimens  Zithromax® (azithromycin) 1 g orally in a  single dose OR  Doxycycline (Vibramyicin) 100 mg 2-3 time...
Alternative Regimens  Erythromycin base 500 mg orally four times a day for 7  days OR  Erythromycin ethylsuccinate 800 mg ...
Examine and treat - all sexual partners withinthe last 60 daysTreating gonorrhea is advocated for patientsbeing treated fo...
Recommended Regimens  Azithromycin 1 g orally in a single dose  Amoxicillin 500 mg orally three times a day for 7 days Alt...
In women, chlamydia can cause pelvic inflammatory disease (PID), which can lead to:   Salpingitis, subsequent scarring and...
In men, chlamydia can lead to:  inflammation of testicles  infected prostate  urethral stricture, may extend to epididymis...
If Untreated:  both sexes    sterility  fetus/newborns   Pneumonia   Conjunctivitis   Ear infection   DeathComplications  ...
A chlamydial etiology should be considered for all infants aged ≤30 days who have conjunctivitis, especially if the mother...
tissue culture and nonculture tests (e.g., direct fluorescence antibody [DFA] tests, EIA, and NAAT)   Sensitive and specif...
Neonatal chlamydial conjunctivitis,showing a blood-stained discharge fromthe infants closed, swollen eyes.                ...
Recommended Regimen  Erythromycin base or ethylsuccinate 50  mg/kg/day orally divided into 4 doses daily for  14 daysTreat...
Characteristic signs of chlamydial pneumonia in infants include 1) a repetitive staccato cough with tachypnea   a type of ...
In addition, peripheral eosinophilia (≥400 cells/mm3) occurs frequently. Wheezing is rare,  and infants are typically afeb...
Specimens for chlamydial testing should be collected from the nasopharynx. Tissue culture  definitive standard for chlamyd...
Recommended Regimen Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 daysInfant P...
Once chlamydia has been successfullytreated, it wont come back unless a newinfection is picked up.                   Maria...
Maria Carmela L. Domocmat, RN, MSN
GONOCOCCAL INFECTIONS
is a highly contagious sexually transmitted STD bacterial infection sometimes referred to as the clap.   The nickname of t...
AKA:  Clap  White  Drips  Strain  DoseGonorrhea            Maria Carmela L. Domocmat, RN, MSN
spreads through semen or vaginal fluids duringunprotected sexual contact, heterosexual orhomosexual, with an infected part...
You can NOT catch it from simple kissing,sharing baths, towels, cups, or from toiletseats.                    Maria Carmel...
Neisseria gonorrhoeae  a bacterium that can grow and multiply easily in  the warm, moist areas of the reproductive tract, ...
contact with the penis, vagina, mouth, oranus.Ejaculation does not have to occur forgonorrhea to be transmitted or acquire...
Some – asymptomatic Dysuria and urinary frequency white, yellow, or green discharge from the penis painful or swollen test...
Symptoms often mild most women asymptomatic Even when a woman has symptoms, they can be so non-specific as to be mistaken ...
may also infect the rectum, throat, eyes,blood, skin, & joints.ConjunctivitisPharyngitis                    Maria Carmela ...
Endocervical gonorrhea              Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Hx PE Identify gonococcus on smear or culture of exudate from infected areas Gram stain of a sample from a urethra Culture...
ciprofloxacine (Cipro® XR), IM, 500 mg a single dose ceftriaxone (Rocephin) a single dose, IM ofloxacin (floxin) cefixime ...
Antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are in...
Emphasize – COMPLETE the course of antibiotic Although medication will stop the infection, it will not repair any permanen...
Quinolone antibiotic  Should not be used in MSM or in quinolone- resistant geographic area  Or infections acquired abroad ...
Warn pregnant client – danger of infectinginfant during delivery                    Maria Carmela L. Domocmat, RN, MSN
In women, it can cause:   Salpingitis – can progress to PID   life-threatening complications such as ectopic  pregnancy (o...
In men, it can lead to:  epididymitis  prostatitis  painful inflammation of the testicles, which  may result in reduced fe...
Sexually transmitted infections Part III
Sexually transmitted infections Part III
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Sexually transmitted infections Part III

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Sexually transmitted infections characterized by vaginal discharge: includes chlamydia, gonorrhea

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Sexually transmitted infections Part III

  1. 1. Sexually Transmitted Infections By: Maria Carmela L. Domocmat, RN, MSN Nurse Instructor Northern Luzon Adventist College
  2. 2. 1. Diseases Characterized by 3. Diseases Characterized by Ulcerations Vaginal Discharge Chancroid Bacterial Vaginosis Trichomoniasis Genital HSV Infections Vulvovaginal Candidiasis Granuloma Inguinale (Donovanosis) 4. Human Papillomavirus (HPV) Infection Lymphogranuloma Venereum Genital Warts Syphilis 5. Ectoparasitic Infections2. Diseases Characterized by Scabies Urethritis or Cervicitis Pediculosis Pubis Chlamydial Infections 6. Hepatitis A, B, C Gonococcal Infections 7. Sexually transmitted enteric infections Proctitis, Proctocolitis, and EnteritisOverview Maria Carmela L. Domocmat, RN, MSN
  3. 3. Chlamydial infectionsGonorrhea Maria Carmela L. Domocmat, RN, MSN
  4. 4. CHLAMYDIAL INFECTIONS
  5. 5. Chlamydia one of the most common STDs Known as the silent STD Known as the “great sterilizer” Most important cause of PID and tubal infertility (ectopic pregnancy) Maria Carmela L. Domocmat, RN, MSN
  6. 6. bacterial infection caused by pathogenChlamydia trachomatis Non-motile gram negative bacteriaIncubation Period of Chlamydia 7-21 days Maria Carmela L. Domocmat, RN, MSN
  7. 7. mainly passed through sexual activity: Intimate sexual contact vaginal or anal sex with an infected partner oral sex (less common) sharing sex toys touching parts of the body with fingers (for example, chlamydia often occurs in the eyes) do not cross placenta but vaginal delivery from infected mother can cause conjunctivitis and pneumonia in newbornMode of transmission (MOT) Maria Carmela L. Domocmat, RN, MSN
  8. 8. NOT from simple kissing, sharing baths, towels, cups, or from toilet seats.Mode of transmission (MOT) Maria Carmela L. Domocmat, RN, MSN
  9. 9. people can infect other when they have symptoms & some times when they do not, the partner is infected in approximately 33% of the sexual contacts with an infected partnerInfectivity Maria Carmela L. Domocmat, RN, MSN
  10. 10. 70% of women and 50% of men who have chlamydia – asymptomatic – that’s why usually goes untreated.Signs and Symptoms of Chlamydia Maria Carmela L. Domocmat, RN, MSN
  11. 11. Chlamydia Symptoms in Women: Yellow, mucopurulent vaginal discharge Urethritis with dysuria (pain or a burning on urination) Menorrhagia (bleeding between periods) Dyspareunia (pain during sex) or bleeding after sex low abdominal pain sometimes with nauseaSigns and Symptoms of Chlamydia Maria Carmela L. Domocmat, RN, MSN
  12. 12. Chlamydial cervicitis Maria Carmela L. Domocmat, RN, MSN
  13. 13. Chlamydia Symptoms in Men: Clear to mucopurulent (white/cloudy, watery) discharge from penis Urethritis with dysuria testicular pain and/or swelling Swollen and tender testiclesSigns and Symptoms of Chlamydia Maria Carmela L. Domocmat, RN, MSN
  14. 14. Chlamydia - Symptoms Maria Carmela L. Domocmat, RN, MSN
  15. 15. Both gender Proctitis (inflammation of the rectum) PharyngitisSigns and Symptoms of Chlamydia Maria Carmela L. Domocmat, RN, MSN
  16. 16. culture swab of the cervical mucus Tissue culture from urethra, endocervix, rectum Rapid nonculture detection test on urogenital secretionsDx tests Maria Carmela L. Domocmat, RN, MSN
  17. 17. culture swab or swab test of the cervical mucus can be done in conjunction with a Pap test. about 90% accurate. Tissue culture from urethra, endocervix, rectum expensive, technically difficult Rapid nonculture detection test on urogenital secretions More convenient Less expensive QuickerDx tests Maria Carmela L. Domocmat, RN, MSN
  18. 18. a swab test collecting fluid from the penis or vagina. Swab test is obtained by briefly placing a swab in the opening of the urethra at the tip of the penis; this causes brief discomfort and a burning sensation NAATS To detect C. trachomatis antigen Most sensitive test in endocervical and urethral specimens men - simple urine testDx tests Maria Carmela L. Domocmat, RN, MSN
  19. 19. Direct fluorescent antibody (DFA)microscopy ELISA Nucleic acid amplification test Monoclonal antigen-antibody tests Should also be tested for gonorrheaDx tests Maria Carmela L. Domocmat, RN, MSN
  20. 20. Recommended Regimens Zithromax® (azithromycin) 1 g orally in a single dose OR Doxycycline (Vibramyicin) 100 mg 2-3 times a day for 7 daysTreatment of Chlamydia Maria Carmela L. Domocmat, RN, MSN
  21. 21. Alternative Regimens Erythromycin base 500 mg orally four times a day for 7 days OR Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days OR Levofloxacin 500 mg orally once daily for 7 days OR Ofloxacin 300 mg orally twice a day for 7 daysTreatment Maria Carmela L. Domocmat, RN, MSN
  22. 22. Examine and treat - all sexual partners withinthe last 60 daysTreating gonorrhea is advocated for patientsbeing treated for chlamydia, and vice versa (50%have both infections together)Instruct about the greater risk of infection withmultiple sexual partnersAvoid all sexual activity until both partners arecuredShould use condom thereafterMgmt Maria Carmela L. Domocmat, RN, MSN
  23. 23. Recommended Regimens Azithromycin 1 g orally in a single dose Amoxicillin 500 mg orally three times a day for 7 days Alternative Regimens Erythromycin base 500 mg orally four times a day for 7 days Erythromycin base 250 mg orally four times a day for 14 days Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days Erythromycin ethylsuccinate 400 mg orally four times a day for 14 daysTreatment during Pregnancy Maria Carmela L. Domocmat, RN, MSN
  24. 24. In women, chlamydia can cause pelvic inflammatory disease (PID), which can lead to: Salpingitis, subsequent scarring and occlusion (blocked) fallopian tubes which can result in reduced fertility or ectopic pregnancy infertility long-term pelvic pain early miscarriage or premature birthComplications Maria Carmela L. Domocmat, RN, MSN
  25. 25. In men, chlamydia can lead to: inflammation of testicles infected prostate urethral stricture, may extend to epididymis which may result in reduced fertility or sterility Reiters syndrome (polyarthritis -inflammation of the joints) Urethritis ConjunctivitisComplications Maria Carmela L. Domocmat, RN, MSN
  26. 26. If Untreated: both sexes sterility fetus/newborns Pneumonia Conjunctivitis Ear infection DeathComplications Maria Carmela L. Domocmat, RN, MSN
  27. 27. A chlamydial etiology should be considered for all infants aged ≤30 days who have conjunctivitis, especially if the mother has a history of untreated chlamydia infection.Ophthalmia Neonatorum Causedby C. trachomatis Maria Carmela L. Domocmat, RN, MSN
  28. 28. tissue culture and nonculture tests (e.g., direct fluorescence antibody [DFA] tests, EIA, and NAAT) Sensitive and specific methods Specimens for culture isolation and nonculture tests should be obtained from the everted eyelid using a dacron-tipped swab or the swab specified by the manufacturer’s test kit, and they must contain conjunctival cells, not exudate alone. Specific diagnosis of C. trachomatis infection confirms the need for treatment not only for the neonate, but also for the mother and her sex partner(s). Ocular specimens from infants being evaluated for chlamydial conjunctivitis also should be tested for N. gonorrhoeae.Dx tests: Ophthalmia Neonatorum Maria Carmela L. Domocmat, RN, MSN
  29. 29. Neonatal chlamydial conjunctivitis,showing a blood-stained discharge fromthe infants closed, swollen eyes. Maria Carmela L. Domocmat, RN, MSN
  30. 30. Recommended Regimen Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 daysTreatment: OphthalmiaNeonatorum Maria Carmela L. Domocmat, RN, MSN
  31. 31. Characteristic signs of chlamydial pneumonia in infants include 1) a repetitive staccato cough with tachypnea a type of cough that erupts in short, sudden bursts. 2) hyperinflation and bilateral diffuse infiltrates on a chest radiograph.s/s:Infant Pneumonia Caused by C.trachomatis Maria Carmela L. Domocmat, RN, MSN
  32. 32. In addition, peripheral eosinophilia (≥400 cells/mm3) occurs frequently. Wheezing is rare, and infants are typically afebrile. Because clinical presentations differ, initial treatment and diagnostic tests should include C. trachomatis for all infants aged 1–3 months who are suspected of having pneumonia (especially those whose mothers have untreated chlamydial infection).s/s:Infant Pneumonia Caused by C.trachomatis Maria Carmela L. Domocmat, RN, MSN
  33. 33. Specimens for chlamydial testing should be collected from the nasopharynx. Tissue culture definitive standard for chlamydial pneumonia. Nonculture tests (e.g., EIA, DFA, and NAAT) lower sensitivity and specificityDx tests: Infant PneumoniaCaused by C. trachomatis Maria Carmela L. Domocmat, RN, MSN
  34. 34. Recommended Regimen Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 daysInfant Pneumonia Caused by C.trachomatis Maria Carmela L. Domocmat, RN, MSN
  35. 35. Once chlamydia has been successfullytreated, it wont come back unless a newinfection is picked up. Maria Carmela L. Domocmat, RN, MSN
  36. 36. Maria Carmela L. Domocmat, RN, MSN
  37. 37. GONOCOCCAL INFECTIONS
  38. 38. is a highly contagious sexually transmitted STD bacterial infection sometimes referred to as the clap. The nickname of the clap refers to a treatment that used to clear the blockage in the urethra from gonorrhea pus, where the penis would be clapped on both sides simultaneously. This gonorrhea treatment is rarely used today, however the nomenclature remains.Gonorrhea Maria Carmela L. Domocmat, RN, MSN
  39. 39. AKA: Clap White Drips Strain DoseGonorrhea Maria Carmela L. Domocmat, RN, MSN
  40. 40. spreads through semen or vaginal fluids duringunprotected sexual contact, heterosexual orhomosexual, with an infected partner: vaginal or anal sex with an infected partner oral sex (less common) sharing sex toys touching parts of the body with fingers (for example, touching the private parts and then the eyes) any very close physical contact the bacteria can be passed from hand to hand (very rare isolated cases) Infants from a mother to her infant – vaginal birth Infection of medical personnel through broken skinMOT Maria Carmela L. Domocmat, RN, MSN
  41. 41. You can NOT catch it from simple kissing,sharing baths, towels, cups, or from toiletseats. Maria Carmela L. Domocmat, RN, MSN
  42. 42. Neisseria gonorrhoeae a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. can also grow in the mouth, throat, eyes, and anus. Incubation Period 1-14 daysCause Maria Carmela L. Domocmat, RN, MSN
  43. 43. contact with the penis, vagina, mouth, oranus.Ejaculation does not have to occur forgonorrhea to be transmitted or acquired.Gonorrhea can also be spread from mother tobaby during delivery.People who have had gonorrhea and receivedtreatment may get infected again if theyhave sexual contact with a person infectedwith gonorrhea.MOT Maria Carmela L. Domocmat, RN, MSN
  44. 44. Some – asymptomatic Dysuria and urinary frequency white, yellow, or green discharge from the penis painful or swollen testiclesS/S: Men Maria Carmela L. Domocmat, RN, MSN
  45. 45. Symptoms often mild most women asymptomatic Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. Dysuria and urinary frequency Heavy, yellow-green vaginal discharge Metrorrhagia Cervical erythema Red, swollen, sore vulvaS/S: women Maria Carmela L. Domocmat, RN, MSN
  46. 46. may also infect the rectum, throat, eyes,blood, skin, & joints.ConjunctivitisPharyngitis Maria Carmela L. Domocmat, RN, MSN
  47. 47. Endocervical gonorrhea Maria Carmela L. Domocmat, RN, MSN
  48. 48. Maria Carmela L. Domocmat, RN, MSN
  49. 49. Hx PE Identify gonococcus on smear or culture of exudate from infected areas Gram stain of a sample from a urethra Culture from nongenital specimensDx tests Maria Carmela L. Domocmat, RN, MSN
  50. 50. ciprofloxacine (Cipro® XR), IM, 500 mg a single dose ceftriaxone (Rocephin) a single dose, IM ofloxacin (floxin) cefixime (Suprax) Levaquin® 500 mg a single dose Tequin® 400 mg a single doseTreatment Maria Carmela L. Domocmat, RN, MSN
  51. 51. Antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. CDC now recommends dual therapy (i.e. using two drugs) for the treatment of gonorrhea. Persons with gonorrhea should be tested for other STDs.Treatment Maria Carmela L. Domocmat, RN, MSN
  52. 52. Emphasize – COMPLETE the course of antibiotic Although medication will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea. If a person’s symptoms continue even after receiving treatment, he or she should return to a doctor to be reevaluated.Treatment Maria Carmela L. Domocmat, RN, MSN
  53. 53. Quinolone antibiotic Should not be used in MSM or in quinolone- resistant geographic area Or infections acquired abroad Maria Carmela L. Domocmat, RN, MSN
  54. 54. Warn pregnant client – danger of infectinginfant during delivery Maria Carmela L. Domocmat, RN, MSN
  55. 55. In women, it can cause: Salpingitis – can progress to PID life-threatening complications such as ectopic pregnancy (outside the womb) blocked fallopian tubes (the tubes which carry the egg from the ovaries to the womb), which can result in reduced fertility or infertility long-term pelvic painComplications Maria Carmela L. Domocmat, RN, MSN
  56. 56. In men, it can lead to: epididymitis prostatitis painful inflammation of the testicles, which may result in reduced fertility or sterilityComplications Maria Carmela L. Domocmat, RN, MSN
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