Sexually Transmitted           Infections       By: Maria Carmela L. Domocmat, RN, MSN                                Nurs...
1.   Diseases Characterized by                  3.   Diseases Characterized by Vaginal     Ulcerations                    ...
Bacterial VaginosisTrichomoniasisVulvovaginal Candidiasis      Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSNBACTERIAL VAGINOSIS
results from overgrowth of one of several organisms that are normally present in the vagina, upsetting the natural balance...
Due to change in normal flora          Organisms and pH which results to                 ◦ Gardnerella Vaginalis and vagin...
can spread during sexual intercoursebut also occurs in people who arent sexually activehigher risk of bacterial vaginosis ...
Mild or asymptomatic –vulvovaginitis Mild to moderate malodorous vaginal duscharge    grayish-white, foul-smelling dischar...
diagnosis of BV requires the presence of at least 3 of the following 4 criteria   A homogenous noninflammatory discharge (...
KOH      Maria Carmela L. Domocmat, RN, MSN
Pap smear showing clue cells consistent with bacterialvaginosis.vaginosis. Courtesy of Abner P. Korn, MD. © Copyright 1996...
Maria Carmela L. Domocmat, RN, MSN
Metronidazole 500 mg PO twice a day for 7 days*; OR Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, onc...
Maria Carmela L. Domocmat, RN, MSN
Metronidazole 500 mg orally twice a day for 7 days OR Metronidazole 250 mg orally three times a day for 7 days OR Clindamy...
Bacterial vaginosis is usually not serious.   But recurrence is common In some cases, however, it can cause infections in ...
Maria Carmela L. Domocmat, RN, MSNTRICHOMONIASIS
Trichomoniasis is one of the most common, curable causes of vaginal infections in women AKA: "trich“ common  approximately...
caused by a protozoan parasite called Trichomonas vaginalis and  cause of vaginal infections in women and urethral infecti...
Transmission can occur even if a person isasymptomaticWomen contract trichomoniasis from infected male orfemale partners w...
Using condoms and/or dental dams provide someprotection. Their use is strongly encouraged, but is not 100% safe.Trichomoni...
•   Trichomoniasis Incubation Period    o   If symptoms appear, it usually takes from 3 to 28 days for        them to deve...
o   Many people with trichomoniasis are asymptomatic. o   If there are symptoms, the most common     Trichomoniasis sympto...
Maria Carmela L. Domocmat, RN, MSN
Frequent urination Dysuria Dyspareunia Abdominal pain woman might also find that the above symptoms worsen after menstruat...
Men are usually asymptomatic, but if a man has symptoms, they can include:   Unusual penile discharge   Painful urination ...
The symptoms of trichomoniasis in infected men maydisappear within a few weeks without treatment.                       Ma...
Microscopic exam  Fresh, warm specimen of vaginal exudate in saline wet mount  shows highly motile organism  Note: DO NOT ...
Metronidazole (Flagyl) or Tinidazole (tindamaz single oral dose 500mg 2-3 times a day for 7-10 days.  It is especially imp...
Metronidazole 2 g orally in a single dose OR Tinidazole 2 g orally in a single dose Metronidazole   contraindicated 1st tr...
Metronidazole 500 mg orally twice a day for 7 days* * Patients should be advised to avoid consuming alcohol during treatme...
Treatment should continue through menstrual period  Because vagina is more alkaline at this time –flare up is more likely ...
an infected man, even a man who has never had symptomsor whose symptoms have stopped, can continue to infector re-infect a...
Sex should be stopped until the person withtrichomoniasis and all of his or her recent partnerscomplete treatment for tric...
one of the most common and most curable STDs. The symptoms are more annoying than they are threatening to health. genital ...
ComplicationsIf Untreated: increases a womans susceptibility to HIVinfection if she is exposed to the virus.  Pregnant wom...
Maria Carmela L. Domocmat, RN, MSNVULVOVAGINALCANDIDIASIS
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
Maria Carmela L. Domocmat, RN, MSN
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Sexually transmitted infections. Part IV

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Diseases Characterized by Vaginal Discharge
includes trichomoniasis, bacterial vaginosis

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Sexually transmitted infections. Part IV

  1. 1. Sexually Transmitted Infections By: Maria Carmela L. Domocmat, RN, MSN Nurse Instructor Northern Luzon Adventist College Maria Carmela L. Domocmat, RN, MSN
  2. 2. 1. Diseases Characterized by 3. Diseases Characterized by Vaginal Ulcerations Discharge Chancroid Bacterial Vaginosis Genital HSV Infections Trichomoniasis Granuloma Inguinale (Donovanosis) Vulvovaginal Candidiasis Lymphogranuloma Venereum 4. Human Papillomavirus (HPV) Syphilis Infection2. Diseases Characterized by Urethritis Genital Warts or Cervicitis 5. Ectoparasitic Infections Chlamydial Infections Scabies Gonococcal Infections Pediculosis Pubis 6. Hepatitis A, B, C 7. Sexually transmitted enteric infections Proctitis, Proctocolitis, and EnteritisOverview Maria Carmela L. Domocmat, RN, MSN
  3. 3. Bacterial VaginosisTrichomoniasisVulvovaginal Candidiasis Maria Carmela L. Domocmat, RN, MSN
  4. 4. Maria Carmela L. Domocmat, RN, MSNBACTERIAL VAGINOSIS
  5. 5. results from overgrowth of one of several organisms that are normally present in the vagina, upsetting the natural balance of vaginal bacteria. More than one in six women in the United States has bacterial vaginosis, though many arent aware of having it.Bacterial vaginosis Maria Carmela L. Domocmat, RN, MSN
  6. 6. Due to change in normal flora Organisms and pH which results to ◦ Gardnerella Vaginalis and vaginal overgrowth of diff organisms anaerobes Usually, "good" bacteria outnumber "bad" bacteria in incubation period vagina. ◦ 12 hours to five days But if bad bacteria become too numerous, they upset the balance and bacterial vaginosis results.Bacterial vaginosis Maria Carmela L. Domocmat, RN, MSN
  7. 7. can spread during sexual intercoursebut also occurs in people who arent sexually activehigher risk of bacterial vaginosis Women with new or multiple sex partners women who douche use an intrauterine device (IUD) for birth controlMOT Maria Carmela L. Domocmat, RN, MSN
  8. 8. Mild or asymptomatic –vulvovaginitis Mild to moderate malodorous vaginal duscharge grayish-white, foul-smelling discharge Tend to adhere in vaginal wall “fishy odor” - may be more noticeable after sexual intercourse. Mild vaginal burning and irritation Not common –redness and pruritusSymptoms of bacterial vaginosis Maria Carmela L. Domocmat, RN, MSN
  9. 9. diagnosis of BV requires the presence of at least 3 of the following 4 criteria A homogenous noninflammatory discharge (not many WBCs) Vaginal pH >4.5 (normal: 4 to 4.5) Microscopic exam of discharge : (+) clue cells on either saline wet mount or gram stain of vaginal fluid Clue cells – are desquamated vaginal epithelial cells stippled by adherence of coccobacilli to their surface (+) Whiff test fishy or musty odor when alkaline KOH solution added to smear (vaginal fluid)Diagnosis http://www.medscape.com/viewarticle/719240_3 Maria Carmela L. Domocmat, RN, MSN
  10. 10. KOH Maria Carmela L. Domocmat, RN, MSN
  11. 11. Pap smear showing clue cells consistent with bacterialvaginosis.vaginosis. Courtesy of Abner P. Korn, MD. © Copyright 1996, Korn,SCP Communications, Inc. Maria Carmela L. Domocmat, RN, MSN
  12. 12. Maria Carmela L. Domocmat, RN, MSN
  13. 13. Metronidazole 500 mg PO twice a day for 7 days*; OR Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days OR Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days† * Consuming alcohol should be avoided during treatment and for 24 hours thereafter. † Clindamycin cream is oil-based and might weaken latex condoms and diaphragms for 5 days after use (refer to clindamycin product labeling for additional information).Recommended Regimens Maria Carmela L. Domocmat, RN, MSN
  14. 14. Maria Carmela L. Domocmat, RN, MSN
  15. 15. Metronidazole 500 mg orally twice a day for 7 days OR Metronidazole 250 mg orally three times a day for 7 days OR Clindamycin 300 mg orally twice a day for 7 daysRecommended Regimens forPregnant Women Maria Carmela L. Domocmat, RN, MSN
  16. 16. Bacterial vaginosis is usually not serious. But recurrence is common In some cases, however, it can cause infections in the uterus and fallopian tubes. It is important to treat bacterial vaginosis, especially before having an IUD inserted, an abortion, or tests done on the uterine lining. Both trichomoniasis and bacterial vaginosis have been linked to an increased risk of transmission of human immunodeficiency virus (HIV) and other sexually transmitted diseases.Complications Maria Carmela L. Domocmat, RN, MSN
  17. 17. Maria Carmela L. Domocmat, RN, MSNTRICHOMONIASIS
  18. 18. Trichomoniasis is one of the most common, curable causes of vaginal infections in women AKA: "trich“ common approximately 5 million people in the US every year. affects both men and women.Trichomoniasis Maria Carmela L. Domocmat, RN, MSN
  19. 19. caused by a protozoan parasite called Trichomonas vaginalis and cause of vaginal infections in women and urethral infections in men. Not life-threatening but can be resistant to treatment Recurrence is commonTrichomoniasis Maria Carmela L. Domocmat, RN, MSN
  20. 20. Transmission can occur even if a person isasymptomaticWomen contract trichomoniasis from infected male orfemale partners while men usually contract it only fromfemale partners. vagina - most common site of infection in women urethra (urine canal) - most common site of infection in men.MOT Maria Carmela L. Domocmat, RN, MSN
  21. 21. Using condoms and/or dental dams provide someprotection. Their use is strongly encouraged, but is not 100% safe.Trichomoniasis can also survive on infected objects likesheets, towels, and underwear and could be transmittedby sharing them.MOT Maria Carmela L. Domocmat, RN, MSN
  22. 22. • Trichomoniasis Incubation Period o If symptoms appear, it usually takes from 3 to 28 days for them to develop. Maria Carmela L. Domocmat, RN, MSN
  23. 23. o Many people with trichomoniasis are asymptomatic. o If there are symptoms, the most common Trichomoniasis symptoms include: o Genital itching and/or burning o Excoriation, maceration of vulvar tissue o Vaginal or vulvar redness o Frothy yellow-green vaginal discharge with a strong odor o Blood spotting o Occasionally cervix is covered with punctuate (point-like) hemorrhages : “strawberry cervix”Trichomoniasis Symptoms inWomen Maria Carmela L. Domocmat, RN, MSN
  24. 24. Maria Carmela L. Domocmat, RN, MSN
  25. 25. Frequent urination Dysuria Dyspareunia Abdominal pain woman might also find that the above symptoms worsen after menstruation and that the symptoms may be confused with an yeast infection. This fact emphasizes the importance of always having an yeast infection diagnosed properly, because it might not be an yeast infection.Trichomoniasis Symptoms inWomen Maria Carmela L. Domocmat, RN, MSN
  26. 26. Men are usually asymptomatic, but if a man has symptoms, they can include: Unusual penile discharge Painful urination Burning sensation after ejaculation Tingling inside the penis.Trichomoniasis Symptoms in Men Maria Carmela L. Domocmat, RN, MSN
  27. 27. The symptoms of trichomoniasis in infected men maydisappear within a few weeks without treatment. Maria Carmela L. Domocmat, RN, MSN
  28. 28. Microscopic exam Fresh, warm specimen of vaginal exudate in saline wet mount shows highly motile organism Note: DO NOT use lubricant in vaginal speculum – to avoid destroying the organism If possible –instruct the client to douche before the examinationDx Maria Carmela L. Domocmat, RN, MSN
  29. 29. Metronidazole (Flagyl) or Tinidazole (tindamaz single oral dose 500mg 2-3 times a day for 7-10 days. It is especially important that both partners are treated at the same time because an infected man, even a man who has never had symptoms or whose symptoms have stopped, can continue to infect a female partner until he has been treated. Anyone being treated for trichomoniasis should avoid sex until they and their sex partners have completed the treatment.Treatment Maria Carmela L. Domocmat, RN, MSN
  30. 30. Metronidazole 2 g orally in a single dose OR Tinidazole 2 g orally in a single dose Metronidazole contraindicated 1st trimester of pregnancy Do not drink alcohol including cough syrup (effect: N/V, headache) Urine may turn dark, reddish brownRecommended Regimens Maria Carmela L. Domocmat, RN, MSN
  31. 31. Metronidazole 500 mg orally twice a day for 7 days* * Patients should be advised to avoid consuming alcohol during treatment with metronidazole or tinidazole. Abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.Alternative Regimen Maria Carmela L. Domocmat, RN, MSN
  32. 32. Treatment should continue through menstrual period Because vagina is more alkaline at this time –flare up is more likely to occur Maria Carmela L. Domocmat, RN, MSN
  33. 33. an infected man, even a man who has never had symptomsor whose symptoms have stopped, can continue to infector re-infect a female partner until he has been treated.Therefore, both partners should be treated at the sametime to eliminate the parasite.Persons being treated for trichomoniasis should avoid sexuntil they and their sex partners complete treatment andhave no symptoms.Having trichomoniasis once does not protect a personfrom getting it again. Following successful treatment,people can still be susceptible to re-infection. Maria Carmela L. Domocmat, RN, MSN
  34. 34. Sex should be stopped until the person withtrichomoniasis and all of his or her recent partnerscomplete treatment for trichomoniasis and have nosymptoms. Maria Carmela L. Domocmat, RN, MSN
  35. 35. one of the most common and most curable STDs. The symptoms are more annoying than they are threatening to health. genital inflammation caused by trichomoniasis might however, increase a persons risk of acquiring HIV infection if s/he is exposed to HIV or might also increase the chances of transmitting HIV infection to a sex partner. In rare case, trichomoniasis in pregnant women may cause a premature rupture of the membranes and early delivery.Complications Maria Carmela L. Domocmat, RN, MSN
  36. 36. ComplicationsIf Untreated: increases a womans susceptibility to HIVinfection if she is exposed to the virus. Pregnant women with trichomoniasis may have babies who are born early or with low birth weight (less than five pounds). Maria Carmela L. Domocmat, RN, MSN
  37. 37. Maria Carmela L. Domocmat, RN, MSNVULVOVAGINALCANDIDIASIS
  38. 38. Maria Carmela L. Domocmat, RN, MSN
  39. 39. Maria Carmela L. Domocmat, RN, MSN
  40. 40. Maria Carmela L. Domocmat, RN, MSN
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