maternal mortality and its causes and how to reduce maternal mortality
Sexually transmitted infections. Part IV
1. Sexually Transmitted
Infections
By: Maria Carmela L. Domocmat, RN, MSN
Nurse Instructor
Northern Luzon Adventist College
Maria Carmela L. Domocmat, RN, MSN
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 Infection
2. 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 Enteritis
Overview
Maria Carmela L. Domocmat, RN, MSN
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 aren't aware of having
it.
Bacterial vaginosis
Maria Carmela L. Domocmat, RN, MSN
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. can spread during sexual intercourse
but also occurs in people who aren't sexually active
higher risk of bacterial vaginosis
Women with new or multiple sex partners
women who douche
use an intrauterine device (IUD) for birth control
MOT
Maria Carmela L. Domocmat, RN, MSN
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 pruritus
Symptoms of bacterial vaginosis
Maria Carmela L. Domocmat, RN, MSN
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
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
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 days
Recommended Regimens for
Pregnant Women
Maria Carmela L. Domocmat, RN, MSN
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
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. 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 common
Trichomoniasis
Maria Carmela L. Domocmat, RN, MSN
20. Transmission can occur even if a person is
asymptomatic
Women contract trichomoniasis from infected male or
female partners while men usually contract it only from
female 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. Using condoms and/or dental dams provide some
protection.
Their use is strongly encouraged, but is not 100% safe.
Trichomoniasis can also survive on infected objects like
sheets, towels, and underwear and could be transmitted
by sharing them.
MOT
Maria Carmela L. Domocmat, RN, MSN
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. 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 in
Women
Maria Carmela L. Domocmat, RN, MSN
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 in
Women
Maria Carmela L. Domocmat, RN, MSN
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. The symptoms of trichomoniasis in infected men may
disappear within a few weeks without treatment.
Maria Carmela L. Domocmat, RN, MSN
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
examination
Dx
Maria Carmela L. Domocmat, RN, MSN
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. 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 brown
Recommended Regimens
Maria Carmela L. Domocmat, RN, MSN
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. 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. an infected man, even a man who has never had symptoms
or whose symptoms have stopped, can continue to infect
or re-infect a female partner until he has been treated.
Therefore, both partners should be treated at the same
time to eliminate the parasite.
Persons being treated for trichomoniasis should avoid sex
until they and their sex partners complete treatment and
have no symptoms.
Having trichomoniasis once does not protect a person
from getting it again. Following successful treatment,
people can still be susceptible to re-infection.
Maria Carmela L. Domocmat, RN, MSN
34. Sex should be stopped until the person with
trichomoniasis and all of his or her recent partners
complete treatment for trichomoniasis and have no
symptoms.
Maria Carmela L. Domocmat, RN, MSN
35. one of the most common and most curable STD's.
The symptoms are more annoying than they are
threatening to health.
genital inflammation caused by trichomoniasis might
however, increase a person's 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. Complications
If Untreated: increases a woman's susceptibility to HIV
infection 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