Sexually transmitted infections. Part IV

Sexually Transmitted
Infections
By: Maria Carmela L. Domocmat, RN, MSN
Nurse Instructor
Northern Luzon Adventist College

Maria Carmela L. Domocmat, RN, MSN

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

Bacterial Vaginosis
Trichomoniasis
Vulvovaginal Candidiasis



BACTERIAL VAGINOSIS

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

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

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

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

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


KOH

Pap smear showing clue cells consistent with bacterial
vaginosis.
vaginosis. Courtesy of Abner P. Korn, MD. © Copyright 1996,
Korn,
SCP Communications, Inc.


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


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

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


TRICHOMONIASIS

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

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

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

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

• Trichomoniasis Incubation Period
o If symptoms appear, it usually takes from 3 to 28 days for
them to develop.


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

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

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


The symptoms of trichomoniasis in infected men may
disappear within a few weeks without treatment.


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

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

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


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

Treatment should continue through menstrual period
Because vagina is more alkaline at this time –flare up is more
likely to occur


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.


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.


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

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).



VULVOVAGINAL
CANDIDIASIS

Sexually transmitted infections. Part IV

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