What are the chief complaints of a person w/ an STD?
itching, burning, dysuria, pain
What is a VDRL?
- VDRL= Veneral Disease Research Lab
- -blood test for syphillis, flourescent treponemal antibody test
What is a gram stain used for?
- Gram stain: urethral in males and cervical in females
- Gram negative diploc = GC (ghonnerea). The exclusion of GC= chlymadia
- -enzyme-like immunoassay and direct flourescent antibody tests
Define Genetial Herpes
- -acute, recurring, incurable viral disease
- a) HSV-1: classis cold sore caused from heat, sun, or fever, often referred to as "fever blisters"
- b) HSV-2: genetal herpes
what are the s/sx of HSV?
- -initial and recurrent outbreaks w/ the same symptoms
- -burning sensation of skin or prickly like pins/needles
- -small itchy or painful red bumps
- -bumps become fluid filled vesicles, painful
- -fluid goes from clear to thick and yellow in a few days, they break open w/ very painful sores
- -females may be more painful (due to warm, moist areas)
What is the course of genital herpes?
- -blisters crust over and crusts fall off in 10 days
- -may have swollen lymph glands in groin and other areas
- -50% fever, muscle aches, HA. Most women have vaginal discharge
- -30% males have sores inside urethra causing painful urination
- -firs infection may be mild and go unnoticed until reoccurance, or be severe
Discuss reoccurence in regards to HSV
- -may be q 2 wks to 6 mo.
- -usually less severe. May accompany local trauma (i.e. menses, infection, other STDs, anxiety, stress, poor nutrition
- -outbreaks may become fewer over the years but HSV is incurable.
- -anything over 4 outbreaks/year is considered severe and treated w/ continuout prophylactic meds all year
What are the complications of HSV?
- -spread from initail site by hands, mouth, and can go to other open sores or the eyes causing infection/blindness
- -can go to fingers/fingernails= Herpatic Whitlow - a former occupational hazard when med staff didn't wear gloves, esp. when working in mouth (dentists and anesthesiologist
Discuss pregnant women and HSV
- -should inform MD if they have HSV.
- -if HSV in inactive phase the pt can deliver vaginally, or CS needed to prevent spread to newborn
- -babies of active mother have a 25-40% chance of becoming infected, and 60% of infected babies die
How is HSV transmitted?
- -during viral shedding (type I and type II)
- -just before and during the active outbreak via direct contact genital to genital or mouth to genital
- -virus enters through small cracks/abrasions in skin but virus can also survive outside the body in warm moist environ for a short period of time
- -chlorine kills the virus-you can't get it from swimming pools
What is the Tx for HSV?
- -no cure
- -virus lies dormant in nerve ganglia until body becomes stressed then it comes out again
- we treat the symptoms:
- -astringent compresses (i.e. Burrow's soak for cooling and pain relief)
- -and meds to decr. severity, promote healing and decr. frequency of outbreaks
What are the ANTIVIRAL meds for Herpes?
- *Acyclovir (Zovirax or Avirax)
- -used orally 7-10 days
- -s/e: N/V
- *Famiciclovir (Famvir)
- -used orally 7-10 days
- -educ: start w/in first 48hr of sx
- *Valacyclovir (Valtrex)
- -used orally 7-10 days
- -s/e: GI distress, HA, dizziness
Discuss Tx for HSV
- -avoid touching active blisters and avoid sexual activity
- -used condoms at all times
- -Use cold compresses to reliefve symptoms, avoid hot bc it incr. inflammation
- -wear ventilated clothing, dry blisters w/ powder, corn starch, cool hair dryer
What is considered the "classic STD?"
Discuss Syphillis: cause and incidence
- cause: Treponema pallidum spirochete (slender, spiral shape)
- incidence: fewer cases d/t use of PCN and better public health educ.
Discuss the PRIMARY phase of Syphilis
- -chancre (pronounced "shank-are") at site of inoculation in genitals, about 3wks after exposure
- -Highly infectous- 1st small papule w/in 3-7 days then it breaks down into characteristic painless, indurated, smooth, weeping lesion
- -if no Tx chancre disappears in 6wks and organism disseminates throughout bloodstream, leading to secondary phase
Discuss SECONDARY Syphilis
- -6wks to 6mo after primary syphilis
- -Systemic disease
- -s/sx: malaise, low-grade fever, HA, muscle-ache/pain and sore throat
- -grneralized rash involves papules to squamous papules and pustules
Discuss the LATENT STAGES of Syphilis
- Early Latent: first year after infection
- Late Latent: more than a year duration after infection. Noninfectous except to fetus of pregnant woman.
- Tertiary or Late (can cause extreme damage in body systems): highly variable s/sx, period for 4-20 years
- -sx: benign lesions, skin and mucous memb., bones, aortitis (inflammation of aorta), aneurysms (from weakened vessels), and neurosyphilis (affects whole nervous system and pt can become psychotic)
How is Syphilis diagnosed?
- -incubating Syphilis can NOT be detected w/ lab tests
- -primary can be Dx by microscope identification (spirochetes from oozing canchre looked at under microscope and diagnosed)
- -later stages: VDRL blood test
- -FTA-ABS (flourescent treponemal antibody absorbtion)
- -RPR (rapid plasma reagin-detects 2 types of antibodies)
- -tests can give false neg/false pos even after pt had adequate tx, retreatment may be only choice
What is the Tx for Syphilis?
- Primary Prevention: SAFE SEX!
- Secondary: early Tx, prevntion of complications
- Tertiary: treat complications, notify partners
- *Syphilis is completely curable by using PCN AB (but remember it doesn't provide immunity, you can get the disease again)
- -Gm neg. diplococcus, transmitted by sexual contact or in an to a neonate via an infected birth canal
- -initail symptoms 3-10 days after contact or non-symptomatic
What are the s/sx of GC in MALES?
- -penile discharge, profuse yellow-green, clear or scant
- -GC is referred to as the "drip"
- -rectal bleeding, pain w/ defication, pharyngitis (sore throat from incocculation in oral area)
- -most common- urethra then spread to prostate, seminal vesicles and epididymis
What are the s/sx of GC in FEMALES?
- -change in vaginal discharge, odorus
- -urinary frequency, dysuria
- -anal itch, irritation, bleeding
- -pain w/ defication
- -most commmon: cervix or urethra and spreads up causing PID, endometritis, salpinfitis, pelvis peritonitis
What is the Tx for GC?
- -completely curable
- -must be seen by MD
- -prob w/ incr. resistant strains
- -AB: ceftriaxone (Rocephin) AB of choice- want to mix w/ lidocaine if you give it IM-painful shot, one dose of Rocephin can cure GC
- -C. trachomatis most common transmitted bacteria
- -US: 4 million infected annually
- - invades columnar epithelial tissues in reproductive tract w/ manifestations similar to GC
- -incubation 1-3 wks or months/years
- -many w/o sx, (usually picked up on pap screening)
What are the sx for MALES with Chlamydia
- -frequency of urination
- -mucoid discharge (more h2o, less copious than GC)
- -complications: epididymitis, prostatitis, infertility, Reiter's syndroms (arthrytis)
What are the sx for WOMEN with chlymadia
- -75% asymptomatic
- - mucopurulent cervicitis, change in vaginal discharge
- -dysuria, frequency
- -soreness of infected area
- -COMPLICATIONS: salpingitis, PID, ectopic preg and infertility
- -TX choice: azithromycin (Zithromax) or doxycycline
- -educ: treat partner
- Pelvic Inflammatory Disease:
- -process involves one or more pelvic structures
- -most common in fallopian tubes = leading cause of infertility
- - acute PID-complex lower genital tract organism that migrates to endocervix through endometrail cavity and fallopian tubes
- -PID can lead to: endometritis, peritonitis, salpingitis, oophoritis, parametritis, adhesions, strictures that can lead to a bowel obstruction.
- PID most often caused by STD- GC, chlymadia, mycoplasma
What is the Tx for PID?
- -analgesia, sitz baths, heat on lower back/abdomen, bedrest in semi-fowlers
- -AB as ordered
- -laproscopic or abdominal laparotomy to remove abscesses, masses
- Teach: meticulous perineal hygiene, treat partners for STDs, provide counseling and educ. about infertility, ectopic preg, chronic pain