Sexually transmitted infection

 Spread through sexual contact with an infected partner.

 All STIs can be prevented through safer sex practices including use of condoms during sexual
relations.

 Little disease immunity is developed once it has been contracted, so it is possible to become
reinfected if preventive measures are not followed.

 In most instances, an infected partner should also be treated to prevent cross – contamination.

 Pregnant women should be cautious with STIs because some infections could adversely affect
her health including her fetus or child.

Candidiasis

 Vaginal infection spread by fungus Candida.

 Results in a thick vaginal discharge that resembles cream cheese and is extremely pruritic.

 Vagina appears red and irritated.

 Pregnant – due to high levels of estrogen that causes the vaginal pH to be less acidic.

 Occurs in patients undergoing antibiotic therapy, gestational diabetes and HIV infection.

 Diagnosed by microscopic analysis of the vaginal discharge mounted on a wet slide.

Treatment:

 Miconazole (Monistat) cream applied to vagina for 7 days

 Fluconazole (Diflucan) – one single dose

 During childbirth present – can cause candidal infection/thrush/oral candidiasis/oral thrush

 Oral thrush - white patches

Trichomoniasis

 Infection caused by single cell protozoan spread by coitus.

 Characterized by yellow gray, frothy odorous vaginal discharge.

 Diagnosed by examination of vaginal secretions on a wet slide that has been treated with
potassium hydroxide (KOH) or by vaginal culture.

 Associated with preterm labor, PROM, CS infections.

Treatment:

 Metronidazole (Flagyl) – single oral dose

  Pap smear - Is taken for early detection of cervical cancer and diagnosis of precancerous and
cancerous conditions of the vulva and vagina; it also reveals inflammatory conditions of the
vulva and vagina

Bacterial vaginosis

 Local infection of vagina by the invasion

of Gardnerella vaginalis organism.

 Discharge is gray and has a fishy odor.

 Pruritus is intense.

 Associated with amniotic fluid infection, preterm labor and PROM.

Treatment:

 Metronidazole (Flagyl)/Clindamycin – oral for 7 days

Chlamydia

 Caused by gram (-) intracellular parasite, causes a heavy, gray – white vaginal discharge.

 Diagnosis is made through culture of organism from vaginal secretions using a specific chlamydia
culture kit.

 Strong association between chlamydia and gonorrhea; therefore if chlamydia is documented,

women are usually tested for gonorrhea.

 Associated with PROM, endometritis in postpartum period.

 Infant born while chlamydia infection is present in vagina can suffer from conjunctivitis or
pneumonia.

 Long term effects in the mother are PID that can lead to infertility.

Treatment:

 Doxycycline (Vibramycin) – tetracycline – non pregnant

 Azithromycin (Zithromax)/Amoxicillin (Amoxil) – pregnant

Syphillis

 Systemic disease caused by Treponema Pallidum – spirochete. (ispayrakit)

 First stage results in a painless ulcer (chancre) on the vulva or vagina.

 Before wk 18 – the placenta appears to provide some protection against the disease – can’t
cross the placenta d/t cytotrophoblast

 After can cross that can lead to spontaneous miscarriage, preterm labor, stillbirth, or congenital
anomalies.
  All pregnant women are screened by VDRL (venereal disease research laboratory) TEST.

Treatment:

 Benzathine penicillin G – one injection

 Medicine of choice during pregnancy

 Hypotension, fever, tachycardia and muscle aches.

Genital herpes

 Caused by herpes simplex virus (HSV) type 2.

 Painful, pinpoint vesicles on an erythematous base develop on the vulva or in vagina

accompanied by low grade fever 3 to 7 days after exposure.

 Symptoms fade in few days but the virus remains in local nerve ganglions becoming activated
again any time she has a break in the skin or also possibly by stress.

 Woman with primary infection – herpes can be transmitted across the placenta to cause
congenital infection in newborn – severe systemic infection often fatal.

 To avoid transmission – deliver through CS

 If without lesions – can deliver NSD

 Diagnosis is made by appearance of lesions, pap smear, ELISA (enzyme linked immunosorbent
assay)

Treatment

 Acyclovir (Zovirax) – oral

 Sitz baths or apply warm moist tea bags – reduce pain of lesions

 Condom – male and female to prevent transmission

Gonorrhea

 Gram (-) coccus Neisseria gonorrhoeae.

 Yellow – green vaginal discharge.

 Woman may be asymptomatic.

 Male partner has severe symptoms of pain on urination and purulent yellow penile discharge.

 Associated with spontaneous miscarriage, preterm birth, endometritis.

 Can cause opthalmia neonatorum – birth

 Major cause of PID and infertility.

 Diagnosis is made by culture of organism from vagina, rectum or urethra.

Treatment

 Oral cefixime (Suprax) or IM cetriaxone (Rocephin)

Chlamydial

 Doxycycline – non pregnant

 Amoxicillin/Azithromycin - pregnant

HPV infection

 Causes fibrous tissue overgrowth on the external vulva (condyloma acuminatum)

 Common in women with multiple sexual partners

 Associated with the dev’t of cervical cancer

 Lesions appear as discrete papillary structures; they then spread, enlarge, and coalesce to form
large, cauliflower – like lesions. These tend to increase during pregnancy d/t high vascular flow
in the pelvic area. They may become secondarily ulcerated and infected; when this occurs, a foul
vulvar odor may develop.

 The presence of vulvar lesions appear to have no effect on the fetus during pregnancy, but if
present at birth and obstructs vaginal canal, CS may be necessary.

Treatment

 Podophyllum (Podofin) – applied directly to the lesions – non pregnant

 TCA/Trichloroacetic acid; BCA/Bichloroacetic acid – applied to lesions weekly – pregnant

 Large lesions removed by laser therapy, cryocautery or knife excision.

 Cryocautery – edema at the site becomes evident; lesions become gangrenous and sloughing
occurs in 7 days. Healing will be complete in 4 to 6 weeks with only slight depigmentation on the
area.

 Sitz baths and lidocaine cream may be soothing during healing period.

Group B streptococcal infection

 Infection develops within cervix and vagina and woman usually experiences no symptoms.

 Consequences can be UTI, intra – amniotic infection, leading to preterm birth and postpartum
endometritis.

 CDC recommends all pregnant women be screened for strep b infection at 35 – 38 wk gestation.

 Infected neonates develops pneumonia, sepsis, respiratory distress syndrome, meningitis.

Treatment

 Broad spectrum antibac – ampicillin

  ROM at less 37 wks, given ampicillin via IV in unscreened mothers to reduce risk of spreading
infection to the newborn.

HIV/AIDS

 HIV : a viral infection which involves a gradual and progressive destruction of the immune
system.

 AIDS : the end-stage of HIV

 HIV x HIV (+) x AIDS

 Time of exposure – person is not yet HIV (+)

↓ - WINDOW PERIOD

3 to 6 mos

HIV (+)

WINDOW PERIOD

 the period of time between initial infection of HIV and development of a positive antibody test
for HIV.

 Blood donated during the window phase may test (-) but is already infectious.

1. Initial infection

2. Lasts for 4 weeks to 6 mos ( but could last up to 1 year)

3. Not detectable by present laboratory tests.

HIV have high affinity with

 Brain – prone to dementia

 Intestines – diarrhea

 T – cells - ↓ immune system –2° infection and dev’t of 2° cancers - KS

2° infection

- PCP (pneumocystis pneumonia)

- TB

- Opportunistic infection

Causative agent
  Retrovirus : contains HIV enzyme reverse transcriptase which enables the RNA carrying virus to
convert or transform into a double-stranded DNA carrying virus (known as provirus) by copying
the viral genetic material from RNA.

TYPES

 HIV Type I : prevalent in the US and the west (includes the Philippines)

 HIV Type II : prevalent in West Africa (called the slimming disease bec patients become very thin
and emaciated

 * Target cells of the retrovirus : T4 lymphocytes : helper cells which are identified through their
ID, the surface receptors CD4+ cells.

 * T4 lymphocytes are the coordinators of the immune system :

1. They identify microorganisms entering our body

2. They mobilize the defense system in cases of invasion/infection.

3. Are capable of reproduction of self to reinforce the defense against inf.

** Therefore, with HIV infection, there is a gradual and progressive destruction of the immune system.

 Apoptosis : rupture of DNA and T4; generally refers to “programmed cell death” where the
nuclei of the necrotic cells dissolve and the cytoplasm shrink, round up and is subsequently
phagocytes

 Incubation period : 6 mos. -7 years/ 10 years; average : 1 year

 T4 counts :

a. normal: 800-> 1000 cells/mm3

b. weakening of resistance : 200-800 cells/mm 3

c. AIDS: < 200 cells/mm3

MODE OF TRANSMISSION

A – across the placenta – vertical tranmission – from the mother going to the fetus via placenta

B – blood and blood products; breast milk

C – coitus; semen and vaginal secretions

HIV IS PRESENT

 Saliva - # insignificant

 Urine - # insignificant

 In SWEAT NO HIV

* LET’S NOW TRACE THE DEVELOPMENT OF AIDS

COURSE OF HIV – PAPTA

1. Primary HIV infection

2. Asymptomatic infection

3. Persistent generalized lymphadenopathy

4. Transition/early AIDS

5. AIDS

Primary HIV infection

 Acute retroviral syndrome

 the period from infection with HIV to the development of antibodies to HIV characterized by
intense viral replication and widespread dissemination of HIV in throughout the body.

1. Short, symptomatic period

2. Flu-like symptoms

3. After 3 weeks of infection : mononucleosis-like symptoms will manifest like :

a. fever and headaches.

b. enlarged lymph nodes

c. rashes

d. muscle pains

4. Ideal time for screening test to be done.

ASYMPTOMATIC HIV INFECTION

No symptoms at all

1. With antibodies against HIV but not protective.

2. Viral set point : the balance between the HIV virus and the body’s immune response, where
symptoms resolve bec the CD4 T cell population responds by activating other immune cells (e.g. CD 8
cells) to contain the virus.

 Lasts for 1-20 years, depending on the following factors :

1. Status of immune system upon infection

2. The importance he will give to healthy lifestyles

3. Treatment regimen he undertakes : proper medication delays progress of disease.

Persistent generalized lymphadenopathy

  Enlargement of 2 or more lymph nodes outside the inguinal chain with no other illness or
condition to account for the lymphadenopathy

 3 mos – persitent

Transition/early AIDS

 General malaise, fatigue

 Low grade fever

 Involuntary weight loss – 10%

 Night sweats

 Skin dryness or rashes

Diet - ↑ calorie, ↓ fiber

AIDS

 manifestation of severe immunodepression : T 4 is < 200 cells/mm3.

 * Presence of a variety of infections at one time such as :

1. Oral candidiasis, leucorrhea : appearance of oral hairs (Epstein Barr)

2. AIDS dementia complex

3. Acute encephalopathy

4. GIT involvement : diarrhea, hepatitis, anorectal disease

 5. AIDS defining diseases (environment) :

a. Cytomegalovirus

b. Pneumocystic carnii pneumonia

c. Kaposi’s sarcoma : rare malignancy of blood vessels manifested in skin and mucosa.

6. Tuberculosis

7. Herpes simplex / herpes zoster

8. Pseudomonas infection

9. Blindness

10. Deafness

Diagnostic examinations

1. ELISA : a presumptive test that determines the presence of antibody against HIV :

2. It detects antibodies, not virus

  Developed in 1985 to screen blood donors

 99.5% sensitive when performed @ least 13 wks after infection

 If test is (-) : wait for 4-12 wks/ 6 mos then repeat ELISA test.

2. Western Blot : a confirmatory test that determines the presence of antibody against HIV

 99.9% specific when combined with ELISA

 ( -) ELISA – undergo testing after 1 month

 (+) ELISA – undergo western blot

 (+) western blot – HIV (+)

 (-) Western blot – HIV (-)

Treatment

 Nutritional rehabilitation

 Treatment of opportunistic infections (OI’s)

 AZT (Zidovudine) : delays progress of HIV.

 Access of HIV infection and spread :

1. Blood - the easiest way bec of its access to all parts of the body

2. Semen

3. Cervical discharges

4. Breastmilk

5. CSF

Management

 1. Psychological / emotional support

 2. Medical asepsis

 3. Supportive

 4. Isolation :

a. Reverse/protective : to shield the patient from OI’s :severe immunosuppression

b. Universal : Blood and bloody fluids

PREVENTION

 According to CDC, follow ABC

A – Abstinence

B – Be faithful

C – Condom

 According to DOH, follow 4 C’s

C - Condom

C – Compliance to regimen

C – Contact tracing

C – Counseling

SUBSTANCE ABUSE

 Refers to a maladaptive pattern of use of a substance

3 substances

1. Tobacco – low birth weights; SIDS

2. Alcohol – FAS; MR; craniofacial anomalies; ADHD

3. Cocaine - SGA

 Be cautious with the following signs of w/drawal in newborn-ALCOHOL

1. Restless and tremors

2. High – pitched cry

3. Poor muscle reflexes

4. Restless sleeping

Terratogens

 Any drug, virus or irradiation, the exposure to such may cause damage to the fetus

1. Drugs:

 Streptomycin – anti TB & or Quinine (anti malaria) – damage to 8 th cranial nerve – poor hearing
& deafness

 Tetracycline – staining tooth enamel, inhibit growth of long bone

 Vitamin K – hemolysis (destr of RBC), hyperbilirubenia or jaundice

 Iodides – enlargement of thyroid or goiter

 Thalidomides – Amelia or pocomelia, absence of extremities

 Steroids – cleft lip or palate

  Lithium – congenital malformation

 2. Alcohol – lowered weight (vasoconstriction on mom), fetal alcohol withdrawal syndrome char
by microcephaly

 3. Smoking – low birth weight

 4. Caffeine – low birth weight

 5. Cocaine – low birth weight, abruption placenta

TORCH (Terratogenic) Infections – viruses

 CHARACTERISTICS: group of infections caused by organisms that can cross the placenta or
ascend through birth canal and adversely affect fetal growth and development. These infections
are often characterized by vague, influenza like findings, rashes and lesions, enlarged lymph
nodes, and jaundice (hepatic involvement). In some cases the infection may go unnoticed in the
pregnant woman yet have devastating effects on the fetus.

 TORCH: Toxoplasmosis, Other, Rubella, Cytomegalo virus, Herpes simplex virus.  

 T – toxoplasmosis – mom takes care of cats. Feces of cat go to raw vegetables or meat

 O – others. Hepa A or infectious hepa – oral/ fecal (hand washing)

Hepa B, HIV – blood & body fluids

Syphilis

 R – rubella – German measles – congenital heart disease (1 st month) normal rubella titer 1:10

<1:10 – less immunity to rubella, after delivery, mom will be given rubella vaccine. Don’t get
pregnant for 3 months. Vaccine is terratogenic

 C – cytomegalo virus

 H – herpes simplex virus