O.

Herpes Zoster
Herpes zoster is infection that results when varicella-zoster virus reactivates from its
latent state in a posterior dorsal root ganglion. Symptoms usually begin with pain along
the affected dermatome, followed within 2 to 3 days by a vesicular eruption that is
usually diagnostic. Treatment is with antiviral drugs, ideally given within 72 hours after
skin lesions appear.
Chickenpox and herpes zoster are caused by the varicella-zoster virus (human
herpesvirus type 3); chickenpox is the acute, primary infection phase of the virus, and
herpes zoster (shingles) represents reactivation of virus from the latent phase.
Herpes zoster inflames the sensory root ganglia, the skin of the associated dermatome,
and sometimes the posterior and anterior horns of the gray matter, meninges, and
dorsal and ventral roots. Herpes zoster frequently occurs in older and HIV-infected
patients and is more frequent and severe in immunocompromised patients because
cell-mediated immunity in these patients is decreased. There are no clear-cut
precipitants.
Shingles is a viral infection that causes a painful rash. Although shingles can occur
anywhere on your body, it most often appears as a single stripe of blisters that wraps
around either the left or the right side of your torso.
Shingles is caused by the varicella-zoster virus — the same virus that causes
chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near
your spinal cord and brain. Years later, the virus may reactivate as shingles.
Shingles isn't a life-threatening condition, but it can be very painful. Vaccines can help
reduce the risk of shingles. Early treatment can help shorten a shingles infection and
lessen the chance of complications. The most common complication is postherpetic
neuralgia, which causes shingles pain for a long time after your blisters have cleared.

Symptoms
The signs and symptoms of shingles usually affect only a small section of one side of
your body. These signs and symptoms may include:
 Pain, burning, numbness or tingling
 Sensitivity to touch
 A red rash that begins a few days after the pain
 Fluid-filled blisters that break open and crust over
 Itching
Some people also experience:
  Fever
 Headache
 Sensitivity to light
 Fatigue
Pain is usually the first symptom of shingles. For some, it can be intense. Depending on
the location of the pain, it can sometimes be mistaken for a symptom of problems
affecting the heart, lungs or kidneys. Some people experience shingles pain without
ever developing the rash.
Most commonly, the shingles rash develops as a stripe of blisters that wraps around
either the left or right side of your torso. Sometimes the shingles rash occurs around
one eye or on one side of the neck or face.

Causes
Shingles is caused by the varicella-zoster virus — the same virus that causes
chickenpox. Anyone who's had chickenpox may develop shingles. After you recover
from chickenpox, the virus enters your nervous system and lies dormant for years.
Eventually, it may reactivate and travel along nerve pathways to your skin — producing
shingles. But, not everyone who's had chickenpox will develop shingles.
The reason for shingles is unclear. But it may be due to lowered immunity to infections
as you grow older. Shingles is more common in older adults and in people who have
weakened immune systems.
Varicella-zoster is part of a group of viruses called herpes viruses, which includes the
viruses that cause cold sores and genital herpes. Because of this, shingles is also
known as herpes zoster. But the virus that causes chickenpox and shingles is not the
same virus responsible for cold sores or genital herpes, a sexually transmitted infection.

Diagnosis
Shingles is usually diagnosed based on the history of pain on one side of your body,
along with the telltale rash and blisters.
 Clinical evaluation
Herpes zoster is suspected in patients with the characteristic rash and sometimes even
before the rash appears if patients have typical pain in a dermatomal distribution.
Diagnosis is usually based on the virtually pathognomonic rash.
If the diagnosis is equivocal, detecting multinucleate giant cells with a Tzanck test can
confirm infection, but the Tzanck test is positive with herpes zoster or herpes simplex.
Herpes simplex virus (HSV) may cause nearly identical lesions, but unlike herpes
zoster, HSV tends to recur and is not dermatomal. Viruses can be differentiated by
culture or polymerase chain reaction (PCR). Antigen detection from a biopsy sample
can be useful.

Treatment
There's no cure for shingles, but prompt treatment with prescription antiviral drugs can
speed healing and reduce your risk of complications. These medications include:
 Acyclovir (Zovirax)
 Famciclovir
 Valacyclovir (Valtrex)
Shingles can cause severe pain, so your doctor also may prescribe:
 Capsaicin topical patch (Qutenza)
 Anticonvulsants, such as gabapentin (Neurontin)
 Tricyclic antidepressants, such as amitriptyline
 Numbing agents, such as lidocaine, delivered via a cream, gel, spray or skin
patch
 Medications that contain narcotics, such as codeine
 An injection including corticosteroids and local anesthetics
Shingles generally lasts between two and six weeks. Most people get shingles only
once, but it is possible to get it two or more times.

Nursing Interventions and Rationales

 Assess pain level
o Note location and quality of pain

o Duration

o Non-verbal clues

o Relieving factors
 
Severe nerve (burning) pain is the primary complaint with preceding sensations of
tingling or itching.
 
 Apply cool moist dressings to lesions while in vesicle stage. Discontinue once
lesions begin to crust.
 
Cool moist dressings can help relieve pain and itching and provide some protection
against secondary infection or spread of disease to others
 
 Administer medications and apply topical steroids, antihistamines and analgesics
as necessary
 
 Antivirals (acyclovir, valacyclovir)  are given to decrease the severity and
duration of symptoms
 Oral analgesics (opioids) are given to treat severe pain of acute phase;
 Antidepressants and antiepileptic medications may be given to treat
postherpetic neuralgia;
 Topical steroids provide an anti-inflammatory effect;
 Antihistamines help with itching, especially at bedtime;
 Topical analgesics provide pain relief
 
 Assess for signs / symptoms of bacterial infections on skin and obtain culture and
sensitivity test as indicated
 
This test provides an indication for appropriate antibiotics if necessary for infection
 
 Initiate contact precautions
o Wear and encourage visitors to wear appropriate PPE
 o Limit visitors, especially those who may be at high risk (elderly, pregnant,
infants, anyone who has not had chickenpox or chickenpox vaccine)
o Cluster care and anticipate needs

 
The disease is spread through direct contact with open lesions; limiting contact with
visitors and staff help reduce the risk of spreading the disease.
 
 Assess for changes in vision and rash on forehead or nose
 
Shingles that affects the cranial or optic nerve can cause serious loss of vision.
Treatment with oral antivirals is essential and must be started as soon as possible.

P. Herpes Simplex
The herpes simplex virus, also known as HSV, is an infection that causes herpes.
Herpes can appear in various parts of the body, most commonly on the genitals or
mouth. There are two types of the herpes simplex virus.
 HSV-1: primarily causes oral herpes, and is generally responsible for cold sores
and fever blisters around the mouth and on the face.
 HSV-2: primarily causes genital herpes, and is generally responsible for genital
herpes outbreaks.

Causes
The herpes simplex virus is a contagious virus that can be transmitted from person to
person through direct contact. Children will often contract HSV-1 from early contact with
an infected adult. They then carry the virus with them for the rest of their lives.
HSV-1
HSV-1 can be contracted from general interactions such as:
 eating from the same utensils
 sharing lip balm
 kissing
The virus spreads more quickly when an infected person is experiencing an outbreak.
An estimated 67 percentTrusted Source of people ages 49 or younger are seropositive
for HSV-1, though they may never experience an outbreak. It’s also possible to get
genital herpes from HSV-1 if someone who performed oral sex had cold sores during
that time.
HSV-2
HSV-2 is contracted through forms of sexual contact with a person who has HSV-2. An
estimated 20 percent of sexually active adults in the United States are infected with
HSV-2, according to the American Academy of Dermatology (AAD). HSV-2 infections
are spread through contact with a herpes sore. In contrast, most people get HSV-1 from
an infected person who is asymptomatic, or does not have sores.

Risk Factors
Anyone can be infected with HSV, regardless of age. Your risk is based almost entirely
on exposure to the infection.
In cases of sexually transmitted HSV, people are more at risk when they have sex not
protected by condoms or other barrier methods.
Other risk factors for HSV-2 include:
 having multiple sex partners
 having sex at a younger age
 being female
 having another sexually transmitted infection (STI)
 having a weakened immune system
If a pregnant woman is having an outbreak of genital herpes at the time of childbirth, it
can expose the baby to both types of HSV, and may put them at risk for serious
complications.

Signs & Symptoms

It’s important to understand that someone may not have visible sores or symptoms and
still be infected by the virus. They may also transmit the virus to others.
Some of the symptoms associated with this virus include:
 blistering sores (in the mouth or on the genitals)
  pain during urination (genital herpes)
 itching
You may also experience symptoms that are similar to the flu. These symptoms can
include:
 fever
 swollen lymph nodes
 headaches
 tiredness
 lack of appetite
HSV can also spread to the eyes, causing a condition called herpes keratitis. This can
cause symptoms such as eye pain, discharge, and a gritty feeling in the eye.

Diagnosis
This type of virus is generally diagnosed with a physical exam. Your doctor may check
your body for sores and ask you about some of your symptoms.
Your doctor may also request HSV testing. This is known as a herpes culture. It will
confirm the diagnosis if you have sores on your genitals. During this test, your doctor
will take a swab sample of fluid from the sore and then send it to a laboratory for testing.
Blood tests for antibodies to HSV-1 and HSV-2 can also help diagnose these infections.
This is especially helpful when there are no sores present.
Alternatively, at-home testing for Herpes Simplex is available.

Treatment
There is currently no cure for this virus. Treatment focuses on getting rid of sores and
limiting outbreaks.
It’s possible that your sores will go away without treatment. However, your doctor may
determine you need one or more of the following medications:
 acyclovir
 famciclovir
 valacyclovir
These medications can help people infected with the virus reduce the risk of
transmitting it to others. The medications also help to lower the intensity and frequency
of outbreaks.
These medications may come in oral (pill) form, or may be applied as a cream. For
severe outbreaks, these medications may also be administered by injection.

Nursing Management
There is no way to eradicate herpes virus from the body, but antiviral medications can
reduce the frequency, duration, and severity of outbreaks.
 Pain killers like ibuprofen can reduce pain and fever.
 Anti viral drugs like acyclovir, valacyclovir, famciclovir, and penciclovir. If used
correctly, they may speed up the healing time of a recurrent infection.
 Topical application of antiviral creams can also help in healing outbreak of
infection. They do not get rid of the herpes simplex virus or prevent future
outbreaks of cold sores occurring.

Q. Tinea
Tinea infections are caused by dermatophytes and are classified by the involved site.
The most common infections in prepubertal children are tinea corporis and tinea capitis,
whereas adolescents and adults are more likely to develop tinea cruris, tinea pedis, and
tinea unguium (onychomycosis). The clinical diagnosis can be unreliable because tinea
infections have many mimics, which can manifest identical lesions. For example, tinea
corporis can be confused with eczema, tinea capitis can be confused with alopecia
areata, and onychomycosis can be confused with dystrophic toe-nails from repeated
low-level trauma. Physicians should confirm suspected onychomycosis and tinea capitis
with a potassium hydroxide preparation or culture. Tinea corporis, tinea cruris, and tinea
pedis generally respond to inexpensive topical agents such as terbinafine cream or
butenafine cream, but oral antifungal agents may be indicated for extensive disease,
failed topical treatment, immunocompromised patients, or severe moccasin-type tinea
pedis. Oral terbinafine is first-line therapy for tinea capitis and onychomycosis because
of its tolerability, high cure rate, and low cost. However, kerion should be treated with
griseofulvin unless Trichophyton has been documented as the pathogen. Failure to treat
kerion promptly can lead to scarring and permanent hair loss.
The term tinea means fungal infection, whereas dermatophyte refers to the fungal
organisms that cause tinea. Tinea is usually followed by a Latin term that designates the
involved site, such as tinea corporis and tinea pedis. Tinea versicolor (now called
pityriasis versicolor) is not caused by dermatophytes but rather by yeasts of the
genus Malassezia. Tinea unguium is more commonly known as onychomycosis.
Dermatophytes are usually limited to involvement of hair, nails, and stratum corneum,
which are inhospitable to other infectious agents. Dermatophytes include three
genera: Trichophyton, Microsporum, and Epidermophyton.

Tinea corporis, tinea cruris, and tinea pedis can often be diagnosed based on
appearance, but a potassium hydroxide preparation or culture should be
performed when the appearance is atypical.

Acceptable treatments for tinea capitis, with shorter treatment courses than
griseofulvin, include terbinafine (Lamisil) and fluconazole (Diflucan).

The diagnosis of onychomycosis should generally be confirmed with a test such

as potassium hydroxide preparation, culture, or periodic acid–Schiff stain before
initiating treatment.

Fungal Infections of the Skin

Dermatophytes

Tinea corporis (ringworm), includes tinea gladiatorum and tinea faciei

Tinea capitis (ringworm of the scalp)

Tinea cruris (jock itch)

Tinea pedis (athlete's foot)

Tinea unguium (onychomycosis)

Tinea manuum (commonly presents with “one-hand, two-feet” involvement)

Tinea barbae (beard infection in male adolescents and adults)

 Tinea incognito (altered appearance of dermatophyte infection caused by topical
steroids)

Candida (yeast) and mold, which may cause onychomycosis or coexist in a dystrophic

nail

Pityriasis versicolor (formerly tinea versicolor) caused by Malassezia species

Uncommon fungal skin infections that involve other organs (e.g., blastomycosis,
sporotrichosis)

The most common infections in prepubertal children are tinea corporis and tinea
capitis, whereas adolescents and adults are more likely to develop tinea cruris,
tinea pedis, and tinea unguium (onychomycosis). Tinea infections can be
difficult to diagnose and treat. In one survey, tinea was the skin condition most
likely to be misdiagnosed by primary care physicians.
Tinea Corporis, Tinea Cruris, and Tinea Pedis
Tinea corporis (ringworm) typically presents as a red, annular, scaly, pruritic
patch with central clearing and an active border. Lesions may be single or
multiple and the size generally ranges from 1 to 5 cm, but larger lesions and
confluence of lesions can also occur. Tinea corporis may be mistaken for many
other skin disorders, especially eczema, psoriasis, and seborrheic dermatitis. A
potassium hydroxide (KOH) preparation is often helpful when the diagnosis is
uncertain based on history and visual inspection. Worsening after empiric
treatment with a topical steroid should raise the suspicion of a dermatophyte
infection. Conversely, if a nonfungal lesion is treated with an antifungal cream,
the lesion will likely not improve or will worsen. Cultures are usually not
necessary to diagnose tinea corporis.2 Skin biopsy with periodic acid–Schiff
(PAS) stain may rarely be indicated for atypical or persistent lesions.

Tinea cruris (jock itch) most commonly affects adolescent and young adult males, and
involves the portion of the upper thigh opposite the scrotum. The scrotum itself is
usually spared in tinea cruris, but involved in candidiasis. A Wood lamp examination
may be helpful to distinguish tinea from erythrasma because the causative organism of
erythrasma (Corynebacterium minutissimum) exhibits a coral red fluorescence.
However, results of the Wood lamp examination can be falsely negative if the patient
has bathed recently.
Tinea cruris (jock itch) most commonly affects adolescent and young adult males, and
involves the portion of the upper thigh opposite the scrotum. The scrotum itself is
usually spared in tinea cruris, but involved in candidiasis. A Wood lamp examination
may be helpful to distinguish tinea from erythrasma because the causative organism of
erythrasma (Corynebacterium minutissimum) exhibits a coral red fluorescence.
However, results of the Wood lamp examination can be falsely negative if the patient
has bathed recently.

Tinea corporis, tinea cruris, and tinea pedis can often be diagnosed based on
appearance, but a KOH preparation or culture should be performed when the
appearance is atypical.
MANAGEMENT
Tinea corporis, tinea cruris, and tinea pedis are generally responsive to topical creams
such as terbinafine (Lamisil) and butenafine (Lotrimin Ultra), but oral antifungal agents
may be indicated for extensive disease, failed topical treatment, immunocompromised
patients, or severe moccasin-type tinea pedis. Patients with chronic or recurrent tinea
pedis may benefit from wide shoes, drying between the toes after bathing, and placing
lamb's wool between the toes. Patients with tinea gladiatorum, a generalized form of
tinea corporis seen in wrestlers, should be treated with topical therapy for 72 hours
before return to wrestling.

Tinea Management Pitfalls

Do not use nystatin to treat any tinea infection because dermatophytes are resistant
to nystatin. (However, nystatin is often effective for cutaneous Candida infections.)

Do not use oral ketoconazole to treat any tinea infection because of the U.S. Food
and Drug Administration boxed warnings about hepatic toxicity and the availability of
safer agents.

Do not use griseofulvin to treat onychomycosis because terbinafine (Lamisil) is

usually a better option based on its tolerability, high cure rate, and low cost.

Do not use combination products such as betamethasone/clotrimazole because they

can aggravate fungal infections.

Do not use topical clotrimazole or miconazole to treat tinea because topical

butenafine (Lotrimin Ultra) and terbinafine have better effectiveness and similar cost.

Do not, in general, treat tinea capitis or onychomycosis without first confirming the
diagnosis with a potassium hydroxide preparation, culture, or, for onychomycosis, a
periodic acid–Schiff stain. However, kerion should be treated aggressively while
awaiting test results, and it may be reasonable to treat a child with typical lesions of
tinea capitis involving pruritus, scale, alopecia, and posterior auricular
lymphadenopathy without confirmatory testing. If there is no lymphadenopathy, a
confirmatory test is recommended.

Do not treat tinea capitis solely with topical agents, but do combine oral therapy with
sporicidal shampoos, such as selenium sulfide (Selsun) or ketoconazole.

Do not perform potassium hydroxide preparations or cultures on asymptomatic

household members of children with tinea capitis, but do consider empiric treatment
with a sporicidal shampoo.

Tinea Capitis
In the United States, tinea capitis most commonly affects children of African heritage
between three and nine years of age. There are three types of tinea capitis: gray
patch, black dot, and favus. Black dot, caused by Trichophyton tonsurans, is most
common in the United States. Early disease can be limited to itching and scaling, but
the more classic presentation involves one or more scaly patches of alopecia with
hairs broken at the skin line (black dots) and crusting. Tinea capitis may progress to
kerion, which is characterized by boggy tender plaques and pustules. The child with
tinea capitis will generally have cervical and suboccipital lymphadenopathy, and the
physician may need to broaden the differential diagnosis if lymphadenopathy is
absent. However, lymphadenopathy can also occur in nonfungal scalp disease, and
the absence of lymphadenopathy in an otherwise typical presentation should not
delay aggressive treatment for tinea capitis.
Many physicians treat tinea capitis without a confirmatory culture or KOH preparation if
the presentation is typical (i.e., urban setting and child presents with scaling, alopecia,
and adenopathy).  The most common mimics include seborrheic dermatitis and alopecia
areata. In atypical cases, a KOH preparation can be performed by scraping the black
dots (broken hairs) and looking for fungal spores. The spores of T. tonsurans will be
contained within the hair shaft, but for the less common Microsporum canis, the spores
will coat the outside of the hair shaft.
A culture, which is more sensitive than the KOH preparation, can be performed by
moistening a cotton applicator or toothbrush with tap water and rubbing it over the
involved scalp. The sample is then applied to Sabouraud liquid medium or
Dermatophyte test medium. Children with kerion have a high false-negative culture
rate. A Wood lamp examination of scalp lesions is often not helpful because the most
common cause, T. tonsurans, does not fluoresce. M. canis, which is more common in
white children, exhibits a green fluorescence under a Wood
lamp. Microsporum infections result from exposure to infected dogs or cats and may
produce much more inflammation than Trichophyton infections.

MANAGEMENT
Tinea capitis must be treated with systemic antifungal agents because topical agents do
not penetrate the hair shaft. However, concomitant treatment with 1% or 2.5% selenium
sulfide (Selsun) shampoo or 2% ketoconazole shampoo should be used for the first two
weeks because it may reduce transmission. For many years, the first-line treatment for
tinea capitis has been griseofulvin because it has a long track record of safety and
effectiveness. However, randomized clinical trials have confirmed that newer agents,
such as terbinafine and fluconazole (Diflucan), have equal effectiveness and safety and
shorter treatment courses. Terbinafine may be superior to griseofulvin
for Trichophyton species, whereas griseofulvin may be superior to terbinafine for the
less common Microsporum species. Culture results are usually not available for two to
six weeks, but 95% of tinea capitis cases in the United States are caused
by Trichophyton, making terbinafine a reasonable first choice. However, kerion should
be treated with griseofulvin unless Trichophyton has been documented as the
pathogen. Failure to treat kerion promptly can lead to scarring and permanent hair loss.

MANAGEMENT
Tinea capitis must be treated with systemic antifungal agents because topical agents do
not penetrate the hair shaft. However, concomitant treatment with 1% or 2.5% selenium
sulfide (Selsun) shampoo or 2% ketoconazole shampoo should be used for the first two
weeks because it may reduce transmission. For many years, the first-line treatment for
tinea capitis has been griseofulvin because it has a long track record of safety and
effectiveness. However, randomized clinical trials have confirmed that newer agents,
such as terbinafine and fluconazole (Diflucan), have equal effectiveness and safety and
shorter treatment courses. Terbinafine may be superior to griseofulvin
for Trichophyton species, whereas griseofulvin may be superior to terbinafine for the
less common Microsporum species. Culture results are usually not available for two to
six weeks, but 95% of tinea capitis cases in the United States are caused
by Trichophyton, making terbinafine a reasonable first choice. However, kerion should
be treated with griseofulvin unless Trichophyton has been documented as the
pathogen. Failure to treat kerion promptly can lead to scarring and permanent hair loss.

The most common onychomycosis mimics include chronic trauma and

psoriasis. Adolescents and young adults can develop dystrophic toenails from repeated
sudden-stop trauma associated with basketball, soccer, and tennis. The great toes are
most often involved in onychomycosis and trauma-related dystrophy, but exclusive little
toe involvement is likely related to trauma.
The diagnosis of onychomycosis should usually be confirmed with a KOH preparation,
culture, or PAS stain because the treatment is long and potentially expensive, and the
nonfungal mimics are common. In one study, less than 50% of dystrophic toenails
resulted in positive fungal cultures. However, the involvement of multiple toenails, or
accompanying tinea pedis, may justify treatment without confirming the diagnosis. The
most sensitive diagnostic test, and the most expensive, is the PAS stain, which can be
performed by placing toenail clippings or curettings in 10% formalin and transporting
them to the pathology laboratory. Culture has poor sensitivity, but good specificity.
MANAGEMENT
Treatment courses for onychomycosis are long (three to six months), failure rates are
high, and recurrences are common (up to 50%). In older adults, treatment of
onychomycosis is often optional, but most adolescents and young adults request
treatment for cosmetic reasons or discomfort from shoes. Topical therapy is usually
ineffective except in the treatment of the white superficial form. However, some patients
resist systemic treatment, and ciclopirox nail lacquer (Penlac) can be offered together
with information about its low cure rate. Oral fluconazole is an option, but for most
patients oral terbinafine is the treatment of choice because of its superior
effectiveness, tolerability, and low cost. Because toenails grow slowly, assessment of
cure takes nine to 12 months.
KOH Preparation
KOH preparations are often needed to confirm the diagnosis of tinea infections. Some
tips for performing KOH preparations are available online. However, some clinicians
may not have immediate access to a microscope or have a Certificate of Provider-
Performed Microscopy, and transporting skin scrapings to a distant laboratory will not
support immediate point-of-care treatment decisions. Even when a microscope is
available, the decision to perform an immediate KOH preparation may have to be
balanced against other priorities.

R. Pediculosis
A sesame seed-size parasite that feeds on human blood, the head louse (Pediculus
humanus capitis) is a nuisance known around the world. These tiny insects infest
human hair and can also sometimes be found in the eyebrows and eyelashes. 
Pediculosis is an infestation of the hairy parts of the body or clothing with the eggs,
larvae or adults of lice. The crawling stages of this insect feed on human blood, which
can result in severe itching. Head lice are usually located on the scalp, crab lice in the
pubic area and body lice along seams of clothing. Body lice travel to the skin to feed
and return back to the clothing.
Anyone may become louse infested under suitable conditions of exposure. Pediculosis
is easily transmitted from person to person during direct contact. Head lice infestations
are frequently found in school settings or institutions. Crab lice infestations can be found
among sexually active individuals. Body lice infestation can be found in people living in
crowded, unsanitary conditions where clothing is infrequently changed or laundered.
For both head lice and body lice, transmission can occur during direct contact with an
infested individual. Sharing of clothing and combs or brushes may also result in
transmission of these insects. While other means are possible, crab lice are most often
transmitted through sexual contact.
A head-lice infestation isn't a sign of poor personal hygiene or an unclean living
environment. Head lice don't carry bacterial or viral infectious diseases.

Signs & symptoms

Common signs and symptoms of a lice infestation can include:
 Itching. The most common symptom of a lice infestation is itching on the scalp,
neck and ears. This is an allergic reaction to louse bites. When a person has a
lice infestation for the first time, itching may not occur for four to six weeks after
infestation.
 Lice on scalp. Lice may be visible but are difficult to spot because they're small,
avoid light and move quickly.
 Lice eggs (nits) on hair shafts. Nits stick to hair shafts. Incubating nits may be
difficult to see because they're very tiny. They're easiest to spot around the ears
and the hairline of the neck. Empty nits may be easier to spot because they're
 lighter in color and further from the scalp. However, the presence of nits doesn't
necessarily indicate an active infestation.
 Sores on the scalp, neck and shoulders. Scratching can lead to small, red
bumps that may sometimes get infected with bacteria.
Causes
A head louse is a tan or grayish insect about the size of a strawberry seed. It feeds on
human blood from a person's scalp. The female louse produces a sticky substance that
firmly attaches each egg to the base of a hair shaft no more than 3/16 inch (5
millimeters) from the scalp.
The louse life cycle
A louse goes through three stages:
 Eggs that hatch after six to nine days.
 Nymphs, immature forms of the louse that become mature adults after nine to 12
days.
 Adult lice, which can live for three to four weeks. The female louse lays six to 10
eggs a day.
Transmission
Head lice crawl, but they can't jump or fly. Transmission of a head louse from one
person to another is often by direct head-to-head contact, often within a family or among
children who have close contact at school or play.
Indirect transmission is uncommon, but lice may spread from one person to another by
items such as:
 Hats and scarves
 Brushes and combs
 Hair accessories
 Headphones
 Pillows, towels and upholstery
Indirect transfer could also occur among items of clothing stored together. For example,
hats or scarves hung on the same hook or stored in the same school locker could serve
as vehicles for transmitting lice.
Household pets, such as dogs and cats, don't play a role in spreading head lice.
Diagnosis
According to the American Academy of Pediatrics guidelines, the gold standard for
diagnosing an active head-lice infestation is the identification of a live nymph or adult
louse.
These guidelines recommend an examination of wet hair lubricated with such products
as a standard hair conditioner. Your doctor will carefully comb your child's hair with a
fine-toothed comb (nit comb) from the scalp to the end of the hair. If no live louse is
found, he or she will likely repeat the entire exam at a second appointment.
Identifying nits
Your doctor will also look for nits in your child's hair. To find nits, he or she may use a
specialized light called a Wood's light, which causes nits to appear bluish. But the
identification of nits does not necessarily confirm the diagnosis of an active lice
infestation.
A live nit needs to be near the scalp to survive. Nits found more than about 1/4 inch (6
millimeters) from the scalp are likely dead or empty. Suspect nits can be examined
under a microscope to determine if they're living — evidence of a likely active lice
infestation.
If no live nits are found, they're probably left from a previous infestation and do not need
to be treated.
Treatment
Your doctor will likely recommend an over-the-counter (OTC) medication that kills lice
and some of the nits. These medications may not kill recently laid eggs. Therefore, an
appropriately timed second treatment is usually necessary to kill nymphs after they
hatch but before they become adult lice.
Some studies suggest that retreating seven to nine days after the first treatment is the
ideal time for a second treatment, but other retreatment schedules exist. Ask your
doctor for written instructions for a recommended treatment schedule.
Over-the-counter (OTC) products
OTC medications are based on pyrethrin, a chemical compound extracted from the
chrysanthemum flower that is toxic to lice. Wash your child's hair with shampoo with no
conditioner before using one of these treatments. Rinsing the hair with white vinegar
before washing may help dissolve the glue that holds the nits to the hair shafts. Follow
directions on the package for how long to leave the medication in the hair, and rinse
your child's hair over a sink with warm water.
OTC medications include the following:
  Permethrin (Nix). Permethrin is a synthetic version of pyrethrin. Permethrin does
not kill nits, and treatment needs to be repeated nine to 10 days after first
application. Side effects may include redness and itching of the scalp.
 Pyrethrin with additives (Rid). In this OTC medication, pyrethrin is combined
with another chemical that enhances its effectiveness. This product only kills lice,
not nits, and needs to be reapplied nine to 10 days after first treatment. Side
effects may include itching and redness of the scalp. Pyrethrin shouldn't be used
if your child is allergic to chrysanthemum or ragweed.
Prescription medications
In some geographic regions, lice have developed resistance to OTC medications.
Also, OTC treatment may fail because of incorrect use, such as not repeating the
treatment at an appropriate time.
If the correct use of an OTC treatment has failed, your doctor may recommend a
prescription treatment. These include:
 Ivermectin (Sklice). Ivermectin is toxic to lice. It is approved for use with people
age 6 months or older. It can be applied once to dry hair and then rinsed with
water after 10 minutes. Ivermectin is also available as a tablet to be taken by
mouth to children weighing more than 33 lbs. if other topical treatments do not
effectively eliminate a lice infestation.
 Spinosad (Natroba). Spinosad is approved for use with people age 6 months or
older. It can be applied to dry hair and rinsed with warm water after 10 minutes. It
kills lice and nits and usually doesn't need repeated treatment.
 Malathion. Malathion is approved for use with people age 6 or older. The lotion
is applied, left to dry naturally and rinsed out after eight to 12 hours. The drug
has a high alcohol content, so it can't be used with a hair dryer or near an open
flame. Malathion can be reapplied seven to nine days after the first treatment if
necessary.

Nursing Interventions and Rationales

 Assess the scalp for nits or active lice; common behind the ears, at the base of
the neck and on the crown of the head
 
Nits will be small and firmly attached to the hair shaft. Shells of nits will still be present
after they hatch, but will appear more yellow. Adult lice may be more difficult to see as
they are darker and crawl quickly.
 
  Use PPE for examining patient
 
Lice are easily transmitted in clothing and on skin; use gloves to examine patient and
change gloves between patients to prevent further transmission
 
 Use Wood’s lamp (black light) to determine presence of lice or nits
 
This method involves less chance of transmission of lice and is done by shining the
black light on the patients head. Lice and nits will look like glowing yellow or green dots.
 
 Apply pediculicide shampoo to patient’s scalp and hair
 
Over the counter and prescription strength shampoos are available. Hair should not be
washed again for 1 -2 days following treatment.
 
 Comb hair with nit comb
 
This is a long and tedious process, but it required to remove lice and nits from the hair
and prevent reinfestation. Some shampoos only kill adult lice and nymphs, so nits
(eggs) must be manually removed.
 
 Administer oral medication as a last option (Ivermectin)
 
This medication is given orally when all other treatments have failed.
There may be significant side effects to this medication, so monitor for signs of liver
damage, joint or muscle pain, weakness, vision changes or rash.
 
 Assess skin for signs of infection
 
Itching is the most worrisome symptom, but introducing bacteria into excoriated skin can
lead to skin infections.
 
 Ensure patient’s nails are trimmed and clean
 
Scratching to relieve itching is a normal response, and often is done during sleep. Make
sure nails are trimmed and clean to reduce likelihood of infection.
 
 Address patient or caregivers’ emotional distress
 
Many people feel that lice is a reflection of poor hygiene. Reassure families that anyone
can have lice and provide guidance on how to cope. Try to help them view the situation
as a medical condition and avoid scolding or punishing the child.
 
 Provide education for patient and caregivers on ways to prevent further
infestation
 
 Treatment must be reapplied within 7-10 days to ensure that all newly hatched
lice and nymphs have been removed.
 Wash all bed linens, towels and clothes belonging to the patient separately in hot
water.
 Vacuum carpets, rugs, furniture and mattresses to remove lice that may be
hiding there
 For items that cannot be washed, such as toys or stuffed animals, seal them in a
plastic bag for 4-5 weeks to kill any remaining lice or nymphs.
 
S. Parasitic infections 
Parasites are organisms that live off other organisms, or hosts, to survive. Some
parasites don’t noticeably affect their hosts. Others grow, reproduce, or invade organ
systems that make their hosts sick, resulting in a parasitic infection.
Parasitic infections are a big problem in tropical and subtropical regions of the
world. Malaria is one of the deadliest parasitic diseases. Parasitic infections can also
occur in the United States. Common parasitic infections found in the United States
include:
 trichomoniasis
 giardiasis
 cryptosporidiosis
 toxoplasmosis
Symptoms
The symptoms of parasitic infections vary depending on the organism. For example:
 Trichomoniasis is a sexually transmitted infection caused by a parasite that often
produces no symptoms. In some cases, it may cause itching, redness, irritation,
and an unusual discharge in your genital area.
 Giardiasis may cause diarrhea, gas, upset stomach, greasy stools, and
dehydration.
 Cryptosporidiosis may cause stomach cramps, stomach pain, nausea, vomiting,
dehydration, weight loss, and fever.
 Toxoplasmosis may cause flu-like symptoms, including swollen lymph nodes and
muscle aches or pains that can last for over a month.

Causes
Parasitic infections can be caused by three types of organisms:
 protozoa
 helminths
 ectoparasites
Protozoa are single-celled organisms that can live and multiply inside your body. Some
infections caused by protozoa include giardiasis. This is a serious infection that you can
contract from drinking water infected with Giardia protozoa.
Helminths are multi-celled organisms that can live in or outside of your body. They’re
more commonly known as worms. They include flatworms, tapeworms, thorny-headed
worms,and roundworms.
Ectoparasites are multicelled organisms that live on or feed off your skin. They include
some insects and arachnids, such as mosquitos, fleas, ticks, and mites.
Parasitic infections can be spread in a number of ways. For example, protozoa and
helminths can be spread through contaminated water, food, waste, soil, and blood.
Some can be passed through sexual contact. Some parasites are spread by insects that
act as a vector, or carrier, of the disease. For example, malaria is caused by parasitic
protozoa that are transmitted by mosquitos when they feed on humans.

Diagnosis
Parasitic infections can be diagnosed in a number of ways. For example, your doctor
might perform or order:
 A blood test
 A fecal exam: In such an exam, a sample of your stool will be collected and
checked for parasites and their eggs.
 An endoscopy or colonoscopy: These tests may be ordered if the results of a
stool exam are inconclusive. While you are sedated, your doctor will pass a thin
flexible tube through your mouth or rectum and into your digestive system to
examine your intestinal tract.
 X-rays, magnetic resonance imaging (MRI), or computerized axial tomography
(CAT): These scans are used to check for signs of lesions or injury to your
organs caused by parasites.
Your doctor may also order tests to check for bacteria or other things that can cause
infections.

Your treatment plan will depend on your specific diagnosis. Typically, your doctor will
prescribe medications. For example, they may prescribe medications to treat
trichomoniasis, giardiasis, or cryptosporidiosis. They probably won’t prescribe
medications for toxoplasmosis if you’re not pregnant and otherwise healthy, unless you
have a severe and prolonged infection.
Your doctor may also recommend other treatments to relieve your symptoms. For
example, many parasitic infections can cause diarrhea, which often leads to
dehydration. Your doctor will likely encourage you to drink plenty of fluids to replenish
those you lose.

T. Scabies
Scabies is an itchy skin condition caused by a tiny burrowing mite called Sarcoptes
scabiei. Intense itching occurs in the area where the mite burrows. The urge to scratch
may be especially strong at night.
Scabies is contagious and can spread quickly through close physical contact in a family,
child care group, school class, nursing home or prison. Because scabies is so
contagious, doctors often recommend treatment for entire families or contact groups.
Scabies can be readily treated. Medications applied to your skin kill the mites that cause
scabies and their eggs. But you may still have some itching for several weeks after
treatment.

Symptoms
Scabies signs and symptoms include:
 Itching, often severe and usually worse at night
 Thin, irregular burrow tracks made up of tiny blisters or bumps on your skin
The burrows or tracks typically appear in folds of skin. Though almost any part of the
body may be involved, in adults and older children scabies is most often found:
 Between the fingers
 In the armpits
 Around the waist
 Along the insides of the wrists
 On the inner elbows
 On the soles of the feet
 Around the breasts
 Around the male genital area
 On the buttocks
 On the knees
In infants and young children, common sites of infestation usually include the:
 Scalp
 Palms of the hands
 Soles of the feet
If you've had scabies before, signs and symptoms may develop within a few days of
exposure. If you've never had scabies, it can take as long as six weeks for signs and
symptoms to begin. You can still spread scabies even if you don't have any signs or
symptoms yet.

Causes
The eight-legged mite that causes scabies in humans is microscopic. The female mite
burrows just beneath your skin and makes a tunnel where it deposits eggs.
The eggs hatch, and the mite larvae work their way to the surface of your skin, where
they mature and can spread to other areas of your skin or to the skin of other people.
The itching of scabies results from your body's allergic reaction to the mites, their eggs
and their waste.
Close physical contact and, less often, the sharing of clothing or bedding with an
infected person can spread the mites.
Animals and humans all are affected by their own distinct species of mites. Each
species prefers one specific type of host and doesn't live long away from that preferred
host.
Humans may have a temporary skin reaction from contact with the animal scabies mite.
But people generally can't develop full-blown scabies from this source, as they might
from contact with the human scabies mite.

Diagnosis
To diagnose scabies, your doctor examines your skin, looking for signs of mites,
including the characteristic burrows. When your doctor locates a mite burrow, he or she
may take a scraping from that area of your skin to examine under a microscope. The
microscopic examination can determine the presence of mites or their eggs.

Treatment
Scabies treatment involves eliminating the infestation with medications. Several creams
and lotions are available with a doctor's prescription.
Your doctor will likely ask you to apply the medication to your whole body, from the neck
down, and leave the medication on for at least eight to 10 hours. Some treatments
require a second application, and treatments need to be repeated if new burrows and a
rash appear.
Because scabies spreads so easily, your doctor will likely recommend treatment for all
household members and other close contacts, even if they show no signs of scabies
infestation.
Medications commonly prescribed for scabies include:
 Permethrin cream. Permethrin is a topical cream that contains chemicals that
kill scabies mites and their eggs. It is generally considered safe for adults,
pregnant women, and children age 2 months and older.
 Ivermectin (Stromectol).Doctors may prescribe this oral medication for people
with altered immune systems, for people who have crusted scabies, or for people
who don't respond to the prescription lotions and creams. Ivermectin isn't
recommended for women who are pregnant or nursing, or for children who weigh
less than 33 pounds (15 kilograms).
 Crotamiton (Eurax, Crotan). This medication is available as a cream or a lotion.
It's applied once a day for two days. The safety of this medication hasn't been
established in children, adults 65 and older, or women who are pregnant or
nursing. Frequent treatment failure has been reported with crotamiton.
Although these medications kill the mites promptly, you may find that the itching doesn't
stop entirely for several weeks.
Doctors may prescribe other topical medications, such as sulfur compounded in
petrolatum, for people who don't respond to or can't use these medications.

Nursing Interventions
The following are the nursing interventions for a patient with scabies :
 Prevent infection. Wash hands and teach patient and SO to wash hands before
contact with patients and between procedures with the patient; encourage fluid
intake of 2,000 to 3,000 mL of water per day, unless contraindicated; teach the
patient, family, and caregivers, the purpose and proper technique for maintaining
isolation; if infection occurs, teach the patient to take antibiotics as prescribed.
Instruct patient to take the full course of antibiotics even if symptoms improve or
disappear.
 Restore skin integrity. Monitor status of skin around wound; monitor patient’s
skin care practices, noting the type of soap or other cleansing agents used,
temperature of water, and frequency of skin cleansing; tell patient to avoid
rubbing and scratching; provide gloves or clip the nails if necessary; and instruct
patient, significant others, and family in the proper care of the wound
including hand washing, wound cleansing, dressing changes, and application of
topical medications).
  Relieve pain. Acknowledge reports of pain immediately; provide rest periods to
promote relief, sleep, and relaxation; provide analgesics as ordered, evaluating
the effectiveness and inspecting for any signs and symptoms of adverse effects;
and determine the appropriate pain relief method.

U. All Sexually Transmitted Disease

The term sexually transmitted disease (STD) is used to refer to a condition passed from
one person to another through sexual contact. You can contract an STD by having
unprotected vaginal, anal, or oral sex with someone who has the STD.
An STD may also be called a sexually transmitted infection (STI) or venereal disease
(VD).
That doesn’t mean sex is the only way STDs are transmitted. Depending on the specific
STD, infections may also be transmitted through sharing needles and breastfeeding.

Symptoms of STDs in men

It’s possible to contract an STD without developing symptoms. But some STDs cause
obvious symptoms. In men, common symptoms include:
 pain or discomfort during sex or urination
 sores, bumps, or rashes on or around the penis, testicles, anus, buttocks, thighs,
or mouth
 unusual discharge or bleeding from the penis
 painful or swollen testicles
Specific symptoms can vary, depending on the STD. 

Symptoms of STDs in women

In many cases, STDs don’t cause noticeable symptoms. When they do, common STD
symptoms in women include:
 pain or discomfort during sex or urination
 sores, bumps, or rashes on or around the vagina, anus, buttocks, thighs, or
mouth
 unusual discharge or bleeding from the vagina
 itchiness in or around the vagina
The specific symptoms can vary from one STD to another. 

Types of STDs
Many different types of infections can be transmitted sexually. The most common STDs
are described below.
Chlamydia
A certain type of bacteria causes chlamydia. It’s the most commonly reported STD
among Americans, notes the Centers for Disease Control and Prevention (CDC)Trusted
Source.
Many people with chlamydia have no noticeable symptoms. When symptoms do
develop, they often include:
 pain or discomfort during sex or urination
 green or yellow discharge from the penis or vagina
 pain in the lower abdomen
If left untreated, chlamydia can lead to:
 infections of the urethra, prostate gland, or testicles
 pelvic inflammatory disease
 infertility
If a pregnant woman has untreated chlamydia, she can pass it to her baby during birth.
The baby may develop:
 pneumonia
 eye infections
 blindness
Antibiotics can easily treat chlamydia. Read more about chlamydia, including how to
prevent, recognize, and treat it.
HPV (human papillomavirus)
Human papillomavirus (HPV) is a virus that can be passed from one person to another
through intimate skin-to-skin or sexual contact. There are many different strains of the
virus. Some are more dangerous than others.
The most common symptom of HPV is warts on the genitals, mouth, or throat.
Some strains of HPV infection can lead to cancer, including:
  oral cancer
 cervical cancer
 vulvar cancer
 penile cancer
 rectal cancer
While most cases of HPV don’t become cancerous, some strains of the virus are more
likely to cause cancer than others. According to the National Cancer InstituteTrusted
Source, most cases of HPV-related cancer in the United States are caused by HPV 16
and HPV 18. These two strains of HPV account for 70 percent of all cervical cancer
cases.
There’s no treatment for HPV. However, HPV infections often clear up on their own.
There’s also a vaccine available to protect against some of the most dangerous strains,
including HPV 16 and HPV 18.
If you contract HPV, proper testing and screenings can help your doctor assess and
manage your risk of complications. Discover the steps you can take to protect yourself
against HPV and its potential complications.
Syphilis
Syphilis is another bacterial infection. It often goes unnoticed in its early stages.
The first symptom to appear is a small round sore, known as a chancre. It can develop
on your genitals, anus, or mouth. It’s painless but very infectious.
Later symptoms of syphilis can include:
 rash
 fatigue
 fever
 headaches
 joint pain
 weight loss
 hair loss
If left untreated, late-stage syphilis can lead to:
 loss of vision
 loss of hearing
  loss of memory
 mental illness
 infections of the brain or spinal cord
 heart disease
 death
Fortunately, if caught early enough, syphilis is easily treated with antibiotics. However,
syphilis infection in a newborn can be fatal. That’s why it’s important for all pregnant
women to be screened for syphilis.
The earlier syphilis is diagnosed and treated, the less damage it does. Find the
information you need to recognize syphilis and stop it in its tracks.
HIV
HIV can damage the immune system and raise the risk of contracting other viruses or
bacteria and certain cancers. If left untreated, it can lead to stage 3 HIV, known
as AIDS. But with today’s treatment, many people living with HIV don’t ever develop
AIDS.
In the early or acute stages, it’s easy to mistake the symptoms of HIV with those of the
flu. For example, the early symptoms can include:
 fever
 chills
 aches and pains
 swollen lymph nodes
 sore throat
 headache
 nausea
 rashes
These initial symptoms typically clear within a month or so. From that point onward, a
person can carry HIV without developing serious or persistent symptoms for many
years. Other people may develop nonspecific symptoms, such as:
 recurrent fatigue
 fevers
 headaches
  stomach issues
There’s no cure for HIV yet, but treatment options are available to manage it. Early and
effective treatment can help people with HIV live as long as those without HIV.
Proper treatment can also lower your chances of transmitting HIV to a sexual partner. In
fact, treatment can potentially lower the amount of HIV in your body to undetectable
levels. At undetectable levels, HIV can’t be transmitted to other people, reports
the CDCTrusted Source.
Without routine testing, many people with HIV don’t realize they have it. To promote
early diagnosis and treatment, the CDCTrusted Source recommends that everyone
between the ages of 13 and 64 be tested at least once. People at high risk of HIV
should be tested at least once a year, even if they don’t have symptoms.
Free and confidential testing can be found in all major cities and many public health
clinics. A government tool for finding local testing services is available here.
With recent advancements in testing and treatment, it’s possible to live a long and
healthy life with HIV. Get the facts you need to protect yourself or your partner from HIV.
Gonorrhea
Gonorrhea is another common bacterial STD. It’s also known as “the clap.”
Many people with gonorrhea develop no symptoms. But when present, symptoms may
include:
 a white, yellow, beige, or green-colored discharge from the penis or vagina
 pain or discomfort during sex or urination
 more frequent urination than usual
 itching around the genitals
 sore throat
If left untreated, gonorrhea can lead to:
 infections of the urethra, prostate gland, or testicles
 pelvic inflammatory disease
 infertility
It’s possible for a mother to pass gonorrhea onto a newborn during childbirth. When that
happens, gonorrhea can cause serious health problems in the baby. That’s why many
doctors encourage pregnant women to get tested and treated for potential STDs.
Gonorrhea can usually be treated with antibiotics. Learn more about the symptoms,
treatment options, and long-term outlook for people with gonorrhea.
Pubic lice (‘crabs’)
“Crabs” is another name for pubic lice. They’re tiny insects that can take up residence
on your pubic hair. Like head lice and body lice, they feed on human blood.
Common symptoms of pubic lice include:
 itching around the genitals or anus
 small pink or red bumps around the genitals or anus
 low-grade fever
 lack of energy
 irritability
You might also be able to see the lice or their tiny white eggs around the roots of pubic
hair. A magnifying glass can help you spot them.
If left untreated, pubic lice can spread to other people through skin-to-skin contact or
shared clothing, bedding, or towels. Scratched bites can also become infected. It’s best
to treat pubic lice infestations immediately.
If you have pubic lice, you can use over-the-counter topical treatments and tweezers to
remove them from your body. It’s also important to clean your clothes, bedding, towels,
and home. Here’s more on how to get rid of pubic lice and prevent reinfection.
Trichomoniasis
Trichomoniasis is also known as “trich.” It’s caused by a tiny protozoan organism that
can be passed from one person to another through genital contact.
According to the CDCTrusted Source, less than one-third of people with trich develop
symptoms. When symptoms do develop, they may include:
 discharge from the vagina or penis
 burning or itching around the vagina or penis
 pain or discomfort during urination or sex
 frequent urination
In women, trich-related discharge often has an unpleasant or “fishy” smell.
If left untreated, trich can lead to:
 infections of the urethra
  pelvic inflammatory disease
 infertility
Trich can be treated with antibiotics. Learn how to recognize trich early to get treatment
sooner.
Herpes
Herpes is the shortened name for the herpes simplex virus (HSV). There are two main
strains of the virus, HSV-1 and HSV-2. Both can be transmitted sexually. It’s a very
common STD. The CDC estimates more than 1 out of 6Trusted Source people ages 14
to 49 have herpes in the United States.
HSV-1 primarily causes oral herpes, which is responsible for cold sores. However, HSV-
1 can also be passed from one person’s mouth to another person’s genitals during oral
sex. When this happens, HSV-1 can cause genital herpes.
HSV-2 primarily causes genital herpes.
The most common symptom of herpes is blistery sores. In the case of genital herpes,
these sores develop on or around the genitals. In oral herpes, they develop on or
around the mouth.
Herpes sores generally crust over and heal within a few weeks. The first outbreak is
usually the most painful. Outbreaks typically become less painful and frequent over
time.
If a pregnant woman has herpes, she can potentially pass it to her fetus in the womb or
to her newborn infant during childbirth. This so-called congenital herpes can be very
dangerous to newborns. That’s why it’s beneficial for pregnant women to become aware
of their HSV status.
There’s no cure for herpes yet. But medications are available to help control outbreaks
and alleviate the pain of herpes sores. The same medications can also lower your
chances of passing herpes to your sexual partner.
Effective treatment and safe sexual practices can help you lead a comfortable life with
herpes and protect others from the virus. Get the information you need to prevent,
recognize, and manage herpes.
Other STDs
Other, less common STDs include:
 chancroid
 lymphogranuloma venereum
 granuloma inguinale
  molluscum contagiosum
 scabies

STDs from oral sex

Vaginal and anal sex aren’t the only way STDs are transmitted. It’s also possible to
contract or transmit an STD through oral sex. In other words, STDs can be passed from
one person’s genitals to another person’s mouth or throat and vice versa.
Oral STDs aren’t always noticeable. When they do cause symptoms, they often include
a sore throat or sores around the mouth or throat. 
Curable STDs
Many STDs are curable. For example, the following STDs can be cured with antibiotics
or other treatments:
 chlamydia
 syphilis
 gonorrhea
 crabs
 trichomoniasis
Others can’t be cured. For example, the following STDs are currently incurable:
 HPV
 HIV
 herpes
Even if an STD can’t be cured, however, it can still be managed. It’s still important to get
an early diagnosis. Treatment options are often available to help alleviate symptoms
and lower your chances of transmitting the STD to someone else. 

STDs and pregnancy

It’s possible for pregnant women to transmit STDs to the fetus during pregnancy or
newborn during childbirth. In newborns, STDs can cause complications. In some cases,
they can be life-threatening.
To help prevent STDs in newborns, doctors often encourage pregnant women to be
tested and treated for potential STDs. Your doctor might recommend STD testing even
if you don’t have symptoms.
If you test positive for one or more STDs while pregnant, your doctor might prescribe
antibiotics, antiviral medications, or other treatments. In some cases, they might
encourage you to give birth via a cesarean delivery to lower the risk of transmission
during childbirth.
Diagnosis of STDs
In most cases, doctors can’t diagnose STDs based on symptoms alone. If your doctor
or other healthcare provider suspects you might have an STD, they’ll likely recommend
tests to check.
Depending on your sexual history, your healthcare provider might recommend STD
testing even if you don’t have symptoms. This is because STDs don’t cause noticeable
symptoms in many cases. But even symptom-free STDs can cause damage or be
passed to other people.
Healthcare providers can diagnose most STDs using a urine or blood test. They may
also take a swab of your genitals. If you’ve developed any sores, they may take swabs
of those, too.
You can get tested for STDs at your doctor’s office or a sexual health clinic.
Home testing kits are also available for some STDs, but they may not always be
reliable. Use them with caution. Check to see if the U.S. Food and Drug Administration
has approved the testing kit before buying it.
It’s important to know that a Pap smear isn’t an STD test. A Pap smear checks for the
presence of precancerous cells on the cervix. While it may also be combined with an
HPV test, a negative Pap smear doesn’t mean you don’t have any STDs.
If you’ve had any type of sex, it’s a good idea to ask your healthcare provider about
STD testing. Some people may benefit from more frequent testing than others. Find out
if you should be tested for STDs and what the tests involve.
Treatment of STDs
The recommended treatment for STDs varies, depending on what STD you have. It’s
very important that you and your sexual partner be successfully treated for STDs before
resuming sexual activity. Otherwise, you can pass an infection back and forth between
you.
Bacterial STDs
Usually, antibiotics can easily treat bacterial infections.
It’s important to take all your antibiotics as prescribed. Continue taking them even if you
feel better before you finish taking all of them. Let your doctor know if your symptoms
don’t go away or return after you’ve taken all of your prescribed medication.
Viral STDs
Antibiotics can’t treat viral STDs. While most viral infections have no cure, some can
clear on their own. And in many cases, treatment options are available to relieve
symptoms and reduce the risk of transmission.
For example, medications are available to reduce the frequency and severity of herpes
outbreaks. Likewise, treatment can help stop the progression of HIV. Furthermore,
antiviral drugs can lower your risk of transmitting HIV to someone else.
Other STDs
Some STDs are caused by neither viruses nor bacteria. Instead, they’re caused by
other small organisms. Examples include:
 pubic lice
 trichomoniasis
 scabies
These STDs are usually treatable with oral or topical medications. Ask your doctor or
other healthcare provider for more information about your condition and treatment
options.
STD prevention
Avoiding sexual contact is the only foolproof way to avoid STDs. But if you do have
vaginal, anal, or oral sex, there are ways to make it safer.
When used properly, condoms provide effective protection against many STDs. For
optimal protection, it’s important to use condoms during vaginal, anal, and oral
sex. Dental dams can also provide protection during oral sex.
Condoms are generally effective at preventing STDs that spread through fluids, such as
semen or blood. But they can’t fully protect against STDs that spread from skin to skin.
If your condom doesn’t cover the infected area of skin, you can still contract an STD or
pass it to your partner.
Condoms can help protect against not only STDs, but also unwanted pregnancy.
In contrast, many other types of birth control lower the risk of unwanted pregnancy but
not STDs. For example, the following forms of birth control don’t protect against STDs:
 birth control pills
 birth control shot
  birth control implants
 intrauterine devices (IUDs)
Regular STD screening is a good idea for anyone who’s sexually active. It’s particularly
important for those with a new partner or multiple partners. Early diagnosis and
treatment can help stop the spread of infections.
Before having sex with a new partner, it’s important to discuss your sexual history. Both
of you should also be screened for STDs by a healthcare professional. Since STDs
often have no symptoms, testing is the only way to know for sure if you have one.
When discussing STD test results, it’s important to ask your partner what they’ve been
tested for. Many people assume their doctors have screened them for STDs as part of
their regular care, but that’s not always true. You need to ask your doctor for specific
STD tests to ensure you take them.
If your partner tests positive for an STD, it’s important for them to follow their healthcare
provider’s recommended treatment plan. You can also ask your doctor about strategies
to protect yourself from contracting the STD from your partner. For example, if your
partner has HIV, your doctor will likely encourage you to take pre-exposure prophylaxis
(PrEP).
If you’re eligible, you and your partner should also consider getting vaccinated for HPV
and hepatitis B.
By following these strategies and others, you can lower your chances of getting STDs
and passing them to others. Learn more about the importance of safe sex and STD
prevention.

Living with STDs

If you test positive for an STD, it’s important to get treatment as soon as possible.
If you have one STD, it can often increase your chances of contracting another. Some
STDs can also lead to severe consequences if left untreated. In rare cases, untreated
STDs may even be fatal.
Fortunately, most STDs are highly treatable. In some cases, they can be cured entirely.
In other cases, early and effective treatment can help relieve symptoms, lower your risk
of complications, and protect sexual partners.
In addition to taking prescribed medications for STDs, your doctor may advise you to
adjust your sexual habits to help protect yourself and others. For example, they’ll likely
advise you to avoid sex altogether until your infection has been effectively treated.
When you resume sex, they’ll probably encourage you to use condoms, dental dams, or
other forms of protection.
Following your doctor’s recommended treatment and prevention plan can help improve
your long-term outlook with STDs.

V. What is:

Incubation period
Incubation period: In medicine, the time from the moment of exposure to an infectious
agent until signs and symptoms of the disease appear. For example, the incubation
period of chickenpox is 14-16 days.
In biology, the incubation period is the time needed for any
particular process of development to take place. For example, the length of time for
turtle eggs to hatch is the incubation period.
The incubation period occurs in an acute disease after the initial entry of the pathogen
into the host (patient). It is during this time the pathogen begins multiplying in the host.
However, there are insufficient numbers of pathogen particles (cells or viruses) present
to cause signs and symptoms of disease. Incubation periods can vary from a day or two
in acute disease to months or years in chronic disease, depending upon the pathogen.
Factors involved in determining the length of the incubation period are diverse, and can
include strength of the pathogen, strength of the host immune defenses, site of
infection, type of infection, and the size infectious dose received. During this incubation
period, the patient is unaware that a disease is beginning to develop.
The prodromal period occurs after the incubation period. During this phase, the
pathogen continues to multiply and the host begins to experience general signs and
symptoms of illness, which typically result from activation of the immune system, such
as fever, pain, soreness, swelling, or inflammation. 
Invasion period
the period between infection and the appearance of symptoms of the disease

The period of illness is followed by the period of decline, during which the number of
pathogen particles begins to decrease, and the signs and symptoms of illness begin to
decline. However, during the decline period, patients may become susceptible to
developing secondary infections because their immune systems have been weakened
by the primary infection. The final period is known as the period of convalescence.
During this stage, the patient generally returns to normal functions, although some
diseases may inflict permanent damage that the body cannot fully repair.
Communicable period
The time during which an infectious agent may be transferred directly or indirectly from
an infected person to another person, from an infected animal to humans, or from an
infected person to animals, including arthropods. 
In diseases such as diphtheria and streptococcal infection, in which mucous
membranes are involved from the initial entry of the infectious agent, the period of
communicability is from the date of first exposure to a source of infection until the
infecting microorganism is no longer disseminated from the involved mucous
membranes, i.e., from the period before the prodromata until termination of a carrier
state, if the latter develops. Some diseases are more communicable during the
incubation period than during the actual illness (e.g., hepatitis A, measles). 
In diseases such as tuberculosis, leprosy, syphilis, gonorrhea and some of the
salmonelloses, the communicable state may exist over a long and sometimes
intermittent period when active chronic lesions permit the discharge of infectious agents
from the surface of the skin or through any of the body orifices.
In diseases transmitted by arthropods, such as malaria and yellow fever, the periods of
communicability (or more properly infectivity) are those during which the infectious
agent occurs in the blood or other tissues of the infected person in sufficient numbers to
permit infection of the vector. A period of communicability (transmissibility) is also to
be noted for the arthropod vector, namely, when the agent is present in the tissues of
the arthropod in such form and locus (infective state) as to be transmissible.

Latent period
The period between exposure and infection is called 'latent period', since the pathogen
is present in a 'latent' stage, without clinical symptoms or signes of infection in the host.

Defervescence period
Defervescence occurs between  3 to 7 days of illness. Defervescence is known as the
period in which the body temperature (fever) drops to almost normal (between 37.5 to
38°C).