CARE OF MOTHER, CHILD AT RISK WITH PROBLEM (ACUTE AND CHRONIC)

SEXUALLY TRANSMITTED INFECTION

MARK GREGORY M. ADDATU
MRS. FELITA LACERONA

OUTLINE - The adolescent will notice vulvar and vaginal

I. Sexually Transmitted Infections reddening, burning and itching and even bleeding
i. How to avoid STI’s? from hairline fissures.
ii. Nursing Responsibility - A thick, cream-cheese like discharge can usually be
iii. Fact observed at the vaginal outlet.
A. Candidiasis - The vagina shows white patches that cannot be
B. Trichomoniasis spread away without bleeding on the walls.
C. Bacterial Vigonis
D. Chlamydia Trachomatis Infection DIAGNOSIS
E. Human Papillomavirus - Candidal infection are diagnosed by removing a
F. Herpes Genitals sample of the discharged from the vaginal wall and
G. Hepatitis B and Hepatitis C placing it on a glass slide.
H. Gonorrhea - An at-home test kit (Vagisil Screening Kit) is
I. Syphilis available, which gives results instantly. A woman
J. Group B Streptococcal inserts a pH want into her vagina and in a few
K. HIV seconds. Compares the color of the swab to ah pH
color chart.
I. Sexually Transmitted Infections - If the reading is above 5.0, it suggest she may have
- This are disease that are spread through sexual bacterial infections and should see her health care
contact with an infected part. provider.
- A pH level of 4.5 plus itching and/or burning, unusual
How to avoid STI’s? discharge, or yeast color suggests a yeast infection
- Abstinence or condom use provides the best and it suggest that it will be all right for her to use an
protection against STI’s. Additional measures over-the counter treatment.
including avoiding immediately and washing genitals
well with soap and water after sexual intercourse as THERAPEUTIC MANAGEMENT
well as choosing sexual partners with low risks for - Therapy for candida infections includes vaginal
infection. (ex. Avoiding persons who are intravenous
tablets or cream applications of antifungal
drug users or those with multiple sexual partners)
preparations such as over-the-counter miconzote
(Monistal) or Clotrimazole (Lotrimin) once a day
Nursing Responsibility for 3 to 7 days.
- Educating about safer sex practices
- Oral flucarozole (Diflucan) can be administered as
a. Including the need of condom
one time dose and approved during pregnancy.
b. Importance of health screening for these - To stop vaginal drainage, teach women to use
disorders. antifungal pills or lotions before bed. Even when a
woman is having her period, treatment shouldn't
FACT!
stop. and girls who get sick a lot should get a glucose
- STI’s are becoming more difficult to treat test done on their urine to rule out diabetes. If she is
because the causative organisms are becoming using oral contraceptives, she might be told to switch
increasingly resistant to antibiotics.
to something else. If a teen is sexually active, his
male partner may need to take medicine to keep the
virus from coming back.
INFORMATION/S UNDER TOPIC
PREGNANCY AND CADIDIASIS
A. CANDIDIASIS - It happens more often during pregnancy than at other
- It is commonly known as yeast infection, and it is times because the higher estrogen level makes the
cause by small fungus. Healthy women normally vaginal pH less acidic, making it even better for yeast
have small numbers of them in the vagina. to grow.
Sometimes the numbers grow and cause such - It's essential to treat infections during pregnancy, not
problem as: only because they can cause a lot of discharge and
A. Vaginal Itching itching but also because if the disease is still in the
B. Burning vagina when the baby is born, it can give the baby a
C. Curdy candida infection or thrush.
D. White discharge and; - Before using an over-the-counter product, pregnant
E. Pain when having sex women should call their primary care providers to
make sure that the product is safe to use during
Yest Infection in men are common also because fungus that pregnancy. This way, the primary care providers can
causes yeast infections is normally present on skin, specially also know if a vaginal infection is happening.
moist skin. But, yeast infection is not STI but it is possible to
pass yeast infection to your partner during vaginal, oral or anal B. TRICHOMONIASIS
sex. So, if yeast infection left untreated, vaginal candidiasis - Trichomoniasis vaginalis is a curable STI and has the
will most likely get worse, causing itchy, redness and highest prevalence among adolescent.
inflammation. - The incubation period is 4 to 20 days.
- A serious consequence of trichomoniasis is that
infection can cause such genital inflammation that it
ASSESSMENT makes it easier for the person to be infected with the
HIV virus or to pass the HIV virus on to a sex partner.
 CARE OF MOTHER, CHILD AT RISK WITH PROBLEM (ACUTE AND CHRONIC)
SEXUALLY TRANSMITTED INFECTION
MARK GREGORY M. ADDATU
MRS. FELITA LACERONA
ASSESSMENT
- Females may only have a small amount of vaginal
discharge or a lot of itching and frothy white or
grayish-green vaginal discharge.
- The top of the vagina looks red and may have tiny
red dots called petechiae. Some women's bodies
change so much during this time that A Pap test
result could be wrong as showing abnormal tissue.
- Most of the time, males with the same infection don't
show any symptoms.
- A sample of the vaginal discharge is looked at under
a microscope to determine if there is an infection.
Trichomonads look like round, moving structures.
THERAPEUTIC MANAGEMENT
- Trichomonas infections can be cured by taking
metronidazole (Flagyl) or tinidazole (Tindamax).
- When sexual partners use condoms, it keeps both of
them from getting Trichomonas again. Because
metronidazole interacts with alcohol in a way that
makes people feel sick and throw up quickly, women
and older teens should not drink alcohol while taking
this drug.
PREGNANCY AND TRICHOMONIASIS
- Trichomoniasis infections can cause early labor,
premature rupture of the membranes, and conditions
after cesarean delivery.
- Metronidazole taken by mouth in a single dose is
the best drug to use during pregnancy.
- Even though it is a Class B pregnancy drug, it can't
be administered during the first trimester of
pregnancy because it could harm the baby.
C. BACTERIAL VAGINOSIS
- Bacterial vaginosis is when there aren't enough
lactobacilli in the vaginal flora or when there aren't
any at all. It's common in women of childbearing age.
- A vaginal discharge that itches a lot looks milky white
to gray and smells like fish.
- Bacterial vaginosis, like trichomoniasis, can make a
woman more likely to get STIs like herpes simplex
virus (HSV), chlamydia, gonorrhea, and HIV.
- Metronidazole can be taken by mouth or through the
vaginal canal for seven days.
- The woman's sexual partner should also be treated
to keep the infection from returning.
- In the future, probiotic lactobacilli therapy could
change the organisms in the vaginal area.
PREGNANCY AND BACTERIAL VAGINOSIS
- Pregnant women take oral metronidazole or
clindamycin for seven days to prevent early labor
and premature membrane rupture.
D. CHLAMYDIA TRACHOMATIS INFECTION
- In the United States, Chlamydia trachomatis
infections are now the most common bacterial cause
of STIs.
- Symptoms include a heavy, grayish-white discharge
and itching in the vulvar area. The incubation period
is 1 to 5 weeks.
DIAGNOSIS
- The organism needs to be identified, which can be
done at the point of care with a swab of the urethra
or cervix.
- A urine sample can also be used as a way to screen
people.
THERAPEUTIC MANAGEMENT
- The treatment is either doxycycline by mouth for
seven days or a single dose of azithromycin.
Because the infection is so common now, most
public health departments require that it be reported
to them, just like gonorrhea or other sexually
transmitted diseases. Since there is a strong link
between gonorrhea and Chlamydia, women who
have been diagnosed with Chlamydia are often also
tested for gonorrhea. Infections with Chlamydia can
cause PID, which could lead to infertility.
PREGNANCY AND CHLAMYDIA TRACHOMATIC
- A woman's first prenatal visit is often when a vaginal
culture is done to check for Chlamydia.
- Screening may be done again in the third trimester if
a woman has more than one sexual partner.
- Doxycycline (Vibramycin), which is the treatment
for women who aren't pregnant, can cause long-
bone deformities in the fetus. Instead, azithromycin
(Zithromax) or amoxicillin (Amoxil) are used.
- Her partner should also be treated to keep a woman
from getting sick again.
- During pregnancy, it's essential to treat chlamydial
infections because they can lead to premature
rupture of the membranes, early labor, and
endometritis after giving birth.
- If a baby is born while the mother has Chlamydia, the
baby can get conjunctivitis or pneumonia after birth.
E. HUMAN PAPILLOMAVIRUS
- The human papillomavirus (HPV) causes genital
warts, which are overgrowths of fibrous tissue
outside the vulva, vagina, or cervix (condyloma
acuminatum).
- At first, lesions look like separate papillary structures.
Later, they spread, grow, and join together to form
large lesions that look like cauliflower. The infection
may be present in as many as 10% to 30% of
women, and it is most common in women with more
than one sexual partner.
- Teens who get an HPV vaccine should avoid HPV
infections and cancers of the cervical and penile
regions.
PREGNANCY AND HUMAN PAPILLOMAVIRUS
- During pregnancy, HPV lesions grow because of a
lot of blood flow to the pelvis. Infected vulvar ulcers
can cause an unpleasant odor.
- Podophyllum could hurt the baby if the mother is
pregnant. During pregnancy, TCA or BCA can be put
on lesions once a week.
- Women who don't mind the moles may wait until after
giving birth to get rid of them. In the meantime, you
should remind them that the sores are spreadable.
- A cesarean birth may be scheduled if the vulvar
lesions are so extensive that they block the way for
the baby to come out.
 CARE OF MOTHER, CHILD AT RISK WITH PROBLEM (ACUTE AND CHRONIC)
SEXUALLY TRANSMITTED INFECTION
MARK GREGORY M. ADDATU
MRS. FELITA LACERONA
THERAPEUTIC MANAGEMENT
- A wart treatment called podophyllin (Podofin) can
eliminate small growths. Large lesions can be cut out
with a laser, cryocautery, or knife. Cryocautery
causes rapid swelling, gangrenous lesions,
sloughing in 7 days, and complete healing in 4 to 6
weeks with only mild depigmentation. Warm baths
and lidocaine cream may help the wound get better.
- Infections with the virus HPV can lead to penile and
cervical cancer in the future. If a woman has had one
condition, she should get a Pap test every year for
the rest of her life, and men should check their penis
for ulcers or abnormal growths. Teenage girls and
boys should get Gardasil or Cervarix as a standard
shot.
F. HERPIS GENITALS
- Herpes is caused by a virus called HSV2 (also called
herpes simplex virus type 2 or HSV-2). It is one of
four very similar herpes viruses. The other three are
cytomegalovirus, Epstein–Barr, varicella zoster, and
herpes 1 and 2. (HSV-2). In the US, genital herpes is
widespread, and HSV-1 is causing more and more
new infections.
- Herpes genitals is a lifelong disease that may not
directly cause cervical cancer. Still, women with
cervical cancer tend to have more antibodies against
the virus or have been exposed to it more often. The
virus spreads through cuts or sores on the skin,
mouth, and nose. The virus can affect the whole
body or kill newborns.
ASSESSMENT
- Herpes can be found by culturing lesion fluid from the
vulva, vagina, cervix, or penis or by finding HSV
antibodies in blood serum.
- Between 3 and 14 days of incubation
- Primary lesions that get a big start as tiny bumps on
an erythematous base. Within a few days, the
blisters get sores and become wet, painful ones that
drain.
- A teenager may have flu-like symptoms and a fever,
and lesions in the vaginal area may cause a lot of
vaginal discharge. Clothing or urine that is too acidic
hurts a lot.
- A Pap smear, an enzyme-linked immunosorbent
assay, and lesions are used to determine what's
wrong. The wounds heal after a week, but the virus
stays dormant in the sensory nerve ganglia.
- The condition can worsen when the person is sick,
has a fever, gets too much sun, or is stressed out.
This secondary response only causes local wounds,
not symptoms that affect the whole body.
THERAPEUTIC MANAGEMENT
- Antivirals like acyclovir (Zovirax) and valacyclovir
(Valtrex) stop DNA from copying, so symptoms
improve.
- For resistant lesions, use imiquimod (Aldara) or
foscarnet (Foscavir). Wear a finger cot or glove
when putting Ointment or vaginal gel on a patient so
you don't get the virus or take in the drug. Patients
may feel less pain if they take warm baths three times
a day.
- Emollients, like A&D Ointment, can ease pain, but
their moisture slows down the healing process.
- To stop the virus from spreading, infected people
must tell their partners about any active sores and
either avoid sexual contact or use a condom.
- If a woman has genital herpes, she should get a Pap
test every year for the rest of her life. Men should
check themselves for recurrent lesions.
PREGNANCY AND HERPIS GENITALS
- If a woman gets HSV-2 while pregnant, the virus can
be passed to the baby through the placenta and
cause a congenital infection.
- If there are primary or secondary active lesions in or
on the vulva at birth, the herpes infection can be
passed on to the baby. When this happens, it can
lead to a severe condition that affects the whole body
and is often fatal.
- Most of the time, women with active lesions are
scheduled to have cesarean births so that the
disease doesn't spread.
- When a woman is pregnant, the best drug to treat a
herpes infection is the same as when she is not
pregnant: acyclovir (Zovirax) or valacyclovir
(Valtrex).
- Women can ease the pain of the lesions by taking
baths or putting warm, moist tea bags on the area.
G. HEPATITIS B AND HEPATITIS C
- Hepatitis B and C are STIs because they can be
passed on through blood and sperm. They are talked
about with other kinds of hepatitis. Teens who are
sexually active and were not vaccinated against
hepatitis B as babies need to get vaccinated.
H. GONORRHEA
- Neisseria gonorrhoeae grows well in mucus from the
vaginal or penis areas. Males get urethritis (pain and
the need to urinate often) and a urethral discharge
after a 2- to the 7-day incubation period. If the
infection isn't treated, it can spread to the testicles,
scarring the tubules and making the person sterile for
life. It usually goes along with chlamydia.
- Among the signs of gonorrhea in women is a yellow
discharge from the genital area. When Bartholin
glands get swollen, it hurts. If the infection isn't
treated, it can spread to the organs in the pelvis,
especially the fallopian tubes. This can cause PID
and make men permanently sterile. Both men and
women can get arthritis or heart disease from a
disease that affects the whole body.
ASSESSMENT
- All children with vulvovaginitis or a urethral discharge
should have a urine culture for the gonococcal
bacillus, as well as vaginal, urethral, and maybe even
anal and oral cultures, to rule out gonorrhea.
THERAPEUTIC MANAGEMENT
- At the moment, gonorrhea, chlamydia, and syphilis
are treated with one intramuscular injection of
ceftriaxone (Rocephin) and seven days of oral
doxycycline (Vibramycin) or azithromycin
(Zithromax).
- After treatment, gonorrhea that can spread is gone in
24 hours. A follow-up culture should be done seven
days after treatment to make sure the disease is
gone (few adolescents take this precaution without
urging).
 CARE OF MOTHER, CHILD AT RISK WITH PROBLEM (ACUTE AND CHRONIC)
SEXUALLY TRANSMITTED INFECTION
MARK GREGORY M. ADDATU
MRS. FELITA LACERONA
- Most states need to know about gonorrhea, and
teens are asked to name their sexual partners to stop
the disease from spreading. A health department
investigator can tell them they were exposed to an
STI and need treatment, even if they don't know who
put them at risk.
PREGNANCY AND GONORRHEA
- Gonorrhea can cause a woman to miscarry, give
birth early, or get endometritis after giving birth.
Women who are pregnant should not take
doxycycline. Azithromycin is given to them. If
gonorrhea is present when a baby is born, it can
cause a severe eye infection that can lead to the
baby going blind.
I. SYPHILIS
- Treponema pallidum causes systemic syphilis. It's a
disease that needs to be reported, like gonorrhea
and chlamydia.
- From oral to genital or genital to anal contact, after
10 to 90 days a deep ulcer (chancre) shows up on
the genitalia (penis or labia), vagina, mouth, lips, or
rectal area. There may also be swollen lymph nodes,
which are less obvious. If you don't treat a chancre,
it will last for 6 weeks.
- After 2 to 4 weeks, a round, copper-colored rash
shows up. The feet, hands, arms, legs, and whole
body are affected. A low-grade fever is a sign of a
general illness. A test for syphilis is now positive.
This stage of syphilis goes away whether you get
treatment or not.
- A latency period can last anywhere from a few years
to a few decades. Serology tests continue to show
that the disease is present.
- Final stage syphilis is a neurological disease that
affects the heart and nervous system. It can cause
blindness, paralysis, mental confusion, slurred
speech, and lack of coordination. If nothing is done,
this third stage can kill you.
ASSESSMENT
- Syphilis is diagnosed by looking at the three stages
of symptoms and by doing serologic serum tests,
such as the Venereal Disease Research Laboratory
(VDRL) test, the automated reagin test (ART), the
rapid plasma reagin (RPR), or the fluorescent
treponemal antibody–adsorption test (FTA-ABS).
THERAPEUTIC MANAGEMENT
- Benzathine penicillin G given through the muscle
works. Teenagers who are allergic to penicillin can
take erythromycin or tetracycline by mouth for 10 to
15 days. Sexual partners are treated the same as the
person who has the disease. At any stage of a
disease, therapy can stop it. After therapy, teens may
have low blood pressure, a fever, a fast heart rate,
and muscle aches.
- The reaction goes away after 24 hours. Since it is
easy to treat, syphilis should be easy to get rid of.
Because the first chancre doesn't hurt, many people
ignore it and pass the disease on to partners who
don't know they have it. Teens should get a history
and physical to check for STIs, and sexuality should
be talked about when they go to the doctor. They
need to know that they won't be judged if they tell
about the disease and name sexual partners.
PREGNANCY AND SYPHILIS
- Before week 18, the placenta might keep syphilis
away. After this time, the spirochete can move freely
across the placenta and may cause a spontaneous
miscarriage, early labor, stillbirth, or congenital
disabilities.
- At their first prenatal visit, all women get a VDRL,
ART, or FTA-ABS test.
- Week 36 tests are done on pregnancies with more
than one father.
- In some places, women are rechecked when they
start to give birth, and their newborns' cord blood is
used to check for HIV.
- The best way to treat syphilis during pregnancy is
with one injection of benzathine penicillin G. The
baby needs penicillin if the mother has syphilis.
- Syphilis that is not treated during pregnancy can
cause congenital disabilities in the baby.
- Infected babies either don't live or are born with
congenital disabilities. Wet sores may be infectious,
like those on the cord or in the nose.
- A week after being born, babies get a copper-colored
rash on their faces, palms, and soles of their feet.
- Babies may have bad rhinitis (stuffiness). Long
bones' epiphyseal lines change between 1 and 3
months. By 5–6 months, you might not notice these
bone changes.
- When permanent teeth come in at age 5 or 6, they
may be pointed or notched (Hutchinson's teeth),
which makes them easy to decay.
- Interstitial keratitis is an inflammatory corneal
reaction that can happen when a child is in school. If
it is not treated, it can lead to scarring and blindness.
As the disease gets worse, it may cause severe
neurological symptoms.
J. GROUP B STREPTOCOCCAL
- Even though Streptococcus B is less well-known
than HSV-2 or gonorrhea, it may be more common.
A UTI while pregnant can lead to intra-amniotic
infections, preterm birth, and postpartum
endometritis.
- At 35 to 38 weeks, pregnant women are tested for
streptococcus B to ensure it doesn't pass through the
placenta or come into contact with vaginal secretions
at birth. Infections in newborns can lead to things like
pneumonia, sepsis, RDS, or meningitis.
- The best antibiotic is ampicillin. Women whose
membranes break before 37 weeks and who haven't
been checked may be given ampicillin through an IV
during labor to keep the baby from getting sick.
K. HIV
- HIV is an STI because it can be spread through
sperm and other body fluids. There is talk about
viruses and problems with the immune system.