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STIs-FSU341

STIs

QuestionAnswer
CDC estimates of new STI infections yearly 19 million
STIs that are reported to CDC Gonnorrhea, syphilis, chlamydia, and AIDS
STIs that are not reported to CDC HPV and herpes
Contributing factors to the rise in STI infections -Earlier reproductive maturity and longer sexual life span, media influence -Greater sexual freedom -media emphasis
Oral contraceptives affect on STI transmission affects acidity of vaginal/cervical secretions that can promote the growth of certain organisms causing STIs
Assessment for screening of STIs includes -info sexual hx (partners, hx of STI, birth control or protection methods, # of partners in past year, overview of privacy and protection of confidentiality, culturally sensitive communication and emotional sensitivity, signs and symptoms, physical exam)
physical exam of genital and rectal areas and mouth include checking if inguinal nodes are inflamed, lesions--pelvic exam (woman), digital rectal exam (man)
Nursing diagnoses related to STIs -Anxiety -Knowledge Deficit -Risk for infection -Ineffective health maintenance -Noncompliance with treatment -High risk sexual behavior
Potential complications of STIs Increased risk for ectopic pregnancy, Infertility, Transmission of infection, Neurosyphilis , Gonococcal meningitis, Gonococcal arthritis HIV-related complications
Second most frequently reported STI in the United States Gonorrhea (2010, the rate of reported gonorrheal infections was 100.8 (120.9 in 2006) per 100,000 persons)
Highest incidence of gonorrhea found in.... Adolescents, Women, People living in the southern United States, minority populations
Most common STI in the United States HPV (Estimated 20 million Americans are currently infected)
How many types of HPV exist? 40 (some patients present with warts, most show no visible symptoms)
Which STI is linked to cervical cancer? HPV
Two types of HPV diagnosis Serologic and cytologic tests (helps distinguish between strains and treat high risk strains) Diagnosis on basis of appearance of lesions (may be confused with other diseases)
Treatment of HPV Removal of symptomatic warts (Removal may or may not decrease infectivity, Difficult to treat, Often require multiple office visits & variety of treatment modalities)
Gonorrhea is caused by Neisseria gonorrheae [Gram-negative bacteria Mucosa with columnar epithelium is susceptible, Gonorrhea is spread through direct physical contact with infected host (penis, vagina, mouth, or anus)]
Gonorrhea can cause Tubal pregnancy, Chronic pelvic pain and Infertility in women (Elicits inflammatory process that can lead to fibrous tissue & adhesions)
Etiology and Pathophysiology of gonorrhea Easily killed by drying, heating, or washing with antiseptic, provides no immunity to subsequent reinfection,incubation period: 3 to 8 days
syphilis infections are highest in women ages 20-24, men ages 35-39; men who have sex with men
Incidence of syphilis infections in 2006 36,000 cases
Syphilis is caused by Treponema pallidum (Spirochete bacterium Enters the body through breaks in skin or mucous membranes)
Syphilis Pathophysiology Complex disease in which many organs and tissues can become infected, causes production of antibodies that react with normal tissues, not all exposures cause disease
Incubation of syphilis 10-90 days
Syphilis and pregnancy (complication and transmission to fetus) Spread in utero after anytime during pregnancy, infected mother has a greater risk of a stillbirth or having a baby who dies shortly after birth
Drug therapy for syphilis treatment: 1 penicillin 2 erythromyocin 3 azithromycin
Collaborative Care for syphilis Monitor neurosyphilis with periodic serologic testing, clinical evaluation, and repeat CSF exams for 3 years, confidential counseling and HIV testing, case finding, surveillance
Most common REPORTED STI in the United States Chlamydia (2006, 1,030,911 chlamydial infections were reported to CDC 2010-1,307,893 and estimated 2.8 million (r/t non reporting)
Chlamydia infections are major contributor to... PID, Ectopic pregnancy, Infertility in women, Nongonococcal urethritis in men
Most common reported age group of chlamydia infections: 24 years old and younger
Chlamydia is caused by a gram negative bacteria called... Chlamydia trachomatis
Chlamydia is often unreported or under reported due to: infected persons are often asymptomatic, infection often not diagnosed until complications appear
Transmission routes of chlamydia vaginal, anal, or oral sex
Drug therapies for chlamydia (3): 1 single dose of azythromycin 2 doxycycline (tetracycline) 3 antibiotics
Complications of herpes (3) Aseptic meningitis, Lower neuron damage (Atonic bladder, Impotence, Constipation), High risk of transmission in pregnancy with episode near delivery
A diagnosis of herpes uses: History and physical examination, viral isolation by tissue culture, antibody assay for specific HSV viral type
Drug therapy for herpes includes (3): antivirals such as 1 acyclovir 2 valacyclovir 3 penaclovir no cure, but can shorten outbreak duration. Topical or oral forms
Guardasil prevents: 4 types of HPV (including 6, 11, 17 & 19)
Goals for patients with STIs include: Demonstrate understanding of mode of transmission and risks imposed, complete treatment and follow-up, notify or assist in notification of sexual contacts, abstain until infection is resolved, demonstrate knowledge of safer sex practices
Nursing care for patients with STIs: should show compassion and respect, establish risk of contracting STI, Screening and education programs,avoid sexual contact with HIV-infected persons, teach good hygiene and avoid douching
What practices offer SOME protection against STI infection Proper condom use and if void immediately after intercourse and wash genitalia and adjacent areas with soap and water
When counseling patient with STI, nurse needs to emphasize.... Abstinence during treatment period, condoms afterward Locating and examining all contacts of person with STI for testing and treatment Explain side effects, need for treatment adherence, and follow-ups
Initial infection site of gonorrhea in men: urethra
Symptoms of gonorrhea in men develop when? In 1-14 days
Symptoms of gonorrhea in women? Mostly asymptomatic or have minor symptoms (Vaginal discharge, Dysuria, Frequency of urination)
After incubation period in women, what symptoms of gonorrhea may occur (4)? Redness and swelling occur at site of contact Greenish, yellow purulent exudate often, develops. May develop abscess.Disease may remain local or spread by tissue extension to uterus, fallopian tubes, and ovaries
Transmission of gonorrhea is more often: Seen through vaginal intercourse transmitted from men to women or through anal intercourse
Anorectal gonorrhea: gonorrhea spread through anal intercourse (symptoms include Include soreness, itching, and discharge of anus)
Orogenital gonorrhea: Few symptoms, gonoccocal pharyngitis can develop
Gonorrhea diagnosis in men is determined by (2): A presumptive diagnosis made if History of sexual contact with a new or infected partner followed within days by urethral discharge or Positive finding in Gram-stained smear of discharge gives an almost certain diagnosis
Gonorrhea diagnosis in women is determined by: Must have culture to confirm diagnosis!! Smears and discharge do not establish diagnosis Female GU tract harbors organisms resembling N. gonorrhea
Most common form of drug therapy for gonorrhea IM injection (rosephin)
Oral forms of drug therapy for gonorrhea 1 cefixime (cephalosporin) 2 azithromycin 3 doxycycline must have 2 of 3
Patients who have coexisting syphilis with gonorrhea may have both cured with same drug therapy for gonorrhea
What are individuals with syphilis more likely to have? HIV (Syphilitic lesions on the genitals enhance HIV transmission, evaluation of all patients with syphilis includes testing for HIV with patient’s consent)
Diagnostic tests for syphilis include (3): Detailed and accurate sexual history, PE to examine lesions and S/S, and serologic test: VDRL and RPR – FTA-ABS or MHA-TP
Syphilis signs and symptoms are varied and mimic other diseases
The stages of syphilis (4): Primary, Secondary, Latent or hidden stage, and Tertiary or late stage
S/S of primary stage syphilis: Chancres appear--Painless indurated lesions Occur 10 to 90 days after inoculation Lasting 3 to 6 weeks
S/S of secondary stage syphilis: Systemic--(Begins a few weeks after chancres) Blood-borne bacteria spread to all major organ systems Flu-like symptoms Bilateral symmetric rash Mucous patches
S/S of latent or hidden stage syphilis: Immune system is suppressing infection, No signs/symptoms at this time Diagnosis with positive specific antibody test for syphilis
S/S of tertiary or late stage syphilis: Manifestations rare, Significant morbidity/mortality rates, Destructive skin, bone, soft tissue nodular lesions Aneurysms, heart valve insufficiency, and heart failure Neurosyphilis & speech disturbances
Collaborative care for syphilis includes: Monitor neurosyphilis with periodic serologic testing, clinical evaluation, and repeat CSF exams for 3 years Confidential counseling and HIV testing Case finding Surveillance
Clinical Manifestations of chlamydia in Men (2): Urethritis (Dysuria and discharge), Proctitis Rectal discharge and pain during BMs), Epididymitis (Unilateral scrotal pain, Swelling, Tenderness,Fever), Possible infertility and reactive arthritis
Clinical Manifestations of chlamydia in Women (3): Cervicitis (Mucopurulent discharge, Hypertrophic ectopy), Urethritis(Dysuria, Frequent urination, Pyuria), PID(Abdominal pain, nausea, vomiting, fever, malaise, abnormal vaginal bleeding, menstrual abnormalities)Can lead to chronic pain and infertility
Chlamydia is diagnosed by: Laboratory tests, Nucleic acid amplification test (NAAT), Direct fluorescent antibody (DFA), Enzyme immunoassay (EIA), Testing for other STIs, Culture for chlamydia
Estimated number of infected individuals of genital HSV 45 million people (true incidence is hard to determine)
Types of HSV 1) HSV-1 Causes infection above the waist 2) HSV-2 Frequently infects genital tract & perineum
HSV is caused by... herpes simplex virus
How does HSV infection occur? Through mucous membranes o. breaks in the skin during contact, spreads to surrounding cells, enters peripheral or autonomic nerve endings, to sensory or autonomic nerve ganglion where dormant,Recurrence when virus descends to initial site of infection,
Clinical manifestations of HSV: Primary episode: may complain of burning or tingling at site of inoculation, Vesicular lesions rupture and form shallow, moist ulcerations, Crusting and epithelialization of erosions occur, painful urination or Purulent vaginal discharge may be present
Ways to reduce the risk of spreading HSV: Condoms or abstinence, Suppressive therapy reduces but does not eradicate shedding, Women with recurrent symptoms shed virus up to 1% of the time even with no lesions present
Autoinoculation of HSV to extragenital sites can occur such as in... Lips, breasts, and fingers (Recurrences may be associated with stress, sunburn, dental work, inadequate rest, and inadequate nutrition.)
HSV can cause lower neuron damage, associated with: Atonic bladder, Impotence, and Constipation
Symptomatic care of HSV includes Genital hygiene, wearing loose-fitting cotton underwear, keeping lesions clean and dry,sitz baths, barrier methods during sexual activity drying agents, Pain management
HPV is caused by... human papillomavirus (HPV) - (Usually types 6 and 11)
HPV is often seen in populations of young, sexually active adults
Incubation period of HPV 3 to 4 months
The spread and growth of HPV. Minor trauma causes abrasions for HPV to enter and proliferate into warts Epithelial cells infected undergo transformation and proliferation to form a warty growth
Clinical manifestations of HPV Discrete single or multiple growths, white to gray and pink-fleshed colored, may form large cauliflower-like masses, Itching may occur with anogenital warts, bleeding on defecation may occur with anal warts
HPV and pregnancy Rapid growth with pregnancy, Transmitted to newborn
Primary goal of treatment for genital warts Removal of symptomatic warts (Removal may or may not decrease infectivity, difficult to treat, often require multiple office visits & variety of treatment modalities)
Chemical treatment of genital warts 1 trichlorocetic acid (tca) 2 bichlorocetic acid
Patient managed treatment of genital warts 1 condylox (topical med) 2 imiqumod (immune response modifier-topical)
If warts do not regress with chemical or patient managed therapies.... Cryotherapy with liquid nitrogen, electro-cautery, laser therapy, use of α-interferon, surgical excision
Collaborative care for HPV includes... Recurrences and reinfection possible Careful long-term follow-up advised Vaccine to prevent cervical cancer, precancerous genital lesion, and genital warts due to HPV (Gardasil)
Incubation period of chlamydia 1 to 3 weeks
Symptoms of gonorrhea in men include (2): Dysuria and Profuse, purulent urethral discharge. (It is unusual to be asymptomatic in men)
Created by: 21715308