Sexually transmitted infections



Sexually transmitted infections







  • Infections spread through sexual contact with an infected partner


  • During pregnancy, may place the woman at greater risk for problems because of potential effect of sexually transmitted infections (STIs) on the pregnancy, fetus, or neonate (see Selected STIs and pregnancy, pages 88 to 93)


  • Possible maternal complications: preterm labor and premature rupture of membranes


Causes



  • Fungi


  • Bacteria


  • Protozoa


  • Parasites


Signs and symptoms



  • Typically involving some type of vaginal discharge or lesion


  • Vulvar or vaginal irritation, causing pruritus


Management



  • Provide an antifungal or antimicrobial.


  • Teach the patient about safer sex practices.


  • Explain the mode of transmission of the STI, and teach the patient how to reduce the risk of transmission.


  • Urge the patient to refrain from sexual intercourse until the active infection has completely resolved.


  • Advise the patient that partners need to be examined so they can be treated.


  • Provide comfort measures.


  • Encourage the patient to keep the vulvar area clean and dry, and to avoid strong soaps, creams, or ointments unless prescribed.


  • Allow cool or tepid sitz baths to relieve itching.


  • Suggest that patient wear cotton underwear and avoid tight-fighting clothing as much as possible.



Selected STIs and pregnancy

This table lists several sexually transmitted infections (STIs), their causative organisms, assessment findings, and appropriate treatment for pregnant patients.
























































STI Causative organism Assessment findings Treatment Special considerations
Chlamydia Chlamydia trachomatis

  • Commonly produces no symptoms; suspicion raised if partner treated for nongonococcal urethritis
  • Heavy, gray-white vaginal discharge
  • Painful urination
  • Positive vaginal culture using special chlamydial test kit


  • Amoxicillin (Amoxil)


  • Screening for infection at first prenatal visit because it’s one of the most common types of vaginal infection seen during pregnancy
  • Repeated screening in the third trimester if the woman has multiple sexual partners
  • Doxycycline (Vibramycin)—drug of choice for treatment if the woman isn’t pregnant—contraindicated during pregnancy because of its association with fetal long bone deformities
  • Concomitant testing for gonorrhea because of the high incidence of concurrent infection
  • Possible premature rupture of membranes (PROM), preterm labor, and endometritis in the postpartum period resulting from infection
  • Possible development of conjunctivitis or pneumonia in neonate born to mother with infection present in the vagina
Condyloma acuminata Human papillomavirus

  • Discrete papillary structures that spread, enlarge, and coalesce to form large lesions; increasing in size during pregnancy
  • Possible secondary ulceration and infection with foul odor


  • Topical application of trichloroacetic acid or bichloracetic acid to lesions
  • Lesion removal with laser therapy, cryocautery, or knife excision


  • Serious infections associated with the development of cervical cancer later in life
  • Lesions left in place during pregnancy unless bothersome; removed during the postpartum period
Genital herpes Herpes simplex virus, type 2

  • Painful, small vesicles with erythematous base on vulva or vagina rupturing within 1 to 7 days to form ulcers
  • Low-grade fever
  • Dyspareunia
  • Positive viral culture of vesicular fluid
  • Positive enzyme-linked immunosorbent assay


  • Acyclovir (Zovirax) orally or as ointment


  • Reduction or suppression of symptoms, shedding, or recurrent episodes only with drug therapy; not a cure for infection
  • Abstinence urged until vesicles completely heal
  • Primary infection transmission possible across the placenta, resulting in congenital infection in the neonate
  • Transmission to neonate possible if active lesions present in the vagina or on the vulva at birth, which can be fatal
  • Cesarean delivery recommended if patient has active lesions
Gonorrhea Neisseria gonorrhoeae

  • May not produce symptoms
  • Yellow-green vaginal discharge
  • Male partner who experiences severe pain on urination and purulent yellow penile discharge
  • Positive culture of vaginal, rectal, or urethral secretions


  • Cefixime (Suprax) I.M. (single dose)


  • Associated with spontaneous miscarriage, preterm birth, and endometritis in the postpartum period
  • Treatment of sexual partners required to prevent reinfection
  • Major cause of pelvic infectious disease and infertility
  • Severe eye infection leading to blindness in the neonate (ophthalmia neonatorum) if infection present at birth
Group B streptococci infection Spirochete

  • Usually produces no symptoms
 

  • Occurs in as many as 15% to 35% of pregnant women
  • May lead to urinary tract infection, intra-amniotic infection leading to preterm birth, and postpartum endometritis
  • Screening for all pregnant women recommended by the Centers for Disease Control and Prevention at 35 to 38 weeks’ gestation
Syphilis Treponema pallidum

  • Painless ulcer on vulva or vagina (primary syphilis)
  • Hepatic and splenic enlargement, headache, anorexia, and maculopapular rash on the palms and soles (secondary syphilis; occurring about 2 months after initial infection)
  • Cardiac, vascular, and central nervous system changes (tertiary syphilis; occurring after an undetermined latent phase)
  • Positive Venereal Disease Research Laboratory serum test; confirmed with positive rapid plasma reagin and fluorescent treponemal antibody absorption tests
  • Dark-field microscopy positive for spirochete


  • Broad-spectrum antibiotic such as ampicillin
  • Penicillin G benzathine (Bicillin L-A) I.M. (single dose)


  • Possible transmission across placenta after about 18 weeks’ gestation, leading to spontaneous miscarriage, preterm labor, stillbirth, or congenital anomalies in the neonate
  • Standard screening for syphilis at the first prenatal visit, screening at 36 weeks’ gestation for women with multiple partners, and possible rescreening at beginning of labor, with neonates tested for congenital syphilis using a sample of cord blood
  • Jarisch-Herxheimer reaction (sudden hypotension, fever, tachycardia, and muscle aches) after medication administration, lasting for about 24 hours, and then fading because spirochetes are destroyed
Trichomoniasis Single-cell protozoan infection

  • Yellow-gray, frothy, odorous vaginal discharge
  • Vulvar itching, edema, and redness
  • Vaginal secretions on a wet-mount slide treated with potassium hydroxide positive for organism


  • Topical clotrimazole (Gyne-Lotrimin) instead of metronidazole (Flagyl) because of its possible teratogenic effects if used during first trimester of pregnancy


  • Possibly associated with preterm labor, PROM, and postcesarean infection
  • Treatment of partner required, even if asymptomatic
Vaginosis, bacterial Gardnerella vaginalis infection (most commonly)

  • Thin, gray vaginal discharge with a fishlike odor
  • Intense pruritus
  • Wet-mount slide positive for clue cells (epithelial cells with numerous bacilli clinging to the cells’ surface)


  • Topical vaginal metronidazole after the first trimester, usually late in pregnancy


  • Rapid growth and multiplication of organisms, replacing the normal lactobacilli organisms that are found in the healthy woman’s vagina
  • Treatment goal of reestablishing the normal balance of vaginal flora
  • Untreated infections associated with amniotic fluid infections and, possibly, preterm labor and PROM

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Jul 26, 2016 | Posted by in NURSING | Comments Off on Sexually transmitted infections

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