WEEK 11 - SEXUALLY TRANSMITTED INFECTIONS

1. NCM 109- Care of Mother
and Child at Risk or with
Problems
(Acute and Chronic)-LECTURE
Wesleyan University –Philippines
Cabanatuan City
CONAMS
Jhonee Balmeo
Instructor

3. Sexually transmitted infections (STIs) are diseases
that are spread through sexual contact with an
infected partner. They range in severity from easily
treated infections, such as trichomoniasis, to human
immunodeficiency virus (HIV) infection, which,
despite advances in therapy, is life-threatening.
If these diseases are discovered in young children,
the possibility of sexual abuse has to be considered
(Reading & Rannan-Eliya, 2007). STIs may be spread
among women having sex with women or men
having sex with men (Evans et al., 2007).
Male circumcision does not appear to reduce the
spread

4. SEXUALLY TRANSMITTED DISEASES AND PREGNANCY
a.Candidiasis (Thrush)
 >Is a common fungus that harmlessly infect people and it is normally well
controlled by our immune system
 >If immune system is weakened because of infection, excessive alcohol or
diseases such as diabetes, an infection can take hold of the body
 >Can affect people taking antibiotic
Causative Organism: Candida albicans

5. Site:
 >Mucous membrane
 >Internal lining of the genitals and the mouth
Signs and Symptoms In Women:
 >Itchiness around the vagina
 >Thick, white discharges
 >Vaginal dryness

6. Site:
 >Mucous membrane
 >Internal lining of the genitals and the mouth
Signs and Symptoms In Women:
 >Itchiness around the vagina
 >Thick, white discharges
 >Vaginal dryness

7. In Men: > irritation and itching around the tip of the penis
• >Can be sexually transmitted but is not often the primary cause and often recurs
• >Does not affect fertility
Treatment:
 >Tropical creams – Canesten
 >Vaginal tablets
 >Single dose or oral tablet – Diflucan to prevent Candida infection

8. In immunosuppressed individuals, it can become systemic (Blyth, Palasanthiran,
& O’Brien, 2007).

9. Sometimes Candida can multiply and cause an
infection if the environment inside the vagina
changes in a way that encourages its growth.
Candidiasis in the vagina is commonly called
a “vaginal yeast infection.” Other names for
this infection are “vaginal candidiasis,”
“vulvovaginal candidiasis,” or “candidal
vaginitis.”

10. Therapy for candidal infections includes vaginal suppositories or cream applications of antifungal
preparations such as miconazole (Monistat) or clotrimazole (Lotrimin), once a day for 3 to 7 days. Oral
fluconazole (Diflucan) can be administered as a one-time oral dose.

11. Prevention
 >Avoid wearing synthetic underwear
 >Do not wash with soaps or bubble baths – use
water only
 >Avoid wearing clothing that is tight around the
crotch
 >Taking live, natural yogurts – can help because it
restore the natural pH balance

12. b. Chlamydia
> Is a sexually transmitted infection (STI) that affects both men
and women
> Can be easily treated and cured
> If left untreated, can cause severe reproductive problem such
as PID (Pelvic Inflammatory Disease) which can cause
infertility due to damaged fallopian tubes
> Associated with gonorrhea
Signs and Symptoms:
> Heavy, gray – white discharges

13. C.Agent: chlamydia trachomatis (C. trachomatis)

14. Chlamydia

15. Diagnosis:
 > Culture of the organism from vaginal secretions
 using a specific chlamydial kit

16. Treatment: In Non pregnant Women:
 >Doxycycline (Vibramycin), a tetracycline
In pregnant Women:
 >Azithromycin (Zithromax) or amoxicillin
(Amoxil) – to prevent fetal long bone
deformity

17. c. Syphylis
> A systemic disease caused by the spirochete Treponema pallidum
 * Before the 18th week, the placenta provides some protection against the disease
 * After this time, the spirochete crossed the placenta freely and may be responsible
for spontaneous abortion, pre term labor, stillbirth or congenital anomalies of the
newborn

18. Signs and Symptoms:
 Painless ulcer (chancre) on the vulva or vagina

19. Signs and Symptoms:
 Painless ulcer (chancre) on the vulva or vagina

20. Diagnosis:
> All pregnant women should screened for syphilis 1st the first natal visit
 In some institution, women are screened again at the beginning of labor and
newborns are screened for congenital syphilis by a cord blood sample

21. Diagnosis:
> All pregnant women should screened for syphilis in the first natal visit
 In some institution, women are screened again at the beginning of labor and
newborns are screened for congenital syphilis by a cord blood sample

22. Treatment:
 >One injection of benzithine penicillin G – drug of
Choice during pregnancy
 Woman may experience a sudden episode of
hypotension, fever, tachycardia and muscle aches -
 >This called as the Jarisch – Herxheimer reaction –
caused by sudden destruction of spirochetes
 >Reaction lasts for 24H and then fades

23. d. Human Pappiloma Virus Infection
 >Fibrous overgrowth on the external vulva
 >Lesions has no effect on the fetus during pregnancy, but if it obstruct the birth
canal, C/S is recommended
 >It is a serious condition for the mother because it can cause cervical cancer later
in life
 >If with one infection, woman should have a yearly Pa test for the rest of her life

24. Signs and Symptoms:
 >At first, lesions appear as discrete pappilary
structures, they, spread, enlarge and coalesce to form
large, a cauliflower like lesions
 >Tend to increase in size during pregnancy because of
high vascular flow in the pelvic area
 >Become secondary, ulcerated and infected lesion
 >With foul, vulvar odor

25. Treatment:
Goal: To dissolve the lesions and end any secondary
infection present
 >Podophyllum (Podofin) – drug of choice; to be
applied directly to lesions of pregnant women
 >Trichloroacetic acid (TCA) for non pregnant
women
 >Large lesions – laser therapy

26. Treatment:
Goal: To dissolve the lesions and end any secondary
infection present
 >Podophyllum (Podofin) – drug of choice; to be
applied directly to lesions of pregnant women
 >Trichloroacetic acid (TCA) for non pregnant
women
 >Large lesions – laser therapy

27. Treatment:
Goal: To dissolve the lesions and end any secondary
infection present
 >Podophyllum (Podofin) – drug of choice; to be
applied directly to lesions of pregnant women
 >Trichloroacetic acid (TCA) for non pregnant
women
 >Large lesions – laser therapy

28. Example:
• 1.Cryocautery
 >At first, edema may be present at the site, lesions become gangrenous, and
sloughing off occurs within 7 days
 >Healing is complete within 14 days with slight depigmentation on site
 2.Sitz bath and lidocaine may have some soothing effects
 >If it is not a burden on the woman, it can be left and be removed during the
postpartal period
 3.Knife excision

29. e. HIV Infection
 >Caused by a retrovirus that infects and disables T
lymphocytes, without T lymphocytes, the body
cannot fight infection through T – cell and B – cell
activity
 >Contacted through sexual intercourse
 >By exposure to infected blood
 >By vertical transmission across the placenta to the
fetus at birth
 >By breast mik to the new born

30. During pregnancy, HIV can pass
through the placenta and infect
the fetus.
During labor and delivery, the baby
may be exposed to the virus from a
woman's blood and other fluids.
When a woman goes into labor, the
amniotic sac breaks (her water
breaks). Once this occurs, the risk of
transmitting HIV to the baby
increases.
https://www.acog.org/womens-health/faqs/hiv-and-pregnancy

31. Risk factors:
 >Multiple sexual partners
 >Bisexual partners
 >IVF used (contaminated materials)
 >Blood transfusion (rare)

32. Assessment:
 >CD4 cell count testing - to determine how many T4 cells are present and
functioning
 >If ↓500 cells/mm3 or the vital load rises above 5,000 copies/ml it will lead to
difficulty to resist opportunistic infections
 >Presence of early symptoms of other diseases

33. A CD4 count above 500 is considered
“normal”. A CD4 count below 350 shows HIV
has damaged your immune system.
A CD4 count is a test that measures the number of CD4
cells in your blood. CD4 cells, also known as T cells, are
white blood cells that fight infection and play an important
role in your immune system

34. Without Therapy, HIV may progress
 >Initial invasion of the virus with flulike symptoms
 >Seroconversion, in which the woman converts from
having no HIV antibodies positive for HIV (serum
positive) from 6 weeks to 1 year after exposure
 >Asymptomatic period during which the woman appears
to be disease free except for symptoms such as weigth
loss and fatigue (wasting syndrome)
2 to 6 years.
> A symptomatic period during which the woman develops
opportunistic infection and possible malignancies (
toxoplasmosis, oral and vaginal candidiasis, carinti
pneumonia (PCP), candida

35. Without Therapy, HIV may progress
 >Initial invasion of the virus with flulike symptoms
 >Seroconversion, in which the woman converts from having no HIV antibodies
positive for HIV (serum positive) from 6 weeks to 1 year after exposure
 >Asymptomatic period during which the woman appears to be disease free except
for symptoms such as weigth loss and fatigue ( wasting syndrome)
2 to 6 years.
> A symptomatic period during which the woman develops opportunistic infection and
possible malignancies ( toxoplasmosis, oral and vaginal candidiasis, carinti
pneumonia (PCP), candida

36. Esophagitis, Kaposi sarcoma, and HIV – associated
dementia), CD4 count is below 200 cells/mm3.

37. Esophagitis, Kaposi sarcoma, and HIV – associated
dementia), CD4 count is below 200 cells/mm3.
What causes HIV-associated
dementia? When HIV spreads to
the brain, it results in
encephalopathy (a disease which
affects the brain's function), which
causes dementia. The greater the
spread of infection in the brain, the
worse the dementia symptoms
become.

38. Therapeutic Management:
Goal: To maintain the CD4 cell count at greater than
500 cells/mm3
 >If HIV positive – advise woman not to get pregnant
 >Administration of protease inhibitor such as Ritonavir
(Norvir), Zidovudine – to help reduce mother to fetal
transmission
> 100 mg p.o. 5x/day during pregnancy
>During labor – IV
>For the newborn – drug in syrup – 2 mg q 6H x 6 weeks

39.  >Amniocentesis should be avoided to
prevent exposure to maternal blood
 >Episiotomy is also avoided to limit a
possible blood source
 >Breast milk may transmit HIV and also
increased the incidence of mastitis- also
exhausting for the debilitated woman
 >Patient education – mode of transmission
and safer sex practices
 >Use standard precaution

40. f. Gonorrhea
> Caused by gram – negative coccus Neisseria Gonorrhea
 >Associated with spontaneous miscarriage, preterm birth, endometritis in the
postpartal period
 >Major cause of PID and infertility

41. DX:
 >Culture of the organism from the vagina, rectum or
urethra
Treatment:
> Cefixime (Suprax) – one time IM injection – current
recommended therapy, can be safely administered
during pregnancy
 >Sexual partner should be treated to prevent infection
 >Possibility to have a chlamydial infection – non
pregnant woman should receive doxycycline
therapy at the same time
 >If pregnant – amoxicillin
 >If present at the time of birth, can cause severe eye
infection that can lead to blindness in the new born
(Opthalmia Neonatorum)

42. Signs and Symptoms:
 >Yellow – green vaginal discharge
 >Woman may be asymptomatic
 >Male partner usually has severe symptoms of pain on urination and a purulent
yellow discharge

43. STIs are most common in which age
group?
• A. Teens and young adults up to age 24
• B. People ages 30 to 45
• C. People 60 and older
• D. All of the above.

44. As long as a person has no
symptoms of an STI, they:
A. Cannot pass on an STI
B. Don't have an STI
C. A and B
D. None of the above.

45. Which of these is a health problem that
can be caused by STIs in women?
A. Pelvic inflammatory disease (PID)
B. Ectopic pregnancy
C. Higher risk for cervical cancer
D. All of the above.

46. Which major organ can be affected by
untreated syphilis?
A. Heart
B. Brain
C. Liver
D. A and B.

47. Done!