Sexually transmitted infections Part V

Sexually Transmitted
Infections
By: Maria Carmela L. Domocmat, RN, MSN
Nurse Instructor
Northern Luzon Adventist College

1. Diseases Characterized by 3. Diseases Characterized by
Ulcerations Vaginal Discharge
Chancroid Bacterial Vaginosis
Trichomoniasis
Genital HSV Infections
Vulvovaginal Candidiasis
Granuloma Inguinale
(Donovanosis) 4. Human Papillomavirus (HPV)
Infection
Lymphogranuloma Venereum
Genital Warts
Syphilis
5. Ectoparasitic Infections
2. Diseases Characterized by Scabies
Urethritis or Cervicitis Pediculosis Pubis
Chlamydial Infections 6. Hepatitis A, B, C
Gonococcal Infections 7. Sexually transmitted enteric
infections
Proctitis, Proctocolitis, and
Enteritis

Overview
Maria Carmela L. Domocmat, RN, MSN

HUMAN PAPILLOMAVIRUS
(HPV) INFECTION

GENITAL WARTS
(Condyloma Acuminata)

Genital Warts
a group of more than 70 viruses, some
of which can lead to cervical cancer.
Several strains of HPV cause external
genital warts.

Organism: Human Papilloma Virus HPV

Infectivity: people can infect others
when they have lesions & sometimes
when they do not; 66% of people who
have sexual contact with a partner who
has genital warts will develop genital
warts, usually within 3 months

Genital Warts
Incubation: 1 to
20 months;
usually about 1-2
months


warts on genitals, rectum or throat
(similar in both sexes)
Benign growth, multiple, painless clusters
Laryngeal papillomatosis in infant
Born vaginally from infected mother

Symptoms

Most people with HPV do not develop symptoms
or health problems from it.
In 90% of cases, the body’s immune system
clears HPV naturally within two years.
But, sometimes, HPV infections are not cleared
and can cause:
Genital warts
Rarely, warts in the throat -- a condition called recurrent
respiratory papillomatosis, or RRP. When this occurs in
children it is called juvenile-onset RRP (JORRP).
Cervical cancer and other, less common but serious
cancers, including cancers of the vulva, vagina, penis,
anus, and oropharynx (back of throat including base of
tongue and tonsils).


The types of HPV that can cause genital
warts are not the same as the types that
can cause cancers.
There is no way to know which people
who get HPV will go on to develop cancer
or other health problems.

Note:

genital contact, most often during vaginal and
anal sex.
oral sex and genital-to-genital contact.
can be passed on between straight and same-sex
partners—even when the infected partner has no
signs or symptoms.
A person can have HPV even if years have
passed since he or she had sexual contact with
an infected person.
Most infected persons do not realize they are infected or
that they are passing the virus on to a sex partner.
It is also possible to get more than one type of HPV.

MOT

Rarely, a pregnant woman with genital
HPV can pass HPV to her baby during
delivery. Very rarely, the child can develop
juvenile-onset recurrent respiratory
papillomatosis (JORRP).

MOT

Acetic acid
Biopsies
For subclinical case– Pap smear,
colposcopy (vagina and cervical tissue
exam with scope)

Dx

Five Percent Acetic
Acid Wash
Indicated for Genital Warts or Condylomata Acuminata

1. After completing all other vaginal specimens,
swab the cervix with cotton-tipped applicator
that has been soaked in 5% acetic acid.
2.Leave for one minute.

Five Percent Acetic Acid Wash

Normal Finding Abnormal Finding

There should be no Rapid acetowhitening or
change in the blanching with jagged
appearance of the borders (HPV)
cervix (HPV)


After application of acetic
Apparently normal cervix
acid


There is no cure for HPV, so treatment
aims at controlling outbreaks of warts -- if
you have a strain that causes visible
warts.

Treatment

Visible genital warts
can be removed by the patient him or herself
with prescribed medications.
Topical podofilox nd imiquinod cream
Contraindicated for pregnant women

Treatment

Visible genital warts
They can also be treated by a health care
provider.
Podophyllin resin in tincture of benzoin or
trichloroacetic acid (TCA) or bichloroacetic acid
(BCA)
Applied topically to warts only
Repeated weekly til all lesion disappear and skin healed
Contraindicated for pregnant women

Treatment

Some people choose not to treat warts,
but to see if they disappear on their own.
No one treatment is better than another.

Treatment

Extensive genital warts also may be
removed using
cryotherapy (freezing) – using liquid nitrogen
burned off with electrocauterization
Surgical excision
CO2 lasers
In at least 30 percent of treated cases,
the warts grow back again.

Treatment

Antiviral drug interferon
Expensive
High rate adverse effect

Treatment

Cervical cancer is most treatable when it
is diagnosed and treated early. But
women who get routine Pap tests and
follow up as needed can identify
problems before cancer develops.
Prevention is always better than
treatment.

Treatment

Penile Condyloma

Vaccines
given in three shots.
It is important to get all three doses to get the
best protection.
most effective when given at 11 or 12 years of
age.

Prevention

Cervarix and Gardasil
Gardasil - also protects against most genital
warts, anal, vaginal and vulvar cancers.
for 11 and 12 year-old girls,
for females 13 through 26 years of age, who
did not get any or all of the shots when they
were younger.
These vaccines can also be given to girls
beginning at 9 years of age.
It is recommended to get the same vaccine
brand for all three doses, whenever possible.

Prevention : Girls and women

One available vaccine (Gardasil) protects
males against most genital warts and anal
cancers.
This vaccine is available for boys and
men, 9 through 26 years of age.

Prevention: Boys and men:

Condoms
for those who choose to be sexually active,
condoms may lower the risk of HPV.
To be most effective, they should be used with
every sex act, from start to finish.
But HPV can infect areas that are not covered
by a condom - so condoms may
not fully protect against HPV.

Prevention

Preventing RRP: Cesarean delivery is
not recommended for women with genital
warts to prevent juvenile-onset RRP
(JORRP) in their babies. This is because it
is not clear that cesarean delivery
prevents JORRP in infants and children.

Prevention

Complications

If Untreated: both sexes - warts grow
& obstruct infected body openings, pre-
cancerous lesions of the cervix, vulva, &
penis have been linked to some types of
HPV.


Condyloma acuminatum
or Genital Warts
Anal area


Not necessary to evaluate sexual partners
Coz treatment is not effective in eradicating
infection or its spread
Female partner should be referred for Pap
smear or when indicated – cervial
colposcopy, biopsy
Encourage condom use

Health educ

Vaccine-Preventable STDs
› Hepatitis A
› Hepatitis B
Hepatitis C


There are five types of hepatitis -- A
through E -- all of which cause
inflammation of the liver.
Type D affects only those who also have
hepatitis B,
Hepatitis E is extremely rare in the United
States.


Type A hepatitis
anal-oral contact, by coming in contact with the feces of someone with
hepatitis A, or by eating or drinking hepatitis A contaminated food or water.
Type B hepatitis
infected blood, seminal fluid, vaginal secretions, or contaminated drug
needles, including tattoo or body-piercing equipment. It can also be spread
from a mother to her newborn.
Type C hepatitis
not easily spread through sex.
more likely through contact with infected blood, contaminated razors,
needles, tattoo and body-piercing equipment, or manicure or pedicure tools
that haven't been properly sanitized, and a mother can pass it to her baby
during delivery.
Type D hepatitis
infected blood, contaminated needles, or by sexual contact with an HIV-
infected person.
Type E hepatitis
in feces, through oral contact, or in water that's been contaminated.

MOT

Two weeks to five months, although
hepatitis C can remain dormant for 10
years before symptoms crop up.

Incubation Period:

mild flu-like symptoms
light stools
dark urine
jaundice
Fatigue
Fever
Hepatitis A symptoms may also include
nausea, vomiting, and abdominal pain.

Symptoms

All types of hepatitis are diagnosed with a
blood test.

Testing

Types A and E hepatitis
usually resolve over time.
If traveling to a country where hepatitis A is prevalent,
two doses of a vaccine can prevent the disease.
no vaccine for hepatitis E.
hepatitis B
anti viral medications may help some patients.
a vaccine (three doses) can prevent the disease in the
first place.
the only STD that's preventable with a vaccine,
according to Planned Parenthood.)
hepatitis C and D
interferon and other drugs may help some patients
is no vaccine for either type.

Treatment:

If are not treated
Because types A and E usually go away over
time, neither is likely to lead to chronic
disease.
Types B and C, however, can lead to cirrhosis
(scarring of the liver) and liver cancer if not
treated;
type D can also result in liver cancer.

Complications

Hepatitis is a disease of the liver.
Hepatitis B is transmitted person to
person through blood and body fluids.
There is no treatment for the virus after
it has been contracted.
The only treatment is prevention:
› Abstain from sex
› Always use latex condoms
› Avoid contact with other people’s blood
› Get immunized


Pediculosis Pubis
Scabies


Crab lice, Pthirus pubis
with reddish-brown crab feces.


Crab lice, Pthirus pubis


Tiny insects that live off human blood.
Although they're often found around the
genitals, they can live in any part of the
body with hair.


Through sexual transmission,
skin-to-skin contact,
in clothing, bedding,
on a toilet seat harboring the insects.

MOT

As long as a week if it's the first time had
pubic lice
as little as a day if this is a recurrence.

Incubation Period:

Symptoms of crabs are usually noticed
around 5 days to 7 weeks after infection
and include:
Itching in the genital area or any other
part of the body with hair.
inflammation of the affected area;
sometimes visible lice and eggs;
spots of blood as lice feed from blood
vessels in the skin.

Symptoms:

Pubic lice are very small, whitish-gray
parasites that look like crabs.
insects or their eggs (which are pearl-
colored and oval-shaped) in your hair.
skin under hair -red and scaly, or there
may be small blue spots -- signs of lice
bites.

Testing:

Over-the-counter lotions that contain the chemical
permethrin such as Rid and Nix will get rid of the lice.
(Talk to doctor before using any product that contains
the chemical lindane, which can be toxic, especially
for unborn children.)
After washing with the lotion, use a fine-toothed
comb to comb out the crabs and their eggs (called
nits).
sexual partner(s) must be treated as well
all clothing or bedding that may be infested must be
washed in very hot water or dry-cleaned.
In some cases, clothing, towels, or bedding may need
to be washed a few times before they're completely
lice-free.
It is not necessary to shave pubic hair as this is
unlikely to remove all lice.

Treatment:

If are not treated: If don't seek
treatment you're likely to pass pubic lice
on to any sexual partners, or anyone else
you're in close contact with.

Complication

Molluscum lesions on an
arm


A mite that burrows under the skin and
lays eggs.


Through close contact or through sleeping
in bedding or wearing clothes that are
infested.
Rarely, holding or shaking hands can
transmit scabies.

MOT

As long as a week if it's the first time
you've been infested; a day if it's a
recurrence.

Incubation Period

intense itching
or small bumps or a rash on the penis,
between the fingers, on buttocks, breasts,
wrists, thighs, or around the navel.

Symptoms

Contagiosum can cause
papules to form on the
Scabies around penis skin.(Credit: E van Herck)


Creams and lotions containing permethrin
such as Rid and Nix must be applied to the
whole body from the neck down.
(As with pubic lice, products containing
lindane may be harmful to the fetus if used
by a pregnant woman)
Change clothing and sleep on freshly
laundered sheets after you've applied the
lotion.
Any bedding or clothing that may have been
infested should be washed with very hot
water or dry-cleaned.

Treatment:

Continued scratching can cause an
infection, and if it left untreated, scabies
can be transmitted to anyone you come in
close contact with.

Complications

Found is saliva, urine, semen, and vaginal
secretions
symptoms include pharyngitis, malaise,
fever and lymphadenopathy, heterophil
antibody negative, blood smears may
show atypical lymphocytes
may be fatal to those patients with AIDS

CMV - Cytomegalovirus

Treatment:
most resolve
spontaneoulsy
therapy is often
required for
immunosuppressed
patients
Ganciclovir

CMV

Sexually transmitted infections Part V

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Sexually transmitted infections Part V