Sexually transmitted infections

and pregnancy
STIs are those that are spread
through sexual contact with an
infected partner
 A woman with Trichomoniasis
• Trichomoniasis is an infection caused by a single-cell protozoan (round mobile
structure) spread by coitus.
• Etiology: trichomona Vaginitis
Signs and symptoms:
• A woman notices a yellow-gray, frothy, odorous vaginal discharge.
• Vaginal irritation, redness and pinpoint petechiae
• Extreme vaginal itching
• Dyspareunia
• Increased vaginal pH
• Males-- asymptomatic
DIAGNOSTIC TEST:
• Scrapping of vaginal discharge with drops of Ringer’s Solution
• The infection is diagnosed by examination of vaginal secretions on a wet slide that
has been treated with potassium hydroxide (KOH) or by a vaginal culture.
Treatment:
It is important that trichomoniasis infections be identified and treated
because they may be asssociated with preterm labor, premature rupture
of membranes, and post-cesarean infection.
•The drug of choice is single-dose oral metronidazole (Flagyl) 2gm given to
both woman and sex partner
Metronidazole was once thought to be teratogenic, but the CDC now
confirms it is safe in either early or late pregnancy. This should not be
taken with alcohol– causes acute nausea and vomiting
•Topical– providone iodine or vinegar douche only to reduce symptoms
until metronidazole can be used

NURSING INTERVENTIONS:
1. Advise client to abstain from coitus; male sex partner may use condom
2. Advise woman to use tampons to absurd discharges and increase
comfort
3. Emphasize importance of perineal hygiene
 A woman with Moniliasis
• Moniliasis may affect skin, mucous membranes as in GIT, mouth,
vagina, anus, fingernails, and body folds– groins, neck, axillae
Common in:
• Obese people, perspires profusely
• DM
• pregnancy
• using oral contraceptive pills
• pseudopregnancy state
• antibiotic and steroids users.
Etiology: Candida Albicans
Signs and symptoms:
Cheesy, white non-odorous vaginal discharge
Vaginal and vulvar itching
Red, beefy appearance of affected areas dyspareunia
Causes thrush in newborn
DIAGNOSTIC TEST:
•Scrappingof vaginal discharge with 3-4 gtts of 20% (KOH) potassium hydroxide
TREATMENT:
•4-6 months. Apply Gentium Violet 1% for relief of pruritus (stains underware
permanently)
•Nystatin (mycostatin) drug of choice– DOC
•Male partner to be treated as well
NURSING CARE:
1. Antibiotic by mouth should be stopped
2. Rule out DM and treat properly
3. Weight reduction for obese people
4. Avoid coitus during infection or use condom during treatment period
 A woman with Herpes Genitalis
• Herpes genitalis spreads by skin to skin contact and virus enters thru a
break in the skin or mucous membranes. It is highly contagious.
Incubation period: 3-14 days
Etiology: Herpes Virus Horminis II
• HVH-2-- genital virus (not airborne– not by fomites)
• HVH-1-- non-genital forms- oral skin but it is possible for each virus to
cross infects
Signs and symptoms:
• Vesicular lesion on cervix, vagina, vulva, penis
• Systemic symptoms as headache, malaise, low grade fever
• Dysuria
• Pain intense upon contact with clothing
DIAGNOSTIC TEST:
History and clinical evaluation
Isolation of virus in tissue culture (most accurate)
Scrapping for pap smear or Tzanck smear
TREATMENT:
•Analgesics for pain– aspirin
•Acyclovir (Zovirax) do not cure only alleviate symptoms and reduce spread of
virus

Nursing Care:
1. Abstinences- condoms and spermicide less effective
when to abstain: -presence of lesions
- last 4-6 weeks of pregnancy if partner has HIV1
2. Keep lesion clear and dry
3. Culture virus during pregnancy to safeguard fetus- 50% of newborn may be
infected during delivery
 A woman with syphilis
• Syphilis is a systemic disease caused by the spirochete
Treponema pallidum.
• It is currently increasing in frequency.
Transmission: Sexual contact/ congenital– moves thru skin and
mucous membrane and into the bloodstream and destroy
tissues in an organ in the body

• Early in pregnancy (before week 18), the placenta appears to

provide some protection against the disease. After this time,
however, the spirochete crosses the placenta freely and may be
responsible for spontaneous miscarriage, preterm labor,
stillbirth, or congenital anomalies in the newborn
STAGES:
I. Incubation period
characteristics:
1. 10-90 days– average 21 days
2. No s/s or lesion
3. Presence of etiology agent- blood is infective
II. Primary (early) Syphilis– most infectious stage– lasting 1-6 weeks
Characteristics:
4. Chancre or primary sore painless ulcer appears 1 st in site of entry of the
organism (genitalia, anorectal, lips, oral cavity, fingers)
5. Chancre erodes and heals 4-6 weeks leaves a scar or none at all
6. Inguinal lymph nodes enlarges
7. Presence of indolent, painless ulcerations in any part of the body suspect
III. Secondary syphilis
Characteristics:
1. Follows onset on chancre—9- 90 days
2. Influenza like symptom and rashes ulcerations; Condylomata– moist papules
on cell site– highly infectious
3. General patchy hair loss on scalp
4. Acute iritis
5. Hoarseness, chronic sore throat
IV. Late syphilis
Characteristics:
6. 10-30 days
7. Granuloma– lesions on skin, bones, liver, CVS (heart, and CNS(brain))
DIAGNOSTIC TEST:
Serologic test. All pregnant women are screened for syphilis at a first prenatal visit
by a VDRL, ART, or FTA-ABS antibody reaction test. Those who have multiple
sexual partners are tested again about week 36 of pregnancy. In some
institutions, women are screened again for congenital syphilis by a cord
blood sample.
• Non- treponemal or Reagin test- detect antibiotic like substance
• Treponemal test- measure specific antibiotics to TP
Treatment:
•One injection of benzathine penicillin G is the DOC (drug of choice) for the
treaatment of syphilis during pregnancy.
After therapy, a woman may experience a sudden episode of hypotension,
fever, tachycardia, and muscle aches. This is called Jarisch-Herxheimer reaction
and is caused by the sudden destruction of spirochetes. This reaction lasts for
24 hours then fades

Nursing care:
1. Isolation of infected materials
2. Case follow-up
3. Advise patient to refrain fro sexual contact with untreated previous partner
 A woman with Gonorrhea
• Gonorrhea is an STI caused by the gram-negative coccus Neisseria gonorrhoeae.
Transmission: sexual/ direct contact with discharge
Signs and symptoms:
Woman:
1. Heavy green- purulent discharges, abnormal uterine bleeding; abnormal menses
2.Urinary frequency, pain and burning sensation
3. Ascending infection (PID)
Men:
1. Purulent discharge

• A yellow-green vaginal discharge may be present, or a woman may be asumptomatic. Her male partner
usually has severe symptoms of pain on urination and a purulent yellow penile discharge.
• Despite safer sex practices and effective therapy, this disease still spreads at an epidemic rate in young adults.
• Gonorrhea is associated with spontaneous miscarriage, preterm birth, and endometris in the postpartum
period
• It is also a major cause of pelvic inflammatory disease (PID) and infertility.
Diagnosis of Gonorrhea is made by culture of the organism from the vagina, rectum, or
urethra. Although Gonorrhea has traditionally been treated with amoxicillin and
probenecid, the incidence of penicillinase-producing strains has made this traditional
therapy ineffective. Therefore, oral cefixime (Suprax) or IM ceftriaxone (Rocephin) is the
current recommended therapy.
Sexual partners also should be treated to prevent reinfection. Because most people who
contract gonorrhea also have a chlamydial infection, nonpregnant women should receive
doxycycline therapy at the same time. If a woman is pregnant, she should receive
amoxicillin or azithromycin.
It is important that gonorrhea be identified and treated during pregnancy because if the
infectionis present at the time of birth, it can cause a severe eye infectionthat can lead to
blindness in the newborn
 A woman with HIV infection
• Infection with the human immunodeficiency virus(HIV), the organism
responsible for acquired immunodeficiency syndrome (AIDS), is the most
serious of the STIs because it can be fatal to both mother and child.
• The virus is contracted through sexual intercourse, by exposure to
infected blood, by vertical transmission across the placenta to the fetus
at birth, or by breast milk to the newborn.
• HIV has become the leading cause of death in women 25 to 44 years of
age. 1-2% of every 1,000 women giving birth are HIV positive. Pregnancy
does not appear to accelerate the progression of the disease.
• The disorder is caused by a retrovirus that infects and disables T
lymphocytes. Without T lymphocytes, the body cannot fight infection
through either T-cell or B-cell activity
Risk factors include:
•Multiple sexual partners of the individual or sexual partner
•Bisexual partners
•Intravenous drug use by the individual or sexual partner
•Blood transfusions (rare)
Assessment:
Unlike other STIs, HIV infection rarely begins with the reproductive tract irritation.
Instead, early symptoms are more subtle and often difficult to differentiate from
those of other diseases or even from the symptoms of early pregnancy(ex fatigue,
anemia, diarrhea, weight loss)
Without therapy, HIV infection may progress through the following stages:
•The initial invasion of the virus, which may be accompanied by mild, flulike
symptoms
•Seroconversion, in which a woman converts from having no HIV antibodies in her
blood serum (HIV serum negative) to having HIV antibodies against HIV (HIV serum
Positive). Happens 6 months to 1 year after exposure
•An asymptomatic period, appears to be disease-free except for symptoms such as
weight loss and fatigue (a wasting syndrome), although the virus could be
replicating by this time. Period varies: average of 3-11 years
•An asymptomatic period, woman develops opportunistic infections and possibly
malignancies( ex toxoplasmosis, oral and vaginal candidiasis, GI illness, Herpes
simplex,and HIV-associated dementia). At this point , the CD4 count is usually
below 200 cells/mm3.
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