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OB Ch. 6
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Gravity
Terms in this set (42)
Vaginitis
most common reason women seek gyno care
Bacterial Vaginosis
most prevalent vaginal infection in US
Bacterial Vaginosis: Symptoms
Overgrowth of normal vaginal flora
Thin, watery, white-gray discharge
"Fishy" odor- Adding a 10% potassium hydroxide solution to the vaginal secretion of a patient with bacterial vaginosis, called a "whiff" test, produces a fishy smell
Bacterial Vaginosis: The change in normal flora increases the woman's susceptibility to
other organisms, making the patient more vulnerable to sexually transmitted diseases, including HIV.
Bacterial Vaginosis: The nonpregnant woman who is diagnosed with bacterial vaginosis (BV) is treated with
metronidazole (Flagyl) 500 mg orally twice a day for 7 days; Patients with bacterial vaginosis are high-risk for preterm labor
Vulvovaginal Candidiasis
Fungal or yeast infection
Thick, white vaginal discharge
Severe itching, dysuria, and dyspareunia
Those who are HIV positive, diabetic, or pregnant are more at risk
Treatment: miconazole cream (single dose or 3 day treatments); add yogurt to the diet; treat partners with penile inflammation; wear cotton underwear; avoid douching and vaginal powders, sprays
Sexually transmitted infection (STI) prevention
Prevention and control based on
Education, counseling on safer sexual behavior
Identification
Effective diagnosis and treatment
Evaluation, treatment counseling, education for sex partners
Trichomoniasis
Bacterial organism: Trichomonas vaginalis
Transmission: sexual intimacy
Asymptomatic or mild symptoms
Yellow-green, frothy, odorous discharge
Vulvar itching
Trichomoniasis: Treatment
Metronidazole
Both partners avoid intercourse until cured
Implications in pregnancy- There is a risk of preterm birth, rupture of membranes, and low birth weight
Chlamydia
Bacteria organism - Chlamydia trachomatis
Transmission - vaginal sex- Teens have the highest incidence of sexually transmitted infections, especially chlamydia
Symptoms - 70% of women asymptomatic
Can cause impaired fertility- Chlamydia is a major cause of nongonococcal urethritis (NGU) in men
Chlamydia: Treatment
azithromycin or doxycycline
Both partners - avoid intercourse until cured
Implications in pregnancy
Gonorrhea
Neisseria gonorrhoeae; Transmission: vaginal, anal, or oral sex
80% of women are asymptomatic
Treatment: antibiotic therapy (Rocephin IM for non pregnant women); give doxycycline along with Rocephin to non pregnant women if Chlamydia present also
Herpes Simplex
Viral organism: HSV-1 and HSV-2
Transmission:
Vaginal, anal, or oral sex
Skin-to-skin contact with an infected site
Outbreaks may occur with emotional stress, menstruation (Menstruation seems to trigger recurrences of herpes), ovulation, pregnancy, poor health, etc.
Herpes: Symptoms
primary outbreak
Single or multiple blister like vesicles
Difficult urination and urinary retention
Enlargement of inguinal lymph nodes
Flu like symptoms, genital pruritus, or tingling
Treatment: oral acyclovir
Syphilis
Treponema pallidum; Transmission:
Vaginal, oral, or anal sex
Exposure to exudate from infected individual
Transplacental- can cause intrauterine growth restriction; preterm birth, and stillbirth
Treatment: penicillin G
Syphilis: Symptoms
Symptoms: early stage
Chancre appears, fever, weight loss, malaise
Symptoms: secondary stage
Condylomata lata on vulva, acute arthritis (painful wrist and finger joints)
Enlargement of liver and spleen, enlarged lymph nodes
Chronic sore throat with hoarseness
Syphilis Dx & Treatment
Diagnosis
Early primary - dark-field microscopic examination of chancre
Treatment
Penicillin G
Doxycycline or tetracycline
Jarisch-Herxheimer reaction
Implications in pregnancy
HPV
Viral organism - cervical, anorectal cancers
Transmission - vaginal, oral, anal sex
Symptoms
Painless genital warts
Pruritus
HPV Treatment
Patient or provider therapies for wart removal
Surgical removal
Follow-up
It is not uncommon for warts to return a few months after an initial treatment.
Vaccines- Gardisil- The vaccine is given in three doses over a 6-month period
Pediculosis Pubis
Parasite - Phthirus
Transmission - intimate sexual contact, shared towels, bed linens
Symptoms
Itching in pubic area
Treatment - 1% permethrin cream
Wash and dry linens, towels, clothing
Scabies
Parasite - Sarcoptes scabiei
Transmission - intimate sexual contact in adults
Symptoms
Itching, erythematous, papular lesions or furrows
Treatment - 5% permethrin cream
Wash and dry linens, towels, clothing
Viral Hepatitis: Type A
Transmission - fecal-oral, contaminated food or water
Incubation - 15-50 days
Not chronic; immunization available
Viral Hepatitis: Type B
Transmission - blood/body fluids
Incubation - 45-160 days
Chronic; immunization available
Viral Hepatitis: Type C
Transmission - blood/blood products
Incubation - 14-180 days
Chronic- found in drug users and those with multiple sexual partners
Immunization not available
Viral Hepatitis: Type D
Transmission - blood/body fluids
Incubation - 45-160 days
Chronic; immunization not available
Viral Hepatitis: Type E
Transmission - fecal-oral
Incubation - 15-60 days
Not chronic; immunization not available
Viral Hepatitis Symptoms
Jaundice, anorexia, nausea, vomiting, malaise, fever
Arthritis, arthralgia in B, C, D
Immunizations available for A and B
AIDS
can be fatal; alters presentations of STIs; complicate treatment of STI; fetal implications
Pelvic Inflammatory Disease (PID)
Inflammation of upper female genital tract
Pelvic inflammatory disease usually occurs as a result of ascending sexually transmitted infection
Chlamydia trachomatis and Neisseria gonorrhoea on vaginal culture
CBC, RPR (rapid plasma reagin) ordered usually
Post infection tubal damage associates with infertility; The tubal scarring that occurs from tubal inflammation during PID can prevent a fertilized ovum from passing through the tube into the uterus, causing an ectopic or tubal pregnancy
Treatment:
- IV fluids, pain medication, IV antibiotics (should be
started initially at plan of care)
Symptoms of PID
Bilateral sharp, cramping pain in lower quadrants
Fever greater than 101°F, chills
Mucopurulent cervical or vaginal discharge
Irregular bleeding
Cervical motion tenderness during intercourse
Malaise, nausea, vomiting
Dx & Treatment for PID
Clinical examination defines symptoms
Laboratory tests
Ultrasound
Treatment
Intravenous (IV) fluids, pain medication, IV antibiotics
PO medication once acute symptoms resolve
Treat sexual partner
Causes of UTI in women
Shortness of female urethra
Incompetence of urinary sphincter
Pregnancy
Catheterization
Cystitis
Symptoms:
Dysuria, urgency, frequency
Suprapubic or low-back pain
Low-grade fever
Hematuria
Treatment - antibiotic therapy
Implications in pregnancy
Prevention: urinate when urge is felt; increase fluids; wipe front to back
Cystitis: Risk Factors
Sexual intercourse
Use of a diaphragm and a spermicide
Delayed postcoital micturition
Pregnancy
History of a recent UTI
Pyelonephritis: Symptoms
Sudden onset with chills, high temperature, costovertebral angle tenderness or flank pain
Nausea, vomiting, malaise
Frequency, urgency, burning with urination
Decreased urinary output
Severe colicky pain, vomiting, dehydration, ileus of large bowel
The right side is almost always involved if the woman is pregnant because the large bulk of intestines to the left pushes the uterus to the right
Pyelonephritis: Physiology
Edema of renal parenchyma
Temporary suppression of urinary output
Usual significant bacteremia
Pyelonephritis Treatment
IV antibiotics
IV hydration
Urinary analgesics, e.g., Pyridium
Pain management, medication for fever
Bed rest
Possible catheterization
A woman presents to an obstetrician's office complaining that she and her husband have been trying to conceive for the past 6 months. The client's medical history is significant for diabetes, hypertension, migraine headaches, and pelvic inflammatory disease (PID). Which reason is most likely causing the client's infertility?
Tubal damage from PID; Pelvic inflammatory disease usually produces a tubal infection (salpingitis) that may or may not be accompanied by a pelvic abscess. However, perhaps the greatest problem of PID is postinfection tubal damage, which is closely associated with infertility.
A 14-year-old girl and her mother go to her yearly checkup at the pediatrician's office. The nurse wants to offer a new vaccine against the human papilloma virus. Why is it important for the client to receive this vaccine?
The human papilloma virus is associated with cervical dysplasia and cancer; Condylomata acuminata, also called genital or venereal warts, is a common sexually transmitted infection caused by the human papilloma virus (HPV). Transmission can occur through vaginal, oral, or anal sex. Because of the increased evidence of a link between HPV and cervical and anorectal cancers, the condition is receiving increasing attention. Over 120 HPV subtypes have been identified. Most HPV infections are unrecognized, asymptomatic, or subclinical. Clients with visible genital warts can be infected concurrently with different HPV types.
A client presents to her obstetrician's office for her monthly checkup. This 24 weeks' gestation client is telling the nurse that she has been having a purulent, greenish-yellow discharge, urinary frequency, and painful urination. Which statement, if made by the nurse, is best in this situation?
"Your baby is protected by the presence of the mucous plug in your cervix until your membranes rupture."; The most common symptoms of gonorrheal infection, when they occur, include a purulent, greenish-yellow vaginal discharge, dysuria, and urinary frequency. Some women also develop inflammation and swelling of the vulva. The cervix may appear swollen and eroded and may secrete a foul-smelling discharge in which gonococci are present. Bilateral lower abdominal or pelvic pain may also occur.
If a pregnant woman becomes infected after the third month of gestation, the mucous plug in the cervix will
prevent the infection from ascending, and it will remain localized in the urethra, cervix, and Bartholin's glands until the membranes rupture. Then it can spread upward. A newborn exposed to a gonococcal-infected birth canal is at risk of developing ophthalmia neonatorum. Eye prophylaxis for all newborns is provided to prevent this complication.
A client tells the gynecologic nurse that she has been having a thick, white vaginal discharge, severe itching, and painful urination. Which of the following test results would correctly identify this type of infection as vulvovaginal candidiasis?
A vaginal pH of less than 4.5 and observation of mycelia or pseudohyphae upon direct microscopy; A vaginal pH of less than 4.5 and observation of mycelia or pseudohyphae upon direct microscopy indicate vulvovaginal candidiasis. A strong, fishy, aminelike odor when a 10% potassium hydroxide (KOH) solution is added to the vaginal secretions; a pH of greater than 4.5; and characteristic clue cells seen on a wet-mount preparation with leukocytes conspicuously absent would confirm diagnosis of bacterial vaginosis. Normal vaginal pH should be between 3.8 and 4.2.
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