Transcript Powerpoint - Austin Community College

Rebecca is visiting the clinic seeking birth
control pills. She had sexual intercourse for
the first time 8 weeks ago.
Rebecca, a
16 year old
white female
Subjective data:
Her partner does not use a condom or
spermicide with intercourse
Her last menstrual period was 2 weeks ago
Denies any symptoms other than frequent
urination and some dysuria.
Interested in using oral contraceptives
Very nervous
The Health Care provider after talking
with her does a physical exam including a
pelvic exam.
Lab work is also drawn.
Objective data obtained from examination
and lab results:
◦ Cervical ectopy noted during Pap test
◦ Mucopurulent cervical discharge
◦ Urine pregnancy test is negative
◦ Nucleic acid amplification test is suspect for
Chlamydia and gonorrhea.

After gathering this data, what conclusions can be
drawn?

Why did she not suspect that she might have a STD?


What risk factors were present?

What do you think is the next step? Explain.

Endocervical Culture is completed – came back positive
for Chlamydia and gonorrhea.

Why was a endocervical culture done?

Explain why smears, the nucleic acid amplification test
and EIA tests are not used in confirming the diagnosis in
a female.
Health Care Providers Orders:
◦ Doxycycline 100mg bid for 7 days
◦ Ceftriaxone 250mg IM once

When you see above medications ordered, what
did this tell you?

What are the side effects of these medications?

What medication would be ordered if Rebecca
only had gonorrhea?

What does she need to know about other STD’s What
other testing would you recommend.

What is important to teach regarding Health
Prevention?

What complications can occur is she does not follow
the health teaching?

What symptoms might her sexual partner
exhibit of chlamydia or gonorrhea?

Where is the initial site of infection in the
male?

Why does the male seek medical care early?

How is the male diagnosis confirmed?

Does the partner need to be treated? Explain.
a.
doxycycline (Vibramycin)
b.
Cefixime (Suprax)
c.
levofloxacin (Levaquin)
d.
ceftriaxone (Rocephin)
e.
ciprofloxacin (Cipro)
f.
Amoxicillin (Ampicillin)
g.
acyclovir (Zovirax)

Primary stage

When does this occur?
◦ In what stage does this Bilateral
symmetric rash on trunk, extremities,
and palms appear?
◦ What other symptoms
will the patient exhibit?

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
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

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
Occur mostly in late syphilis
Gummas can produce irreparable damage to bone,
liver, or skin
Aneurysm may press on structures such as
intercostal nerves, causing pain
Scarring of aortic valve
Neurosyphilis
Tabes dorsalis
Sudden attacks of pain
Loss of vision and sense of position

Nonspecific antitreponemal Tests used for screening:
◦ VDRL
◦ RPR

Specific treponemal Tests for confirmation:
◦ Fluorescent treponemal antibody absorption (FTA-Abs)
All these tests – tests for antibodies
Even Better - presence of spirochetes on dark field
microscopy

Mr. L., 61 years old, was admitted to the hospital for
pre-operative preparation for surgery. His preoperative blood work included a VDRL test and it came
back positive.

What would be most important for the nurse to ask the
patient?

Why?

What would be different in this situation if the patient
was 16?

Drug therapy
◦ Benzathine penicillin G (Bicillin)
◦ Aqueous procaine penicillin G
◦ **Be sure they complete full course of
therapy

Contact Isolation
o Lesions of primary and secondary syphilis are
highly infective.
o Gloves should be worn in direct contact
o Good Handwashing after removal of gloves
Which of the following is NOT a symptom of syphilis?
a.
b.
c.
d.
a hard chancre sore
a rash on the skin including the palms and soles.
a thick, yellowish discharge
large ulcers called gummas.
 What
causes a patient with genital
herpes to seek medical care?

Primary (initial) episode
◦ Burning or tingling at site
◦ Small vesicular lesion appear on penis,
scrotum, vulva, perineum, perianal areas,
vagina, or cervix
◦ Primary lesions present for 17 to 20 days
◦ New lesions sometimes continue to develop
for 6 weeks
◦ Lesions heal spontaneously
 When
are they most
contagious?

Recurrent genital herpes
◦ Occurs in 50% to 80% in following year
◦ Triggers




Stress
Fatigue
Sunburn
Menses
◦ Prodromal symptoms of tingling, burning, itching
at lesion site
◦ Symptoms are less severe and lesions heal within
8 to 12 days
◦ With time, lesions will occur less frequently
 How
is the diagnosis
confirmed?
 What
is the major treatment for
genital herpes?

Drug therapy
◦ Inhibit viral replication
◦ Suppress frequent recurrences
 Acyclovir (Zovirax)
 Valacyclovir (Valtrex)
 Famciclovir (Famvir)
 Given several times /day for 7-10 days.

Do the antiviral medications eradicate
the disease?

Symptomatic care
◦ Genital hygiene
◦ Loose-fitting cotton underwear
◦ Lesions clean and dry
◦ Sitz baths
◦ Barrier methods during sexual activity
◦ Drying agents
◦ Pain
 Dilution of urine with water
 Local anesthetic

A primary Herpes Simplex virus (HSV) infection differs
from recurrent HSV episodes in that:
a. Only primary infections are sexually transmitted
b. Systemic manifestations such as fever and myalgia
are more common
c. It is of shorter duration than recurrent episodes
d. Transmission of the virus to a fetus is less likely
during primary infection.
Genital Warts
 What
 Who
causes genital warts?
is most likely to get this
condition?

How is this condition diagnosed?

What is the Primary goal in the
treatment of genital warts?

Treatment includes a course of
therapy rather than one treatment.
Explain.

With removal of genital warts infectivity is
decreased?
Explain

Treatments
◦ Chemical
 Trichloroacetic acid (TCA)
 Bichloroacetic acid (BCA)
 Podophyllin resin
 For small external genital warts
◦ Patient managed
 Podofilox (Condylox/Condoylox gel)
 Imiquimod (Aldara)
 Immune response modifier

Treatments
◦ If warts do not regress with previously
mentioned therapies
 Cryotherapy with liquid nitrogen
 Electrocautery
 Laser therapy
 Use of α-interferon
 Surgical excision

Recurrences and re-infection possible
Careful long-term follow-up advised

Health Preventive Measures

◦ Vaccine to prevent cervical cancer, precancerous
genital lesion, and genital warts due to HPV
◦ Gardisal vaccine
The age group that seems particularly susceptible to HPV
infections is:
a.
b.
c.
d.
students of college age
teenagers
middle-aged adults
senior citizens
Human papilloma viruses (HPVs) are associated with:
a.
b.
c.
d.
cancer of the cervix
skin cancer
lung cancer
spontaneous abortions