Sexually Transmitted Infections 8

SEXUALLY TRANSMITTED INFECTION (STIS)

Reproductive tract infections (RTIs) are infections of the genital tract caused by organisms normally present in the reproductive tract, or introduced from the outside during sexual contact or medical procedures. These different but overlapping categories of RTI are called endogenous, sexually transmitted infections (STIs) and iatrogenic, reflecting how they are acquired and spread.

Each year, there are over 340 million treatable and many more untreatable STI cases. Both men and women are impacted. Although many RTIs are not sexually transmitted, certain RTIs (such syphilis and gonorrhea) are. STIs are one of the leading causes of illness and mortality in pregnant women and newborns.

Ectopic pregnancy, pelvic inflammatory disease, preterm labor, miscarriage, stillbirth, and congenital infection are serious STIS/RTIS consequences that can cause mortality and long-term disabilities (including infertility and genital cancer). Another effect of STIS/RTIS is an elevated risk of HIV/AIDS.

Reducing the risk of STDs

No Risk

• Abstinence (sex): not having oral, vaginal or anal sex
• No genital contact
• Mutual monogamy between non-infected partners

Reduced Risk

• Protected Sex: "Correct and consistent" use of condoms/barriers
• Fewer sexual partners.
• Regular STD testing

How to Prevent STI

Avoiding exposure is the most effective strategy for STI prevention. At this initial stage of prevention, the risk of coming into contact with an STI can be decreased by:

• Delaying sexual activity (for adolescents);
• Decreasing the number of sex partners;
• Using condoms correctly and consistently.

When STIs do occur, they must be promptly identified and effectively treated. This not only lowers the likelihood of difficulties for the person but also stops the spread of new diseases throughout the neighborhood. The sooner a STI is treated, the lower the risk of further transmission.

Nurses should:

• Individualize your preventative advice.
• Promote safer sexual behavior.
• Offer suggestions for improving condom negotiation techniques.
• Women should be informed about STI and pregnancy prevention dual protection..

TORCH is an acronym for a group of five infectious diseases:

• Toxoplasmosis-T
• Other (Hepatitis B)-0
• Rubella (German measles) - R
• Cytomegalovirus (CMV) - C
• Herpes Simplex Virus (HSV)-H Each disease may be teratogenic
• Each crosses the placenta
• Each may adversely affect the developing fetus
• The effect of each varies, depending on developmental stage at time of exposure.

TOXOPLASMOSIS

The protozoan Toxoplasma Gondi is the culprit behind toxoplasmosis. Although more than 60 million Americans are sick, very few of them are showing symptoms. Congenital toxoplasmosis affects 1 in 1000 to 8000 Americans annually.

Transmission

• Eating soil-borne toxoplasma eggs
• Consuming meat that is uncooked or only half cooked, particularly lamb, venison, or pork
• Exposure to contaminated cat waste.
• Transplacentally (if new infection occurs during pregnancy)
• By way of transfusion or organ transplant—very uncommon
• An earlier infection may reactivate in women with weakened immune systems.

Physical Findings

• "Flu"-like symptoms
• Swollen lymph glands (posterior cervical)
• Days to weeks of persistent muscle pain. Diagnostic results: ELISA and serologic antibody testing

Potential maternal and neonatal effects

• Maternal effects:
  90% of women show no symptoms. a higher chance of miscarriage or early labor and delivery.

• Neonatal effects:
  10–24 weeks of gestation is considered high risk. Neurological, ophthalmological, and cognitive sequelae are all possible. Varying in severity, earlier exposure is typically more harmful.

Interventions

• Women who are immuno-compromised or who are pregnant and have a new infection may benefit from pyrimethamine and sulfadiazine treatment.

Health Education

• Before becoming pregnant, a woman contemplating a pregnancy may be tested. There is no reason to be concerned that the infant will contract a new infection if the test is positive. If a test is negative, the woman can take measures.
• After working with soil, put on gloves and properly wash your hands.
• Cook meat completely (until no longer pink inside and juices run clear)
• Wash your hands thoroughly with warm water and soap before handling any raw meat-contact equipment or surfaces.
• Do not feed your cat raw meat and keep it outside. Do not handle stray cats or young kittens who might have consumed raw meat.

HEPATITIS

An inflammation of the liver is known as hepatitis. The condition may go away on its own or worsen into cirrhosis, liver cancer, or fibrosis (scarring). The most frequent cause of hepatitis in the world is hepatitis viruses, but it can also be brought on by other infections, toxic substances (like alcohol and some drugs), and autoimmune diseases.

Hepatitis viruses come in five different types: A, B, C, D, and E. The burden of illness and death they bring along with the potential for outbreaks and epidemic spread make these 5 types the most concerning. Particularly, types II and C are the most prevalent causes of liver cirrhosis and cancer, causing chronic disease in hundreds of millions of people.

The most common way that people contract hepatitis A and E is via consuming infected food or drink. Parenteral contact with bodily fluids that are infected usually results in the development of hepatitis B, C, and D. Receiving contaminated blood or blood products, invasive medical procedures using contaminated equipment, and for hepatitis B transmission from mother to baby at birth, from family member to child, as well as through sexual contact, are common modes of transmission for these viruses.

The symptoms of an acute infection might range from little to none at all, or they can be as severe as jaundice (yellowing of the skin and eyes), dark urine, great exhaustion, nausea, and abdominal discomfort.

Symptoms:

Many hepatitis sufferers may not exhibit any symptoms and are unaware of their infection. If an acute infection develops, symptoms may show up anywhere between two weeks and six months following exposure. It may take decades for chronic viral hepatitis symptoms to appear.

Symptoms of hepatitis can includes

• Fever
• Nausea
• Dark urine
• Jaundice.
• Fatigue
• Vomiting
• Grey-colored stools
• Loss of appetite
• Abdominal pain
• Joint pain 

Types Hepatitis

The most common types of viral hepatitis are: Hepatitis A, Hepatitis B, Hepatitis C

The term "hepatitis" refers to liver inflammation. The liver is a crucial organ that filters and processes nutrients.

Hepatitis A

Oral sex can be used to sexually transfer it (oral to anal contact). Hepatitis B and C are sexually transmitted far less frequently. It is the most prevalent type of hepatitis that is not transmitted during pregnancy but rather through feces and saliva.

• Pregnancy complications:
  • Spontaneous abortion and preterm labor due to dehydration, fever and hypovolemia
• Neonatal complication:
  • low birth weight

How long does Hepatitis last?

Hepatitis A: A few weeks to several months may pass after contracting hepatitis A.

Hepatitis B: Hepatitis B can range from a brief bout of mild disease to a major chronic or lifelong condition. Compared to older children and adults who contract the disease, almost 90% of unvaccinated newborns who become infected acquire a chronic infection.

Hepatitis C: Can be anything from a short-term, minor disease to a severe, lifelong infection. Hepatitis C becomes chronic in the majority of those who are infected.

How serious is it?

Hepatitis A:

• A person's illness could last for a few weeks or months.
• Most people heal without any long-term liver damage
• Death can happen, although being extremely rare.

Hepatitis B:

• Age upon infection determines the likelihood of persistent infection. 90% of infants who contract the infection will go on to have a chronic infection.
• Chronically infected individuals have a 15% to 25% chance of developing cirrhosis, liver failure, or liver cancer.

Hepatitis C:

• A persistent infection is brought on by the Hepatitis C virus in 75–85% of cases.
• Cirrhosis affects 5% to 20% of those with chronic hepatitis C.
• Cirrhosis or liver cancer will result in 1%–5% of deaths.
• The most prevalent chronic blood-borne infection in the United States is hepatitis C. There are 2.7 million people who have a chronic infection.

Neonatal complications:

• 5 of every 100 exposed infants acquire the infection, most commonly during or shortly after birth.
• HCV does not appear to be transmitted through breastfeeding, but HCV-positive mothers should think about stopping if their nipples are cracked or bleeding.

Hepatitis B (HBV)

Due to cirrhosis and liver cancer, hepatitis B (HBV) is a deadly viral infection that accounts for 4,000 to 5,000 fatalities annually in the United States. 1 to 2 out of every 1000 pregnancies experience an acute infection. Around the world, 300 million people are thought to have chronic HBV infection. It spreads 100 times more quickly than HIV does.

Transmission

• Incubation usually 50-180 days
• Mode of transmission
  • Sexual contact
  • Transplacental
  • Perinatal
  • Contact with blood, stool and saliva
  • Shared razors, toothbrushes, towels, and other personal items
• At risk populations
  • Southeast Asians, Eskimos, Africans, Chinese, Filipinos and Indonesians
  • Homosexuals
  • IV drug users
  • Hemophiliacs
  • Transfusion or organ recipients f. Hemodialysis patients

Physical Findings

• Low-grade fever
• Jaundice
• Nausea
• Anorexia
• Hepatomegaly and
• Malaise

Diagnostic findings

• +HbsAg
• +HbeAg (7-14 days after exposure)

Potential Maternal and Neonatal Effects

• Maternal
  • Premature labor and delivery
  • Cirrhosis
  • Liver cancer
• Neonatal
  • Stillbirth
  • Infants infected at birth have a 90% chance of becoming chronically infected
  • Acquires infection from mother
  • Life-long carrier
  • Liver disease and liver cancer

Interventions

1. Maternal

• Women who are pregnant and have been exposed to HBV should get the vaccine and HBIG.
• Women who are already infected during pregnancy should eat healthily, get enough sleep, avoid stress, and abstain from alcohol.
• Lamivudine and alpha interferon are contraindicated during pregnancy.

2. Neonatal

• Infants of infected women should receive HBV vaccine 
• HBIG

Health Education

• The best defense against hepatitis B is immunization. Use of latex condoms correctly and regularly may stop sexual transmission.
• Useless to utilize IV medicines.
• Never share water, "works," needles, or syringes.
• Never exchange personal things like toothbrushes or razors that might be stained with blood.
• Before having a tattoo or piercing, think about the hazards.
• Employees in the healthcare industry should take simple safety precautions and handle sharp objects with care.

RUBELLA (GERMAN MEASLES)

Rubella is a common childhood infection that, if contracted by the mother while she is pregnant, poses a major risk to the fetus. Due to vaccination or prior sickness, the majority of women who are fertile are immune to rubella, although 2 in 10 are thought to be susceptible.

Transmission

• Incubation-2 to 3 weeks
• Highly contagious
• Spread through nasopharyngeal secretions
• Transplacental transmission likely.

Physical Findings

• Rash (lasting about 3 days)
• Swollen glands
• Low-grade fever
• Joint pain
• Headache
• Loss of appetite
• Sore throat and hepatomegaly
• It is often asymptomatic. Diagnostic Findings
• ELISA, isolation of virus from urine or endocervical secretions
• Fluorescent antibody (FA) or complement fixation (CF) test.

Potential Maternal and Neonatal Effects

1. MaternalStillbirth and miscarriage are two outcomes of infection. When a woman is exposed between 11 and 20 weeks of pregnancy, the risk of congenital rubella syndrome is at its highest (up to 90%).

2. Neonatal
One or more birth abnormalities affect about 25% of newborns whose mothers had rubella during the first trimester:

• Blindness
• Mental retardation
• Cataracts
• Movement disorders and
• Development of diabetes during childhood or later.

Some infected babies have short-term health problems

• Diarrhea
•  Feeding problems
• Meningitis
• Red-purple spots on faces and bodies
• LBW
• Pneumonia
• Anemia
• Enlarged spleen and liver

Interventions

• Maternal
  • Mild analgesics, rest and support.
• Neonatal
  • Congenital rubella does not have a specific treatment.
  • Surgery may be used to improve or correct heart or eye abnormalities.
  • Special education should be provided and difficulties should be carefully screened for. Babies with congenital rubella infection should be kept apart because they are contagious.

Health Education

• The best prevention is immunization of non-immune women before pregnancy.
• It is not advised to get the MMR (measles, mumps, rubella) or rubella immunizations while pregnant. Following vaccination, a woman should wait 28 days before trying to get pregnant (although the risk to an inadvertent pregnancy during this time is very small). Women who are nursing may receive vaccinations.
• Rubella-nonimmune pregnant women should stay away from anyone who has the disease or its symptoms.

CYTOMEGALOVIRUS (CMV)

A typical congenital infection at birth is the cytomegalovirus. Each year, 40,000 infants (about 1% of them) become infected. Fortunately, most infants are unharmed, but CMV causes permanent impairments in roughly 8,000 infants annually.

Transmission Incubation

• CMV is a member of the herpes family and can reactivate just like herpes.
• CMV is particularly prevalent in young children (about 70% of children in child care between the ages of 1 and 3 will be excreting CMV).

Diagnostic Findings

• Maternal:
  The detection of the virus by culture, ELISA, fluorescent antibody (FA), complement fixation (CF), and seroconversion to +IgM.
• Prenatal:
  The infant with the condition may show the following ultrasound results:
  • Microcephaly
  • Hydrocephalus
  • Necrotic cystic or calcified lesions in the brain, liver or placenta
  • IUGR
  • Oligohydramnios
  • Ascites
  • Pleural or pericardial effusion
  • Hypoechogenic bowel and
  • Hydrops
  •  Amniocentesis with culture or DNA identification.
  •  Cordocentesis can be used to document presence and severity of disease.
• Newborn:
  The best way to demonstrate a CMV infection is through virus isolation. Conjunctiva, spinal fluid, nasopharynx, and urine can all be used as specimen sources.

Potential Maternal and Neonatal Effects

• Maternal:
  Most infections are asymptomatic.
• Neonatal:
  Primary maternal infection increases the risk of infection. Congenital infection rate of 1%, roughly. 10% of these will show symptoms, 25% of which will result in fatal disease, and 90% of survivors will have serious aftereffects.
  • IUGR
  • Microcephaly
  • CNS abnormalities
  • Hydrocephaly
  • Periventricular calcification
  • Deafness
  • Blindness and mental retardation.
  • Some newborns who are asymptomatic at birth will also experience late sequelae.

Interventions

Maternal:
Treat symptoms

Neonatal:
There is no treatment that works well. Infant should be kept apart because she is contagious.

Health Education

• By taking all necessary precautions and washing their hands thoroughly, especially after contact with saliva, urine, feces, blood, or mucus, women can lower their risk of contracting CMV.
• Never share drinking or eating utensils.
• To find out if they have CMV, health professionals might think about getting tested before getting pregnant, as they would then have little reason to be concerned.

HERPES SIMPLEX VIRUS

Herpes is brought on by herpes simplex viruses, which are related to those that cause shingles and chickenpox. Herpes simplex viruses have the ability to hide inside nerve cells after the initial infection and then reactivate previous attacks.

There are 2 main kinds of herpes simplex virus (HSV):

Type I: It is frequently connected with mouth sores

Type II: It is frequently connected to genital sores.

Points to Remember:

Both types can affect the mouth and genitalia and both can spread to the unborn child. There are about 1,000 newborn infections each year, and there are about 45 million Americans who have genital herpes.

Transmission

• 2 to 10 days for incubation
• Intercourse, mouth-to-genital contact, or kissing while sporting a cold sore are all examples of intimate mucocutaneous exposure.
• Passing through a birth canal that is infected
• Ascending infection when ROM is present
• With an initial maternal infection during pregnancy, transplacental infection occurs infrequently.
• Exposure to saliva that contains a virus

Physical Findings

• Painful
• Clusters of blisters that develop genital lesions rupture, producing an uncomfortable ulcer.
• Before the blisters emerge, there is frequently a "prodrome" of burning, itching, numbness, and tingling (contagious during this stage, too).
• The lesions typically return to the same location. With time, recurrences typically occur less frequently.

Primary infections may include:

• Fever
• Myalgia and
• Malaise
• Lymphadenopathy

Diagnostic Findings

• Vesicular tissue culture-swab sample
• Pap test for a lesion
• Experienced clinician's mental image of a painful lesion that resembles a blister or an ulcer.

Potential Maternal and Neonatal Effects

1. Maternal
A primary infection during pregnancy may increase the risk of PTD and LBW infant in the mother.

2. Neonatal
The greatest risk is to the unborn children of mothers whose primary infection occurred during pregnancy.

Potential Sequelae include:

• Lesions of the skin, mouth, or eyes that could result in long-term nerve or ocular damage.
• HSV frequently spreads to the brain and other internal organs in newborns (around 50% death rate).
• Mental retardation, cerebral palsy, epilepsy, blindness, or deafness affect about 50% of survivors.

Interventions

A cesarean delivery will be advised for women who have prodromal symptoms or an active lesion (still in the blister or ulcer phases).

Antiviral medications can reduce the frequency and length of herpes attacks as well as their symptoms.

In late pregnancy, oral acyclovir may be used to reduce the need for cesarean delivery. Neonatal HSV is treated with acyclovir and vidarabine, which is more effective for a localized infection than one that has spread to the brain and other internal organs.

Health Education

• Encourage those who have experienced genital herpes to stay away from "triggers" including heat, friction, intimate contact, peanuts, chocolate, fever, and stress, especially in the latter stages of pregnancy.
• In pregnant women without HSV who have partners with HSV, advise condom use or abstinence
• People with active cold sore lesions should refrain from kissing others, especially newborns, and instead practice thorough hand washing to prevent the spread of HSV to others or to other parts of the body.
• Women should be made aware of the significance of informing their medical professionals of any lesions or prodromal symptoms when they suspect labor or have ruptured membranes.

CHLAMYDIA

The most common bacterial sexually transmitted infection caused by Chlamydia trachomatis is Chlamydia trachomatis.

• Up to 80% of infections have no symptoms.
• Pregnancy prevalence varies between 2 and 21 percent.

How is it spread?

• Sexual activity in the vagina, anal, or oral cavity with a Chlamydia patient.
• During pregnancy or childbirth, infected pregnant women can transmit it to their unborn child.

Sign and Symptoms

Chlamydia is typically silent in men and women, which makes it exceedingly contagious. Some people go months or even years with the infection without realizing it.

Women who get symptoms may have: Usually NO SYMPTOMS!!!

• Vaginal discharge
• Bleeding between periods or after sex
• Burning or pain when urinating
• Abdominal or pelvic pain
• Pain during sex

Men who get symptoms may have:

• Discharge from the penis
• Burning sensation when urinating
• Pain & swelling in one or both testicles (less common)

Can lead to:

Infection spreads to tube that carries sperm from the testicles

• Pain
• Fever
• Inability to have children (rare)
• In rare cases, people with chlamydia have sore joints (arthritis) or inflammation of the eye (uveitis).

Pregnancy complications:

• PID
• Postpartum or post- abortion endometritis and salpingitis
• Preterm delivery
• Inability to get pregnant
• Ectopic pregnancy
• PROM
• Stillbirth

Neonatal Complications:

• Gets infected from the mother.
• Infections of the oropharynx, rectum, urogenital tract, and eye mucous membranes
• LBW
• Ophthalmia neonatorum

Treatment: First choice

Azithromycin b 1 g orally as a single dose, or doxycycline 100 mg twice daily for seven days.

Effective substitute

Tetracycline 500 mg four times daily for seven days, or ofloxacin 300 mg twice daily for seven days

Treatment of Neonatal Conjunctivitis and/or Pneumonia

For 14 days, administer erythromycin base or ethylsuccinate orally in 4 divided doses.

Follow-Up

Treatment effectiveness is guaranteed by a test-of-cure culture (continuous testing after therapy is finished to identify therapeutic failure). Therefore, this culture should be obtained at a subsequent appointment about two weeks after the end of treatment.

SYPHILIS

Treponema pallidum, a bacterial spirochete, is the source of the systemic, sexually transmitted disease known as syphilis. A chronic disease develops if the first, acute stage is not addressed.

Syphilis has three stages:

The primary stage typically begins 21 days (range: 10-90 days) after infection, during which the infected person experiences a painless genital ulcer that lasts 2–6 weeks.

The second stage is characterized by a generalized skin rash, frequently accompanied by fever and muscle pain. This stage also lasts for two to six weeks, and it is followed by a latent phase that lasts for many years and is symptom-free.

Rash:

• Possibly appear anywhere on the body
• On the palms of the hands or the bottoms of the feet, hard, red or reddish brown patches are typically seen.
• Non-itchy
• Typically appears 4 weeks after the healing of a chancre.
• Won't require treatment to go away, but the infection will advance to the next stage of syphilis.

However, spirochetes may occasionally circulate in the blood even during the latent period, albeit this occurs less frequently over time; as a result, practically all body organs may contract an infection; The tertiary stage develops from years to several decades after infection and might manifest as late benign syphilis, cardiovascular syphilis, or neurosyphilis, which affects the aorta and spinal cord (involving primarily the skin). Without antibiotic therapy, these complications will manifest in about 40% of individuals with latent infection.

Usually occurs during late syphilis but can occur at anytime during the infection

Typically Occurs 10-30 years after infection begins.

• Can harm almost any body part, such as the eyes, heart, brain, spinal cord, and bones.
• Can lead to death, heart disease, blindness, deafness, and mental illness
• Gummas

Types

• Heart disease syphilis
• Benign late syphilis

NEUROSYPHILIS SYPHILIS

Symptoms:

• A problem coordinating one's motions
• Paralysis (not able to move specific parts of your body) (not able to move certain parts of your body)
• Numbness
• Blindness
• Dementia (mental disorder)
• Internal organ damage
• The potential for death

More likely to occur early in the disease process if HIV infection is also present.

Pathophysiology

Treponema pallidum, a motile anaerobic spirochete that cannot be cultured, is the source of syphilis. Both immunity and latency are not effects of syphilis. With the right care, the infection can be cured, but re-infection is always a possibility. It is congenitally transmitted through the placenta to a fetus from an infected mother and is spread as a sexually transmitted disease by intimate contact between moist mucous membranes.

Pregnancy Complications:

• Preterm labor
• Spontaneous abortion
• Stillbirth

Neonatal Complications:

• Acquired infection from mother
• Bone and tooth abnormalities
• Hearing loss
• Blindness
• Brain damage
• Death

Investigation

• VDRL test of couple- both husband and wife
• Current treponemal tests include the EIA
• Fluorescent treponemal antibody absorption (FTA-ABS), T. pallidum agglutination assay (TPPA) and
• T. pallidum hemagglutination assay (TPHA)
• A presumptive diagnosis can be made by using two serologic tests:
• Non-treponemal tests (VDRL and RPR)
• Treponemal tests (FTA-ABS and TP-PA).
• The only reliable procedures for identifying early syphilis are dark-field microscopic studies and direct fluorescent antibody testing of lesion exudate or tissue.

Prevention

• Only when there are obstetrical reasons for a cesarean section can a woman give birth vaginally.
• Stick to the guidelines of not having multiple partners and encourage the use of barrier contraceptives.

Treatment

To achieve proper antibiotic levels in the baby, pregnant women are given 2.4 million units of benzathine penicillin intravenously (IM). The placenta does not readily absorb other drugs. The gravida should still receive a full dose of penicillin utilizing a controlled oral desensitization protocol even if she has a penicillin allergy. Serology titers should be monitored every 1, 3, 6, and 24 months. By six months, titers should have fallen four times, and by 12 to 24 months, they should be negative.

The Jarisch-Herxheimer reaction is characterized by anxiety, myalgia (muscle pain), exacerbation of skin lesions, fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, and vasodilation with flushing within a few hours of the first dose of antibiotic. occurs in half of pregnant women and is associated with treatment. It begins in 1-2 hours, reaches its peak in 8 hours, and ends in 24–48 hours. Acute fever, headache, myalgias, hypotension, and uterine contractions are all associated with it. Administration is a form of care.

GONORRHEA

By the organism Neisseria gonorrhoea, gonorrhea can result in infections of the genitalia, rectum, and throat. The rates of infection are currently highest among young women (ages 15 to 19).

Female symptoms:

• A scorching or uncomfortable feeling when urinating
• Increased vulvar leaking
• Bleeding between cycles in the cervix

Effect on Pregnancy:

• Pelvic inflammatory disease (PID)
• Formation of scar tissue that blocks fallopian tubes
• Ectopic pregnancy
• Inability to get pregnant
• Long-term pelvic/abdominal pain
•  Postpartum sepsis
• Preterm delivery
• PROM
• Spontaneous abortion
• Chorioamnionitis
• Restricted intrauterine growth Bartholin's abscess or a pelvic abscess

Neonatal complications:

• Acquires infection from mother
• Ophthalmia neonatorum
• Sepsis

Male symptoms:

• Urinating with a burning sensation
• A green, white, or yellow discharge from the genital area
• Testicles that are inflamed or hurt (less common) Can result in: a painful condition that affects the testicular tubes
• Not being able to have children
• Sterile

Treatment

First choice

• Cefixime 400 mg orally as a single dose, or ceftriaxone 125-250 mg by intramuscular injection

Effective substitute

•  Ciprofloxacin 500 mg orally as a single dose, or spectinomycin 2 g by intramuscular injection

HUMAN PAPILLOMAVIRUS (HPV)

Human wart virus is the root cause of the human papillomavirus (HPV). Pregnant women experience it more often than non-pregnant women.

How is HPV transmitted?

• Vaginal sex
• Anal sex
• Oral sex

(Vaginal & anal most common)

HPV is VERY common.

Note:

There are numerous forms of HPV, and the majority of sexually active men and women will contract one or more of them at some point in their lives. HPV is sexually transmitted in more than 30 different categories and over 100 different strains. Many common strains of HPV, including those that cause genital warts, are thought to be "low-risk" despite the fact that some "high risk" variants have been related to cervical cancer. The majority of "low risk" infections heal on their own, rarely requiring any medical intervention. In the United States, 6.2 million new cases of HPV are identified each year. The best known methods to guard against potential HPV infection complications are routine cervix checks (pap smears).

HPV Vaccination (Gardasil):

• Males & Females age 9-26 can be vaccinated against 4 common strains of HPV (Types 6, 11, 1 18).
•  Preferably ages 11 or 12

Gardasil for Anal Cancer Prevention (Types 6, 11, 16, 18):

• About 90% of anal cancers are linked to HPV.
• 9–26 year old males and females

The majority of HPV-positive people are unaware of their infection and never experience any symptoms or health issues as a result.

The virus itself has no known cure. But there are remedies for the health issues that HPV might bring about.:

1.Genital warts:
In the vaginal region, it typically manifests as a tiny lump or cluster of bumps. They can be big or little, elevated or flat, or cauliflower-shaped. Usually, a doctor can identify warts by looking at the vaginal region. Warts on the genitalia can be cured. Genital warts can disappear, remain the same, or increase in size or quantity if left untreated.

2. Cervical pre-cancer:
It is treatable. Women who regularly have Pap tests and follow up as necessary can spot issues before cancer manifests. Always choose prevention over treatment.

3. Other HPV-related cancers:
The malignancies of the vulva, vagina, penis, and anus can all be brought on by HPV in addition to cervical cancer. Additionally, it can cause cancer in the tonsils and base of the tongue, as well as in the back of the throat (called oropharyngeal cancer). After a person contracts HPV, cancer frequently takes years or even decades to develop. When detected and treated early, other HPV-related malignancies (other than cervical cancer) are also more curable.

Note:

It is impossible to predict which HPV-positive individuals may experience cancer or other health issues. People with weakened immune systems, such as those with HIV/AIDS, may be less able to combat HPV and more likely to experience health issues as a result of it. The HPV strains that can result in genital warts are distinct from those that can result in cancer.

Complications

Pregnancy Complications:

• Cesarean delivery

Neonatal Complications:

• Acquires infection from mother
•  Juvenile laryngeal papillomata (JLP)

Treatment

Treatment options for precancerous cervical lesions or genital warts caused by HPV are numerous and may include:

• Topical trichloroacetic acid (TCA) 80% to 90%
•  Liquid nitrogen cryotherapy
• Topical imiquimod 5% cream (Aldara)
• Topical podophyllin 10% to 25%
•  Laser carbon dioxide vaporization
• Client-applied Podofilox 0.5% solution or gel
• Simple surgical excision
• Loop electrosurgical excisional procedure (LEEP)
• Intralesional interferon therapy (National Institute of Allergy and Infectious Diseases)

HUMAN IMMUNODEFICIENCY VIRUS

Worldwide, 17.6 million women are thought to be HIV/AIDS positive. Most people treat HIV as a chronic infection that may never lead to AIDS.

"HIV is a virus spread through body fluids that affects specific cells of the immune system, called CD4 cells, or T cells".

HIV:

The letter "H" stands for human.

• Since HIV is a retrovirus, it is incapable of reproduction outside of the human body.
• HIV must be able to reproduce and survive in order to spread infection.

"I" is for Immunodeficiency

• I which refers to an unhealthy immune system which is the body's natural defense against rare infections and diseases.

"V" is for virus.

• Like cold or flu viruses, certain viruses enter the body, remain there for a while, and then eventually leave. HIV, however, does not disappear. There is a cure, but no treatment.
• AIDS is brought on by the HIV virus.
• The immune system, which defends the body against infection, is attacked or compromised by HIV.
• The HIV virus seeks out and kills CD4 or T cells, which are white blood cells that aid in disease fighting. uses it to replicate itself and take control of the cell.

AIDS (Acquired Immuno Deficiency Syndrome)

• A late stage of HIV infection is AIDS.
• The body struggles to combat sickness and some cancers after a diagnosis.
• AIDS has no known cure, but there are treatments.

"A" stands for acquired.
Contrary to heart disease and diabetes, HIV does not run in families. HIV must first enter the body through some means other than perinatal (mother to baby) transmission.

"I' represents the body's immune system
That works to protect the body from infection. "D" refers to a defect in the immune system that causes it not to function properly.

"S" stands for syndrome.
In the US, AIDS is the third leading cause of death for Black women in this age range and the fifth leading cause of death overall for women aged 25 to 44. In the US, women with AIDS make up 79% of the population who are African-American or Hispanic.

Epidemiology

According to the most recent population-based figures (NCASC, 2009), 63,528 adults and children are HIV-positive, which corresponds to an estimated prevalence of 0.39% among adults. According to estimates, AIDS-related causes claimed the lives of 4,701 adults and children in 2009. Women make up almost 29% of Nepal's population of HIV-positive people. 90% of female cases that have been reported are childbearing age.

Effects of HIV on the Immune System

• HIV is a retrovirus that attacks CD4+ T-cells, reducing their population and decreasing their ability to function.
• If left unchecked, HIV can eliminate up to 1 billion CD4 cells day.
• HIV has a complex genetic makeup that appears to be easily adaptable.

Diagnosis Explanation

• Physical examination and lab tests before initiating ARV Therapy:
• Vital signs: Pulse, BP, respiration, including temperature, pallor, cyanosis, icterus, edema, clubbing, lymphadenopathy, JVP
• Body weight of the patient
• Skin:
  • Look out for skin problems like HIV dermatitis, Herpes Zoster, and others.
  • Oropharyngeal mucosa: Check for Kaposi sarcoma, hairy leucoplakia, and candidiasis. Examination of the nervous, musculoskeletal, genitourinary, and gastrointestinal systems.
• Laboratory Tests:
  • TC, DC, ESR, Hb%, Platelets
  • ALT/SGPT-If needed LFT (Liver function test) Blood Urea, Serum creatinine
  • If needed kidney function test (Electrolytes-sodium, potassium)
  • Blood sugar level
  • VDRI
  • Hepatitis B and Hepatitis C
  • Urine analysis to assess for proteinuria
  • Urine pregnancy test as indicated in female Sputum for AFB tested by GeneXpert, Microscopy
  • Chest X ray
• CD4 cell count a positive HIV test and presence of an indicator disease or a CD4/T cell count of less than 200.

Enzyme Linked-Immunosorbent Assay (ELISA):

The use of enzyme conjugates that bind to specific HIV antibodies and substrates/chromogens that produce color in a reaction catalyzed by the bound enzyme conjugate is a feature shared by all types of ELISA. Most ELISA are effective at detecting HIV-1 and HIV-2 antibodies and can be used in locations with a lot of sample volume.

In a single test, the Western Blot (WB) technique captures several antibodies that are present in the serum. This technique uses a longer strip to segregate the several HIV antigens. A patient's serum that contains a variety of antibodies is combined with a strip that contains a variety of antigens, causing an antigen antibody reaction. The presence of major antibodies in the serum is used to interpret the test results. cervical pap smear or another cervical cancer screening method, if one is available, for females.

Transmission

There are three ways of transmission, they are as follows,

• Contact between blood cells
• Sex without protection with HIV-positive individuals
• HIV infection before, during pregnancy, or through breastfeeding

1. Anal sex
The highest rate of HIV sexual transmission occurs during anal intercourse. This is caused by the anus's tighter, thinner lining. Oral sex has the lowest risk of the three, followed by vaginal intercourse. Anal intercourse is practiced by both men and women. Even while oral sex is less dangerous and does not result in pregnancy, it can still put young people at risk for a variety of STDs, including HIV.

2. Sharing needles
Sharing needles is considered blood to blood transmission because a small amount of blood is drawn into the syringe each time a person puts a needle into a vein. Blood from one person is mingled with blood from another when the same needle is used. Transmission can also happen when using a substance like heroin "works" (the spoon, bucket of water and cotton ball that is used while injecting and sharing the drug)

3. Mother-to-child transmission
HIV can be passed from a mother to her kid during pregnancy, childbirth (also known as labor and delivery), or breastfeeding. This is known as mother-to-child transmission of HIV. It is the most typical way for youngsters to contract HIV.

• HIV medications are given to expectant mothers with the virus to lower the chance of mother-to-child transmission. In some circumstances, a woman with HIV may undergo a planned C-section to stop the spread of HIV from mother to kid.
• HIV medication is given to newborns of HIV-positive mothers for six weeks following birth. The HIV medication lowers the possibility of contracting HIV from any virus that might have entered a baby's body following delivery.
• Women who are HIV positive should not breastfeed their infants since HIV can be spread through breast milk. A safe and healthful substitute for breast milk is baby formula.
• All pregnant women are advised by the CDC (Centers for Disease Control and Prevention) to get tested for HIV as soon as feasible in each pregnancy.

MONOLIASIS

A little fungus is the root of monoliasis, sometimes known as "yeast infection." Small amounts of these are often present in the vagina of healthy women. Sometimes the population increases, resulting in issues like heavy, curdy, white discharge, vaginal itching, burning, and pain during sex.

Sign and symptoms

Depending on the location affected, candidiasis has different signs and symptoms. Most candidial infections cause only minor side effects including redness, itching, and discomfort, but in other groups, complications can be severe or even fatal if left untreated. When it comes to healthy (immunocompetent) people, candidiasis typically manifests as a localized infection of the skin, fingernails, toenails, or mucosal membranes of the mouth, pharynx (thrush), esophagus, and genitalia. The gastrointestinal tract, urinary tract, and respiratory tract are locations of candida infection less frequently in healthy individuals.

Symptoms of esophageal candidiasis include difficulty swallowing, painful swallowing, abdominal pain, nausea, and vomiting.

Genitals

Itching, burning, soreness, irritation, and a whitish or whitish-gray discharge are all possible symptoms of vaginal or vulvar infection. Male genital thrush, also known as balanitis, is characterized by red skin around the head of the penis, swelling, itching, and soreness of the penis, thick, lumpy discharge under the foreskin, unpleasant odor, difficulty retracting the foreskin (phimosis), and pain when passing urine or having sex.

Prevention

• A healthy balance of the oral and intestinal flora is facilitated by a diet low in simple carbohydrates and supportive of the immune system.
• Diabetes and yeast infections are linked, however the degree of blood sugar control may not have an impact on the risk.
• Along with avoiding wearing damp clothing for extended periods of time, wearing cotton underwear may help lower the chance of acquiring skin and vaginal yeast infections.
• There is insufficient proof that oral or intravaginal probiotics can help women with recurrent yeast infections avoid getting them again. This covers both tablet form and yogurt form.

Treatment

• Antifungal drugs, such as clotrimazole, nystatin, fluconazole, voriconazole, amphotericin B, and echinocandins, are used to treat candidiasis.
• Immunocompromised or seriously unwell patients are frequently treated with intravenous fluconazole or an intravenous echinocandin such as caspofungin.

TRICHOMONIASIS

• A prevalent sexually transmitted illness is trichomoniasis (STD).
• Trichomonas vaginalis, a microscopic one-celled parasite, is the culprit. It can be acquired by any sexually active person. More women than men, older women than younger women, and African American women than white or Hispanic women are affected by it.
• Trichomonasis frequently goes unnoticed by its victims, and it rarely results in complications. However, if the women don't receive treatment, their risk of contracting or spreading other STDs, like HIV, increases.

Trichomoniasis Causes

By having sex with a person who has the disease, one contracts trichomoniasis. It typically spreads when a penis and a vagina come into touch. Through vaginal touch, women who have intercourse with other women can potentially have trichomoniasis.

The illness usually affects females in the vulva, vagina, cervix, or urethra. It typically affects men in their urethra. Additionally, the gland between the bladder and the penis, the prostate, may contract it in them. Even if you don't experience any symptoms, anyone with trichomoniasis can spread it to other parts of your body like your hands, mouth, or anus.

Trichomoniasis Symptoms

Trichomonasis affects about 70% of people without any symptoms. Others might not exhibit the symptoms for days or even weeks after infection.

Among women with trichomoniasis:

• Vaginal fluid that smells bad and is greenish or yellowish
• Genital itching, burning, redness, or soreness
• Pain when they urinate or have sex
• The need to urinate more often
• Bleeding after sex

Men with trichomoniasis may have:

• Itching or irritation inside their penis
• Pain when they urinate or have sex
• A thin white discharge from the penis
• The need to urinate more often

Trichomoniasis Diagnosis

By obtaining a sample of your urine or vaginal fluid and examining it under a microscope to find the parasite, trichomoniasis can be identified. A test known as a culture should occasionally be performed. The sample is now stored for a few days so the parasite can develop and become simpler to spot under a microscope.

The parasite can potentially be detected using sensitive assays called nucleic acid amplification tests (NAATS).

Trichomoniasis Treatment

• Most people's infections are resolved with antibiotics like metronidazole and tinidazole (Tindamax). You will be given pills to swallow by your doctor, either in a single large dose or multiple smaller doses. Even if you start to feel better before the medication is finished, take the entire dose.
• The parasite will be eliminated by treatment, but the person can still contract it again. Following treatment, 20% of patients have trichomoniasis once more within 3 months.
• Even if your sex partner or partners don't exhibit any symptoms, they should still be treated. After therapy, wait 7 to 10 days before having sex.

Trichomoniasis Prevention

The only way to avoid trichomoniasis is to not have vaginal sex. Other steps to lower your chances of getting it are:

• Use latex condoms exclusively. Make sure to put the condom on early, before it contacts the vagina, as trichomoniasis can be contracted or spread solely through contact.
• Do not douch. A natural balance of microorganisms in the vagina keeps people healthy. When you douche, you eliminate part of those beneficial bacteria, increasing your risk of contracting an STD.
• Maintain a single sexual partner who has tested STD-free. If you find it doesn't work for you, consider reducing the amount of sex partners you have.
• Be honest with your partners about your sexual preferences and the possibility of contracting an infection. You can use this to guide your decision-making for yourself.