Sexually Transmitted Sexually Transmitted DiseasesDiseases

There Maternal and Fetal There Maternal and Fetal EffectsEffects

HERPESHERPES: HSV I & II : HSV I & II • TYPE I is TYPE I is usuallyusually found ABOVE UMBILICUS (except when found ABOVE UMBILICUS (except when

transmitted through oral sex to the genitals), non-transmitted through oral sex to the genitals), non-cancer causing and doesn't return as often as HSVII. cancer causing and doesn't return as often as HSVII.

• TYPE 11 is TYPE 11 is usuallyusually found BELOW UMBILICUS (unless found BELOW UMBILICUS (unless transmitted from the genitals to the oral cavity). It transmitted from the genitals to the oral cavity). It makes one prone to cancer latermakes one prone to cancer later

• Both types can be transmitted orally or through Both types can be transmitted orally or through

intercourse. The two can't be differentiated by sight. intercourse. The two can't be differentiated by sight. The virus enters nervous system and the liver. In the The virus enters nervous system and the liver. In the case of HSVII, the virus can remain dormant In the case of HSVII, the virus can remain dormant In the ganglia reoccur regularly. HSVI does not usually reoccur ganglia reoccur regularly. HSVI does not usually reoccur as regularly or as frequently as HSBII, and if HSVI is as regularly or as frequently as HSBII, and if HSVI is transmitted to the genitalia, may only be responsible transmitted to the genitalia, may only be responsible for one isolated incident. for one isolated incident.

Precipitating factorsPrecipitating factors (t (triggers) = stress, excessive = stress, excessive sunlight, local trauma, PMS, hormonal changes. sunlight, local trauma, PMS, hormonal changes.

SymptomsSymptoms• With active HIV, small vesicles that rupture in 2-3 With active HIV, small vesicles that rupture in 2-3

days becomes ulcerous. days becomes ulcerous. • The genitalia become inflamed with enlarged The genitalia become inflamed with enlarged

inguinal nodes, fever and UTI. inguinal nodes, fever and UTI. • Eventually, the vesicles crust over and don't leave Eventually, the vesicles crust over and don't leave

scars. scars. • Usually takes 3-6 weeks to heal and crust over. Usually takes 3-6 weeks to heal and crust over. • Dormant- tissues shed virus, although the area Dormant- tissues shed virus, although the area

appears clear and the patient is asymptomatic. appears clear and the patient is asymptomatic. ******BEWAREBEWARE:: Labor is stressful and can activate Labor is stressful and can activate

herpes. Tests should be perfromed throughout labor herpes. Tests should be perfromed throughout labor (test is scraping of cells for shedding of virus)-- (test is scraping of cells for shedding of virus)-- if if cells are presentcells are present, , C-Section should be performedC-Section should be performed. .

TreatmentTreatment• The condition is self limiting with symptoms subsiding spontaneously, although the virus The condition is self limiting with symptoms subsiding spontaneously, although the virus

remains dormant and ready to strike again. remains dormant and ready to strike again.

• Primarily, the disease is treated withPrimarily, the disease is treated with acycloviracyclovir (Zovirax) which has been most (Zovirax) which has been most effective. It is given 200mg po q 4 hours 5 times/day X 10 days or 400mg tid X 10 days. effective. It is given 200mg po q 4 hours 5 times/day X 10 days or 400mg tid X 10 days. For recurrent or suppressive therapy: 400mg 2 times/day for up to 12 months, then re-For recurrent or suppressive therapy: 400mg 2 times/day for up to 12 months, then re-evaluate.evaluate.Herpes zoster (herpes around the waist typically seen in elderly with a history of Herpes zoster (herpes around the waist typically seen in elderly with a history of chickenpox in youth): 800mg 5 times/day X 7-10 dayschickenpox in youth): 800mg 5 times/day X 7-10 days OrOr

ffamcicloviramciclovir (Famvir) 500 mg po q8h for 7 days (in normal renal function), beginning as (Famvir) 500 mg po q8h for 7 days (in normal renal function), beginning as immediately after diagnosis is made and for recurrent genital herpes: 250: mg tid x 5-immediately after diagnosis is made and for recurrent genital herpes: 250: mg tid x 5-10days (in normal renal function), within 6 hours of symptoms. 10days (in normal renal function), within 6 hours of symptoms. Side effectsSide effects are minor = are minor = headache, nausea, diarrhea, fatigue.headache, nausea, diarrhea, fatigue.

• VidarabineVidarabine (Vira A, adenine arabinoside and Ara-A ) ophthalmic preparations are effective (Vira A, adenine arabinoside and Ara-A ) ophthalmic preparations are effective for acute keratoconjunctivitis and recurrent superficial keratitis caused by HSV-1 and HSV-for acute keratoconjunctivitis and recurrent superficial keratitis caused by HSV-1 and HSV-2. A 3% ophthalmic ointment is instilled 1 cm inside the lower conjunctival sac of the 2. A 3% ophthalmic ointment is instilled 1 cm inside the lower conjunctival sac of the affected eye 5 times/day while awake (q 3 h). Treatment should be continued for 5 to 7 affected eye 5 times/day while awake (q 3 h). Treatment should be continued for 5 to 7 days after complete healing to prevent recurrences. Possible adverse effects include days after complete healing to prevent recurrences. Possible adverse effects include tearing, irritation, pain, photophobia, and superficial punctate keratitis. tearing, irritation, pain, photophobia, and superficial punctate keratitis.

• If If severe or for complications, HSV can be treated with intravenoussevere or for complications, HSV can be treated with intravenous • VidarabineVidarabine (Vira A) - (Vira A) - Side effectsSide effects = = gastrointestinal: nausea, vomiting, diarrhea,

neurological: = paresthesia, ataxia and seizures) or or more commonlymore commonly with with acycloviracyclovir (Zovirax).(Zovirax). 5-10mg/kg IV q 8 hours X 7-10 days. 5-10mg/kg IV q 8 hours X 7-10 days.

Administer at constant rate over 1 hour. Administer at constant rate over 1 hour. Side effectsSide effects = = Renal toxicity: serum creatinine : serum creatinine and BUN rise and creatinine clearance decreases, and BUN rise and creatinine clearance decreases, Encephalopathy:Encephalopathy: lethargy, obtundation, lethargy, obtundation, tremors, confusion, hallucinations, agitation, seizures or coma tremors, confusion, hallucinations, agitation, seizures or coma and other: transient elevated creatinine, rash or hives; diaphoresis; hematuria; hypotension; headache and nausea (GI side effects reduced if take with meals); thrombocytosis.

Nursing:Nursing:

• Assess for therapeutic and side effects of Assess for therapeutic and side effects of specific medications used. specific medications used.

• Teach appropriate handwashing to parents Teach appropriate handwashing to parents and precautions mother should take if her and precautions mother should take if her lesions are active. lesions are active.

• Cultures should be taken from infants Cultures should be taken from infants throat, conjunctiva, cerebral spinal fluid, throat, conjunctiva, cerebral spinal fluid, blood, urine and any lesions to identify blood, urine and any lesions to identify herpes virus II antibodies in serum IgM herpes virus II antibodies in serum IgM (cultures positive in 24-48hrs). (cultures positive in 24-48hrs).

Implications/ComplicationsImplications/Complications

severe discomfort and severe discomfort and concern about possibility concern about possibility of C-Section and fetal of C-Section and fetal infection. infection.

Development of Development of neonatal Herpes Virus II, neonatal Herpes Virus II, secondary hepatitis with secondary hepatitis with jaundice and neurologic jaundice and neurologic abnormalities. abnormalities. Follow up evaluations Follow up evaluations for potential sequelae of for potential sequelae of microcephaly, spasticity, microcephaly, spasticity, seizures, deafness or seizures, deafness or blindness.blindness.

MATERNALMATERNAL FETALFETAL

HIV and AIDSHIV and AIDS

• The chances of passing HIV to the baby The chances of passing HIV to the baby before or during birth are about one in before or during birth are about one in four, or 25 percent, for each pregnancy. A four, or 25 percent, for each pregnancy. A baby can get HIV from an HIV-infected baby can get HIV from an HIV-infected mother in three ways: during pregnancy. mother in three ways: during pregnancy. during delivery and after delivery through during delivery and after delivery through breast feeding (this is still being breast feeding (this is still being researched -third world countries are researched -third world countries are encouraged to breastfeed even in the encouraged to breastfeed even in the presence of HIV because of the high presence of HIV because of the high morbidity/mortality related to improper morbidity/mortality related to improper nutrition). Most infants acquire AIDS nutrition). Most infants acquire AIDS through perinatal transmission through perinatal transmission (transplacentally) (transplacentally)

Maternal Implications: Maternal Implications: • HIV+ mother should be started on AZT HIV+ mother should be started on AZT (Zidovudine)(Zidovudine), now referred to , now referred to

as as ZDVZDV , during pregnancy (after 1st trimester). , during pregnancy (after 1st trimester). • If mothers don't have active AIDS requiring more aggressive therapy, If mothers don't have active AIDS requiring more aggressive therapy,

the newest therapy which is elective cesarean section before labor the newest therapy which is elective cesarean section before labor (usually at 36-38 weeks of gestation) plus a short oral course of (usually at 36-38 weeks of gestation) plus a short oral course of zidovudine, normally starting at week 32 intravenous zidovudine zidovudine, normally starting at week 32 intravenous zidovudine before cesarean section and later, 10 days of AZT therapy for the before cesarean section and later, 10 days of AZT therapy for the neonate have shown that neonate have shown that 1/3 less1/3 less babies get HIV. babies get HIV.

• AZT does suppress BMAZT does suppress BM = = throimbocytopenia, anemia and throimbocytopenia, anemia and granulocytopenia which is granulocytopenia which is increased with the administration of increased with the administration of acetaminophen (Tylenol),acetaminophen (Tylenol), so patients should be advised to so patients should be advised to avoid avoid this drugthis drug ! !

• Other complications of HIV in pregnancy that should be assessed at Other complications of HIV in pregnancy that should be assessed at every prenatal visit are weight loss in 2nd and 3rd trimester: thrush every prenatal visit are weight loss in 2nd and 3rd trimester: thrush (candidiasis), pneumonia, enlargement of lymph nodes, liver and (candidiasis), pneumonia, enlargement of lymph nodes, liver and spleen and regular visual examinations to watch for toxoplasmosis spleen and regular visual examinations to watch for toxoplasmosis retinitis. retinitis.

• Serology should also be checked regularly for progression of the Serology should also be checked regularly for progression of the disease (absolute CD4 lymphocyte count - if level 200/mm3 or lower, disease (absolute CD4 lymphocyte count - if level 200/mm3 or lower, opportunistic infections are more likely). Also, the ration of CD4 opportunistic infections are more likely). Also, the ration of CD4 (helper cells) to CD8 (suppressor cells) may show changes, usually (helper cells) to CD8 (suppressor cells) may show changes, usually reversed with active AIDS.reversed with active AIDS.

• THERE IS ALSO INCREASED RISK OF INTRAPARTAL and POSTPARTAL THERE IS ALSO INCREASED RISK OF INTRAPARTAL and POSTPARTAL COMPLICATIONS = intrapartal and postpartal hemorrhage, postpartal COMPLICATIONS = intrapartal and postpartal hemorrhage, postpartal infection, poor wound healing and genitourinary infections.infection, poor wound healing and genitourinary infections.

Fetal Implications: Fetal Implications:

• Weekly NST begun at 32 weeks Weekly NST begun at 32 weeks and serial ultrasound to check for and serial ultrasound to check for IUGR. Also Biophysical profiles are IUGR. Also Biophysical profiles are checked regularly. checked regularly. AMNIOCENTESIS SHOULD BE AMNIOCENTESIS SHOULD BE AVOIDED DUE TO INCREASED AVOIDED DUE TO INCREASED RISK OF TRANSFERRING VIRUS !RISK OF TRANSFERRING VIRUS !

Nursing DiagnosesNursing Diagnoses• Altered Nutrition Altered Nutrition

• Altered ParentingAltered Parenting

• Altered Bowel Elimination: Altered Bowel Elimination: diarrheadiarrhea

• Ineffective family coping. (Babies Ineffective family coping. (Babies with AIDS die young in childhood. with AIDS die young in childhood. Some babies who have HIV Some babies who have HIV become very sick and die in their become very sick and die in their first year. Others live longer but first year. Others live longer but may still get sick.) may still get sick.)

• Risk for InfectionRisk for Infection

NURSING/TREATMENT NURSING/TREATMENT for Pregnant Mother and fetusfor Pregnant Mother and fetus • UNIVERSAL PRECAUTIONS, in HIV+ with symptomsUNIVERSAL PRECAUTIONS, in HIV+ with symptoms• Monitor woman without symptoms for developing S/S of Monitor woman without symptoms for developing S/S of

active AIDS/infection/complications (fatigue, anemia, malaise, active AIDS/infection/complications (fatigue, anemia, malaise, progressive weight loss, lympadenopathy, diarrhea, fever, progressive weight loss, lympadenopathy, diarrhea, fever, neurologic dysfunction, or Karposi's Sarcoma - purplish, neurologic dysfunction, or Karposi's Sarcoma - purplish, reddish-brown lesions either external or internal). reddish-brown lesions either external or internal).

• Also if MOM IS HIV+ encourage to check with MD regarding Also if MOM IS HIV+ encourage to check with MD regarding ZDV ZDV (AZT)(AZT) and/or INTERFERON (an immunoglobulin) and/or INTERFERON (an immunoglobulin) PROPHYLACTICALLY during pregnancy to prevent AIDS in the PROPHYLACTICALLY during pregnancy to prevent AIDS in the infant and also treat mother to prevent progression of infant and also treat mother to prevent progression of disease r/t stress of pregnancy. disease r/t stress of pregnancy.

• Parents of H/R babies experience stress and grieving, and Parents of H/R babies experience stress and grieving, and need support. Support groups are available. need support. Support groups are available.

• Encourage them to help child accomplish the most during Encourage them to help child accomplish the most during lifespan. lifespan.

• Perform Discharge Blood Screening for HIV upon infants Perform Discharge Blood Screening for HIV upon infants discharge (Newborn Screening Tests- filter paper). discharge (Newborn Screening Tests- filter paper).

• Teach parents about implications for newborn. Teach parents about implications for newborn.

Implications for Newborns Implications for Newborns born to HIV+ moms born to HIV+ moms

• These infants will show These infants will show +HIV+HIV test results test results up to 15 months of age because they have up to 15 months of age because they have mom's antibodies. mom's antibodies.

• Only Viral Load test (the approved viral Only Viral Load test (the approved viral load test is called the Amplicor HIV-1 load test is called the Amplicor HIV-1 Monitor test, better known as the PCR DNA Monitor test, better known as the PCR DNA test [e.g. RT-PCR called Amplicor by Roche test [e.g. RT-PCR called Amplicor by Roche Labs) will accurately show if newborn is Labs) will accurately show if newborn is HIV+ before 15 months. Infants < 12 HIV+ before 15 months. Infants < 12 months with very high viral loads months with very high viral loads (>100,000) may be at high risk for disease (>100,000) may be at high risk for disease progression and death (<50,000 is low & progression and death (<50,000 is low & undetectable). Two viral load tests should undetectable). Two viral load tests should be obtained as baseline. be obtained as baseline.

Infants and Children with Infants and Children with HIV HIV • This is the 9th leading cause of death among children This is the 9th leading cause of death among children

between 1 and 4 years old. Many children with perinatal between 1 and 4 years old. Many children with perinatal transmission die within the first 24 months of age. As of transmission die within the first 24 months of age. As of December 2000, more than 1,600 children jave been December 2000, more than 1,600 children jave been infected with HIV each day worldwide. infected with HIV each day worldwide.

• The CDC has defined categories for diagnosis as of 1994. A The CDC has defined categories for diagnosis as of 1994. A POSITIVE HIV ANTIBODY TEST IS POSITIVE HIV ANTIBODY TEST IS NOTNOT SUFFICIENT TO SUFFICIENT TO DIAGNOSE AIDS. CD4+ lymphocyte counts in healthy DIAGNOSE AIDS. CD4+ lymphocyte counts in healthy children are much higher than in adults. Normal CD4+ children are much higher than in adults. Normal CD4+ counts slowly decline to adult levels by age 6. counts slowly decline to adult levels by age 6.

• Antiretroviral Therapy is recommended for all children with Antiretroviral Therapy is recommended for all children with HIV infection who have: Clinical symptoms of HIV infection HIV infection who have: Clinical symptoms of HIV infection (Clinical category A, B, or C) or evidence of immune (Clinical category A, B, or C) or evidence of immune suppression (Immune category 2 or 3 = <25% CD4+ suppression (Immune category 2 or 3 = <25% CD4+ count). count).

CDC Clinical CategtoriesCDC Clinical Categtories• CATEGORY N: Not Symptomatic =CATEGORY N: Not Symptomatic = No No

signs/symptoms signs/symptoms OROR one sign/symptom in Category one sign/symptom in Category A A

• CATEGORY A: Mildly Symptomatic =CATEGORY A: Mildly Symptomatic = Two or Two or more of the following: Lymphadenopathy; more of the following: Lymphadenopathy; Hepatomegaly; Splenomegaly; Dermatitis; Hepatomegaly; Splenomegaly; Dermatitis; Parotitis; Recurrent/persistent URIs/sinusitis/otits Parotitis; Recurrent/persistent URIs/sinusitis/otits

• CATEGORY B: Moderately Symptomatic =CATEGORY B: Moderately Symptomatic = HIV- HIV-related signs/symptoms not in Category A/C related signs/symptoms not in Category A/C

• CATEGORY C: Severely Symptomatic =CATEGORY C: Severely Symptomatic = AIDS- AIDS-defining disease defining disease National Pediatric & Family HIV Resource Center National Pediatric & Family HIV Resource Center [1998]. [1998].

Clinical manifestationsClinical manifestations• Early signs are developmental delays or after having achieved Early signs are developmental delays or after having achieved

normal developments, there is loss of motor milestones normal developments, there is loss of motor milestones (motor dysfunction was especially reduced muscle mass), (motor dysfunction was especially reduced muscle mass), microcephaly and emotionally exhibit irritable and microcephaly and emotionally exhibit irritable and inconsolable behaviorsinconsolable behaviors

• Other S/S are lymphadenopathy, hepatosplenomegaly, Other S/S are lymphadenopathy, hepatosplenomegaly, parotitis (parotid gland inflammation near the ear), parotitis (parotid gland inflammation near the ear), opportunistic infections (pnueumocytis carinni pneumonia opportunistic infections (pnueumocytis carinni pneumonia [PCP], persistent oral candidiasis [thrush] and chronic or [PCP], persistent oral candidiasis [thrush] and chronic or recurrent diarrhea. recurrent diarrhea.

• Progressive/terminal signs = cerebral edema, disorientation, Progressive/terminal signs = cerebral edema, disorientation, loss of consciousness. Children with the lowest loss of consciousness. Children with the lowest neuropsychological functioning (IQ < 70) at baseline had the neuropsychological functioning (IQ < 70) at baseline had the highest risk for later HIV disease progression (56%). highest risk for later HIV disease progression (56%). Neurologic involvement is usually seen as progressive Neurologic involvement is usually seen as progressive encephalopathy (occurs in 50% of children with HIV) encephalopathy (occurs in 50% of children with HIV)

Treatment for childTreatment for child • Therapy usually begins on HIV-infected infants <12 months, as Therapy usually begins on HIV-infected infants <12 months, as

soon as the diagnosis is confirmed, regardless of clinical, immune soon as the diagnosis is confirmed, regardless of clinical, immune status, or viral load. Cocktails are preferred (combination of two status, or viral load. Cocktails are preferred (combination of two or more drugs rather than monotherapy). or more drugs rather than monotherapy).

• STRONGLY RECOMMENDED TREATMENTSTRONGLY RECOMMENDED TREATMENT is the use of one is the use of one highly active protease inhibitor plus 2 NRTIs (Nucleoside Reverse highly active protease inhibitor plus 2 NRTIs (Nucleoside Reverse Transcroptase Inhibitors), i.e. Transcroptase Inhibitors), i.e. Protease Inhibitor = Nelfinavir or ritonavir or indinavir (if children Protease Inhibitor = Nelfinavir or ritonavir or indinavir (if children swallow capsules) swallow capsules) NRTI = ZDV (zidovudine/Retrovir) + ddI (didanosine / Videx) NRTI = ZDV (zidovudine/Retrovir) + ddI (didanosine / Videx) oror ZDV + 3TC (lamivudine/Epivir) ZDV + 3TC (lamivudine/Epivir)

• Some children who were treated earlier with monotherapy Some children who were treated earlier with monotherapy (usually ZDV or ddI) and have maintained a low viral load (<100) (usually ZDV or ddI) and have maintained a low viral load (<100) and normal CD4 count before the development of the above and normal CD4 count before the development of the above guidelines should be maintained on a case by case basis. In such guidelines should be maintained on a case by case basis. In such situations monotherapy may be appropriate to continue. situations monotherapy may be appropriate to continue.

• ********Monotherapy and combinations of d4t and ZDV, ddC and ddI, Monotherapy and combinations of d4t and ZDV, ddC and ddI, ddC and d4T, ddC and 3TC ddC and d4T, ddC and 3TC are NOT RECOMMENDED for those are NOT RECOMMENDED for those beginning therapybeginning therapy . .

Nursing CareNursing Care• Nursing care is primarily supportive. Nursing care is primarily supportive. • Physical care is to maintain minimum exposure to infections, Physical care is to maintain minimum exposure to infections,

nutritional support, comfort measures, assessment and recogniton of nutritional support, comfort measures, assessment and recogniton of changes in status that indicate progression of the disease or changes in status that indicate progression of the disease or complications.complications.

• Note Note FEVERFEVER which is the chief sign of infection in all children with which is the chief sign of infection in all children with AIDS. AIDS.

• If the child has gotten the virus transplacentally, multiple problems If the child has gotten the virus transplacentally, multiple problems related to the mother being infected should be investigated (i.e. Is related to the mother being infected should be investigated (i.e. Is she is able to care for the child? Does she abuse drugs? Is she she is able to care for the child? Does she abuse drugs? Is she sexually promiscuous /prostitute? Is she ill or dying? Is there a father sexually promiscuous /prostitute? Is she ill or dying? Is there a father and an extended family who will be able to care for the child?)and an extended family who will be able to care for the child?)

• If the disease is congenitally acquired, the nurse will have to be If the disease is congenitally acquired, the nurse will have to be prepared for feelings of guilt on the part of the parents, (i.e. prepared for feelings of guilt on the part of the parents, (i.e. hemophiliacs acquiring HIV from past blood transfusions – guilt hemophiliacs acquiring HIV from past blood transfusions – guilt particularly the mother since it is transmitted from mother to child particularly the mother since it is transmitted from mother to child on the "X" chromosome. Presently, our blood banks are very careful on the "X" chromosome. Presently, our blood banks are very careful in screening for HIV infected blood). in screening for HIV infected blood).

• The last group the nurse may encounter is the adolescent who has The last group the nurse may encounter is the adolescent who has acquired the disease as the adult would through sexual activity or acquired the disease as the adult would through sexual activity or drug use. This child needs a great deal of support and teaching to drug use. This child needs a great deal of support and teaching to get the appropriate treatment. They may have little family for get the appropriate treatment. They may have little family for support. support.

Tips for dealing with HIV+ Tips for dealing with HIV+ childrenchildren1)1) Help the child to make a schedule for medicines and daily eating Help the child to make a schedule for medicines and daily eating

times that will work him/her times that will work him/her

2)2) Use a calendar or check-off lis as reminders to check off each Use a calendar or check-off lis as reminders to check off each dose. dose.

3)3) Teach adolescent or paretn to use a special marked dosing cup, Teach adolescent or paretn to use a special marked dosing cup, them not to use eating spoons to measure liquid medicines as size them not to use eating spoons to measure liquid medicines as size may vary. may vary.

4)4) Teach them to work times out so that they will adhere to taking Teach them to work times out so that they will adhere to taking the medicine. Keep in mind that taking medicine in a social the medicine. Keep in mind that taking medicine in a social situations may cause embarrassment or emotional distress.situations may cause embarrassment or emotional distress.

5)5) Teach parents to be poositive and consistent. Teach parents to be poositive and consistent.

6)6) Teach the child to take large pills by practicing with candies. Some Teach the child to take large pills by practicing with candies. Some of the pills are quite large and difficult to take. of the pills are quite large and difficult to take.

VAGINITISVAGINITIS

Contributing factors: oral contraceptives, Contributing factors: oral contraceptives, diabetes mellitus, premenstrual factors, diabetes mellitus, premenstrual factors, douching, use of antibiotic therapy and douching, use of antibiotic therapy and change in the body's normal hormone change in the body's normal hormone balance brought on by pregnancy, recent balance brought on by pregnancy, recent childbirth, breast feeding or menopause . childbirth, breast feeding or menopause .

This infection is not sexually transmitted. This infection is not sexually transmitted. S/S = thick, curdy discharge, itching, dysuria S/S = thick, curdy discharge, itching, dysuria

and dyspareunia. Labia may be swollen and and dyspareunia. Labia may be swollen and excoriated if the pruritus was severe. excoriated if the pruritus was severe.

CANDIDA ALBACANS (monilial yeast/fungal infection)

TreatmenTreatmentt

Seven day course of Seven day course of intravaginal insertion of intravaginal insertion of miconazole (Monistate), miconazole (Monistate), clotrimazole (Gyne-Lotrimin), clotrimazole (Gyne-Lotrimin), butoconazole (Femstat), and butoconazole (Femstat), and terconazole (Terazol) terconazole (Terazol) suppositories or cream hs for 3 suppositories or cream hs for 3 days - 1 week.days - 1 week.A single dose of 150-200 mg of A single dose of 150-200 mg of fluconazole (Diflucan) is also fluconazole (Diflucan) is also used, but oral medications are used, but oral medications are not recommended during not recommended during pregnancy or nursing.pregnancy or nursing.A Gentle bathing of the vulva A Gentle bathing of the vulva with weak sodium bicarb solution, with weak sodium bicarb solution, bathe before applying meds. bathe before applying meds. Wear cotton underwear, avoid Wear cotton underwear, avoid vaginal powders or sprays. vaginal powders or sprays. Good therapeutic treatment is Good therapeutic treatment is yogurt (eaten or as a douche). yogurt (eaten or as a douche). If woman has repeated If woman has repeated episodes, test her Glucose episodes, test her Glucose Tolerance because she may be Tolerance because she may be diabetic or check for HIV.diabetic or check for HIV.

Nystatin (Mycostatin) Nystatin (Mycostatin) instilled in baby's oral cavity instilled in baby's oral cavity and mucosa 1 hour after and mucosa 1 hour after feeding usually TID feeding usually TID If breastfeeding, apply If breastfeeding, apply nystatin to nipples. nystatin to nipples. Gentian violet(1-2% - Gentian violet(1-2% - discuss possible staining to discuss possible staining to clothing) can be swabbed in clothing) can be swabbed in infant’s oral cavity 1 hour infant’s oral cavity 1 hour after feeding (usually in place after feeding (usually in place of nystatin). of nystatin). Skin lesions are swabbed Skin lesions are swabbed

with topical nystatin.with topical nystatin.

WomanWoman InfantInfant

PreventionPrevention• AvoidAvoid spreading bacteria from the rectum to the vagina. After spreading bacteria from the rectum to the vagina. After

a bowel movement, wipe from front to back, away from the a bowel movement, wipe from front to back, away from the vagina. vagina.

• Clean Clean the outer genital area thoroughly and keep it as dry as the outer genital area thoroughly and keep it as dry as possible. possible.

• AvoidAvoid irritating agent such as harsh soaps and scented toilet irritating agent such as harsh soaps and scented toilet tissue, deodorant tampons or panty liners. tissue, deodorant tampons or panty liners.

• AvoidAvoid feminine hygiene sprays and douches. An offensive odor feminine hygiene sprays and douches. An offensive odor should not be masked but treated by your physician. should not be masked but treated by your physician.

• Thoroughly cleanThoroughly clean diaphragms, cervical caps and spermicide diaphragms, cervical caps and spermicide applicators after each use. applicators after each use.

• AvoidAvoid tight jeans or slacks. tight jeans or slacks. WearWear panties or pantyhose with a panties or pantyhose with a cotton crotch and avoid synthetic fabrics that will trap cotton crotch and avoid synthetic fabrics that will trap moisture. moisture. Wash and thoroughly dryWash and thoroughly dry, new pantyhose before , new pantyhose before wearing them. wearing them.

• UseUse condoms during sex. condoms during sex. • CheckCheck with your doctor about preventing yeast infections if you with your doctor about preventing yeast infections if you

are prescribed antibiotics for another type of infection. are prescribed antibiotics for another type of infection.

Implications/ComplicationsImplications/Complications

MATERNALMATERNAL FETALFETAL

Increased risk of PROM Increased risk of PROM and preterm birthand preterm birth

Thrush in infant. Thrush in infant.

Multiple congenital Multiple congenital abnormalities if mother abnormalities if mother uses oral medication uses oral medication during pregnancy or during pregnancy or nursing (levels in breast nursing (levels in breast milk similar to plasma milk similar to plasma levels).levels).

NURSING CareNURSING Care• Assess newborns buccol mucosa, tongue, gums and Assess newborns buccol mucosa, tongue, gums and

inside the cheeks for white plaques (usually at 5-inside the cheeks for white plaques (usually at 5-7days old noticable - BE SURE TO DIFFERSNCIATE 7days old noticable - BE SURE TO DIFFERSNCIATE FROM MILK CURDS - Use cotton swab to wipe causes FROM MILK CURDS - Use cotton swab to wipe causes slight bleeding if thrush) and check diaper area for slight bleeding if thrush) and check diaper area for clearly marginated eruptions. clearly marginated eruptions.

• Teach parents to maintain cleanliness of hands, Teach parents to maintain cleanliness of hands, clothing, diapers and feeding items. clothing, diapers and feeding items.

• If breastfeeding, teach mothers to apply nystatin If breastfeeding, teach mothers to apply nystatin (Mycostatin) to their nipples. (Mycostatin) to their nipples.

• Teach parents if use gentian violet, to Teach parents if use gentian violet, to avoid avoid swabbing on normal mucosa because it causes swabbing on normal mucosa because it causes irritation.irritation.

BACTERIAL VAGINOSISBACTERIAL VAGINOSIS (Gardnerella (Gardnerella

vaginalls)vaginalls)

• Can be caused by overgrowth Can be caused by overgrowth of normal floraof normal flora

• S/S = excessive amount of thin, S/S = excessive amount of thin, watery, yellow-gray discharge watery, yellow-gray discharge with fishy foul odor. with fishy foul odor.

TREATMENT TREATMENT

• nonpregnant woman is given nonpregnant woman is given metronidazole (Flagyl -can metronidazole (Flagyl -can be teratogenic to fetus). be teratogenic to fetus).

• Pregnant woman given Pregnant woman given 300mg clindamycin 2xday 300mg clindamycin 2xday (BID) for 7 days. (BID) for 7 days.

TRICHOMONIASISTRICHOMONIASIS

• Caused by trichomonas vaginallis Caused by trichomonas vaginallis usually acquired through sex. usually acquired through sex.

• S/S = yellow-green frothy, odorous, S/S = yellow-green frothy, odorous, discharge frequently accompanied discharge frequently accompanied by inflammation of the vagina and by inflammation of the vagina and cervix, dysuria and dyspareunia. cervix, dysuria and dyspareunia.

TREATMENT TREATMENT

• metronidazole for nonpregnant metronidazole for nonpregnant woman for 7 days or a single 2g dose woman for 7 days or a single 2g dose for both male andfornale partners. for both male andfornale partners.

• Avoid intercourse unfil cured. Avoid intercourse unfil cured. • ***Avoid alcohol while taking ***Avoid alcohol while taking

Flagyl -Flagyl - similar response to taking similar response to taking alcohol and alcohol and Antabuse Antabuse (abdominal (abdominal pain, flushing, or tremors). pain, flushing, or tremors).

• ***Sexual partners must be ***Sexual partners must be treated !treated !

Implications/ComplicationsImplications/Complications

MATERNALMATERNAL FETALFETAL

Discomfort from Discomfort from discharge and itching discharge and itching

Possible Possible prematurity and prematurity and teratogenic effects if teratogenic effects if metronidazole metronidazole (Flagyl) inadvertenly (Flagyl) inadvertenly used used

. .

Chlamydia Chlamydia

• Chlamydia caused by chlamydlal Chlamydia caused by chlamydlal trachomatis is a sexually trachomatis is a sexually transmitted bacteria that infects transmitted bacteria that infects men, women and infants. men, women and infants.

• Nearly 4 million Americans get Nearly 4 million Americans get chlamydial infections each year chlamydial infections each year making it one of the most making it one of the most common sexually transmitted common sexually transmitted diseases (STD) in the United diseases (STD) in the United States. States.

Symptoms Symptoms • The symptoms of chlamydial infections may be minimal The symptoms of chlamydial infections may be minimal

or severe and usually appear within one week to one or severe and usually appear within one week to one month after a person has been exposed to someone month after a person has been exposed to someone with the infection. Untreated, chlamydia can remain in with the infection. Untreated, chlamydia can remain in the genital tract for months to years without symptoms.the genital tract for months to years without symptoms.

• In many cases, it is very difficult to detect the In many cases, it is very difficult to detect the symptoms of chlamydia. About 80% of the women with symptoms of chlamydia. About 80% of the women with chlamydia do not have noticeable symptoms until chlamydia do not have noticeable symptoms until complications set in. Men are more likely to show complications set in. Men are more likely to show symptoms, although most people have no idea they symptoms, although most people have no idea they might have a chlamydial infection until a partner is might have a chlamydial infection until a partner is diagnosed and treated, and may people with the diagnosed and treated, and may people with the disease have it for months or even years without disease have it for months or even years without knowing it. Thus, the only sure way to know is to be knowing it. Thus, the only sure way to know is to be tested.tested.

Painful, burning Painful, burning urinationurinationThin or purulent Thin or purulent (milky or yellow) (milky or yellow) discharge from the discharge from the penispenisRedness and Redness and swelling around the swelling around the opening of the opening of the penispenisPain and swelling Pain and swelling in the testiclesin the testicles

Painful, burning Painful, burning and/or frequency of and/or frequency of urinationurinationThin or purulent Thin or purulent vaginal dischargevaginal dischargeBleeding between Bleeding between menstrual periodsmenstrual periodsPain in lower Pain in lower abdominal area and abdominal area and feverfever

Male Male ReactionsReactions

Female Female ReactionsReactions

TransmissionTransmission

• Chlamydial infections are most Chlamydial infections are most often spread during vaginal or often spread during vaginal or anal sexual contact. In addition, anal sexual contact. In addition, pregnant women with chlamydia pregnant women with chlamydia can pass the infection to the can pass the infection to the baby during birth. baby during birth.

DiagnosisDiagnosis

• Diagnosis is made by culturing material Diagnosis is made by culturing material taken from the cervix in women and taken from the cervix in women and the penis in men. A cotton swab is used the penis in men. A cotton swab is used to collect these samples that are sent to collect these samples that are sent to a laboratory for testing. Test results to a laboratory for testing. Test results take about one week to obtain. This take about one week to obtain. This test is usually not painful and can be test is usually not painful and can be done even when there are no done even when there are no symptoms. symptoms.

Nursing Care/TreatmentNursing Care/Treatment• Chlamydia is curable when promptly and Chlamydia is curable when promptly and

properly treated. Prescribed antibiotic drugs properly treated. Prescribed antibiotic drugs (tetracycline, doxycycline or erythromycin) (tetracycline, doxycycline or erythromycin) should be completed as directed to ensure should be completed as directed to ensure successful treatment. successful treatment.

• Pregnant women should be treated with Pregnant women should be treated with erythromycin ethyl succinate. erythromycin ethyl succinate.

• For Infant, assess perinatal history of preterm For Infant, assess perinatal history of preterm birth, instill opthalmic erthromycin and follow-up birth, instill opthalmic erthromycin and follow-up for eye complications. for eye complications.

• A follow-up appointment will be scheduled three A follow-up appointment will be scheduled three to six weeks after antibiotics are completed for to six weeks after antibiotics are completed for an additional chlamydia culture. Reculture for an additional chlamydia culture. Reculture for chlamydia ensures that treatment was chlamydia ensures that treatment was successful. successful.

• Treatment cannot reverse complications already Treatment cannot reverse complications already caused by infection.caused by infection.

Implications/ComplicationsImplications/Complications

Permanent damage to Permanent damage to the reproductive organs, the reproductive organs, causing chronic pain and causing chronic pain and infertilityinfertilitySterility Sterility

Ectopic pregnancyEctopic pregnancy Premature labor and Premature labor and miscarriagemiscarriageArthritisArthritis

Infections of eyes, ears Infections of eyes, ears or lungsor lungsRisk for fetal death r/t Risk for fetal death r/t premature labor premature labor If tetracycline is used, If tetracycline is used, may permanently may permanently discolor fetal teeth. discolor fetal teeth. If mother is untreated, If mother is untreated, newborn may develop newborn may develop chronic follicular chronic follicular conjunctivitis and conjunctivitis and chlamydial pneumonia chlamydial pneumonia usually after 3-4 days. usually after 3-4 days.

MATERNALMATERNAL FETALFETAL

Guidelines for preventing Guidelines for preventing chlamydial infectionschlamydial infections • The best defense is abstinence, or monogamy The best defense is abstinence, or monogamy

with a non-infected partner. with a non-infected partner. • Properly used protective barriers such as Properly used protective barriers such as

condoms (rubbers) are the best protection. condoms (rubbers) are the best protection. Spermicidal foams and jellies and diaphragms are Spermicidal foams and jellies and diaphragms are less reliable than condoms and should be used less reliable than condoms and should be used along with condomsalong with condoms, not in place of them. , not in place of them.

• If you think you have been exposed to chlamydia, If you think you have been exposed to chlamydia, you you and your partnerand your partner must see a doctor must see a doctor immediately for treatment. Until the infection has immediately for treatment. Until the infection has been sufficiently treated, sexual activity must be been sufficiently treated, sexual activity must be avoided otherwise, partners can infect and avoided otherwise, partners can infect and reinfect each other. reinfect each other.

CondylomaCondyloma – – HUMAN PAPILLOMA VIRUS (HPV)HUMAN PAPILLOMA VIRUS (HPV)

• Condylomata Acuminata or Condylomata Acuminata or Genital Warts are fleshy growths Genital Warts are fleshy growths which appear in the genital which appear in the genital area. They are caused by area. They are caused by Human Papilloma Virus (HPV) Human Papilloma Virus (HPV) typically spread by sexual typically spread by sexual contact. contact.

SymptomsSymptoms

• Genital warts first appear as usually painless, small pink or red Genital warts first appear as usually painless, small pink or red bumps on the vulva (lips of the vagina), vagina, cervix, penis bumps on the vulva (lips of the vagina), vagina, cervix, penis shaft, urinary opening or rectum. Sometimes, people complain shaft, urinary opening or rectum. Sometimes, people complain of itching, burning or slight bleeding from these areas. of itching, burning or slight bleeding from these areas.

• The The incubationincubation (time between exposure to the virus and the (time between exposure to the virus and the appearance of warts) is not known (several weeks to several appearance of warts) is not known (several weeks to several years before symptoms), therefore, it is hard to tell when and years before symptoms), therefore, it is hard to tell when and where the intial exposure took place. where the intial exposure took place.

• According to a research study, 20% of women with genital According to a research study, 20% of women with genital warts also had a vaginal infection which may encourage warts also had a vaginal infection which may encourage spreading. Warts may grow and spread up inside the vagina spreading. Warts may grow and spread up inside the vagina and on the cervix and may also cause abnormal Pap smears. and on the cervix and may also cause abnormal Pap smears. Only treatment can cure warts and can prevent spreading or Only treatment can cure warts and can prevent spreading or increased growth. During pregnancy women can be treated. In increased growth. During pregnancy women can be treated. In men, warts may spread inside the penis causing problems men, warts may spread inside the penis causing problems when they urinate. when they urinate.

DiagnosisDiagnosis• The diagnosis of condylomata The diagnosis of condylomata

acuminata is usually made by simple acuminata is usually made by simple inspection of the genital area. inspection of the genital area.

• Occasionally, the health care provider Occasionally, the health care provider may want to remove a wart to send it may want to remove a wart to send it for further testing if they are for further testing if they are concerned that it may be a type concerned that it may be a type refered to as dysplasia which is pre-refered to as dysplasia which is pre-cancerous. cancerous.

• Because genital warts are considered Because genital warts are considered a sexually transmitted disease, other a sexually transmitted disease, other tests may be done to rule out other tests may be done to rule out other sexually transmitted diseases such as sexually transmitted diseases such as gonorrhea, Chlamydia, syphilis, HIV gonorrhea, Chlamydia, syphilis, HIV and hepatitis. and hepatitis.

Nursing Care/TreatmentNursing Care/Treatment• Some genital warts will disappear on their own. Some genital warts will disappear on their own.

Others can be frutstrating returning despite vigorous Others can be frutstrating returning despite vigorous treatment. Treatment is easier when the warts are treatment. Treatment is easier when the warts are small and few in number. So nurses should teach small and few in number. So nurses should teach parents to keep appointments! parents to keep appointments!

• Certain chemicals may be applied to smaller warts Certain chemicals may be applied to smaller warts on moist areas. The most common drug used is on moist areas. The most common drug used is Trichloroacetic Acid (TCA), a clear, watery liquid Trichloroacetic Acid (TCA), a clear, watery liquid painted on the warts which turns whitish in color, painted on the warts which turns whitish in color, causing warts to shrink and disappear over a causing warts to shrink and disappear over a number of weeks. Instruct patients that a burning number of weeks. Instruct patients that a burning sensation may occur as it dries.sensation may occur as it dries.

• Podophyllin, a brown liquid that may also cause Podophyllin, a brown liquid that may also cause burning, may also be used. It must be washed off burning, may also be used. It must be washed off with soap and water 4 to 6 hours after it has been with soap and water 4 to 6 hours after it has been applied. This may also be applied by the patient at applied. This may also be applied by the patient at home. home.

Nursing Care/Treatment Nursing Care/Treatment Con’tCon’t

• If these meds are ineffective, the doctor If these meds are ineffective, the doctor may try freezing the wart with a treatment may try freezing the wart with a treatment called Cryotherapy. A topical cream, 5FU, called Cryotherapy. A topical cream, 5FU, or laser surgery may be used. When all or laser surgery may be used. When all else fails, Interferon injections may be else fails, Interferon injections may be used. used.

• Even with all these treatments, the warts Even with all these treatments, the warts (HPV) my still return. There may be (HPV) my still return. There may be numerous visits to the doctor and many numerous visits to the doctor and many months of treatment. If the condyloma do months of treatment. If the condyloma do not respond to treatment, the patient may not respond to treatment, the patient may be refered to a Colposcopy Clinic where be refered to a Colposcopy Clinic where the vulva or cervix can be examined the vulva or cervix can be examined through a special magnifying scope. through a special magnifying scope. Tissue samples (biopsies) may be taken Tissue samples (biopsies) may be taken and sent for further study. and sent for further study.

Implications/ComplicationsImplications/Complications

MATERNALMATERNAL FETALFETAL

Possible teterogenic Possible teterogenic effects of podophylln on effects of podophylln on fetus. fetus.

Fetal death with large Fetal death with large doses of podophylln. doses of podophylln. Passing through birth Passing through birth canal of infected mother canal of infected mother may cause newborn may cause newborn laryngeal papillomatosis. laryngeal papillomatosis.

PreventionPrevention

• that the one way to prevent getting warts is that the one way to prevent getting warts is abstinence or manogamy with someone who abstinence or manogamy with someone who doesn’t have the disease. doesn’t have the disease.

• to avoid Sexual Contact during treatmentto avoid Sexual Contact during treatment. . • that if warts are recurrent that if warts are recurrent oror the patient has a new the patient has a new

sexual partner, they should use condoms during sexual partner, they should use condoms during intercourse. intercourse.

• to urge partners to be examined since warts in men to urge partners to be examined since warts in men may be hard to detect if they are inside the penis. may be hard to detect if they are inside the penis. Men may carry HPV even if no condyloma are Men may carry HPV even if no condyloma are detected. detected.

• to seek treatment early because early detection and to seek treatment early because early detection and treatment makes it easier to get rid of the warts. treatment makes it easier to get rid of the warts.

Patients whould be instructed:Patients whould be instructed:

SYPHILISSYPHILIS

• Caused by Treponema pollidum, a spirochete. Caused by Treponema pollidum, a spirochete. • Signs and Symptoms:Signs and Symptoms:

During During early stageearly stage, chancre appears, slight fever, loss , chancre appears, slight fever, loss of weight and malaise which lasts up to 4 weeks. of weight and malaise which lasts up to 4 weeks.

In In 6 weeks to 6 months, secondary S/S appear6 weeks to 6 months, secondary S/S appear, skin , skin eruptions called condylomata lata (wart-like stuff) are eruptions called condylomata lata (wart-like stuff) are highly contagious-, acute arthritis, enlargement of the highly contagious-, acute arthritis, enlargement of the liver and spleen, non-tender enlarged lymph nodes, liver and spleen, non-tender enlarged lymph nodes, iritis, and a chronic sore throat with hoarseness. If the iritis, and a chronic sore throat with hoarseness. If the newborn is infected in utero, the infant will exhibit newborn is infected in utero, the infant will exhibit secondary stage symptoms. secondary stage symptoms.

TertiaryTertiary symptoms are encephalopathy and insanity. symptoms are encephalopathy and insanity. Syphillis may cause preterm birth, stillbirth and neonatal Syphillis may cause preterm birth, stillbirth and neonatal

morbidity if it crosses placenta. morbidity if it crosses placenta.

TREATMENT TREATMENT • If less than 1 year duration, 2.4 million If less than 1 year duration, 2.4 million

units of benzathine penicillin G IM. units of benzathine penicillin G IM. • If syphilis is longer than 1 year, then give If syphilis is longer than 1 year, then give

2.4 million units of benzathine penicillin G 2.4 million units of benzathine penicillin G IM once a week for 3 weeks. IM once a week for 3 weeks.

• Doxycycline can be given if woman is Doxycycline can be given if woman is allerigic to PCN. allerigic to PCN.

• Newborn may show positive test for 3 Newborn may show positive test for 3 months. months.

• ***Sexual partners must also be treated ! ***Sexual partners must also be treated !

NURSING/TREATMENT NURSING/TREATMENT • Teach parents and mother about treatment Teach parents and mother about treatment

regime, and especially about father also getting regime, and especially about father also getting treated to prevent re-infection. treated to prevent re-infection.

• Assess infant for elevated cord serum IgM and FTA-Assess infant for elevated cord serum IgM and FTA-ABS IgM, rhinitis (snuffles), fissures on corners of ABS IgM, rhinitis (snuffles), fissures on corners of mouth and excoriated upper lip, red rash around mouth and excoriated upper lip, red rash around mouth and anus, Copper-colored rash over face, mouth and anus, Copper-colored rash over face, plams and soles of feet, irritablity, generalized plams and soles of feet, irritablity, generalized edema especially over joints, bone lesions and edema especially over joints, bone lesions and painful extremities, hepatosplenomegaly, jaundice, painful extremities, hepatosplenomegaly, jaundice, congenital cateracts, SGA and FTT (failure to congenital cateracts, SGA and FTT (failure to thrive). thrive).

• Isolate infant until on antibiotice 48 hoursIsolate infant until on antibiotice 48 hours ! ! • Administer PCN to infant as ordered. Administer PCN to infant as ordered. • Provide emotional support to parents because of Provide emotional support to parents because of

guilt feelings and long term sequelae possible. guilt feelings and long term sequelae possible.

Implications/ComplicationsImplications/ComplicationsMATERNALMATERNAL FETALFETAL

May result in preterm May result in preterm birth and if untreated in birth and if untreated in second trimester second trimester abortion. abortion. Condition depends on Condition depends on stage of diseasestage of disease

Before 6 weeks = fever, Before 6 weeks = fever, weight loss, malaiseweight loss, malaise6 weeks to 6 months = 6 weeks to 6 months = condylomata lata, arthritis, condylomata lata, arthritis, enlarged lymph nodes, enlarged lymph nodes, liver and spleen, iritis, liver and spleen, iritis, chronic sore throatchronic sore throat tertiary = tertiary = encephalopathy and encephalopathy and insanityinsanity

If infected in utero, the If infected in utero, the infant will exhibit infant will exhibit secondary stage secondary stage symptomssymptomsPreterm birth, stillbirth Preterm birth, stillbirth and neonatal morbidity and neonatal morbidity can occur if the syphillis can occur if the syphillis crosses placenta.crosses placenta.

GONNORHEAGONNORHEA • Caused by Neisseria gonorrhorae. Non-Caused by Neisseria gonorrhorae. Non-

pregnant woman has a risk of PID. pregnant woman has a risk of PID. • Pregnant woman will be infected in urethra, Pregnant woman will be infected in urethra,

cervix, and Bartholin's glands until cervix, and Bartholin's glands until membranes rupture. This is because membranes rupture. This is because mucous plug prevents it from ascending. mucous plug prevents it from ascending.

• Most women are asymptomatic, but most Most women are asymptomatic, but most common S/S are purulent, greenish-yellow common S/S are purulent, greenish-yellow discharge, dysuria, and urinary frequency. discharge, dysuria, and urinary frequency. There may be swelling of the vulva. The There may be swelling of the vulva. The cervix may appear swollen and secrete foul cervix may appear swollen and secrete foul odor. odor.

TREATMENT TREATMENT

• Antibiotic Therapy with 250mg Antibiotic Therapy with 250mg ceftriaxone IM once, plus 100mg ceftriaxone IM once, plus 100mg doxycycline PO 2nd day for 7 days. doxycycline PO 2nd day for 7 days.

• ***Sexual partners must be treated ! ***Sexual partners must be treated !

NURSING CARENURSING CARE

• Assess for conjunctivitis (ophthalmia Assess for conjunctivitis (ophthalmia neonatorum), purulent discharge and neonatorum), purulent discharge and corneal ulcerations, neonatal sepsis with corneal ulcerations, neonatal sepsis with temperature instability, poor feeding temperature instability, poor feeding response and/or hypotonia, and jaundice. response and/or hypotonia, and jaundice.

• Administer opthalmic antibiotic solution Administer opthalmic antibiotic solution (usually erythromycin, or tetracycline - (usually erythromycin, or tetracycline - old treatment was 1% silver nitrate old treatment was 1% silver nitrate [needs to be flushed with .9% NS). [needs to be flushed with .9% NS).

• Initiate referral for to evaluate for vision Initiate referral for to evaluate for vision loss. loss.

Implications/ComplicationsImplications/Complications

MATERNALMATERNAL FETALFETAL

If symptoms If symptoms present may have present may have vaginal and vulva vaginal and vulva discomfort and discomfort and dysuria. dysuria.

May cause May cause ophthalmia ophthalmia neonatorum (severe neonatorum (severe purulent purulent conjunctivitis) in conjunctivitis) in newborn. newborn.