Pathophysiology and Pharmacology Book - Reproductive Disorders PDF

29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle PATHOPHYSIOLOGY and PHARMACOLOGY BOOK - Reproductive Disorders Site: Federation University Moodle...

29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle PATHOPHYSIOLOGY and PHARMACOLOGY BOOK - Reproductive Disorders Site: Federation University Moodle Printed by: Dajou Buloba NURBN 2027 SEM2 2024: Nursing Context 7: Date: Tuesday, 29 October 2024, 3:05 PM Course: Pathophysiology and Pharmacology Applied to Person- Centered Nursing Practice B Combined 001 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK - Book: Reproductive Disorders Table of contents 1. Introduction 2. Scenario 3. Polycystic Ovary Syndrome (PCOS) 4. Endometriosis 5. Cervical Cancer 6. BPH and prostate cancer 7. Testicular cancer 8. Sexually transmitted diseases (STDs) https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 1/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle 1. Introduction  Learning Objectives Upon the completion of this Moodle content and with further reading you will be able to 1. Revise understanding of the structure and function of the female Reproductive System 2. Revise understanding of the structure and function of the male Reproductive System 3. Demonstrate understanding of the pathophysiology, pharmacology, signs and symptoms and diagnosis of Endometriosis 4. Demonstrate understanding of the pathophysiology, pharmacology, signs and symptoms and diagnosis of Polycystic Ovarian Syndrome 5. Demonstrate understanding of the pathophysiology, pharmacology, signs and symptoms and diagnosis of Benign Prostatic Hypertrophy 6. Demonstrate understanding of the pathophysiology, pharmacology, signs and symptoms and diagnosis of Ovarian and Breast Cancer 7. Demonstrate understanding of the pathophysiology, pharmacology, signs and symptoms and diagnosis of Prostate Cancer 8. Demonstrate understanding of the pathophysiology, pharmacology, signs and symptoms and diagnosis of Sexually Transmitted Diseases  Alignment with Assessment Information in this Week will assist in the successful completion of Assessment Task: Practical Exam  Time Allocation This module is expected to take approximately 4.5 hours to complete. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 2/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle 2. Scenario  Activity - Scenario Complete the scenario to prepare for the pathopthysiology book: https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 3/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle 3. Polycystic Ovary Syndrome (PCOS)  Read resources for Polycystic Ovary Syndrome (PCOS) Resources https://www.ivf.com.au/planning-for-pregnancy/female-fertility/pcos - this website has a good explanatory video (3mins) at the bottom of this page. https://www.mja.com.au/system/files/2019-05/10.5694mja18.00656.pdf - this is a really good article summarising the International Evidence-based Guideline for the Assessment and Management of PCOS. https://www.jeanhailes.org.au/health-professionals/webinars/pcos-an-updated-overview - this website contains a lot of useful information and has a longer video about PCOS, but it is not essential that you review it for this module, however it will give you a greater understanding of PCOS. Polycystic Ovary Syndrome (PCOS) Polycystic Ovary Syndrome (or Polycystic Ovarian Syndrome) is a relatively common hormonal disorder, that affects approximately 1 in 10 women. While the underlying cause of PCOS is still unknown, there is some argument that epigenetic changes in the foetal DNA may play a part in predisposing individuals. The simplest explanation for this complex and heterogeneous syndrome would be that hyperandrogenism is a predisposing factor, while insulin resistance triggers the development of PCOS (Harada, 2022). The hyperandrogenism and insulin resistance exacerbate one another: excess androgen secretion induces visceral adiposity and adipocyte dysfunction, while the hyperinsulinemia that develops secondary to the insulin resistance stimulates androgen secretion by ovary cells (Harada, 2022).  Symptoms The nature of PCOS means that is presents differently in every individual. However there are some common symptoms: Irregular or absent menstrual cycles Subfertility or infertility Psychological symptoms – anxiety, depression, psychosexual dysfunction, eating disorders Metabolic features – obesity, dyslipidaemia, diabetes Hirsutism and male pattern balding (due to hyperandrogenism) https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 4/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle To be diagnosed with PCOS, the person needs to have two of the three following conditions (Known as the Rotterdam criteria): Oligo-ovulation or anovulation Hyperandrogenism, either clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone) Polycystic ovaries on ultrasound Note that other conditions that may cause the above must also be excluded (such as congenital adrenal hyperplasia, androgen secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia)  Treatment There is not cure for PCOS, so treatment focus is on symptoms management. Irregular menstrual cycle Oral contraceptive pill – this may be used to assist in managing irregular menstrual cycles. There may be some impact on insulin resistance and this requires monitoring glucose tolerance and lipids. Hirsutim Treatment depends on the person, affordability of treatment and personal preference. Cosmetic therapy (usually Laser or electrolysis) – this is used for localised treatment Eflornithine hydrochloride – this reduces facial hair Infertility Related to age and BMI. As such reducing BMI is beneficial, even if subsequent medications are required. Clomiphene citrate and/or metformin are commonly used to assist with a 30-50% success rate after 6 cycles https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 5/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle In addition, women should be referred to a fertility specialist. Cardiometabolic risk Lifestyle change with a >5% weight loss in those who are overweight reduces diabetes risk by ~50–60% in high risk groups Metformin reduces the risk of diabetes by ~50% in adherent high risk groups  Clomiphene citrate Name * Indication * why are they taking it Action * what does this medication do? Interaction * select more common or more dangerous interactions.at least 3 Adverse reaction (side effects!) * name at least 2 (not headache or GI upset) Nursing considerations * at least 2 considerations Patient education * what is important to tell the person taking the medication? at least 2 points.  Non-Pharmacological Treatment To help ease the effects of PCOS (polycystic ovary syndrome), try to: Stay at a healthy weight. Weight loss can lower insulin and androgen levels. It also may restore ovulation. Ask your health care provider about a weight-control program, if you need one. Meet with a registered dietitian for help in reaching weight-loss goals. Limit carbohydrates. High-carbohydrate diets might make insulin levels go higher. Ask your provider if a low-carbohydrate diet could help if you have PCOS (polycystic ovary syndrome). Choose complex carbohydrates, which raise your blood sugar levels more slowly. Complex carbohydrates are found in fruits, vegetables, whole grains and cooked dry beans and peas. Be active. Exercise helps lower blood sugar levels. If you have PCOS (polycystic ovary syndrome), increasing your daily activity and getting regular exercise may treat or even prevent insulin resistance. Being active may also help you keep your weight under control and avoid developing diabetes. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 6/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle Harada M. (2022). Pathophysiology of polycystic ovary syndrome revisited: Current understanding and perspectives regarding future research. Reproductive medicine and biology, 21(1), e12487. https://doi.org/10.1002/rmb2.12487 https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 7/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle 4. Endometriosis  Endometriosis Endometriosis is a condition where endometrial tissue is present outside of the uterus. The endometrial tissues responds to hormonal signalling from the body and as such acts like endometrial tissue, following the menstrual cycle, proliferating, breaking down and bleeding. The bleeding in particular causes an inflammation response that results in scar tissue and fibrosis formation. The cause of endometriosis is unclear. The current theory is that it is caused by a combination of retrograde menstruation, celomic metaplasia and lymphatic and vascular metastasis and autoimmune changes. There is also a fair amount of variation in terms of the presentation and impact of endometriosis across women, making the disease likely a complicated combination of factors. (https://www.jeanhailes.org.au/health-a-z/endometriosis/symptoms-causes)  Symptoms Endometriosis is often associated with a range of painful symptoms that include: chronic pelvic pain (cyclical and non-cyclical), painful periods (dysmenorrhea), painful sex (dyspareunia), and pain on defecation (dyschezia) and urination (dysuria). The severity can range from mild to debilitating. Some women have no symptoms, others have episodic pelvic pain, and still others experience constant pain in multiple body regions (Horne and Missmer, 2022) Risk factors Several factors place a person at greater risk of developing endometriosis, such as: Never giving birth Starting your period at an early age Going through menopause at an older age Short menstrual cycles — for instance, less than 27 days Heavy menstrual periods that last longer than seven days Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 8/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle Low body mass index One or more relatives (mother, aunt or sister) with endometriosis Any medical condition that prevents the passage of blood from the body during menstrual periods Disorders of the reproductive tract Ultrasound can be used to determine is endometriosis is a likely diagnosis. However more mild forms of endometriosis can be hard to visualise. The gold standard of endometriosis diagnosis is visualisation of endometrial tissue via laparoscopy. Generally, the clinical classification is mild to severe (stages I to IV). This is based on the amount and infiltration of the endometrial tissue. However there are other criteria used, depending on the purpose (such as the Endometrial Fertility Index, EFI)(Lee, Koo and Lee, 2021)  Treatment Treatment for endometriosis usually involves medication or surgery. The approach will depend on how severe your signs and symptoms are and whether there is hope to become pregnant. Doctors typically recommend trying conservative treatment approaches first, opting for surgery if initial treatment fails. surgical ablation/excision of lesions, analgesics, hormonal treatments, non-hormonal treatments including neuromodulators, and non-drug therapies (or a combination of the above), such as pelvic physiotherapy. Medications include combined oral contraceptives and Progestogens Women, healthcare providers, and scientists would benefit from conceptualizing endometriosis as a condition that can affect the whole woman.  Watch This is particularly thorough but gives a good summary https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 9/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle Understanding Endometriosis  Explore Investigate further resources about endometriosis Explore this great website, Endometriosis Australia Review the fact sheet Endometriosis in Australia You can also explore the full report by the Australian Institute of Health and Welfare: Endometriosis in Australia: prevalence and hospitalisations if you would like to explore further Lee, S. Y., Koo, Y. J., & Lee, D. H. (2021). Classification of endometriosis. Yeungnam University journal of medicine, 38(1), 10–18. https://doi.org/10.12701/yujm.2020.00444 https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 10/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle 5. Cervical Cancer  Cervical Cancer Cervical cancer arises from oncogenic changes in the cervical tissue that become cancerous. HPV is responsible for over 90% of cervical cancers (and over 60% of penile cancers), making HPV prevention and screening the most effective ways to manage the condition. The incidence of cervical cancer has decreased significantly in Australia with the introduction of the HPV vaccine. Although there is limited evidence as the program was only implemented in 2007, there is evidence of a reduction of a 38% reduction in high-grade cervical dysplasia in women under 18 years of age was observed within 3 years of the programme's implementation (Cohen, Jhingran, Oaknin, & Denny, 2019). In addition, the Papanicolaou smear (pap smear) had an efficiency of detection of over 80%. This has now been replaced with the Cervical Screening Test which detects for the HPV which can lead to cell changes in the cervix. The latest detection method is self- collection of samples which has the benefit of increased uptake of the screening tool.  Symptoms In its early stages, cervicalcancer is often asymptomatic and might be diagnosed following routine screening or pelvic examination. Symptoms include post-coital or abnormal vaginal bleeding (Cohen, Jhingran, Oaknin, & Denny, 2019). (see below for the combined treatment section)  Watch Take notes on the videos below: What is cervical cancer? Who gets cervical cancer? / Risk factors? Symptoms of cervical cancer? How is cervical cancer diagnosed? Treatment options?  Ovarian cancer Ovarian cancer, although rare, causes significant morbidity and mortality, primarily due to the asymptomatic nature of its presentation. The pathogenesis of ovarian cancer is unclear as the majority of cancers appear to lack an inheretence pattern. There are two types of ovarian cancer: epithelial ovarian neoplasm, which appear to originate from a single cell with oncogenic changes. They represent over 90% of cases. Early detection leads to better prognosis. Germ-cell tumors arise from the gametes and appear to be a result of meiosis error, which can be benign or malignant. There is poor prognosis of malignant germ cell tumors.  Symptoms Ovarian cancer is asymptomatic until the tumour is significant in size. At this stage, the symptoms are related to the impact the tumour is having on surround organs, such as: https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 11/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle abdominal bloating difficulty eating or feeling full quickly frequent or urgent urination back, abdominal or pelvic pain  Treatment There are similarities in the treatment of cervical and ovarian cancer. The types of treatments applied are normally guided by staging the cancer (see below). Staging cancer The TNM system. The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor. The N refers to the number of nearby lymph nodes that have cancer. The M refers to whether the cancer has metastasized. The score then guides treatment and also indicates the prognosis for the cancer. Cancer treatment Surgical removal of the tumour and possible additional tissue (such as lymph nodes) is common. In both cervical and ovrian cancer a total hystercomy is common, however this depends on the stage of the cancer and the desire of the patient to have children. Surgery that removes less of the reproductive organs (such as Unilateral salpingo-oophorectomy or a trachelectomy). Additionally radiotherapy may be given to destroy potential cancerous cells. Finally chemotherapy may also be used to treat cancer that is suspected of metastasis. The Australian cancer council has excellent resources and are well worth using for your own and patient education https://www.cancer.org.au/ Cohen, P. A., Jhingran, A., Oaknin, A., & Denny, L. (2019). Cervical cancer. The Lancet, 393(10167), 169-182. https://doi.org/https://doi.org/10.1016/S0140-6736(18)32470-X https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 12/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle 6. BPH and prostate cancer BPH and prostate cancer Enlargement of the prostate is a common issue as males age. The occurrence of prostate enlargement reaches 80% once men are over the age of 70. Prostate enlargement is either the result of benign prostate hyperplasia (BPH) or prostate cancer. The two conditions are discussed below.  benign prostate hyperplasia (BPH) While the cause of BPH is unknown, there is evidence it is linked to hormonal changes that occur with age, related to testosterone and other androgens (note this is part of the treatment for this condition). Due to these changes, the prostate tissue increases in size, putting pressure on ureter connecting the bladder to the penis (see picture below).  Symptoms The effect on urination is the primary issue cause by BPH, and explains most of the symptoms such as Nocturia (Frequent need to urinate during the night) weak urinary stream or one that stops and starts incomplete bladder emptying difficulty starting urination urgency to urinate  Treatment BPH treatment Medications are aimed at managing the prostates response to testosterone. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 13/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle α-adrenergic receptor blockers (alfuzosin or tamsulosin) Action; SELECTIVE alpha adrenoceptor antagonist ( alpha one receptors are found on the trigone of the bladder, urethra and prostate, decreases urethral pressure resulting in decreased resistance to urine flow during voiding. Side effects; rhinitis, headache, nausea , abdominal pain, renal calculi Interactions; contraindicated with other alpha receptor antagonists, caution when use with anti-hypertensive agents or agents known to prolong the QT Nursing considerations; blood pressure monitoring is a must before starting therapy and regularly during therapy, contraindiacted in patients with liver insufficiency or orthostatic hypotension, caution id used with anti-hypertensives 5-α-reductase inhibitors (finasteride). Action: inhibits the enzyme (type II 5 alpha reductase) that converts testosterone to dihydrotestosterons decreasing the amounts circulating and in the prostate glands Side effects: impotence and decreased libido , decreased ejaculate,testicular pain, Interactions: patient should be thoroughly assessed for prostatic cancer prior to therapy , tablets are not recommended in patients with lactose intolerance Nursing considerations: patient must be advised that the therapy may not decrease the symptoms related to prostatic hyperplasia and tablets should not be handled by pregnant partner because of the risk to male fetus, seek medical advise if there are changes in breast tissue including lumps and discharge Surgery Transurethral resection of the prostate (TURP) TURP is considered the gold standard surgical treatment for BPH. A catheter is inserted into the urethra and the enlarged prostate tissue is removed with a heated loop and bleeding is controlled with cauterization (the tissue is commonly sent for analysis to rule out prostate cancer). After the procedure a three way catheter is inserted so that the bladder has continuous irrigation. This prevents clots forming in the ureter. (note, the entire prostate is not removed as shown in the video below). TURP Transurethral Resection Prostate Surgery, patient education series https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 14/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle A relatively new procedure is prostatic artery embolization. This procedure involves the blocking of some of the arteries that supply blood to the prostate. The reduced blood flow causes the prostate to reduce in size.  Prostate Cancer In contrast to BPH, prostate cancer is prostate growth due to oncogenic changes that causes cancerous growth. The occurrence of prostate cancer is less then BPH, but it is still a common cancer affecting approximately 12.5% of men. Risk factors include age, familiar history of prostate cancer of people under 60 and, interestingly, family history of BRCA1 and BRCA2 gene mutations.  Symptoms The symptoms of prostate cancer are similar to BPH Increased frequency of urination weak stream pain while urinating blood in the urine or semen pain in the back or pelvis Prostate cancer is diagnosed using PSA testing, rectal examination and prostate biopsy. Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. An increase in prostate cancer can increase the PSA level, but it can also be affected by recent exercise or ejaculation. As such a biopsy is needed to confirm prostate cancer.  Treatment Like the previous cancers we have considered, treatment is determined by the staging of the cancer and if it has spread outside the prostate. Many prostate cancers are slow growing and may not even require treatment if they are contained within the prostate. Treatment for prostate cancer then follows similar steps to other cancer treatments: Surgery – to remove the cancerous tissue and possibly surrounding tissue Radiotherapy – to damage/destroy any remaining cancerous tissue. Chemotherapy – more likely to be used if the cancer has metastasised and spread outside the prostate. Cancer council https://www.cancer.org.au/cancer-information/types-of-cancer/prostate-cancer/after-a-diagnosis-of-prostate-cancer https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 15/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 16/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle 7. Testicular cancer  Testicular Cancer Testicular cancer is not common. The occurrence rate is only 0.4%, yet it is the second most common cancer affecting males between the ages of 25 – 39. Both genetic and environmental factors contribute to the development of testicular cancer, for which cryptorchidism (undescended testicle) is the most common risk factor. Cheng, Albers, Berney, et al, 2018). The term testicular cancer usually summarizes germ cell cancers of the testis, which account for the vast majority of up to 98% of testicular malignancies.  Symptoms Testicular cancer may cause no symptoms. The most common symptom is a painless swelling or a lump in a testicle or a change in size or shape. Less common symptoms include: feeling of heaviness in the scrotum feeling of unevenness pain or ache in the lower abdomen, the testicle or scrotum back pain enlargement or tenderness of the breast tissue (due to hormones created by cancer cells). Testicular self-assessment is the best way to detect early changes! See the picture below from the cancer council for how to teach testicular self-assessment:  Treatment https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 17/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle Treatment of testicular cancer has a very high success rate. Treatment normally includes the removal of the abnormal testicle, orchidectomy or orchiectomy (which is then biopsied to check for the type of cancer). This is a relatively straight forward surgery. A prosthetic testicle may be placed at the time or after the treatment has been completed. In addition, chemotherapy is very effective in cell germ tumours. Again, the staging of the cancer and the risk of metastasis will determine the individuals treatment much like the previous cancers discussed. Cheng, L., Albers, P., Berney, D.M. et al. Testicular cancer. Nat Rev Dis Primers 4, 29 (2018). https://doi.org/10.1038/s41572-018-0029-0 https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 18/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle 8. Sexually transmitted diseases (STDs)  Sexually transmitted diseases (STD) Sexually transmitted diseases (STDs) — or sexually transmitted infections (STIs) — are generally acquired by sexual contact. The bacteria, viruses or parasites that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids. Sometimes these infections can be transmitted nonsexually, such as from mothers to their infants during pregnancy or childbirth, or through blood transfusions or shared needles. STDs may be asymptomatic. Therefore prevention is a key areas in managing STDs  Symptoms STDs (Sexually transmitted diseases) can have a range of signs and symptoms, including no symptoms. That's why they may go unnoticed until complications occur or a partner is diagnosed. Signs and symptoms that might indicate an STI (Sexually transmitted infection) include: Sores or bumps on the genitals or in the oral or rectal area Painful or burning urination Discharge from the penis Unusual or odorous vaginal discharge Unusual vaginal bleeding Pain during sex Sore, swollen lymph nodes, particularly in the groin but sometimes more widespread Lower abdominal pain Fever Rash over the trunk, hands or feet Signs and symptoms may appear a few days after exposure. However, it may take years before symptoms present, depending on the organism causing the STI (Sexually transmitted infection).  Causes STDs (Sexually transmitted diseases) can be caused by: Bacteria. Gonorrhea, syphilis and chlamydia are examples of STDs (Sexually transmitted infections) that are caused by bacteria. Parasites. Trichomoniasis is an STD (Sexually transmitted infection) caused by a parasite. Viruses. STDs (Sexually transmitted infections) caused by viruses include HPV (Human papillomavirus), genital herpes and HIV (Human immunodeficiency virus). Other kinds of infections — hepatitis A, B and C viruses, shigella infection and giardia infection — can be spread through sexual activity, but it's possible to be infected without sexual contact.  Activity Taking a sexual history can be a sensitive and potentially awkward conversation. However it can be essential for establishing causes and identifying the need for further testing or treatment. The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) has an excellent website on how to take a sexual history https://www.sexualhistorytaking.com.au/home/universal-principles-for-sexual-health-history-taking/ Prevention There are several ways to avoid or reduce the risk of STDs (Sexually transmitted diseases) or STIs (Sexually transmitted infections). https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 19/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle Wait and test. Avoid vaginal and anal intercourse with new partners until you have both been tested for STIs (Sexually transmitted infections). Oral sex is less risky, but use a latex condom or dental dam to prevent skin-to-skin contact between the oral and genital mucous membranes. Get vaccinated. Getting vaccinated early, before sexual exposure, is also effective in preventing certain types of STIs (Sexually transmitted infections). Vaccines are available to prevent human papillomavirus (HPV), hepatitis A and hepatitis B. Use condoms and dental dams consistently and correctly. Use a new latex condom or dental dam for each sex act, whether oral, vaginal or anal. Never use an oil-based lubricant, such as petroleum jelly, with a latex condom or dental dam. REMEMBER nonbarrier forms of contraception, such as birth control pills or intrauterine devices (IUDs), don't protect against STIs (Sexually transmitted infections). Consent is a significant area for preventing STDs. In Victoria in particular there are now laws that make it an offence to "intentionally causes another person to be infected with a very serious disease is guilty of an indictable offence." See this link for more information (https://healthequitymatters.org.au/article/hiv-law-victoria-competing-demands-public-health- criminal-justice/)  Diagnosis If a patient sexual history and current signs and symptoms suggest that they have a sexually transmitted disease (STD) or a sexually transmitted infection (STI), a physical or pelvic exam to look for signs of infection, such as a rash, warts or discharge is required. Laboratory tests can identify the cause and detect coinfections you might also have. Blood tests. Blood tests can confirm the diagnosis of HIV (Human immunodeficiency virus) or later stages of syphilis. Urine samples. Some STIs (Sexually transmitted infections) can be confirmed with a urine sample. Fluid samples. If you have open genital sores, your doctor may test fluid and samples from the sores to diagnose the type of infection.  Treatments STDs (Sexually transmitted diseases) or STIs (Sexually transmitted infections) caused by bacteria are generally easier to treat. Viral infections can be managed but not always cured. If a patient is pregnant and have an STI (Sexually transmitted infection), getting treatment right away can prevent or reduce the risk of the baby becoming infected. Treatment for STIs (Sexually transmitted infections) usually consists of one of the following, depending on the infection: Antibiotics. Antibiotics, often in a single dose, can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomoniasis. Antiviral drugs. Herpes or HIV are treated with (Human immunodeficiency virus) antiviral drugs. Fewer herpes recurrences occur during daily suppressive therapy with a prescription antiviral drug. However, it's still possible to give a partner herpes. Antiviral drugs can keep HIV (Human immunodeficiency virus) infection in check for many years, but there is still a risk on transmission.  Watch This is a great summary video from WA health https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 20/21 29/10/2024, 15:05 PATHOPHYSIOLOGY and PHARMACOLOGY BOOK -Reproductive Disorders | Moodle What is an STI? https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654128 21/21