Sexually Transmitted Infections (STIs) - PDF

CHAPTER 26 – Alterations of the Male Reproductive System Etiology of epididymitis. Complications? Etiology: generally, occurs in sexually active young males (younger than 35) and is rare before puberty Cause: (most common) sexually transmitted microorganism, such as N. gonorrheoeae, or C. trachomati...

CHAPTER 26 – Alterations of the Male Reproductive System Etiology of epididymitis. Complications? Etiology: generally, occurs in sexually active young males (younger than 35) and is rare before puberty Cause: (most common) sexually transmitted microorganism, such as N. gonorrheoeae, or C. trachomatis Men who practice unprotected anal intercourse may acquire sexually transmitted epididymitis because of the Escherichia coli, Haemophilus influenza, TB, Cryptococcus, or Brucella In men older than 35, enterobacteriaceae and Pseudomonas aeruginosa associated with UTI and prostatitis may also cause epididymitis Other cause: Chemical inflammation caused by the reflux of sterile urine into the ejaculatory ducts Associated with urethral strictures, congenital posterior valves, and excessive physical straining Complications: abscess formation, infarction of the testis, recurrent infection, and infertility Infarction probably is caused by thrombosis (obstruction by blood clots) of the prostatic vessels secondary to severe inflammation. Recurrent epididymitis may result from inadequate initial treatment or failure to identify or treat predisposing factors. Chronic epididymitis à scarring of the epididymal endothelium. o Once scarring has occurred à treat CHAPTER 27 – STIs Know all STIS: pathophysiology, etiology, clinical manifestations, diagnostic tests, treatment, and complications. How is each transmitted during pregnancy to the fetus? Know the different stages of syphilis; what organism causes each STI and is it viral, bacterial etc.? Do you treat both partners and why? What age group has the greatest risk of STIs and why? FOUR STAGES OF SYPHILLIS Primary Syphilis Local bacterial invasion: multiplies in epithelium and produces a granulomatous tissue (incubation period (chancre) at the site Consider syphilis with any open lesion ranges from 12 days Chancre (eroded, painless, firm and indurated ulcer 50% individuals with primary & 100% in secondary à useful in screening/assessing treatment response à high rates of false positives 2. Treponemal antibody done if VDRL antigen (RPR test is positive) a. Used to assess for antibody response to T. Pallidum b. Include enzyme immunoassays (EIAs) FTA-AB test & TP-PA assay During latent phase – patients can have positive serologic evidence, but confirmation must include presence of treponemata in cerebrospinal fluid to confirm. TREATMENT Preferred treatment for all stages is parenteral injection of benzathine PCN G. no other types of penicillin are effective If 1 year infected; asymptomatic and assumed to be in late stage à treatment is 3 weekly injections Penicillin is okay for pregnant women (prevent vertical transmission to baby) Non-pregnant women who are allergic to PCN receive Doxycycline 100mg BID x14 days Pregnant women with PCN allergy should be desensitized then treated with PCN G since tetracycline causes permanent, lifelong discoloration of fetus teeth. Repeated assessment of VDRL and RPR titers = determine effectiveness of treatment à titers should decrease 4-fold Sexual partners are examined and treated and use of condoms recommended until treatment If infants require treatment, PCN is drug of choice. o Infants are given serologic tests for syphilis every 2-3 months until test becomes nonreactive or titer has decreased 4-fold. An individual has syphilis, secondary stage. On ASSESSMENT, typical symptoms found: Low grade fever, malaise, and sore throat. This stage (secondary) presents with variable systemic symptoms, including: low-grade fever, malaise, sore throat, hoarseness, anorexia, generalized adenopathy, headache, joint pain, and skin or mucous membrane lesions or rashes. Age Group with Highest Risk of STDs 2  Each year in the United States, 19 million individuals contract a sexually transmitted infection; half of those infected are younger than 25 years of age. Partly because of risk-taking behavior (unprotected intercourse or selection of high-risk partners), adolescents have the greatest risk for STI exposure and infection. In addition, adolescent women may have a physiologically increased susceptibility to infections of cervical immaturity. Is prevalent in ALL socioeconomic and racial or ethnic groups. CDC does not require that all STI’s be reported, so most private MD’s don’t but Health Departments do. o Thus, the reasoning it appears urban & lower income population. Etiology may be bacterial, viral, protozoal, parasitic, or fungal What causes cervical cancer? Persistent infection with high-risk HPV serotypes is a risk for developing cervical or anal cancer. More than 120 different types of HPV have been identified. More than 40 serotypes are unique to the stratified squamous epitheliums of the genital area. These are divided into serotypes that have a high risk of causing cervical cancer and low-risk serotypes, which are associated with benign genital lesions or warts. High-risk types 16 and 18 are the most common, causing up to 70% of anogenital cancers. Low-risk subtypes can coexist with the high-risk types, but do not cause cancer. Most cases occur in post-menopausal women ages 50-60 with mortality of black women twice as high. Fortunately, most cases of HP are transient and resolve on their own within 2 years. The persistence of the virus, the body's immune response, and the presence of cofactors such as smoking and hormonal contraceptive exposure, may contribute to the progression from HPV exposure to cervical dysplasia and cancer. Sexually transmitted diseases in teenage girls-why are they more susceptible? Teenage girls are more susceptible to STIs due to: Risk-taking behavior (unprotected intercourse or selection of high-risk partners) Increased susceptibility to infection because of cervical immaturity Especially vulnerable to HPV because of their cervical anatomy In older women, squamous epithelial cells cover the cervix's outer portions, while columnar epithelial cells line the cervical canal. The transformation zone, where these cell types meet, is highly susceptible to HPV's oncogenic effects. 3