Gynecological Infections

Chlamydia-

Definition:

• Caused by Chlamydia trachomatis
• Most common bacterial sexually transmitted infection (STI)
• Frequently concurrent with gonorrhea

Clinical Presentation:

• Estimated that 75% of all chlamydial infections are asymptomatic § Cervicitis
• Pelvic inflammatory disease
• Endometriosis
• Salpingitis

Collaborative Management:

Assessment-

• Cervical, uterine cultures
• Test for other STIs
• Encourage testing of sexual partner(s)

Interventions-

• Antibiotics – Azithromycin, Doxycycline

Syphilis-

Definition:

• Caused by Treponema pallidum
• More common in females and drug abusers

Clinical Presentation:

• Primary – Painless ulcer or chancre on mouth or anogenital area
• Secondary – 4–10 weeks after primary infection, Myalgia, Lymphadenopathy, Flu-like symptoms, Rash on palms of the hands, soles of the feet
• Tertiary – 2–19 years after initial symptoms in untreated patients, Psychosis, delirium, dementia

Collaborative Management:

Assessment-

• Venereal disease research laboratory test (VDRL), rapid plasma reagin (RPR) tests
• Suspect if sexually active with genital ulcer or rash
• Consider testing for other STIs

Interventions:

• Antibiotic options – Penicillin IM once, Doxycycline or tetracycline for 14 days

Gonorrhea-

Definition:

• Caused by Neisseria gonorrhoeae
• Second most common cause of STI in the U.S.
• Leading cause of cervicitis, pelvic inflammatory disease (PID) in females; urethritis in males
• Can cause infertility, ectopic pregnancy, chronic pelvic pain

Clinical Presentation:

• Signs and symptoms of UTI
• Mucoid discharge from cervix or penis
• Men may be asymptomatic

Collaborative Management:

Assessment-

• Gonorrhea, chlamydia cultures
• Consider testing for syphilis, other STIs

Interventions-

• Antibiotic options – Ceftriaxone IM once, Cefixime PO once, A cephalosporin IM plus azithromycin PO once, Doxycycline for 7 days

Herpes Simplex Virus-

Definition:

• Viral infection – Chronic, incurable STI with remissions and exacerbations

Clinical Manifestations:

• Painful vesicles, ulcerations on genitalia, Fever, Malaise, Myalgia, Lymphadenopathy, Dysuria
• Approximately 70% of those infected are asymptomatic

Interventions:

• Antiviral therapy

Discharge Teaching-

All STIs-

• Take medications as prescribed
• Follow up with PCP
• Consistently use condoms
• Inform sexual partners
• Treat past sexual partners

Chlamydia-

• No intercourse for at least 7 days after treatment

Herpes-

• Avoid intercourse during outbreaks
• Increased risk of transmission to fetus
• C-section recommended

Linchpins: (Key Points)

• Shame, fear, lack of access to primary care are just some reasons patients may not seek care.
  • They get to feeling really bad and/or symptoms increase so they come to ED.
• Also, important to point out screening for victims of sexual assault
• Consistently use condoms
• Inform sexual partners