Chapter 44: STI

Vulvovaginitis:
 Inflammation of the vulva and vagina.
Signs and symptoms:
 Asymptomatic
 Redness, itching, burning, excoriation, pain, swelling of the vagina and labia, and
discharge

Urethritis:
 Men: inflammation of the urethra, prostate, and epididymis.
 Women: can develop mucopurulent cervicitis
Signs and symptoms:
 Men: painful and frequent urination, urethral discharge (clear, cloudy, or yellow)
Causes:
 Neisseria Gonorrhea, Chlamydia, Ureaplasma, Trichomonas Vaginalis, herpes simplex.

Mucopurulent Cervicitis:
 Inflammation of the cervix
Signs and symptoms:
 Asymptomatic
 Produce a mucopurulent yellow exudate on the cervix
Pregnancy complications:
 Conjunctivitis of the fetus, pneumonia in infants, and puerperal infection in mother

Proctitis and Enteritis:

 Proctitis – inflammation of the rectum and anus.
o Can be sexually transmitted or transmitted by non-sexual microbes
 Enteritis – inflammation of the lining of the intestine.
o May occur as a result of contamination during anal intercourse
o Glardia Lambila is most common organism

Genital Ulcers:
 Papules or macules erode and leave painful, raw, or pitted areas on or around the
genitals
 STI’s that can produce ulcers:
o Syphilis, Herpes, and HIV
Pelvic Inflammatory Disease:
 Infection of the upper genital tract that can cause chronic pelvic pain due to
inflammation.
 Primary sources – C. Trachomatis and Gonorrhea.
Complications:
 Cervicitis, Endometritis, Salpingitis (fallopian tube inflammation), and pelvic cavity
inflammation.
 Infertility and risk of ectopic pregnancy
Signs and symptoms:
 Women: lower abdominal pain, tenderness, purulent vaginal discharge, vaginal
bleeding, pain with intercourse, fever, GI upset, pain with urination.
 Physical examination shows: Adnexal tenderness upon palpation, pain in uterus, and
pain in cervix.
Treatment:
 Serious infection – hospitalization and IV therapy
 Minor infection – Oral antibiotics

Chlamydia:
 Transmitted sexually, by blood, and body fluids
 Often asymptomatic
Complications:
 Can cause urethritis, MPC, and conjuctivitits
 Can lead to Fitz-Hugh-Curtis syndrome – inflammation of the liver (nausea, vomiting,
sharp pain at the base of the ribs).
 Increased risk of HIV
Pregnancy complications:
 PID and infertility
 Can be passed from mother to baby
Diagnosed by:
 Nucleic Acid Amplification test (NAAT) – identifies chlamydia in urine, cervical, and
urethral specimens.
 PAP test
Treatment:
 Antibiotics (Tetracyclines, Fluoroquinolones, and Macrolides)
 Erythromycin or Azithromycin is used in pregnancy
 Use of Erythromycin ophthalmic is used in infants to treat conjunctivitis
Gonorrhea:
 Transmission – vaginally, rectally, orally, contact with mucous membranes, blood, and
body fluids
Signs and symptoms:
 Men: urethritis with a yellow urethral discharge
 Women: sore throat, MPC, urethritis, abnormal menstrual symptoms (bleeding between
periods)
Complications:
 Fitz-Hugh-Curtis syndrome
 Inflammation of the joints, skin, meninges, and lining of the heart.
Diagnosed by:
 Microscopic examination of smears and cultures of discharge
Treatment:
 Cephalosporin antibiotics
 Patient should also be treated for Chlamydia due to possible co-infection
Pregnancy complications:
 Newborns can develop Ophthalmia neonatorum – inflammation of the conjunctivae
and deeper parts of the eye.

Syphilis:
 Primary stage – entry of the Treponema Pallidum Spirochete through the skin or
membranes.
 3-90 days later, a papule develops at the site and sloughs off, leaving a chancre.
o Chancre formation is usually the only symptom in the primary stage.
 Secondary stage – begins 2 to 8 weeks after primary stage.
o Causes flu like symptoms, joint pain, hair loss, skin rashes, mouth sores,
lymphadenopathy
Diagnosed by:
 Cultures
 Venereal Disease Research Laboratory test
 Rapid Plasma Reagin test
 Automated Reagin test
 Latent phase can be diagnosed by serologic testing
Treatment:
 Penicillin G antibiotic
 For anyone allergic to penicillin, Doxycycline and Tetracycline can be used
Pregnancy complications:
 Passed from mother to baby
 Hepatosplenomegaly – increase in Bilirubin
 Destruction of red blood cells
 Birth defects
Trichomoniasis:
 STI caused by a protozoan parasite
 Transmitted through nonsexual contact with infected articles
 Can be asymptomatic for many years
Signs and symptoms:
 Redness, swelling, itching, and burning in genitals.
 Pain with intercourse, voiding, and frothy foul-smelling discharge.
 Men: can develop prostatitis and infertility.
 Strawberry cervix
Diagnosed by:
 Pap smear, NAAT, and antigen testing.
Treatment:
 Metronidazole and Tinidazole
Pregnancy complications:
 Risk for preterm delivery and low birth weight.

Herpes:
 Caused by Herpes Simplex Virus types 1 and 2.
 Affinity for the skin and nervous system
 Initial outbreak following infection with HSV occurs 2 days to 2 weeks after exposure.
Signs and symptoms:
 HSV-1: oral lesions
 HSV-2: genital lesions
 Increased risk for cervical cancer in women
Diagnosed by:
 Viral collection kits for swabs or scraped specimens from lesions
 Cell cultures and PCR
Treatment:
 Antiviral medications – Acyclovir, Valacyclovir, and Famciclovir
Pregnancy complications:
 If infected the baby’s skin, eyes, mucous membranes, and nervous system can be
involved.
 Death from disseminated herpes infection possible
 Pregnant women with a history of HSV are treated prophylactically with antiviral
medication starting at 36 weeks.
HPV:
 High risk HPV – can cause cervical, vaginal, and vulvar cancers in women.
 Low risk HPV – Genital warts (Condylomata Acuminata)
o Caused by a viral infection
o Warts develop on the external genitalia and perineum as well as internally in the
vagina and cervix.
Vaccination:
 Women and men can receive the vaccine between ages 9-12 years old.
 Age 11 and 12 is the recommended age
 If the vaccine is initiated between 9 and 14, two doses are needed.
o Second dose is 6 to 12 months after first
 If the child is older than 15, three doses are needed.
o Second dose is 2 months after first, and third dose is 6 months after second.
Treatment:
 Freezing, burning, or chemically destroying warts.
 Cryotherapy for warts.
High risk HPV is diagnosed by:
 Conventional pap or liquid based pap
 Screening is recommended every 3 years

Hepatitis B:
 Infection of the liver caused by the Hepatitis B virus
 Can be transmitted through sexual contact with blood and body fluids.
 May be transmitted from mother to baby

Genital Parasites:
 May be transmitted through close body contact
 Pubic lice and scabies
Treatment:
 Topical insecticides (Permethrin and Malathion)