BLUEPRINT – FINAL EXAM NURS 4540 SP 21
Chapter 4,5, 6 (10 items)
Contraceptive methods- Barrier methods, IUD, Condom
● Barrier methods
○ Any user of a barrier method must also be aware of emergency contraception (EC) options in
case of a failure of that method
○ Best protect against STIs and HIV
○ Condoms
■ In addition to providing a physical barrier for sperm, latex condoms also provide a barrie
for STIs and HIV transmission
■ Latex condoms break down with oil-based lube and should be used only with water-base
or silicone lubricants
■ Those with a latex allergy can use polyurethane condoms
● Prone to slip or lose contour when compared to latex condoms
■ Natural skin condoms—made from lamb cecum
● Don’t provide the same protection against STIs and HIV as they contain small
pores that may allow passage of viruses
■ Female condoms
● Inserted into the vagina and anchored around the cervix with the open ring
covering the labia
● A woman whose partner won’t wear a male condom can use this device as an
alternative
○ Diaphragm
■ A shallow, dome-shaped, latex or silicone device with a flexible rim that covers the
cervix
■ Should be the largest size the woman can comfortably wear
■ Women using a diaphragm need an annual gynecologic exam to assess its fit
■ Not a good option for women with poor vaginal muscle tone or recurrent UTIs
■ Contraindicated for women with pelvic relaxation (uterine prolapse) or a large cystocele
○ Cervical cap
■ Fits snugly around the base of the cervix close to the junction of the cervix and vaginal
fornices
■ Recommended that the cap remain in place no less than 6 hours and no more than 48
hours at a time and is left in place at least 6 hours after the last act of intercourse
■ Size should be checked at least once a year
■ Can be used for repeated acts of intercourse without adding more spermicide later
when compared to a diaphragm
■ Women with a history of TSS should not use a cervical cap
***Toxic shock syndrome (TSS) can occur with use of diaphragms and cervical caps***
■ Most common signs of TSS include a sunburn type of rash, diarrhea, dizziness, faintness
weakness, sore throat, aching muscles and joints, sudden high fever and vomiting
, ○ Contraceptive sponge
■ The vaginal sponge is a small, round, polyurethane sponge that contains N-9 spermicide
■ It's designed to fit over the cervix
■ Sponge must be moistened with water before insertion into the vagina
■ Provides protection for up to 24 hours and it should be left in place at least 6 hours after
the last act of intercourse and no more than 24 to 30 hours
● IUD
○ An intrauterine device is a small T shaped device with bendable arms for insertion through the
cervix into the uterine cavity
○ The Copper T380A IUD is approved for 10 years of use
■ Copper primarily serves as a spermicide and inflames the endometrium, preventing
fertilization
■ More likely to be associated with regular menses that have a heavier flow
■ IUDs containing copper can provide an emergency contraception option if inserted
within a few days of unprotected intercourse
○ Levonorgestrel-releasing IUD is effective for up to 5 years
■ Works by impairing sperm motility, irritating the lining of the uterus, and exerting some
anovulatory effects
■ More likely to experience scant, irregular episodes of vaginal bleeding or amenorrhea
○ Contraceptive effects are reversible
○ Neither the copper T380A nor the levonorgestrel IUD offer protection against STDs or HIV
○ Women should be taught to check for the presence of the IUD thread after menstruation to rule
out expulsion of the device
■ If pregnancy occurs with the IUD in place, the IUD should be removed immediately in
the first trimester if the strings are visible
○ The risk of pelvic inflammatory disease (PID) is higher for women with IUDs and does
NOT protect against STIs or HIV
STD’S/math
Sexually transmitted bacterial infections
● Chlamydia
○ The most frequently reported infectious disease in the US, yet many cases are asymptomatic
○ The symptoms (if present) are nonspecific
■ Acute salpingitis, or PID, is the most serious complication
■ Some experience spotting or postcoital bleeding, mucoid or purulent cervical discharge o
dysuria
○ Diagnosis
■ Lab diagnosis is by culture, DNA probe, enzyme immunoassay, and nucleic acid
amplification tests of urine specimens or specimens from the endocervix/vagina
■ All pregnant women should have cervical cultures for chlamydia at the first prenatal visit
○ Management
■ Treatment includes doxycycline or azithromycin
■ As it is often asymptomatic, women must take all prescribed medication
, ■ Women treated with these medications don’t need to be retested unless symptoms
continue
● Gonorrhea
○ The oldest communicable disease in the US, almost exclusively transmitted by sexual contact
■ Principle means of transmission is genital-to-genital contact during sexual activity
○ Age is the most important risk factor
■ Highest reported rates of infection are among sexually active teens and young adults
■ Majority are younger than 20 and engaging with multiple partners
○ When symptomatic women may experience—
■ Greenish-yellow purulent endocervical discharge or menstrual irregularities
■ Women may complain of pain or menses that last longer or are more painful than norma
■ Diffuse vaginitis with vulvitis is the most common form of gonococcal infection in
prepubertal girls
■ Signs of infection may include vaginal discharge, dysuria or swollen, reddened labia
○ Screening and Diagnosis
■ All pregnant women should be screened at first prenatal visit
■ Cultures should be obtained from the endocervix, the rectum, and when indicated, the
pharynx
● Martin cultures are recommended to diagnose gonorrhea in women
○ Management
■ Management is becoming more challenging as drug-resistant strains are increasing
■ Treatment of choice is ceftriaxone given once IM
● Syphilis
○ One of the earliest described STIs
○ Transmission is thought to be by entry through microscopic abrasions in the SQ tissue, which
can occur during sexual intercourse
■ Can be also transmitted though kissing, biting, or oral-genital sex
○ Can lead to serious systemic disease and even death when untreated
○ Primary syphilis—
■ Characterized by a primary lesion, the chancre, which appears 5-90 days after infection;
often begins as a painless papule at the site of inoculation and erodes to form a nontend
indurated, clean ulcer
○ Secondary syphilis—
■ Occurs 6 weeks to 6 months after the appearance of the chancre
■ Characterized by a widespread, symmetric, maculopapular rash on the palms and soles
and generalized lymphadenopathy
■ If untreated, woman enters latent phase that may be asymptomatic for some
○ Tertiary syphilis—
■ Left untreated this occurs in 1/3 of women
■ Neurologic, CV, musculoskeletal or multiorgan system complications can develop
, ○ Screening and Diagnosis
■ All high-risk pregnant women should be screened at the first prenatal visit and again in
the late 3rd trimester
■ Diagnosis depends on microscopic examination of primary and secondary lesion tissue
and serology during latency and late infection
■ Two types of serologic tests are used—
● Nontreponemal
○ Venereal Disease Research Laboratory (VDRL) and rapid plasma regain
(RPR) are used as screening tests
○ False-positives are not unusual
● Treponemal
○ Fluorescent treponemal antibody absorbed and microhemagglutination
assays for antibody to T. pallidum are used to confirm positive results
■ Management
● Penicillin G is the preferred drug for all stages of syphilis
● Alternative treatments for those with penicillin allergies include—
○ Doxycycline, tetracycline and erythromycin
○ Both doxycycline and tetracycline are contraindicated in pregnancy
● Some pts. may experience Jarisch-Herxherimer reaction, an acute febrile reaction
often accompanied by headache, myalgias and arthralgias that develop within firs
24hrs of tx
● This reaction may be treated with analgesics and antipyretics
● Monthly follow-up is mandatory
Sexually transmitted viral infections
● Human papillomavirus (HPV)
○ The most common viral STI seen in the ambulatory healthcare setting
○ Lesions are most commonly seen in the posterior part of the introitus
■ Typically, small, soft, papillary swellings occurring singly or in clusters on the genital
and anal-rectal region
○ Symptoms
■ Profuse, irritating vaginal discharge; itching; dyspareunia; or postcoital bleeding
■ Women may also report “bumps” on her vulva or labia
○ Screening and Diagnosis
■ Physical inspection of the vulva, perineum, anus, vagina and cervix is essential whenever
HPV lesions are suspected or seen in one area
■ Viral screening and typing for HPV are available, but not standard practice
■ History, evaluation of S&S, pap test, and physical exam are used in making a diagnosis
■ The only definitive diagnostic test is a histologic eval of a biopsy specimen
○ Management
■ Treatment of warts (if needed) is difficult
■ No therapy has been shown to eradicate HPV, so goal of treatment is removal of warts
and relief of S&S
Chapter 4,5, 6 (10 items)
Contraceptive methods- Barrier methods, IUD, Condom
● Barrier methods
○ Any user of a barrier method must also be aware of emergency contraception (EC) options in
case of a failure of that method
○ Best protect against STIs and HIV
○ Condoms
■ In addition to providing a physical barrier for sperm, latex condoms also provide a barrie
for STIs and HIV transmission
■ Latex condoms break down with oil-based lube and should be used only with water-base
or silicone lubricants
■ Those with a latex allergy can use polyurethane condoms
● Prone to slip or lose contour when compared to latex condoms
■ Natural skin condoms—made from lamb cecum
● Don’t provide the same protection against STIs and HIV as they contain small
pores that may allow passage of viruses
■ Female condoms
● Inserted into the vagina and anchored around the cervix with the open ring
covering the labia
● A woman whose partner won’t wear a male condom can use this device as an
alternative
○ Diaphragm
■ A shallow, dome-shaped, latex or silicone device with a flexible rim that covers the
cervix
■ Should be the largest size the woman can comfortably wear
■ Women using a diaphragm need an annual gynecologic exam to assess its fit
■ Not a good option for women with poor vaginal muscle tone or recurrent UTIs
■ Contraindicated for women with pelvic relaxation (uterine prolapse) or a large cystocele
○ Cervical cap
■ Fits snugly around the base of the cervix close to the junction of the cervix and vaginal
fornices
■ Recommended that the cap remain in place no less than 6 hours and no more than 48
hours at a time and is left in place at least 6 hours after the last act of intercourse
■ Size should be checked at least once a year
■ Can be used for repeated acts of intercourse without adding more spermicide later
when compared to a diaphragm
■ Women with a history of TSS should not use a cervical cap
***Toxic shock syndrome (TSS) can occur with use of diaphragms and cervical caps***
■ Most common signs of TSS include a sunburn type of rash, diarrhea, dizziness, faintness
weakness, sore throat, aching muscles and joints, sudden high fever and vomiting
, ○ Contraceptive sponge
■ The vaginal sponge is a small, round, polyurethane sponge that contains N-9 spermicide
■ It's designed to fit over the cervix
■ Sponge must be moistened with water before insertion into the vagina
■ Provides protection for up to 24 hours and it should be left in place at least 6 hours after
the last act of intercourse and no more than 24 to 30 hours
● IUD
○ An intrauterine device is a small T shaped device with bendable arms for insertion through the
cervix into the uterine cavity
○ The Copper T380A IUD is approved for 10 years of use
■ Copper primarily serves as a spermicide and inflames the endometrium, preventing
fertilization
■ More likely to be associated with regular menses that have a heavier flow
■ IUDs containing copper can provide an emergency contraception option if inserted
within a few days of unprotected intercourse
○ Levonorgestrel-releasing IUD is effective for up to 5 years
■ Works by impairing sperm motility, irritating the lining of the uterus, and exerting some
anovulatory effects
■ More likely to experience scant, irregular episodes of vaginal bleeding or amenorrhea
○ Contraceptive effects are reversible
○ Neither the copper T380A nor the levonorgestrel IUD offer protection against STDs or HIV
○ Women should be taught to check for the presence of the IUD thread after menstruation to rule
out expulsion of the device
■ If pregnancy occurs with the IUD in place, the IUD should be removed immediately in
the first trimester if the strings are visible
○ The risk of pelvic inflammatory disease (PID) is higher for women with IUDs and does
NOT protect against STIs or HIV
STD’S/math
Sexually transmitted bacterial infections
● Chlamydia
○ The most frequently reported infectious disease in the US, yet many cases are asymptomatic
○ The symptoms (if present) are nonspecific
■ Acute salpingitis, or PID, is the most serious complication
■ Some experience spotting or postcoital bleeding, mucoid or purulent cervical discharge o
dysuria
○ Diagnosis
■ Lab diagnosis is by culture, DNA probe, enzyme immunoassay, and nucleic acid
amplification tests of urine specimens or specimens from the endocervix/vagina
■ All pregnant women should have cervical cultures for chlamydia at the first prenatal visit
○ Management
■ Treatment includes doxycycline or azithromycin
■ As it is often asymptomatic, women must take all prescribed medication
, ■ Women treated with these medications don’t need to be retested unless symptoms
continue
● Gonorrhea
○ The oldest communicable disease in the US, almost exclusively transmitted by sexual contact
■ Principle means of transmission is genital-to-genital contact during sexual activity
○ Age is the most important risk factor
■ Highest reported rates of infection are among sexually active teens and young adults
■ Majority are younger than 20 and engaging with multiple partners
○ When symptomatic women may experience—
■ Greenish-yellow purulent endocervical discharge or menstrual irregularities
■ Women may complain of pain or menses that last longer or are more painful than norma
■ Diffuse vaginitis with vulvitis is the most common form of gonococcal infection in
prepubertal girls
■ Signs of infection may include vaginal discharge, dysuria or swollen, reddened labia
○ Screening and Diagnosis
■ All pregnant women should be screened at first prenatal visit
■ Cultures should be obtained from the endocervix, the rectum, and when indicated, the
pharynx
● Martin cultures are recommended to diagnose gonorrhea in women
○ Management
■ Management is becoming more challenging as drug-resistant strains are increasing
■ Treatment of choice is ceftriaxone given once IM
● Syphilis
○ One of the earliest described STIs
○ Transmission is thought to be by entry through microscopic abrasions in the SQ tissue, which
can occur during sexual intercourse
■ Can be also transmitted though kissing, biting, or oral-genital sex
○ Can lead to serious systemic disease and even death when untreated
○ Primary syphilis—
■ Characterized by a primary lesion, the chancre, which appears 5-90 days after infection;
often begins as a painless papule at the site of inoculation and erodes to form a nontend
indurated, clean ulcer
○ Secondary syphilis—
■ Occurs 6 weeks to 6 months after the appearance of the chancre
■ Characterized by a widespread, symmetric, maculopapular rash on the palms and soles
and generalized lymphadenopathy
■ If untreated, woman enters latent phase that may be asymptomatic for some
○ Tertiary syphilis—
■ Left untreated this occurs in 1/3 of women
■ Neurologic, CV, musculoskeletal or multiorgan system complications can develop
, ○ Screening and Diagnosis
■ All high-risk pregnant women should be screened at the first prenatal visit and again in
the late 3rd trimester
■ Diagnosis depends on microscopic examination of primary and secondary lesion tissue
and serology during latency and late infection
■ Two types of serologic tests are used—
● Nontreponemal
○ Venereal Disease Research Laboratory (VDRL) and rapid plasma regain
(RPR) are used as screening tests
○ False-positives are not unusual
● Treponemal
○ Fluorescent treponemal antibody absorbed and microhemagglutination
assays for antibody to T. pallidum are used to confirm positive results
■ Management
● Penicillin G is the preferred drug for all stages of syphilis
● Alternative treatments for those with penicillin allergies include—
○ Doxycycline, tetracycline and erythromycin
○ Both doxycycline and tetracycline are contraindicated in pregnancy
● Some pts. may experience Jarisch-Herxherimer reaction, an acute febrile reaction
often accompanied by headache, myalgias and arthralgias that develop within firs
24hrs of tx
● This reaction may be treated with analgesics and antipyretics
● Monthly follow-up is mandatory
Sexually transmitted viral infections
● Human papillomavirus (HPV)
○ The most common viral STI seen in the ambulatory healthcare setting
○ Lesions are most commonly seen in the posterior part of the introitus
■ Typically, small, soft, papillary swellings occurring singly or in clusters on the genital
and anal-rectal region
○ Symptoms
■ Profuse, irritating vaginal discharge; itching; dyspareunia; or postcoital bleeding
■ Women may also report “bumps” on her vulva or labia
○ Screening and Diagnosis
■ Physical inspection of the vulva, perineum, anus, vagina and cervix is essential whenever
HPV lesions are suspected or seen in one area
■ Viral screening and typing for HPV are available, but not standard practice
■ History, evaluation of S&S, pap test, and physical exam are used in making a diagnosis
■ The only definitive diagnostic test is a histologic eval of a biopsy specimen
○ Management
■ Treatment of warts (if needed) is difficult
■ No therapy has been shown to eradicate HPV, so goal of treatment is removal of warts
and relief of S&S
