disease of and acquired through genito-urinary tract

8/19/2019 Disease of and Acquired Through Genito-urinary Tract

1/73

DISEASEs OF ANDACQUIRED THROUGH

GENITO-URINARY TRACT


2/73

DISEASES ACQUIREDTHROUGH INOCULATION

OF THE MUCOUS

MEMBRANE


3/73

GONORRHEACLAP/ FLORES BLANCAS / GLEET/ DRIP


4/73

Definition A sexually transmitted

bacterial disease involving

the mucosal lining of thegenito-urinary tract, the

rectum and pharynx


5/73

Etiologic Agent

• It is fragile and does not survive long

outside the body.

• Readily killed by drying, sunlight orultraviolet light.

• May be killed by ordinary

disinfectant.


6/73

Incubation Period

• he incubation

period is from ! to "#

days and averages

from ! to $ days


7/73

Period ofCommunicability

• he period of communicability if

the disease is varied.

• Remains communicable as longas the organisms are present in

secretions and discharges.


8/73

ode of Tran!"i!!ion

• %ontact from exudates from the

mucous membrane of infected

person.

• hrough contact &ith

contaminated vaginal secretions

of the mother as the baby

comes out of the birth canal.• 'exually transmitted


9/73Pat#ogene!i!


10/73

Clinical anife!tation!

IN FEALES

• (urning sensation and fre)uent urination

• *ello& purulent vaginal discharge

• Redness and s&elling of genitals

• Itching of the vaginal area• +rethritis and cervicitis occurs initially a

fe& days after exposure.

• ndometritis salphingitis or pelvic

peritonitis are symptoms of uterineinvasion &hich may lead to infertility


11/73

IN ALES

• ysuria &ith purulent discharge "-/ days

after exposure0

• Rectal infection in common in

homosexuals

• Inflammation of the urethra

• 1rostatitis

• 1elvic pain and fever


12/73

Co"$lication!

• 'terility and pelvic infection in

&omen

• pididymitis

• Arthritis

• ndocarditis

• %on2unctivitis

• Meningitis


13/73

Diagno!tic E%a"

• In fe"ale& culture specimen is taken

from the cervix and anal canal.

• Inoculation of specimen on

hayer- Martin medium. hemedium contains antibiotic that

inhibits the gro&th of

microorganisms

• In "ale& gram stain


14/73

Treat"ent• %eftriaxone IM single dose0

• oxycycline for seven days

• %eftriaxone IM 3 rythromycin / days0

• A)ueous procaine penicillin 4M units IM

A5'

'nco"$licated

gonorr#ea in adult!

Preganant (o"en


15/73

• %efixime 466 mg7 ciproflxacin $66 mg

• %eftriaxone IM and irrigation of infected

eye &ith normal saline solution

Contraindicated for

c#ildren


16/73

Nur!ing "anage"ent

• rug sensitivities must be noted

• xplain to patient that until cultures prove

negative he8 she is still infectious

• 1ractice standard precaution

• Maintain privacy• Isolation of patient

• 9or those &ith gonococcal arthritis apply

moist heat to relieve pain to affected areas

• Infants infected should be instilled &ith onepercent silver nitrate or any recommended

prophylaxis into both eyes


17/73

SIGNS OF OPT)ALIA

NEONATOR'

• :id edema

• (ilateral con2unctival edema

• Abundant purulent discharge "-!

days after birth

• +ntreated gonococcal con2unctivitis

can progress to corneal ulceration

and blindness


18/73

'*1;I:I'

Lue! *enereal/

orbu! Gallicu!/Frenc# Po%/ Pad

Blood/ Cu$id+!

Di!ea!e

,t#e great i"itator+


19/73

Definition

• A chronic infectious,

sexually transmitted

disease that usually

begins in the mucous

membrane and )uickly

becomes systemic.


20/73

Etiologic agent

• Tr$one"a Pallidu"

• May pass the mucosa even though a

visible crack in the surface may not be

present at the site of entry.• Able to pass the placenta

• %annot &ithstand drying but able to

&ithstand variable temperature

variation• ;as been found alive in a drinking glass

half hour after has been rinsed &ith

cold &ater.


21/73

Source! of Infection• ischarges from obvious or concealed

lesions of the skin or mucous membrane.

• he semen and blood of infected person,

tears and urine

• Mucous discharges from the nose, eyes,

genital tract or bo&el

• 'urface lesion contains spirochete in

infinite numbers.


22/73

Incubation Period

• #6-


23/73

Period of

Co""unicabilit-

=Indefinite andvariable>.?


24/73

ode of tran!"i!!ion

• Direct tran!"i!!ion

• Intimate contact &ith infected person

• Indirect contact

• Articles freshly soiled &ith dischargesor blood containing the organism

• %an be transmitted congenitally through

the placenta of a syphilitic mother

• %an be transmitted from a syphilitic babyto a &et nurse or to anyone &ho carelessly

handle diapers


25/73

1athogenesis

1A;@1;*'I@:@*


26/73

FO'R STAGES OF

S.P)ILIS AND

CLINICALANIFESTATIONS


27/73

A Incubation Stage

• he spirochetes multiply locally at the site

of entry and spread through nearby

lymphnodes.

• he first sign of infection is the

de0elo$"ent of $a$ule (#ic# brea1!

do(n and beco"e! an ulcer (it# a

clean #ard ba!e 1no(n a!

#ard2c#ancre3 %hancres develop on

sites &here it is involved in the sexual actsuch as lips, tongues and breast.


28/73


29/73

B Pri"ar- Stage

• his is the stage &here the disease

becomes highly contagious because

the chancre contains many germs.

. pallidium is no& present in theulceration but there is no

obvious signs and

symptoms present. :ymph nodes

during this stage are enlarged.


30/73

C Secondar- Stage

• %ontagious lesions may recur &ithin !-$years post infectious phase.

• Appearance of pink macules in the skin

often in palms and soles is present.

• 'potty loss of hair and mucus patches onlips, vulva and glans penis is possible.

• In &arm moist areas of the body, like the

perineum, vulva, rolls of fats in the

scrotum, the lesions enlarge and erode,producing highly contaminated punk or

grayish &hite lesion condylamata lata0


31/73

• ;eadache, anorexia, malaise, &eight loss,

nusea and vomiting, sore throat and

possibly slight fever.

• Alopecia may occur but it is temporary

• 5ails become brittle and pitted


32/73

BBBB9ollo&ing this stage is a latent

period &here there are no signsand symptoms presented but to

some, they proceed to the tertiary

stage.


33/73

D Tertiar- Stage 4late !tage5

• his follo&s the secondary stage after

#$-"6 years.

• his is characteriCed by the formation of

granulo"atou! le!ion! or gu""a firm

yello&ish &hite central focus surrounded

by fibrous tissues0.

• %onsidered destructive but non- infective

stage.


34/73

A Late Benign S-$#ili!

• evelops # to #6 years after infection

• ypical lesion is a +MMA, a chronic

superficial nodule can be found in any

bone, particularly the long bones of the

legs0


35/73

B Late S-$#ili!

• In0ol0e! t#e li0er

• %an cause epigastric pain, tenderness, enlarged spleen

and anemia.

• If it affects the upper respiratory tract, it may cause

perforation of the nasal septum or the palate

• In severe cases, the disease causes the destruction

of bones and other organisms that can lead to death.

• BBB cardio0a!cular !-$#ili! de0elo$! about t(o

-ear! after t#e initial infection 4t#e $atient "a-a$$ear a!-"$to"atic but "a- re!ult in aortic

regurgitation and aneur-!"0


36/73


37/73

Congenital S-$#illi!

• his is a condition &here a mother &ith

syphilis transmits the . palladium to

fetus through the placenta beginning in

the #6th to #$th &eeks of gestation.

• 'ome infected fetus die in the &omb

&hile others through a miscarriage.

• here are those born alive &ith the

symptoms of the infection.


38/73

Earl- Congenital S-$#ili!

A Le!ion! of t#e S1in and "ucou! "e"brane

• (ullous rash, sometimes called !-$#ilitic

$#e"$#igu!

• :oss of &eight may $roduce (rin1ling of t#e

!1in ,old "an loo1+

• 'yphilitic papules may involve the skin and nails

may be loosened and shed !-$#ilitic

anon-c#ia5

• Mucous pathches maybe also be found on lips,in the mouth, in the throat and in nasal

passages. 5asal disharges maybe slightly

mucoid or purulent7 blood- stained.


39/73

b Li0er and S$leen

• he infantDs abdomen is protuberant

o&ing to the enlargement of the liver

and the spleen.

• :iver cells tend to be immature and

imperfectly formed

• ;epatic insufficiency results in failure of

protein metabolism


40/73

Late Congenital S-$#ili!

• Inter!titial 1eratiti!& late le!ion

• It may begin at any stage from four to

thirty years or even later.

• 'evere lesions are likely to cause

corneal scarring, giving rise to opacities

&hich may cause slight impairment of

vision or may result in complete

blindness


41/73

Co"$lication!

• 'evere damage to several

organs and the nervous

system• ;eart disease, insanity and

brain damage

• 'evere illness or death inne&born


42/73

Diagno!tic $rocedure

• ark field illumination

• 9lourescent treponemal

antibody absorption test• %'9 analysis


43/73

Treat"ent

• 1enicillin benCathine IM ----- early

syphilis

• @ral tetracycline or doxycycline---- for

preganant &omen &ith allergy to

penicillin

• Abstination from sexual contact


44/73

Nur!ing "anage"ent

• 'tress to the client the importance of

completing the treatment even after the

symptoms subside.

• 1ractice universal precaution

• Eeep lesions dry as much as possible. If

they are draining, dispose contaminated

materials properly

• %heck for decreased cardiac output and

pulmonary congestion

• Fatch for signs of ataxia


45/73


46/73

efinition

• Is the spectrum of disorders resulting from

advanced ;IG infection. his chronic

infection &ith variable course results in cell

death and a decline in immune function

resulting in opportunistic infections,

malignancies and neurologic problems

• his condition progressively reduces the

effectiveness of the immune system and

leaves individuals susceptible to

opportunistic infections and tumors.


47/73

tiologic agent

• ;:G-I

• ;:G-II

• ;IG-I;IG-II


48/73

Incubation Period

• he time bet&een infection and the

appearance of symptoms tends to be

much longer, allo&ing more opportunities

for these microorganisms to be transmitted

to other hosts. he period bet&eeninfection and the appearance of AI' can

take from 6 to 78 -ear!


49/73

ode of tran!"i!!ion


50/73

Period of Co""unicabilit-

As long as the

patient harborsthe disease


51/73


52/73

1athogenesis

• ;uman beings produce antibodies against specificinfections.

• Fhen )I* infection takes place, anti-;IG

antibodies are produced but they do not appear

immediately. his is called the =&indo& effect?.• In some cases, antibodies to )I* become

detectable 4 to H &eeks after infection.

• Fhen ;IG is in circulation, it invades several types

of cells the lymphocytes, macrophages, the:angerhans cells, and neurons &ithin the %5'.

• ;IG attacks the bodyDs immune system.


53/73

• he organism attaches to a protein molecule

called %4 &hich is found in the surface of

4cells.

• @nce the virus enters the 4, it inserts its

genetic materials into the 4 cellDs nucleus taking

over the cell to replicate itself.

• ventually the 4 cell dies after having been

used to replicate )I*.


54/73

• he virus mutates rapidly making it more

difficult for the bodyDs immune system to

JrecogniCe? the invaders.

• ;IG infection progresses through several

stages.• he clinical course of ;IG infection begins

&hen a person becomes infected

&ith )I* throughK

• sexual contact &ith infected person• in2ection of infected blood or blood products

• 1erinatal or vertical transmission.


55/73

Clinical "anife!tations

inor Sign!9

• 1ersistent %ough for one month

• eneraliCed pruritic dermatitis

• Recurrent herpes Coster • @ropharyngeal candidiasis

• %hronic disseminated herpes simplex

• eneraliCed lymphadenopathy


56/73

a:or Sign!9

• :oss of &eight #6 percent of

body &eight

• %hronic diarrhea for more thanone month

• 1rolonged fever for one month


57/73


58/73

Co"$lication!

Co""on O$$ortuni!tic Infection!

• 1neumocystis carinii pneumonia

• @ral candidiasis

• oxoplasmosis of the %5'

• %hronic diarrhea8&asting syndrome

• 1ulmonary8extra-pulmonary tuberculosis

• %ancers


59/73

• ;a$o!i+! !arco"a affects smallblood vessels and internal organs

• Cer0ical d-!$la!ia and cancer

Researchers found out that &omen &ith

;IG have higher rates of this type ofcancer. %ervial carcinoma is associated

&ith ;uman 1apilloma Girus ;1G0.

• Non&)odg1in+! l-"$#o"a

cancerous tumor of the lymph nodes.his is usually a late manifestation of

;IG infection.


60/73


61/73


62/73

Diagno!tic E%a"ination

• :A or :I'A nCyme link

immunosorbent assay

• 1article agglutination 1A0 test

• Festern blot analysis confirmatory

diagnostic test

• Immunofluorescent test

• Radio immuno-precipitation assay RI1A0

• Many people are una&are that they are

infected &ith ;IG.

• ;IG tests are usually performed on venous

blood.


63/73

• Many laboratories use fourth

generation screening tests &hich detect

anti-;IG antibody Ig and IgM0

• he detection of ;IG antibody or antigen in

a patient previously kno&n to be negativeis evidence of ;IG infection.

• Individuals &hose first specimen indicates

evidence of ;IG infection &ill have a

repeat test on a second blood sample toconfirm the results.


64/73

Treat"ent• AI' rugs? are medicines used to treat

but not to cure ;IG infection.

• hese drugs are sometimes referred to as

2antero0iral drug!3• hese &ork by inhibiting the reproduction

of the virus. here are t&o groups

of antero0iral


65/73

7 Re0er!e trancri$ta!e in#ibitor! they

inhibit the enCyme called reverse

transcriptase &hich is needed to =copy?

information for the virus to replicate. hese

drugs areKa. Ledovudine LG0 Retirvir

b. Lalcitabine ;avid

c. 'tavudine Lerit

d. :amivudine pivir

e. 5evirapine Giramune

f. idanosine Gidex


66/73

8 Protea!e in#ibitor!. hey &ork by

inhibiting the enCyme protease &hich are

needed for the assembly of viral particles.

hese drugs areK

a. 'a)uinavir Invarase

b. Ritonavir 5orvir

c. Indinavir %rixivan

N i t


67/73

Nur!ing anage"ent

• ;ealth education he healthcare &orker mustK• Eno& the patient

• Avoid fear tactics

• Avoid 2udgmental and moralistic messages

• (e consistent and concise

• +se positive statement

• ive practical advice


68/73

• Practice uni0er!al/!tandard $recaution

• here is a need for a thorough medical

hand&ashing after every contact &ith

patient and after removing the go&n

and gloves, and before leaving theroom of an AI' suspect or kno&n

AI' patient.

• +se of universal barrier or 1ersonal

1rotective )uipment 110 e.g., cap,mask, gloves, % go&n, face

shield8goggles are very necessary.


69/73

• 1reventive care should be taken to avoidaccidental pricks from sharp instruments

contaminated &ith potentially infectious

materials form AI' patient.

• loves should be &orn &hen handling bloodspecimens and other body secretions as &ell

as surfaces, materials and ob2ects exposed

to them.

• (lood and other specimens should belabeled &ith special &arning =AI'

1recaution?.


70/73

• (lood spills should be cleaned immediately usingcommon household disinfectants, like =chlorox?.

• 5eedles should not be bent after use, but should

be disposed into a puncture-resistant container.

• 1ersonal articles like raCor or raCor blades,toothbrush should not be shared &ith other

members of the family. RaCor blades may be

disposed in the same manner as needles are

disposed.• 1atients &ith active AI' should be isolated.

T#e Fo r C! in t#e


71/73

T#e Four C! in t#e

anage"ent of )I*/AIDS

#. Co"$liance giving of information andcounseling the client &hich results to the

clientDs successful treatment, prevention

and recommendation.

". %ounseling8education

a. iving instruction about the treatment

b. isseminating information about the

disease

c. 1roviding guidance on ho& to avoid

contracting ' again

d. 'haring facts about ;IG and AI'


72/73

QUESTIONS?


73/73

THANK YOU….

disease of and acquired through genito-urinary tract

Documents