PATCHS PROGRAM PUBLIC HEALTH NURSING ADVOCATES TEACHING CHILD HEALTH AND SAFETY HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE (HCPCFC)
Volume 1, Issue 30		March 2008

Medical Information Fact Sheet

Sexually Transmitted Disease (STD):

This is the first newsletter in a series that will be discussing different Sexually Transmitted Diseases (STD). For your information STDs have also been referred to as STIs which stands for Sexually Transmitted Infection.
This first newsletter will cover Chlamydia and Gonorrhea. Future newsletters will include information on Syphilis, Genital Herpes, Human Papillomavirus/Genital Warts, Pelvic Inflammatory Disease, Bacterial Vaginosis, Trichomoniasis, Vaginitis and Vaginal Yeast Infection.
 If you would like to view the information pertaining to HIV/AIDS, Hepatitis and other health topics that have been covered please visit the Riverside County Public Health Nursing website at http://www.rivcoph.org/phn/phn.htm and click on Court Flash Newsletter.

Chlamydia:
            Chlamydia is a curable STI. One can get a chlamydial infection during vaginal, oral, or anal sexual contact with an infected partner. It can cause serious problems in men and women, such as penile discharge and infertility, respectively, as well as infection in newborn babies of infected mothers.
            Chlamydia is one of the most widespread bacterial STIs in the United States. The Centers for Disease Control and Prevention (CDC) estimates 2.8 million people are infected each year. In 2007, over 6000 cases of chlamydia were reported in Riverside County compared to 4400 in 2006. The majority of cases occurred in females 15-24 years of age.

Cause:
Chlamydia is caused by bacteria called Chlamydia trachomatis

Transmission:
You can get Chlamydia during oral, vaginal or anal sexual contact with an infected partner.

Symptoms:
            Chlamydia bacteria live in vaginal fluid and in semen. About 70% of chlamydial infections have no symptoms. Symptoms usually appear 1 to 3 weeks after one is infected. Those who do have symptoms may have and abnormal discharge (mucus or pus) from the vagina or penis or experience pain while urinating. These early symptoms may be very mild.
            If not treated the bacterial infection may move inside the body.

• In women, bacteria can infect the cervix and urinary tract. If the bacteria move into the fallopian tubes, they can cause Pelvic Inflammatory Disease (PID). PID will be covered in a later issue of this newsletter.
• In men, bacteria can infect the urinary tract and the epididymis, causing epididymitis (inflammation of the reproductive area near the testicles).

PID and epididymitis are both very serious illnesses.
C. trachomatis also can cause inflammation of your rectum and lining of your eye (conjunctivitis or “pink eye”). The bacteria can also infect one’s throat if having oral sexual contact with an infected partner.

Diagnosis:
            Chlamydia is easily confused with gonorrhea because the symptoms of both diseases are similar and because they can occur at the same time.
            The most reliable ways to find out whether the infection is chlamydia is through laboratory tests.

• A health care provider may collect a sample of fluid from the vagina or penis and send it to a laboratory that will look for and identify the bacteria.
• Another test looks for the bacteria in a urine sample and does not require a pelvic exam or swabbing of the penis.

Treatment:
            If one is infected with C. trachomatis, your health care provider will probably give a prescription for an antibiotic. There are several types of antibiotics that can be used to treat Chlamydia. You and your doctor can decide what the best course of treatment for you is.
            If one has chlamydia, one should

• Take all your medicine, even after symptoms disappear, for the amount of time prescribed.
• Return to your health care provider if the symptoms do not disappear within 1 to 2 weeks after finishing all the medication.
• Abstain from sexual contact until treatment is completed and successful.
• Tell your sex partners that you have chlamydia so they can be tested and treated, if necessary.

These steps will help you to avoid being reinfected with the bacteria. Repeated infections may increase the risks for reproductive complications.

Prevention:
            The surest way to avoid transmission of STIs is to abstain from sexual contact or be in a long term mutually monogamous relationship with a partner who has been tested and is not infected.
            By using latex condoms correctly and consistently during vaginal or rectal sexual activity, one can reduce the risk of getting chlamydia and developing complications.
            It is recommended by a physician that all sexually active women 25 years of age and younger get screened annually.
            If you have genital symptoms like burning while urinating or have a discharge, you should stop having sexually intercourse and see your health care provider immediately.

Complications:
            Each year up to 1 million women in the United States, develop PID, a serious infection of the reproductive organs. 20% to 40% of women with chlamydial infections that are not adequately treated develop PID.
            PID can cause scarring of the fallopian tubes, which can block the tubes and prevent fertilization from taking place. It is estimated that 100,000 women each year become infertile because of PID.
            In other cases, scarring may interfere with the passage of the fertilized egg to the uterus during pregnancy. When this happens, the egg may attach itself to the fallopian tube. This is called an ectopic or tubal pregnancy. This very serious condition can result in miscarriage and can even cause death of the mother.
            In men, untreated chlamydia may lead to pain and swelling in scrotal area. This is a sign of inflammation of the epididymis. Though complications in men are rare, infection could cause pain, fever, and sterility.

Complications in Newborns:
            A baby who is exposed to C. trachomatis in the birth canal during delivery may develop an eye infection or pneumonia. Symptoms of an eye infection, called conjunctivitis or “pink eye” include discharge in the eye and swollen eyelids and usually develop within the first 10 days after birth.
            Symptoms of pneumonia, including a cough that gets steadily worse and congestion, most often develop within 3 to 6 weeks of birth. Health care providers can treat both conditions successfully with antibiotics.
            Due to these risks to the newborn, many health care providers recommend that all pregnant women get tested for chlamydia as part of their prenatal care.

Chlamydia. (2007, June). National Institute of Allergy and Infectious Diseases, National Institutes of Health. Retrieved March 11, 2008, from http://www3.niaid.nih.gov/healthscience/healthtopics/chlamydia/

Gonorrhea:
            Gonorrhea is a curable sexually transmitted infection (STI). It is the second most commonly reported bacterial STI in the United States following chlamydia. According to the Centers for Disease Control and Prevention (CDC), 358,366 cases of gonorrhea were reported in 2006. There were over 1300 cases reported in Riverside County in 2007 as compared to 879 in 2006.

                     

Cause:
            Gonorrhea is caused by bacteria called Neisseria gonorrhoeae. This bacterium can infect the genital tract, mouth, and rectum of both men and women. In women, the opening to the uterus (cervix) is the first place of infection.

                    

Transmission:
            You can get gonorrhea during vaginal, oral, or anal sex with an infected partner.
            If you are pregnant and have gonorrhea, you may give the infection to your baby as it passes through your birth canal during delivery.

Symptoms:
            The bacterium is carried in semen and vaginal fluids and cause a discharge in men and women. A small number of people may be infected for several months without showing symptoms.
            For women, the early symptoms of gonorrhea often are mild. Symptoms usually appear within 2 to 10 days after sexual contact with an infected partner. When women have symptoms, the first ones may include

• Bleeding during vaginal intercourse
• Painful or burning sensations when urinating
• Yellow or bloody vaginal discharge

            More advanced symptoms, which may indicate development of PID, include cramps and pain, bleeding between menstrual periods, vomiting, or fever.
           
Men have symptoms more often than women including

• White, yellow, or green pus from the penis with pain
• Burning sensations during urination that may be severe
• Swollen or painful testicles.

If left untreated, men could experience prostate complications and epididymitis.
           
Symptoms of rectal infection include discharge, anal itching, and occasional painful bowel movements with fresh blood in the feces. Symptoms typically appear 2 to 5 days after but could appear as long as 30 days.

Diagnosis:
            Health care providers usually use urine tests to diagnose gonorrhea.
           
Treatment:
Health care providers usually prescribe a single dose of antibiotics.
            If you are pregnant, or are younger than 18 years old, you should not be treated with certain types of antibiotics. Your health care provider can prescribe the best and safest antibiotic for you.
            Gonorrhea and chlamydia often infect people at the same time. Therefore, health care providers usually prescribe a combination of antibiotics, which will treat both diseases.

If you have gonorrhea, all of your sexual partners should get tested and then treated if infected, whether or not they have symptoms. Health experts also recommend that you abstain from sexual contact until your infected partners have been treated.
                           
Prevention:
            The best way to avoid transmission of STIs is to abstain from sexual contact or be in a long-term mutually monogamous relationship with a partner who has been tested and is not infected.
            By using latex condoms correctly and consistently during the vaginal or rectal sexual activity, you can reduce your risk of getting gonorrhea and developing complications.

Complications:
            In untreated gonorrhea infections, the bacteria can spread up into the reproductive tract, or more rarely, can spread into the blood stream and infect the joints, heart valves, or the brain.
           
The most common result of untreated gonorrhea is PID. Gonococcal PID often appears immediately after the menstrual period. PID causes scar tissue to form in the fallopian tubes. If the tube is partially scarred, the fertilized egg may not able to pass into the uterus. If this happens, the embryo may implant in the tube causing a tubal (ectopic) pregnancy. This serious complication may result in a miscarriage and can cause death of the mother.
           
In men, gonorrhea causes epididymitis, a painful condition of the testicles that can lead to infertility if left untreated. Also, gonorrhea affects the prostate gland and may cause scarring in the urine canal.
           
Rarely, untreated gonorrhea can spread through the blood to the joints. This can cause an inflammation of the joints, which is very serious.
           
            If you are infected with gonorrhea, your risk of getting HIV infection increases. Therefore, it is extremely important for you to either prevent yourself from getting gonorrhea or get treated early if you are already infected with it.

Complications in newborns and children:
            If you are pregnant and have gonorrhea, you may give the infection to your baby as it passes through the birth canal during delivery. A health care provider can prevent infection of your baby’s eyes by applying silver nitrate or other medicine to the eyes immediately after birth.
            Because of the risks from gonococcal infection to both of you and your baby, health experts recommend that pregnant women have at least one test for gonorrhea during prenatal care.
            When gonorrhea occurs in the genital tract, mouth or rectum of a child, it is most commonly a result of sexual abuse and must be reported to Child Protective Services.

*** It is important to remember that minors age 12 and above may give consent for diagnosis and treatment of STDs and other communicable diseases.

 

Centers for Disease Control and Prevention. (2007). National Immunization Program. Retrieved on April 22, 2007, from the World Wide Web: http://www.cdc.gov/nip

Attachment obtained from: Centers for Disease Control and Prevention. (2007). 2007 Childhood & Adolescent Immunization Schedule. Retrieved on April 22, 2007, from the World Wide Web: http://www.cdc.gov/nip/recs/child-schedule.htm#Printable

Further information regarding some of these diseases can be found in previous issues of this newsletter on the County of Riverside Public Health Nursing website: http://www.rivcoph.org/phn/newsltr.htm

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HCPCFC PROGRAM UPDATES AND ANNOUNCEMENTS.  March is Social Worker Appreciation month.  Thank you to all the Social Workers and the great job they do. Your work does not go unnoticed.  April is National Child Abuse Prevention Month. April is National Child Abuse Prevention Month, a time to raise awareness about child abuse and neglect and encourage individuals and communities to support children and families.

 

Editor: Kristen Thompson, PHN

Contributors: Nicole Boyd, PHN, Assistant Nurse Manager, Cherry Macalino, PHN, Nurse Manager
and Hermia Parks, MA, Director of Public Health Nursing.

Special Thanks to Barbara Cole, MSN, Director of Disease Control for her input on this subject matter,
making this newsletter possible.