Chlamydial Infection

Is a common sexual transmitted disease that occurs in women and men, particularly in adolescents and young adults. Women are asymptomatic or present with cervicitis. Men are commonly asymptomatic but may present with urethritis. Untreated chlamydial infections can lead to epididymitis, salphingitis, pelvic inflammatory disease and eventually sterility. Mode of Transmission 1. The disease is transmitted through vaginal or rectal intercourse. 2. The disease is also transmitted through oral-genital contact with an infected person. 3. Conjunctivitis, otitis media, and pneumonia may develop to children born to mothers with chlamydial infection passed through birth canal. Clinical Manifestations 1. May be asymptomatic or have vaginal discharge may be clear mucoid to creamy discharge. 2. May have dysuria and mild pelvic disorder. 3. Cervix may be covered by thick mucopurulent discharge and be tender, erythematous, edematous, and friable. Diagnostic Evaluation 1. DNA detection test on cervical smear or urine sample (by DNA amplification method). 2. Chlamydia culture from cervical exudate. 3. Screening urinalysis in males for leukocytes; if positive result, confirmed by DNA detection test. 4. ELISA 5. Direct fluorescent anti-body test. 6. The Centers for Disease Control and Prevention (CDC) recommends annual screening for all sexually active adolescents women as well as young women, ages 20 to 24, and older women at high risk (multiple sex partners or new partner). Complications 1. Pelvic Inflammatory Disease. 2. Ectopic pregnancy or infertility secondary to untreated or recurrent pelvic inflammatory diseases. 3. Transmission to neonate born through infected birth canal. Treatment 1. Doxycycline oral for several days. 2. Azithromycin in single dose. Nursing Interventions 1. Advice abstinence from sexual intercourse until treatment has been completed. No follow-up culture is necessary to ensure cure; however, re-screening is recommended 3 to 4 months after treatment to detect reinfection, particularly in adolescents and young women. 2. Ensure that the partner is treated at the same time; recent partners should receive treatment despite lack of symptoms and negative Chlamydia result. 3. Report case to local public health department (Chlamydia is a reportable infectious disease). 4. Ensure that the patient begins treatment and will have access to prescription follow up. 5. Explain mode of transmission, complications, and the risk for other STDs. 6. Teach about all STDs and their symptoms. 7. Explain the treatment regimen to patient and advise her of adverse effects. 8. Encourage abstinence, monogamy, or safer sex methods, such as female or male condom. 9. Stress the importance of follow-up examination and testing to eradication of infection. Recurrence rates are highest in young patients.

Erythema Infectiosum (Fifth Disease

Definition Erythema infectiosum or the Fifth Disease is an infectious disorder that affects children aging 2-12 years of age. The term fifth disease was based on the classification system for childhood rashes decades ago. Generally, the five frequent childhood rashes are the following:

1. Measles (rubeola) 2. Chickenpox (vaicella) 3. German measles (rubella) 4. Roseola 5. Erythema Infectiosum (Parvovirus B19) Because erythema infectiosum is the fifth disease that causes rashes in children, thus, the term has been used by most people. The prevalence of the illness is more commonly seen during spring and winter period and studies show that females are often affected than males. Parvovirus B19, sometimes called as erythrovirus B19 is a part of the genus Parvoviridae. It was accidentally detected in 1975 by an Australian virologist Yvonne Cossart. Fifth Disease Related Data Causative Agent: Parvovirus B19 Incubation period: 6-14 days Mode of transmission: droplet (respiratory secretions transmitted by cough and sneeze) Period of communicability: uncertain Signs and symptoms Fifth disease produces symptoms that are benign and go away on their own. The following are most likely observed: Fever, headache, coryza, abdominal pain, sore throat and malaise on the first week. Rashes appear a week after, erupting in three sequential phases: Face Bright red rash coalesces at the cheeks forms a slapped face appearance.(Hallmarksign) Extensor surface of extremities(outer arm) Rashes are expected to scatter on the extremities (extensor surface) a day after the facial rash develops. (Extensor surfaces refers to the part of the skin that do not touch when the joints are bend) Flexor surfaces of extremities and trunk Rash invasion in these areas are observed a day after it appeared on the extensor surfaces (inner arm and leg). The eruptions will last for a week or more. Rashes start to fade from the center outward (a lace-like appearance will be observe due to this manner of disappearance) Management Home care: 1. Adequate fluid intake 2. Frequent hand washing. 3. Acetaminophen (Tylenol) is given to decrease body temperature. Aspirin (acetylsalicylic acid) is not recommended as it is related to the occurrence of Reye syndrome. Droplet precautions should be implemented if the child is hospitalized. (wearing mask,gloves, eyewear, spacing client in single room) Avoid contact to pregnant women. Parvovirus B19 is teratogenic. It causes severe anemia with congestive heart failure to the fetus. A child may resume school as soon as the rash appears. (the disease is no longer contagious at this time)