Module 7

• Candidiasis


  Mild superficial fungal infection caused by genus candida
• Types of candida infections

  • Onychomycosis (nail infection)
  • Oral thrush (oropharynx infection)
  • Moniliasis (vaginal infection)
• Causative agent


  Candida albicans
• Candida albicans


  • Part of the normal flora of the GIT, mouth, vagina, and skin
  • Cause infection when resistance is lowered
• Factors that lower resistance and cause candida infection


  • Diabetes mellitus
  • Cancer
  • Immunosuppressive drugs
  • Radiation exposure
  • Aging
  • HIV infection
  • Pregnancy
  • IV/urinary catheters, drug abuse, hyperalimentation, surgery
• Signs and symptoms of candidiasis


  • Scaly, erythematous, papular rash
  • Nail redness, swelling, darkening, purulent discharge, nail separation
  • Oropharyngeal thrush (cream/bluish white patches)
  • Retrosternal pain, regurgitation
  • Vaginal white/yellow discharge, pruritus, inflammation
  • Fever, flank pain, dysuria, hematuria, pyuria (renal)
  • Hemoptysis, fever, cough (pulmonary)
  • Headache, nuchal rigidity, seizures (brain)
  • Systolic/diastolic murmur, fever, chest pain (endocardium)
  • Blurred vision, orbital/periorbital pain (eye)
• Diagnostic tests for candidiasis


  • Stool culture
  • Gram staining of skin, vaginal discharge, or scrapings
• Treatments for candidiasis


  • Nystatin for oral thrush
  • Clotrimazole, fluconazole, ketoconazole for mucous membranes and vaginal infection
  • Fluconazole and amphotericin for systemic infection
• Prevention of candidiasis


  • Check high risk patients for signs
  • Check vaginal discharge
  • Avoid sharing utensils
  • Meticulous mouth care
  • Proper disposal of oral secretions
• Chancroid


  STD characterized by painful genital ulcers and inguinal adenitis
• Causative agent of chancroid


  Hemophilus ducreyi; a gram-negative, non-spore forming streptobacilli
• Incubation period of chancroid


  1 to 14 days, average 3 to 5 days
• Pathology of chancroid lesions


  • Shallow surface with polymorphonuclear cells, RBCs, debris
  • Wide middle zone is edematous with endothelial proliferation
  • Deep zone has dense infiltration of plasma cells and lymphocytes
• Signs and symptoms of chancroid


  • Small lesions appear at groin or inner thigh
  • Lesions on penis in males, vulva/vagina/cervix in females
  • Lesions may also appear on lips, tongue, breasts, navel
  • Papule rapidly ulcerates, becomes painful, soft, malodorous, bleeds easily, produces pus
  • Inguinal adenitis may develop, leading to suppurated, inflamed nodes that may rupture
  • Phimosis (tightening of foreskin) may develop during healing
• Diagnostic tests for chancroid


  • Gram-stain of ulcer exudate
  • Biopsy
  • Darkfield examination
  • Serologic test
• Treatments for chancroid


  • Azithromycin 500 mg single dose
  • Erythromycin 500 mg BID x 7 days
  • Ceftriaxone 250 mg IM single dose
• Nursing management for chancroid


  • Practice standard precautions
  • Check for drug allergy
  • Apply lotion/cream/oil on lesions
  • Instruct patient to abstain from sex until healing
  • Instruct patient to wash genitalia daily with soap and water
• Prevention of chancroid


  • Avoid sexual contact with infected person
  • Use condom during sexual activity
  • Wash genitalia with soap and water after sex
• Chlamydial infections


  Most common STD in US, caused by Chlamydia trachomatis, can lead to urethritis, epididymitis, salpingitis, PID, sterility, abortion, premature delivery
• Modes of transmission for chlamydial infections


  Vaginal or rectal intercourse<|>Oral-genital contact with infected person
• Chlamydial infections in newborns


  • Conjunctivitis
  • Otitis media
  • Pneumonia
• Signs and symptoms of chlamydial infections


  • Women: cervical erosion, mucopurulent discharge, pelvic pain, dyspareunia
  • Women with PID: pelvic/abdominal pain, cervical/uterine/lymph node tenderness, chills, fever, breakthrough bleeding, post-coital bleeding
  • Men: dysuria, pyuria, urinary frequency
  • Men with epididymitis: painful scrotal swelling, urethral discharge
  • Rectal: diarrhea, tenesmus, pruritus, bloody/mucopurulent discharge, ulceration
• Diagnostic tests for chlamydial infections


  • Swab from site of infection
  • Culture of aspirated materials
  • ELISA
  • Direct fluorescent antibody test
• Treatments for chlamydial infections


  • Doxycycline oral for 7 days
  • Azithromycin single dose
• Nursing management for chlamydial infections


  • Practice universal precautions
  • Suggest both partners get HIV tested
  • Check newborn for signs of infection