7 STDs Flashcards
what causes syphilis?
treponema pallidum
what is treponema pallidum
a spirochete that has never bee ncultured
primary syphillis
localized disease
secondary syphillis
systemic disease
tertiary syphillis
long-term inflammation of the CNS, aorta, brain, skin, spine, eye
congenital syphillis
systemic, chronic, inflammation
those with syphillis often have
HIV, other STDs
can syphilis go through skin if someone shakes your hand?
yes
transmission of syphilis
humans are only known hosts
-transmission almost always by direct contact with infectious lesions
highest incidence of syphillis
20-29 year olds, sexually active adults
what percent of exposed people contract the disease
30%
how many cases of primary or secondary syphilis diagnosed per year in US
30,000
how many cases of early latent syphilis, diagnosed per year in US
30,000
primary syphillis
- chancre appears 10-90 days (3 wks) after exposure at inoculation site; heals in 3-6 weeks (up to 26 weeks)
- regional adenopathy (painless, rubbery)
- larger the inoculum, larger the chancre
- serological testing during this stage is negative and the disease is essentially local
chancre
hard, indurated, highly infectious, painless (genitalia or orally)
primary syphillis can be diagnosed with what kind of microscopy
darkfield
secondary syphilis
lesions begin 6-8 (“2-24”) weeks after initial chancre, may overlap with time when chancre is present, especially with HIV
- systemic disease
- lasts 2-6 weeks
skin + mucous membranes are sites of
- principal manifestations
- macular to papular
- occasionally pustular or nodular rash
- palms and soles
- patchy alopecia
- mucous patches
-alopecia
bald spot
systemic syphillis
malaise, anorexia, headache, sore throat, arthralgias, low fevers, adenopathy
adenopathy
enlargement of lymph nodes anywhere in your body
secondaria syphillis
high bacteremia + very
contagious
nicekl/dime lesions
secondary syphilis
verrucous papules
syphillis
latent syphilis—> tertiary syphilis
-25% experience a relapse of secondary syphlis
duration of latent syphilis
variable
how many people with secondary syphilis will progress to tertiary syphilis
1 in 3, 1 to 30 years later
hallmark of latent syphilis
positive serological test in the absence of any clinical disease or symptoms
spirochetes
syphillis
tertiary syphilis contagious?
no, but highly destructive and usually takes years to occur
tertiary syphilis: late benign or gummatous syphilis
develops in 15% of cases 1-10 years after infection
gummas
nodular lesions with granulomatous inflammation , can be any organ
cardiovascular tertiary syphili
10% of cases develop this 10-40 years after infection
what occurs during cardiovascular tertiary syphii
arteritis (vasuclitis) results in thickening/hardening of the vasa vasorum; aortic regurgitation; aneurysms, obstruction
neurosyphilis during tertiary syphilis
8% untreated cases, 5-25 y after infection; dementia, general paresis, tabes dorsal
ulcerating gumma occurs in
late syphilis
if mother infective with syphilis, , child will be
still born or present with fulminant syphilis
fulminant syphilis
rhitinis, snuffles followed by skin lesions
- osteochondritis (inflamed bone, cartilage)
- hepatosplenomegaly and adenopathy
- immune complex glomerulonephritis
congenital syphilis death in infant
in first 2 years with pulmonary hemorrhages, bacterial infecitons, hepatitis
Hutchinsons’s teeth**
- occurs in congenital syphilis
- notched, narrow edged permanent incisors
- mulberry molars
congenital syphilis
develop lesions similar to tertiary syphilis
- symmetric hydrarthrosis of knee joins
- deafness
- hutchinson’s teeth
- saddle noses
- saber shinsrhagades
rhagades
fissures, cracks, fine linear dermal scars especially around the mouth, and areas subjected to frequent movement
perforation of the hard palate caused by
- syphilitic gumma
- gummas are granuloma like lesions seen in tertiary syphilis
screwdriver shaped incisors with notching
hutchinson’s teeth-congenital syphillis
saddle nose
deformities of the nasal cartilage due to congenital, untreated syphilis
diagnosis + treatment of primary syphillis
- presenting signs and symptoms, history
- dark field examination of exudate in lesion, direct fluorescent antibody
- seronegative
diagnosis + treatment of secondary syphlis
screenig test using nontreponemal antigen (cardiolipin lecithin)
what percentage develops relapses of secondary syphilis
25%
what percent develops late syphilis
30%
treatment during what stages of syphilis cures the disease
primary or secondary
changes of what stage of syphilis are not reversible after treatment, except for gummas
tertiary
penicillin
if latent, 2-3 weekly doses, primary or secondary 1 dose; tertiary 3 doses; congenital 10 days
mothers with congenital syphilis
before 16th week, no congenital syphillis in child; after 16th week, cannot prevent all manifestations with peniillin
what causes gonorrhea
neisseria gonorrhoeae
neisseria gonorrhoeae gram stain
-gram negative diplococcus
neisseria gonorrhoeae infects
-mucus secreting epithelial cells
neisseria gonorrhoeae evades host thorugh
alteration of cell surface
men with neisseria gonorrhoeae
> 95% symptomatic
women with neisseria gonorrhoeae
no symptoms
skreet
urethral scarring in men with gonorrea
pelvic inflammamtory disease with abscesses, subsequenct ectopic pregnancies or sterility in
women with gonorrhea
-can be lethal
more gonorrhea symptoms
- dissemintated bacteremia occurs with rash and arthritis
- gonorrheal pharyngitis
what is common with gonorrhea?
gonorrhea pharyngitis
twists?
- antigenic variation via gene rearrangement
- protease cleaves IgA1 but not IgA2
- can attach to, and invade, nonciliated epithelial cells, where they can multiply and either cause local inflammation or disseminated disease
- in contrast, GC LPS kills epithelial ciliated cells, which might otherwise “sweep” them away
GC
the clap
GC= the clap
-1 million reported cases/year but 2/3 mill per year
-
1/3rd of all urethritis in US males have
THE CLAP= GC
after a single exposure, risk for women and men
50% risk of acquisition for women, 20% for men after a single exposure
pharyngeal infection with GC common cause of sore throat
pharyngitis, tonsillitis, gingivitis- in men who have sex with other men and is principle origin of gonococcemia
epipidiymis enlarges in
gonorrhea
gonoccocal ophtlamia
eye is red
GC rash
lesions are not raised, but instead are depressed and not bullous
GC in women
30% GU tract infected with with GU are completely asymptomatic; others have vague symptoms that are nonspecific, treatment not sought (if pharynx may have sore throat)
usual site of infection for women with GC is in the
cervix, which gets inflamed; contiguous spread to rectum, urethra, bartholin’s glands
10-20% GC women develop
pelvic inflammatory disease (PID)- endometritis, salpingitis, tubovarian abscesses, peritonitis
tubo-ovarian abscess secondary to
gonorrhea in females
gonorrhea tx
- cetriaxone + other agent
- quinolones nor cefixie alone are acceptaple therapy
- there is increasing resistance to antibiotics
neisseria gonorrhea located i
cervix, urethra, rectum
do not use these drugs in pregnant women
quinolones or tetracyclines
principle origin of gonococcemia
men who have sex with other men
bacteria of chlamydiae
C. trachomatis, psittaci, pneumoniae
chlamydiae bactera are
intracellular
two stages of chlamydiae
reticulate body (Active metabolism) and the elementary body (transit form that goes from one cell to another)
what are the most common causes of urethritis and cervicitis in the US
chlamydiae
->50% in males
what causes PID
chlamydiae
what causes trachoma, which leads to blindness
trachomati
3rd most common STD in the US
chlamydiae
genital C. trachomatis uses what as a precursor for Trp
indole
C. trachomoatis servovars D-k causes (chlamydiae)
urethritis, cervicitis, endometritis, salpingitis, pelvic inflammatory disease, epididymitis, prostatitis, proctitis, arthritis, conjunctivitis, pneumonoitis
C. trachomoatis servovars L1, L2, L3 cause
lympgranuloma vernereum (LGV), abscesses of the inguinal lymph nodes, and painful genital lesions
C. psittaci causes
pneumonia in humans and birds
C. pnuemonieae causes
upper and lower respirtaroy tract infections in humans, very comong (1/2 young adults have had)
chlamydia genome
small 15% size of E.coli -encodes 500 proteins -cannot generate ATP -no oxidative enzymes, flavoproteins, or cytochromes -can make their own proteins
chlamydia genome endocytosis leads to
colonies within phagosomes (intracytoplasmic inclusions)
-lysosomes do not fuse with phagosomes and so bacteria survive
evidence for chlamydia type III secretion
inject proteins into cytoplasm avoiding lysosomes
chlamydia diagnosed more in women than men because
women get screened often
lymphogranuloma granuloma LGV serovars L1, L2, L3
- primary sore small, painless
- swellign 1-4 weeks later
- LNs may ulcerate, go undetected if in urethra, vagina, or rectum (proctitis)
- scarring in rectum, abscesses in perineum
diagnosis of chlamydia
direct fluorescent assays used; gene probe methods like nucleic acid ammplicfication tests (NAAT)
tx of chlamydia
tetracylcines, macrolides, quinolones, sulfonamides, - are all active against active form (Reticulate bodies)-must penetrate the host cell and make their way to the intracellular bacteria
*what are the tx of choice
doxycycline or azithromycin
-erythromicin is alternative for children or pregnant women
tx LGV
doxycycline 100mg 2x a day for 21 days
clamydia urethritis/cervitis
1g azithromycin 2x daily doxy 100mg for a week
Papillomavirus
noneveloped, shed with skin, hearty
- cutaneous and ano-genital warts and cervical cancer
- juvenile onset recurrent respiratory papillomatosis (JORRP) + focal oral hyperplasia
respiratory pap
death by suffocation-during vaginal delivery, infant’s oropharynx infected
papilloma virus vaccine
prevents HPV6, 11, 16, 18
complications of genital infection
- aseptic meningitis
- rare complicatoins
-aseptic meningitis-of herpes
- more common in primary than recurrent infection
- generally no neurological sequelae
rare complications of genital infection- herpes
stromatitis, pharyngitis
- radicular pain
- sacral parathesias
- transverse myelitis
- autonomic dysfunction
oral herpes
soft palate
first clinical episode of genital herpes
may become severe or prolonged
-antiviral therapy should be used-especially if symptoms
