9- STI Flashcards
The immediate goal of screening for STI’s is to
identify and treat infected people before they develop complications, and to identify, test and treat their partners to prevent transmission and reinfections
T. pallidum is what kind of bacteria, and how is it detected?
order spirochaetales, cannot be seen by direct microscopy, needs darkfield microscopy (has rotary motion with flexing movement which are considered sufficiently characteristic to be diagnostic
transmission of T pallidum is via
direct contact with an infectious lesion (primary chancre, mucous patches, condyloma lata) during sex, it readily crosses the placenta, not through blood transfusions bc it cannot survive longer than 24-48 hours under storage conditions
which syphilis stages are considered contagious
those with early latent syphilis
which type of syphilis has serological evidence but no symptoms
latent syphilis
early syphilis includes
primary and secondary syphilis (occur weeks to months after initial infection), and early latent syphilis (which is an asymptomatic infection that was acquired within the previous 12 months)
when do pts enter late latent syphilis , and does it have symptoms
when pts are untreated during the early syphilis stages
no this stage is asymptomatic
what is teritary syphilis
when pts are not treated for early syphilis and they develop major complications
when do events due to late syphilis occur
they can occur anytime from 1-30 years after primary infection and can involve a variety of different tissues
when can pts get neurosyphilis
any time during the course of the infection
pathology of a chancre
the lesion starts 21 days after initial infection; it begins as a papule (painless) at the site of inoculation, then ulcerates, 1-2 cm in size with a raised indurated margin
T/F chancres heal spontaneously within 3-6 weeks without treatment
T (note that as the chancre disappears, the infections disseminates)
what % of people develop secondary syphilis
25%
T/F the acute manifestations of syphilis resolve spontaneously, except in cases of severe cutaneous ulceration called lues maligna
T
common findings in secondary syphilis
- rash (maculo-papular also on palms and soles)
- lymphadenopathy
- condyloma lata (in moist regions where a previous chancre was)
alopecia type in secondary syphilis
moth eaten alopecia (is reversible with treatment)
T/F most pts with ocular syphilis develop diminished visual acuity, secondary to posterior uveitis
T (other manifestations are retinal necrosis, and optic neuritis)
note that involvement of the eye should be considered manifestation of neurosyphilis
most common clincal manifestations of late syphilis
- aortitis (CV syphilis)
- gummatous syphilis (granulomatous, nodular lesions in skin and bone)
- CNS involvement (general paresis, and tabes dorsalis)
who gets tertiary syphilis
pts with late syphilis who have symptomatic manifestations involving the cardiovascular system or gummatous disease
why do you need to know the difference between early and late latent syphilis
to know the risk of transmission; pts with late latent dx are not infectious, but pts with early latent dx are
- pregnant women with late latent syphilis can transmit T. pallidum to their fetus for upto 4 years
T/F like all herpes virus strains, HSV has a latent state followed by viral reactivation and recurrent local disease
T
T/F perinatal transmission of HSV can lead to significant fetal morbidity and mortality
T
define primary HSV
the infection in a pt without preexisting antibodies to HSV1 or HSV2
define non primary HSV
getting genital HSV1 in a pts with pre existing antibodies to HSV2 or the acquisition of genital HSV2 ina pt with pre existing abs to HSV1
define recurrent HSV
the reactivation of genital HSV in which the HSV type found in the lesion is the same as the antibodies in serum
T/F subclinical HSV infection with no symptoms can still be infectious
true, transmission can occur in cases of subclinical viral shedding
manifestations of primary HSV
p severe painful genital ulcers, dysuria, fever, tender local inguinal lymphadenopathy, headache. Note that it can also be asymptomatic
T/F there is no clear difference in clinical presentation of HSV1 or HSV2
T
Manifestations of non primary infection HSV
fewer lesions, and less systemic symptoms than primary infection (maybe bcuz abs against one HSV offer protection against the other)
manifestation of recurrent HSV
they are less severe than non/primary infection
duration of lesions is shorter than time of primary lesions
duration of viral shedding is 2-5 days
T/F the likelihood of recurrence of HSV is much higher for HSV2
T (recurrence is also more common in immunocompromised)
DX of HSV
lab testing PCR or serological test
tx of HSV
acyclovir or famiciclovir or valacyclovir (dose depends on stage)
T/F different HPV types has a propensity to infect different body sites and are associated with different diseases
T
T/F HPV 6, 11 causes 90% of genital warts
T
T/F HPV 16, 18 cause 90% of anal cancers and precancerous anal lesions
T
T/F HPC plays a role in the pathogenesis of SCC of the head and neck
T
most common benign laryngeal tumor in children
recurrent respiratory papillomatosis due to HPV 6, 11 acquired during passage through the birth canal of infected mother
dx of HPV
cytology, or HPV testing of cervical specimens or cytology of anal specimens
what is trichomaniasis
a genitourinary infection with the protozoan trichomonas vaginalis (it is the most common non viral STD worldwide)
dx of trichomaniasis
cervical cytology, culture, nucleic acid amplification test, microscopy
tx of trichomaniasis
metronidazole, tinidazole
should you treat sex partners of trichomaniasis pts
yes
T/F majority of people with chlamydia are asymptomatic
T
dx of chlamydia
nucleic acid amplification testing PCR
whom to test for chlamydia
symptomatic and at risk asymptomatic pts
pts with recent exposure
pts with persistent symptoms
recurrence of symptoms
tx of chlamydia
tetracycline, macrolides (alternate therapy is quinolones)
chlamydia coinfection with gonorrhea
give single injection of ceftriaxone (250 MG) for uncomplicated gonococcal urogenital anorectal and pharyngeal infections
ceftriaxone can be used in preganancy
true
