B8-074 CBCL STI/STD Flashcards
neonatal infection with Ng during vaginal delivery causing conjunctivitis
ophtalmia neonatorum
why is there no effective vaccine for Ng?
antigenic variation of carboxy termini
phase variation of pilin
mechanism of immune evasion for Ng
IgA protease
mechanism of toxicity for Ng
lipooligosaccharide (LOS) endotoxin
causes symptoms
Thayer-Martin medium
Ng
sensitive and specific test for diagnosis of Ng in symptomatic males
gram stain
DOC for Ng
ceftriaxone
no classic peptidoglycan layer
chlamydia
(week Gram stain –> Giemsa stain)
Giemsa stain
chlamydia
why are beta-lactam antibiotics ineffective treatment for chlamydia?
no peptidoglycan layer
species specific and serovar-defining protein of chlamydia
MOMPS
(act as adhesins and implicated in disease manifestations)
auxotrophs dependent on host cell for ATP
chlamydia trachomatis
(cause a vacuole: “chlamydial inclusion”)
[…] body is the infectious form of chlamydia trachomatis
(key to extracellular survival)
elementary
(reticulate body only found intracellularly)
Ct does not infect epithelial cells of the […]
vagina
(lacking receptors?)
important because specimen must contain infected epithelial cells, so should be from urethra or cervix
Ct MOMPs A-C cause
trachoma
Ct MOMPs D-K cause
genital infections
Ct MOMPs L1-L3 cause
lymphogranuloma vereneum
(painful enlarged lymph nodes –> rupture)
leading cause of preventable blindness
Ct trachoma
MOMPs A-C
treatment for Ct trachoma
oral tetracycline
women with a history of Ng or Ct have an increased risk of sequelae with
PID
“inclusion conjunctivitis” in neonates
Ct
Ct in neonates can cause pneumonia presenting with a distinct […]
staccato cough
DOC for Ct
doxycycline 7 days
(single dose azithromycin if tetracyclines are contraindicated)
multiple shallow painful genital lesions
HSV
painless papule/ulcer with painful unilateral adenopathy
lymphogranuloma venereum
(Amboss: usually painless ulcer resolves in 1 week, then is followed by painful adenopathy 2+ weeks later)
painless lesion with firm raised border and regional lymphadenopathy
primary syphillis
painless, slowly progressive ulcerative lesion without lymphadenopathy
granuloma inguinale (Donovanosis)
few, large painful genital lesions
chancroid
HSV type […] is more likely to cause recurrent genital ulcers
2
treatment for HSV that has better bioavailability [2]
valacyclovir
famciclovir
(pts take less often; more $$)
gram negative coccobacillus causing chancroid
H. ducreyi
(do cry= painful)
not common in US, but common worldwide
stem may be traveler presenting with STD [2]
chancroid (painful)
granuloma inguinale (painless)
L1-L3 serotypes of Ct cause
LGV
can cause severe proctocolitis in MSM pts
LGV
(be vigilent if chlamydia PCR +)
ulcer causes inflammatory reaction in both superficial and deep inguinal nodes
characteristic “groove sign”
LGV
gram negative rod causing granuloma inguinale
Klebsiella granulomatis
Donovan bodies on tissue biopsy
granuloma inguinale
coccobacilli are visible as inclusion bodies in macrophages
spirochete cause syphilis
treponema pallidum
most characteristic finding of secondary syphillis
rash
classically diffuse maculopapular of trunk, palms, and soles
unusual and severe variant of secondary syphilis rash
usually seen in immunocompromised and spares palms/soles
lues maligna
asymptomatic syphilis having been acquired in the previous year
early latent
(established via last negative test)
asymptomatic syphilis having been acquired more than a year ago OR unclear duration
late latent
slowly progressive syphilis 5-30 years after initial infection
tertiary syphilis
diagnosis of neurosyphilis requires […] analysis
CSF
what stage of syphilis does neurosyphilis typically present?
can occur at any stage
spreads to CNS early
thick, white “clumpy” vaginal discharge associated with pruritic erythema from excoriation
vaginal candidiasis
treatment for vaginal candidiasis
fluconazole
treatment for syphilis
penicillin G
(if neuro symptoms –> IV)
thin, off-white fishy vaginal discharge
bacterial vaginosis
diagnosed via clue cells
bacterial vaginosis
treatment for BV
metronidazole
mucopurlent discharge
motile protozoa on wet mount
T. vaginalis
treatment of T. vaginalis
metronidazole
pt evaluated for cervicitis and all other testing comes back negative
mycoplasma genitalium
(underdiagnosed but PCR is becoming more widely available)
treatment for mycoplasma genitalium
azithromycin
most common and most often asymptomatic STD
chlamydia
why is the pt retested for gonorrhea/chlamydia after 3 month?
risk of reinfection
UTI pathogens are a common cause of […] in older men
epididymitis
3 complications of PID
infertility
tubo-ovarian abscess
peri-hepatitis (Fitz-Hugh-Curtis)
most common cause of epididymits/orchitis in young males [2]
Ct
Ng
most common cause of epididymits/orchitis in older males [2]
E coli
Pseudomonas
presents with localized pain/tenderness over the posterior testis
pain relieved with scrotal elevation (+Prehn sign)
epididymitis
retesting for gonorrhea/chlamydia should be done in 3 months due to the high likelihood of […]
reinfection
DOC for chancroid
ceftriaxone
DOC for LGV
doxycycline
caused by chlamydia
DOC for trichomonas
metronidazole (1 dose orally)
(treat partner as well)
DOC for bacterial vaginosis
metronidazole (7 days)
HPV serotypes associated with genital warts [2]
6, 11
HPV serotypes most associated with cancer [2]
16, 18
[what stage of syphilis]
asymptomatic
latent
(early vs. late latent determined based on time since infection)
if a patient is asymptomatic, tests positive for syphilis, and we do not know when the infection was acquired, what stage is it?
late latent
all sexually active women under 25 should be screened for […] due the high prevalence in this age group [2]
gonorrhea
chlamydia
(include HIV if they haven’t been screened previously)
[gonorrhea/chlamydia]
antegenic variation in pilin
gonorrhea
[gonorrhea/chlamydia]
more likely to present as urethritis with purulent urethral discharge
gonorrhea
[gonorrhea/chlamydia]
gram negative diplococci on gram stain
gonorrhea
DOC for vaginal candidiasis
fluconazole
when left untreated, causes subcutaenous granulomas (gummas), tabes dorsalis, and personality changes
syphilis
[gonorrhea/chlamydia]
can cause reactive arthritis
chlamydia
(classic triad: urethritis, conjunctivitis, arthritis; aka Reiters)
can’t pee, can’t see, can’t climb a tree
[gonorrhea/chlamydia]
can cause a migratory, asymmetric arthritis
gonorrhea
what is the bacterial classification of H. ducreyi?
gram negative coccobacillus
HSV is a […] stranded […]NA virus
HSV is a [double] stranded [D]NA virus
culture from reactive arthritis due to chlamydia will be
negative
causes an immune mediated arthritis
most accurate test option for Ng or Ct
NAAT of the discharge
but can do urine PCR
[gonorrhea/chlamydia]
dark brown intracellular inclusion bodies on Giemsa staining
chlamydia
what class of antibiotics inhibits the 30S ribosomal subunit?
tetracyclines
what class of antibiotics inhibits the 50S ribosomal subunit?
macrolides (-mycins)
antibacterial/antiprotozoal agent that damages DNA within pathogens by forming toxic free radicals
metronidazole
antifungal agent that inhibits fungal steroid synthesis
fluconazole
[gonorrhea/chlamydia]
symptoms of neonatal conjunctivitis begin 5-14 days after birth
chlamydia
[gonorrhea/chlamydia]
symptoms of neonatal conjunctivitis present 2-5 days after birth
gonorrhea
(in US, all neonates receive erythromycin eyedrops to prevent)
neonatal conjunctivitis due to chlamydia can cause […] via descending infection
pneumonia
[gonorrhea/chlamydia]
more likely to cause high fever and purulent discharge
gonorrhea
primary virulence factor of Ng
type IV pili
complications of PID
ectopic pregnancy
tubo-ovarian abscess
infertility
chronic pain
