Bacterial STIs Flashcards
What are risk factors for infection due to C. trachomatis and N. gonorrheae?
High risk sexual behavior
Young age (adolescent females have ectopic endocervix, exposed and easy target)
Contraceptive use (hormones increase cervical ectopy)
Prior history of STIs
What are uncomplicated presentations of C. trachomatis or N. gonorrheae infections?
- Urethritis (Acute urethral syndrome in females)
- Cervicitis
- Bartholinitis
- Conjunctivitis
- Pharyngitis
- Proctitis
What is definition of urethritis?
Inflammation of urethra
What are clinical signs/symptoms of Chlamydial urethritis?
- Can be asymptomatic
- Dysuria
- Mild/moderate whitish or clear urethral discharge
What are clinical signs/symptoms of Gonococcal urethritis?
- Dysuria
- Purulent, perfuse urethral discharge
- Common co-infection with Chlamydia
What is definition of cervicitis?
Inflammation of endocervix
What are clinical signs/symptoms of cervicitis?
- Usually asymptomatic
- Pelvic examination may appear normal or have cervical mucopurulent discharge
What is definition of batholinitis?
Inflammation of duct of Bartholin glands on labia
What are clinical signs/symptoms of bartholinitis?
Pain/swelling of labia majora
Purulent drainage from Bartholin ducts
Which serotypes of Chlamydia trachomatis usually cause conjunctivitis?
D-K
How can one differentiate between Chlamydial or Gonococcal conjunctivitis?
Chlamydial - mild hypertrophy of conjunctival follicles
Gonococcal - purulent
Does Chlamydia or Gonorrhea cause pharyngitis?
N. gonorrheae
Which serotypes of Chlamydia trachomatis usually cause proctitis?
L1-L3
What are clinical signs/symptoms of proctitis?
Range from minimal anal pruritus to extensive and severe rectal pain and discharge
What are complicated presentations of C. trachomatis or N. gonorrheae infections?
- Epidydimitis
- Pelvic inflammatory disease (PID)
- Reiter’s syndrome
- Disseminated gonococcal infection (DGI)
What is definition of epidydimitis?
Inflammation of epidydimis as result of untreated ascending infection from distal urethra
What are clinical signs/symptoms of epidydimitis?
Unilateral scrotal pain, swelling and tenderness
What is definition of pelvic inflammatory disease (PID)?
Upper genital tract inflammation (usually of fallopian tubes) as a result of untreated ascending infection from cervix or vagina
What are clinical signs/symptoms of pelvic inflammatory disease (PID)?
- Can be asymptomatic
- Non-specific lower abdominal pain
- Cervical motion tenderness on bimanual pelvic exam
- Adnexal tenderness (pain on both sides of lower abdomen on bimanual exam)
What are complications of pelvic inflammatory disease (PID)?
Immediate: - Perihepatitis (inflammation of liver capsule) - Pelvic peritonitis Late: - Ectopic pregnancies - Chronic pelvic pain - Infertility
What is the definition and clinical signs/symptoms of Retier’s syndrome?
Disorder characterized by:
- Urethritis (usually from C. trachomatis)
- Conjunctivitis
- Reactive arthritis
- Skin lesions
What is the definition of Disseminated gonococcal infection (DGI)?
Gonococcal bacteremia
What are clinical signs/symptoms of disseminated gonococcal infection (DGI)?
- Acute arthritis
- Skin lesions (usually tender, necrotic pustule on distal extremities)
Which infections can be diagnosed by rapid tests?
Urethritis in male - Gram stain
Conjunctivitis (only if theres purulence) - Gram stain
What is the treatment for chlamydial and gonococcal infections?
Ceftriaxone - for gonococcal
Doxycycline - for chlamydial
(Usually give both for co-infection, except in the case of disseminated gonococcal infection)
To what drugs are chlamydial and gonoccocal infections very resistant?
Fluoroquinolones, do not give these!
What organism causes syphilis?
Treponema pallidum
What are clinical signs/symptoms of syphilis?
Two clinically distinct early stages
Primary stage: painless chancre
Secondary stage: rash on body including palms and soles, flu-like illness, lymphadenopathy
What organism causes chancroid?
Haemophilus ducreyi
What are clinical signs/symptoms of chancroid?
Painful lesions, painful lymphadenopathy
What organism causes lymphogranuloma venerum (LGV)?
Chlamydia trachomatis serotypes L1-L3
What are clinical signs/symptoms of lymphogranuloma venerum (LGV)?
Inguinal and femoral lymphadenopathy and drainage through skin
Ulcer usually gone by the time patient presents
Late presentation: anal fistulas, recto-vaginal fistulas
What are important rapid diagnosis tests are available for syphilis/chancroid/LGV?
Dark-field microscopy (syphilis)
Gram stain (chancroid)
Serum RPR
What is the treatment for syphilis?
Penicillin or doxycycline
What is the treatment for chancroid?
Azythromicin (single dose)
Cetriaxone (single dose)
Ciprofloxacin (single dose)
Erythromycin (7 days)
What is the treatment for lymphogranuloma venerum (LGV)?
Doxycycline
