Bacterial STIs

Question 1

What are risk factors for infection due to C. trachomatis and N. gonorrheae?

Answer 1

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

Question 2

What are uncomplicated presentations of C. trachomatis or N. gonorrheae infections?

Answer 2

• Urethritis (Acute urethral syndrome in females)
• Cervicitis
• Bartholinitis
• Conjunctivitis
• Pharyngitis
• Proctitis

Question 3

What is definition of urethritis?

Answer 3

Inflammation of urethra

Question 4

What are clinical signs/symptoms of Chlamydial urethritis?

Answer 4

• Can be asymptomatic
• Dysuria
• Mild/moderate whitish or clear urethral discharge

Question 5

What are clinical signs/symptoms of Gonococcal urethritis?

Answer 5

• Dysuria
• Purulent, perfuse urethral discharge
• Common co-infection with Chlamydia

Question 6

What is definition of cervicitis?

Answer 6

Inflammation of endocervix

Question 7

What are clinical signs/symptoms of cervicitis?

Answer 7

• Usually asymptomatic

- Pelvic examination may appear normal or have cervical mucopurulent discharge

Question 8

What is definition of batholinitis?

Answer 8

Inflammation of duct of Bartholin glands on labia

Question 9

What are clinical signs/symptoms of bartholinitis?

Answer 9

Pain/swelling of labia majora

Purulent drainage from Bartholin ducts

Question 10

Which serotypes of Chlamydia trachomatis usually cause conjunctivitis?

Answer 10

D-K

Question 11

How can one differentiate between Chlamydial or Gonococcal conjunctivitis?

Answer 11

Chlamydial - mild hypertrophy of conjunctival follicles

Gonococcal - purulent

Question 12

Does Chlamydia or Gonorrhea cause pharyngitis?

Answer 12

N. gonorrheae

Question 13

Which serotypes of Chlamydia trachomatis usually cause proctitis?

Answer 13

L1-L3

Question 14

What are clinical signs/symptoms of proctitis?

Answer 14

Range from minimal anal pruritus to extensive and severe rectal pain and discharge

Question 15

What are complicated presentations of C. trachomatis or N. gonorrheae infections?

Answer 15

• Epidydimitis
• Pelvic inflammatory disease (PID)
• Reiter’s syndrome
• Disseminated gonococcal infection (DGI)

Question 16

What is definition of epidydimitis?

Answer 16

Inflammation of epidydimis as result of untreated ascending infection from distal urethra

Question 17

What are clinical signs/symptoms of epidydimitis?

Answer 17

Unilateral scrotal pain, swelling and tenderness

Question 18

What is definition of pelvic inflammatory disease (PID)?

Answer 18

Upper genital tract inflammation (usually of fallopian tubes) as a result of untreated ascending infection from cervix or vagina

Question 19

What are clinical signs/symptoms of pelvic inflammatory disease (PID)?

Answer 19

• 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)

Question 20

What are complications of pelvic inflammatory disease (PID)?

Answer 20

Immediate:
- Perihepatitis (inflammation of liver capsule)
- Pelvic peritonitis
Late:
- Ectopic pregnancies
- Chronic pelvic pain
- Infertility

Question 21

What is the definition and clinical signs/symptoms of Retier’s syndrome?

Answer 21

Disorder characterized by:

• Urethritis (usually from C. trachomatis)
• Conjunctivitis
• Reactive arthritis
• Skin lesions

Question 22

What is the definition of Disseminated gonococcal infection (DGI)?

Answer 22

Gonococcal bacteremia

Question 23

What are clinical signs/symptoms of disseminated gonococcal infection (DGI)?

Answer 23

• Acute arthritis

- Skin lesions (usually tender, necrotic pustule on distal extremities)

Question 24

Which infections can be diagnosed by rapid tests?

Answer 24

Urethritis in male - Gram stain

Conjunctivitis (only if theres purulence) - Gram stain

Question 25

What is the treatment for chlamydial and gonococcal infections?

Answer 25

Ceftriaxone - for gonococcal
Doxycycline - for chlamydial
(Usually give both for co-infection, except in the case of disseminated gonococcal infection)

Question 26

To what drugs are chlamydial and gonoccocal infections very resistant?

Answer 26

Fluoroquinolones, do not give these!

Question 27

What organism causes syphilis?

Answer 27

Treponema pallidum

Question 28

What are clinical signs/symptoms of syphilis?

Answer 28

Two clinically distinct early stages
Primary stage: painless chancre
Secondary stage: rash on body including palms and soles, flu-like illness, lymphadenopathy

Question 29

What organism causes chancroid?

Answer 29

Haemophilus ducreyi

Question 30

What are clinical signs/symptoms of chancroid?

Answer 30

Painful lesions, painful lymphadenopathy

Question 31

What organism causes lymphogranuloma venerum (LGV)?

Answer 31

Chlamydia trachomatis serotypes L1-L3

Question 32

What are clinical signs/symptoms of lymphogranuloma venerum (LGV)?

Answer 32

Inguinal and femoral lymphadenopathy and drainage through skin
Ulcer usually gone by the time patient presents
Late presentation: anal fistulas, recto-vaginal fistulas

Question 33

What are important rapid diagnosis tests are available for syphilis/chancroid/LGV?

Answer 33

Dark-field microscopy (syphilis)
Gram stain (chancroid)
Serum RPR

Question 34

What is the treatment for syphilis?

Answer 34

Penicillin or doxycycline

Question 35

What is the treatment for chancroid?

Answer 35

Azythromicin (single dose)
Cetriaxone (single dose)
Ciprofloxacin (single dose)
Erythromycin (7 days)

Question 36

What is the treatment for lymphogranuloma venerum (LGV)?

Answer 36

Doxycycline