Chapter 10-2: Infectious Disease (STDs)

Question 1

Clinical manifestations of Congenital Syphilis

Answer 1

1/2 with congenital syphilis die shortly before or after birth
-hepatomegaly, slplenomegaly, mucocutaneous lesions, jaundice, lymphadenopathy, snuffles==bloody mucopurulent nasal discharge

Question 2

long term sequelae of congenital syphilis

Answer 2

deafness, mental retardation

Question 3

Syphillis acquired through sexual contact manifestations

Answer 3

1) Primary stage chancre at the inoculation site
(well demarcated, firm, painless genital ulcer with an indurated base)
2) Secondary: widespread dermatologic infolvement
-generalized (including palms and soles) macular rash that are erythematous and progress to papules
-fever, malaise, pharyngitis, mucosal ulcerations, genralized lymphadenopathy
3) yard after primary exposure
-gummas (granulomatous tissues) destroy surrounding tissues especially in the skin, heart, bone, and CNS
**tertiary syphillis can occur w/o a previous primary or secondary manifestation

Question 4

Tests for syphillis

Answer 4

• scrapings show rapidly mobile organisms w/ corkscrew like motion
• RPR and VDRL are excellent blood screening tests
• neonates w/ suspected congenital need lumbar puncture; CSF pleocytosis and elevated protein suggest neurosyphillis; positive CSF VDRL is diagnostic

Question 5

What is PID?

Answer 5

constellation of symptoms and signs related to ascending spread of pathogenic organisms from the lower female genital tract to the endometrium, fallopian tubes, and contiguous structures

Question 6

Pathogens in PID

Answer 6

-generally polymicrobial
(chlamydia and gonorrhea most commonly)
-these infections in prepubertal child strongly suggests sexual abuse

Question 7

Risk factors for PID

Answer 7

• sexual intercorse w/ multiple partners
• unprotected intercourse
• pre-existing STI

Question 8

Diagnosis of PID

Answer 8

presence of at least one minimum criteria

Question 9

Minimum criteria for PID

Answer 9

cervical motion tenderness

uterine or adenexal tenderness

Question 10

Additional criteria for PID

Answer 10

• oral temp >101
• elevated ESR or c-reactive protein
• prsence of WBC on saline microscopy of vaginal secretions
• mucopurulent cervical or vaginal discharge
• lab evidence of cervical infection w/ gonorrhea or chlamydia

Question 11

What should you ALWAYS test for in suspected PID

Answer 11

pregnancy because ectopic pregnancy is a life-threatening condition that must be ruled out
-also because you may need to alter treatment if uteral pregnancy

Question 12

Tx of PID

Answer 12

treat for gonorrhea (doxycycline) chlamydia (ceftriaxone) and cover for anaerobes (metronidazole; clindamycin)

Question 13

What is most common complication of gonorrhea in bloodstream

Answer 13

arthritis

Question 14

What is most common complication of chlamydia in bloodstream

Answer 14

(rare)
Reiter Syndrome (can't see, can't pee, can't climb a tree)
-uretheritis
-conjunctivitis
-arthritis

Question 15

Trich

Answer 15

mobile flagellated protozoan
-maladorous, forthy gray discharge w/ vaginal discomfort
-dysuria nand vague lower abdominal pain
Tx oral metronidzole twice daily for 7 days
(treat sexual partner)

Question 16

BV

Answer 16

decreased lactobacillus
clue cells
-thin, white, foul smelling discharge
-fishy odor when mixed w/ potassium hydroxide
-pH greater than 4.5
TX metronidazole twice daily for 7 days
(treating sexual partner doesn’t effect recurrence rates)

Question 17

Vaginal Candidiaisis

Answer 17

all are colonized w/ candida

• factors like abx use, pregnancy, diabetes, immunosuppression, organ contraceptive use predispose to candidal overgrowth
• single dose of fluconazole is an alternative

Question 18

Urethritis

Answer 18

gonorrhea and trachoma tis are most important pathogens
-urethral discharge, itching, dysuria, urinary frequency
Tx dual therapy w/ IM ceftriaxone AND oral azithromycin OR days oral doxycycline