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8th > Chapter 175 - Gonorrhea, Mycoplasma, and Vaginosis > Flashcards

Chapter 175 - Gonorrhea, Mycoplasma, and Vaginosis Flashcards

1
Q

Most commonly reported STD

A

Chlamydia

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2
Q

Most common cause of PID in women

A

Chlamydia

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3
Q

Neisseria gonorrhoeae is a Gram ___ aerobic diplococci located intracellularly in PMNs

A

Negative

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4
Q

2nd most commonly reported infectious disease in the US

A

Gonorrhea

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5
Q

The highest rate of reported gonococcal infections is among secually active teenagers and young adults, aged ___

A

15 to 24 years old

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6
Q

The rate in African Americans is __ times higher than whites and in Hispanics ___ times than in whites

A

20x; 2x

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7
Q

Important risk factor for acquisition of new gonococcal infection

A

Prior Gonorrhea infection (recidivism)

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8
Q

Incubation period of gonorrhea

A

2 to 8 days

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9
Q

___% of men and ___% of women have asymptomatic Gonorrhea

A

10%; 50%

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10
Q

The most common manifestation of gonoccoal infection in men is

A

Urethritis

Spontaneous profuse cloudy discharge from penile meatus

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11
Q

Entire distal penis may sometimes become swollen termed as

A

Bull head clap

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12
Q

Testicular pain or orchitis may be the only presenting symptom for gonorrhea.
True or False

A

True, but more commonly with combined infection with Chlamydia

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13
Q

Common site of local infection of gonorrhea in women

A

Endocervix

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14
Q

Vaginitis is commonly seen in gonorrhea. True or False

A

False, only in prepubertal girls or postmenopausal women as vaginal epithelium of sexually mature women does not support growth of N. Gonorrhoeae

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15
Q

Classic triad of disseminated gonococcal infection present in 0.5% to 3% of cases

A

Dermatitis
Migratory polyarthritis
Tenosynovitis

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16
Q

Macules or vesiculopustules on an erythematous base located on palms and soles with necrotic centers is often described as

A

‘Gun metal gray’

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17
Q

PID occurs in about ___% of uncomplicated gonorrheal infections in women

A

10-40%

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18
Q

Sequela of PID (4)

A

Tubo-ovarian abscesses
Ectopic pregnancies
Chronic pelvic pain
Infertility

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19
Q

Inflammation of liver capsule present in 1/4 of women with PID secondary to Chlamydia or Neisseria

A

Fitz Hugh Curtis Syndrome

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20
Q

Mainfestation of Fitz Hugh Curtis syndrome

A

RUQ pain/tenderness

Abnormal LFTs

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21
Q

True septic arthritis caused by Neisseria gonorrhoeae is typically polyarticular.
True or False

A

False, monoarticular or pauciarticular

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22
Q

In gonococcal endocarditis affecting 1-2% of disseminated cases, vegetations primarily affect the ___ in young male patients

A

Aortic valve

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23
Q

Profuse purulent discharge common in newborns of mothers with gonococcal infection

A

Ophthalmia neonatorum

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24
Q

Prophylaxis for ophthalmia neonatorum

A

Erythromycin 0.5% ophthalmic ointment both eyes immediately after birth
Or
Ceftriaxone 25-50mg/kg IV or IM in a single dose (not to exceed 125 mg)

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25
Permanent sequelae of gonococcal infection in women (2)
Infertility | Increased risk of ectopic pregnancies
26
Pathogenesis of gonococcal infection involves bacterial attachment to columnar cells via (2)
Pili (pilC and Opa) | Fimbriae
27
Contributes to pathogenesis of disseminated gonococcal infection
Endotoxin
28
Aside from ophthalmia neonatorum, neonatal gonococcal infection can lead to (4)
``` Growth retardation LBW Prematurity Blindness Infant death ```
29
Gram stain for gonococcal infection has high specificity (>___%) and high sensitivity (___%) hence considered diagnostic for infection
99%; 95%
30
A negative Gram stain rules out gonococcal infection in asymptomatic men at high risk for infection. True or False
False, cannot
31
Best specimen for gram staining for diagnosis of gonococcal infection
Urethra specimen Never vaginal!!! Cervical, not used for screening!
32
Gold standard culture for N. Gonorrhoeae required (4)
Nicotinamide adenine dinucleotide Heme Yeast extract CO2
33
Used to provide more rapid diagnosis in STI clinics
NAAT (nucleic acid amplification tests)
34
First line treatment for gonorrhoeae according to CDC (2015)
Azithromycin 1g PO single dose | + Ceftriaxone 250mg IM single dose
35
__% of people with gonorrhoeae also are coninfected with Chlamydia
10-30%
36
Recommended CDC regimen for DGI affecting joints
Azithromycin 1g PO single dose | Ceftriaxone 1g IM/IV q 24h for 7 days
37
Recommended CDC regimen for DGI endocarditis/meningitis
1g Azithromycin PO single dose | + Ceftriaxone 1-2 g IV q 12-24h for 10-14 days
38
Allergic reactions are common with 3rd gen cephalosporins. | True or False
False, uncommon
39
Alternative for Cephalosporin in cases of IgE mediated penicillin allergy
``` Gemifloxacin 320mg PO + Azithromycin 2g PO OR Gentamicin 240mg IM + Azithromycin 2g PO ```
40
Yearly Screening recommendation of CDC for gonorrhea for the ff (5)
1. Men who engages in receptive anal intercourse 2. All sexually active women younger than 25 years old 3. Any woman with a new sex partner 4. Multiple sex partner 5. Partner with STI
41
Treatment of gonococcal infection in neonates
Ceftriaxone 25-50mkday IV/IM in single daily dose for 7 or 10-14 days if meningitis is documented OR Cefotaxime 25 mkday IV/IM BID for 7 days or 10-14 days
42
Smallest free-living self-replicating bacteria which lacks a cell wall that colonize repiratory/urogenital tracts of humans
Mycoplasma 1. Mycoplasma spp. 2. Ureaplasma spp.
43
Most common Mycoplasma strains isolated from genital tract
``` Mycoplasma hominis (P100): 20-50% of sexually active women Mycoplasma genitalium (P110 and P140): 1% to 6.4% ```
44
Most common cause of synptomatic nongonococcal urethritis
``` #1Chlamydia spp #2 Ureaplasma #3 M. Genitalium ```
45
Most common cutaneous disease in men with mycoplasma infection; in women
Urethritis; Cervicitis
46
Disseminated Mycoplasma infection in immunocompromised hosts leads to (3)
Respiratory tract infection Osteomyelitis Infectious arthritis
47
Associated with bacteremia after renal transplantation, surgical wound infections, pericardial effusions, prosthetic heart valves, subcutaneous abscesses, synovial fluid with rheumatoid arthritis
Mycoplasma hominis
48
Causative role in female infertility
M. Hominis | Ureaplasma
49
M. Genitalium infection leads to male infertility. | True or False
False, unknown
50
Req’t for growth of Mycoplasma and of Ureaplasma
Cholesterol and urea
51
Mycoplasma take ___ mos to speciate
6, slow-growing
52
Preferred method of testing for Mycoplasma infection
Nucleic acid amplification test, first voided urine
53
Standard of care for Mycoplasma infection
Empiric treatment in persistent or recurrent urethritis, cervicitis, and PID
54
Detection of Mycoplasma antibodies denotes active infection. | True or False
False, denotes prior colonization or cross reaction but increasing titer for acute infection
55
Treatment of Mycoplasma urethritis
Azithromycin 1g PO single dose Azithromycin 500mg PO on day 1 + 250mg PO for 4 days Or Moxifloxacin 400 mg/day for 7-14 days
56
CDC recommendation for PID unresponsive to standard treatment
Moxifloxacin 400 mg PO for 14 days
57
Chlamydia primarily affects mucous membranes of 3 systems
Ophthalmic Genitourinary respiratory
58
Used to monitor prevalence of Chlamydia infection
NHANES | National Health and Nutrition Examination Survey
59
The prevalence of Chlamydia infection in sexually active women is ___ proportional to age with highest rates between ages of
Inversely; 14-24 years old
60
Most common manifestation of C. Trachomatis infection
Urogenital infection
61
Most common site of infection in men for Chlamydia is __; in women, is ___
Urethra; urethra and cervix
62
Most common cause of epididymitis in male patients younger than 35 years of age
C. Trachomatis | N. Gonorrhoeae
63
Unilateral testicular pain and swelling with dysuria and fever
Epididymitis
64
Proctitis limited to rectum presenting with pruritus, pain, mucopurulent discharge is caused by serovars
Serovar D-K of C. Trachomatis
65
PID is a combination of (3)
Endometritis Salpingitis Peritonitis
66
Perinatal infection of Chlamydia may result to (2)
Conjunctivitis | Pneumonia
67
Neonatal chlamydial penumonia presents within __ after birth with tachypnea, nasal symptoms and staccato cough. No wheezing. (+) peripheral eosinophilia
8 weeks
68
Immune mediated arthritis resulting from mucosal infection (urethritis), concomitant conjunctivitis, and cutaneous lesions involving the genitals
Reactive arthritis
69
Increased risk of developing reactive arthritis
HLAB27 individuals
70
C. Trachomatis is a nonmotile Gram (___) intracellular bacteria that replicates in human cells
Negative
71
2 phase life cycle of Chlamydia
Elementary body —> Reticulate body in 6-8 hours
72
Matching type 1. LGV 2. Chronic conjunctivitis 3. Urogenital tract infection 4. Trachoma A. A to C B. D to K C. L1 to L3
C A B A
73
Chlamydia symptoms occur __ after exposure
1-3 weeks
74
Preferred method of testing for Chlamydia infections
NAAT of urethral specimen in men and endocervical or vaginal in women Nucleic acid amplification test
75
NAAT is most sensitive test availble and as almost as specific as culture. True or False
True
76
NAAT remains positive __ after treatment
3 weeks
77
First line treatment for Chlamydia infection
Doxycycline 100 mg PO BID for 7 days Or azithromycin 1 g PO single dose
78
CDC recommends retest at __ or wirhin at least ___ of treatment
3 months; at least 1 year
79
Most recurrences are the result of treatment failure. | True or False
False, reinfection
80
CDC recommendation for screening
Annual screening for 1. Sexually active women younger than 25 years old 2. Older women with risk factors (new or multiple partners)
81
Most common vaginal infection in women 15 to 44 years old
Bacterial vaginosis
82
Most common risk factors for bacterial vaginosis (2)
Having sex at an early age | New or multiple sex partners
83
Protective against development of bacterial vaginosis
Hormonal contraception | Estrogen-progestin/progestin
84
Help maintain acidic pH of vagina
Lactobacilli
85
In bacterial vaginosis, lactobacilli is replaced by (7)
``` Gram (-) anaerobic bacteria 1. Gardnerella vaginalis 2. M. Hominis 3. M. Curtisii Gram (-) anaerobic rods 1. Prevotella 2. Porphyromonas 3. Bacteroides 4. Peptostreptococus ```
86
__% of bacterial vaginosis infections are asymptomatic
84
87
Amsel criteria for bacterial vaginosis should satisfy 3 out of 4 findings
1. Profuse milky vaginal discharge 2. (+) whiff test result exposed to 10-20% KOH 3. Vaginal pH greater than 4.5 4. Clue cells greater than 2% on microscopic examination
88
Most reliable indicator of BV
At least 20% of epithelial cells on saline wet mount
89
Sensitivity of 92.8% and specificity of 85.7% for BV
DNA probe-based test (16SrRNA gene)
90
100% sensitivity compared with Amsel’s criteria
AmpliSens Florocenosis/ | Bacterial vaginosis-FRT multiplex real time PCR
91
Treatment of asymptomatic non pregnant women is not necessary. True or False
True
92
Treatment of BV
Metronidazole 500 mg BID x 7 days Metronidazole 0.75% gel 5g intravaginally OD x 5 days Tinidazole 2g PO OD x 3 days Clindamycin 5% cream 5g intra vaginally OD x 7 days
93
Treatment of BV in pregnant women
Metronidazole 250 mg PO TID x 7 days Metronidazole 500 mg PO BID x 7 days Clindamycin 300 mg BID x 7 days

8th (28 decks)

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