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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
Q

Permanent sequelae of gonococcal infection in women (2)

A

Infertility

Increased risk of ectopic pregnancies

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26
Q

Pathogenesis of gonococcal infection involves bacterial attachment to columnar cells via (2)

A

Pili (pilC and Opa)

Fimbriae

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27
Q

Contributes to pathogenesis of disseminated gonococcal infection

A

Endotoxin

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28
Q

Aside from ophthalmia neonatorum, neonatal gonococcal infection can lead to (4)

A 
Growth retardation 
LBW
Prematurity
Blindness
Infant death
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29
Q

Gram stain for gonococcal infection has high specificity (>___%) and high sensitivity (___%) hence considered diagnostic for infection

A

99%; 95%

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30
Q

A negative Gram stain rules out gonococcal infection in asymptomatic men at high risk for infection.
True or False

A

False, cannot

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31
Q

Best specimen for gram staining for diagnosis of gonococcal infection

A

Urethra specimen
Never vaginal!!!
Cervical, not used for screening!

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32
Q

Gold standard culture for N. Gonorrhoeae required (4)

A

Nicotinamide adenine dinucleotide
Heme
Yeast extract
CO2

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33
Q

Used to provide more rapid diagnosis in STI clinics

A

NAAT (nucleic acid amplification tests)

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34
Q

First line treatment for gonorrhoeae according to CDC (2015)

A

Azithromycin 1g PO single dose

+ Ceftriaxone 250mg IM single dose

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35
Q

__% of people with gonorrhoeae also are coninfected with Chlamydia

A

10-30%

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36
Q

Recommended CDC regimen for DGI affecting joints

A

Azithromycin 1g PO single dose

Ceftriaxone 1g IM/IV q 24h for 7 days

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37
Q

Recommended CDC regimen for DGI endocarditis/meningitis

A

1g Azithromycin PO single dose

+ Ceftriaxone 1-2 g IV q 12-24h for 10-14 days

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38
Q

Allergic reactions are common with 3rd gen cephalosporins.

True or False

A

False, uncommon

39
Q

Alternative for Cephalosporin in cases of IgE mediated penicillin allergy

A 
Gemifloxacin 320mg PO 
\+ 
Azithromycin 2g PO
OR
Gentamicin 240mg IM
\+ 
Azithromycin 2g PO
40
Q

Yearly Screening recommendation of CDC for gonorrhea for the ff (5)

A
  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
Q

Treatment of gonococcal infection in neonates

A

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
Q

Smallest free-living self-replicating bacteria which lacks a cell wall that colonize repiratory/urogenital tracts of humans

A

Mycoplasma

  1. Mycoplasma spp.
  2. Ureaplasma spp.
43
Q

Most common Mycoplasma strains isolated from genital tract

A 
Mycoplasma hominis (P100): 20-50% of sexually active women
Mycoplasma genitalium (P110 and P140): 1% to 6.4%
44
Q

Most common cause of synptomatic nongonococcal urethritis

A 
#1Chlamydia spp 
#2 Ureaplasma
#3 M. Genitalium
45
Q

Most common cutaneous disease in men with mycoplasma infection; in women

A

Urethritis; Cervicitis

46
Q

Disseminated Mycoplasma infection in immunocompromised hosts leads to (3)

A

Respiratory tract infection
Osteomyelitis
Infectious arthritis

47
Q

Associated with bacteremia after renal transplantation, surgical wound infections, pericardial effusions, prosthetic heart valves, subcutaneous abscesses, synovial fluid with rheumatoid arthritis

A

Mycoplasma hominis

48
Q

Causative role in female infertility

A

M. Hominis

Ureaplasma

49
Q

M. Genitalium infection leads to male infertility.

True or False

A

False, unknown

50
Q

Req’t for growth of Mycoplasma and of Ureaplasma

A

Cholesterol and urea

51
Q

Mycoplasma take ___ mos to speciate

A

6, slow-growing

52
Q

Preferred method of testing for Mycoplasma infection

A

Nucleic acid amplification test, first voided urine

53
Q

Standard of care for Mycoplasma infection

A

Empiric treatment in persistent or recurrent urethritis, cervicitis, and PID

54
Q

Detection of Mycoplasma antibodies denotes active infection.

True or False

A

False, denotes prior colonization or cross reaction but increasing titer for acute infection

55
Q

Treatment of Mycoplasma urethritis

A

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
Q

CDC recommendation for PID unresponsive to standard treatment

A

Moxifloxacin 400 mg PO for 14 days

57
Q

Chlamydia primarily affects mucous membranes of 3 systems

A

Ophthalmic
Genitourinary
respiratory

58
Q

Used to monitor prevalence of Chlamydia infection

A

NHANES

National Health and Nutrition Examination Survey

59
Q

The prevalence of Chlamydia infection in sexually active women is ___ proportional to age with highest rates between ages of

A

Inversely; 14-24 years old

60
Q

Most common manifestation of C. Trachomatis infection

A

Urogenital infection

61
Q

Most common site of infection in men for Chlamydia is __; in women, is ___

A

Urethra; urethra and cervix

62
Q

Most common cause of epididymitis in male patients younger than 35 years of age

A

C. Trachomatis

N. Gonorrhoeae

63
Q

Unilateral testicular pain and swelling with dysuria and fever

A

Epididymitis

64
Q

Proctitis limited to rectum presenting with pruritus, pain, mucopurulent discharge is caused by serovars

A

Serovar D-K of C. Trachomatis

65
Q

PID is a combination of (3)

A

Endometritis
Salpingitis
Peritonitis

66
Q

Perinatal infection of Chlamydia may result to (2)

A

Conjunctivitis

Pneumonia

67
Q

Neonatal chlamydial penumonia presents within __ after birth with tachypnea, nasal symptoms and staccato cough. No wheezing. (+) peripheral eosinophilia

68
Q

Immune mediated arthritis resulting from mucosal infection (urethritis), concomitant conjunctivitis, and cutaneous lesions involving the genitals

A

Reactive arthritis

69
Q

Increased risk of developing reactive arthritis

A

HLAB27 individuals

70
Q

C. Trachomatis is a nonmotile Gram (___) intracellular bacteria that replicates in human cells

71
Q

2 phase life cycle of Chlamydia

A

Elementary body —> Reticulate body in 6-8 hours

72
Q

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

73
Q

Chlamydia symptoms occur __ after exposure

74
Q

Preferred method of testing for Chlamydia infections

A

NAAT of urethral specimen in men and endocervical or vaginal in women
Nucleic acid amplification test

75
Q

NAAT is most sensitive test availble and as almost as specific as culture.
True or False

76
Q

NAAT remains positive __ after treatment

77
Q

First line treatment for Chlamydia infection

A

Doxycycline 100 mg PO BID for 7 days
Or
azithromycin 1 g PO single dose

78
Q

CDC recommends retest at __ or wirhin at least ___ of treatment

A

3 months; at least 1 year

79
Q

Most recurrences are the result of treatment failure.

True or False

A

False, reinfection

80
Q

CDC recommendation for screening

A

Annual screening for

  1. Sexually active women younger than 25 years old
  2. Older women with risk factors (new or multiple partners)
81
Q

Most common vaginal infection in women 15 to 44 years old

A

Bacterial vaginosis

82
Q

Most common risk factors for bacterial vaginosis (2)

A

Having sex at an early age

New or multiple sex partners

83
Q

Protective against development of bacterial vaginosis

A

Hormonal contraception

Estrogen-progestin/progestin

84
Q

Help maintain acidic pH of vagina

A

Lactobacilli

85
Q

In bacterial vaginosis, lactobacilli is replaced by (7)

A 
Gram (-) anaerobic bacteria
1. Gardnerella vaginalis
2. M. Hominis
3. M. Curtisii
Gram (-) anaerobic rods
1. Prevotella
2. Porphyromonas
3. Bacteroides
4. Peptostreptococus
86
Q

__% of bacterial vaginosis infections are asymptomatic

87
Q

Amsel criteria for bacterial vaginosis should satisfy 3 out of 4 findings

A
  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
Q

Most reliable indicator of BV

A

At least 20% of epithelial cells on saline wet mount

89
Q

Sensitivity of 92.8% and specificity of 85.7% for BV

A

DNA probe-based test (16SrRNA gene)

90
Q

100% sensitivity compared with Amsel’s criteria

A

AmpliSens Florocenosis/

Bacterial vaginosis-FRT multiplex real time PCR

91
Q

Treatment of asymptomatic non pregnant women is not necessary.
True or False

92
Q

Treatment of BV

A

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
Q

Treatment of BV in pregnant women

A

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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