Chapter 41: STI

Question 1

Give a reason why the reported incidence of STIs may not accurately reflect the true incidence.

Answer 1

because many STIs are not reportable or not reported

Question 2

State the significance of genital warts.

Answer 2

HPV (genital warts) can also be transmitted though nonsexual routes including mother to newborn (vertical transmission) and fomites

Question 3

Explain the recurrent infections of genital herpes.

Answer 3

Recurrent HSV episodes are usually milder than the initial episode—there typically are fewer lesions, and viral shedding occurs at a lower concentration and for a shorter duration (about 3 days). However, the prodromal symptoms of itching, burning, and tingling at the lesion site are similar. Except for the greater tendency of HSV-2 to recur, the clinical manifestations of genital HSV-2 and HSV-1 infections are similar. The frequency and severity of recurrence vary from person to person. Numerous factors, including emotional stress, lack of sleep, overexertion, other infections, vigorous or prolonged coitus, and premenstrual or menstrual distress, have been identified as triggering mechanisms

Question 4

State the signs and symptoms of infections caused by Candida albicans and Trichomonas vaginalis.

Answer 4

CANDIDA ALBICANS
-vulvovaginal pruritus
irritation, erythema, swelling, dysuria, and dyspareunia.
The characteristic discharge, when present, is usually thick, white, and odorless

TRICHOMONAS VAGINALIS
- The infection causes a copious, frothy, malodorous, green or yellow discharge. There commonly is erythema and edema of the affected mucosa, with occasional itching and irritation. Sometimes, small hemorrhagic areas, called strawberry spots, appear on the cervix.

Question 5

Name the organism responsible for chlamydial infections.

Answer 5

C. trachomatis

Question 6

Compare the signs and symptoms of gonorrhea in the male and female.

Answer 6

People presented with gonorrhea may be asymptomatic

MEN:
-urethral pain and a creamy yellow, sometimes bloody, discharge -chronic and affect the prostate, epididymis, and periurethral glands. -Rectal infections are common in homosexual men.

WOMEN
-unusual genital or urinary discharge, dysuria, dyspareunia, pelvic pain or tenderness, unusual vaginal bleeding (including bleeding after intercourse),
-fever, and proctitis.
Symptoms may occur or increase during or immediately after menses because the bacterium is an intracellular diplococcus that thrives in menstrual blood but cannot survive long outside the human body. There may be infections of the uterus and development of acute or chronic infection of the fallopian tubes (i.e., salpingitis), with ultimate scarring and sterility.

Question 7

Describe the three stages of syphilis.

Answer 7

PRIMARY STAGE:

• Syphilis is characterized by the appearance of a chancre at the site of exposure.
• Chancres typically appear within 3 weeks of exposure but may incubate for 1 week to 3 months.
• The primary chancre begins as a single, indurated, buttonlike papule up to several centimeters in diameter that erodes to create a clean-based ulcerated lesion on an elevated base. These lesions usually are painless and located at the site of sexual contact. Primary syphilis is readily apparent in the male, where the lesion is on the scrotum or penis. Although chancres can develop on the external genitalia in females, they are more common on the vagina or cervix, and primary syphilis therefore may go untreated. There usually is an accompanying regional lymphadenopathy. The infection is highly contagious at this stage, but because the symptoms are mild, it frequently goes unnoticed. The chancre usually heals within 3 to 12 weeks, with or without treatment.

SECONDARY STAGE:
varies lasting from 1 week to 6 months. The symptoms of a rash (palms, soles), fever, sore throat, stomatitis, nausea, loss of appetite, and inflamed eyes may come and go for a year but usually last for 3 to 6 months. Secondary manifestations may include alopecia and genital condylomata lata. Condylomata lata are elevated, red brown lesions that may ulcerate and produce a foul discharge. They are 2 to 3 cm in diameter, contain many spirochetes, and are highly infectious.

LATENT PHASE:
-may last a life time here or progress into tertiary stage, patient can be infective the first 1-2 years of latency

TERTIARY STAGE:
Tertiary syphilis is a delayed response to the untreated disease. It can occur as long as 20 years after the initial infection. Only approximately one third of those with untreated syphilis progress to the tertiary stage of the disease, and symptoms develop in approximately one half of these. Approximately one third undergo spontaneous cure, and the remaining one third continue to have positive serologic tests but do not develop structural lesions. When syphilis does progress to the symptomatic tertiary stage, it commonly takes one of three forms: -development of localized destructive lesions called gummas,
-development of cardiovascular lesions, or development of central nervous system lesions.
The syphilitic gumma is a peculiar, rubbery, necrotic lesion that is caused by noninflammatory tissue necrosis. Gummas can occur singly or multiply and vary in size from microscopic lesions to large, tumorous masses. They most commonly are found in the liver, testes, and bone. Central nervous system lesions can produce dementia, blindness, or injury to the spinal cord, with ataxia and sensory loss (i.e., tabes dorsalis). Cardiovascular manifestations usually result from scarring of the medial layer of the thoracic aorta with aneurysm formation. These aneurysms produce enlargement of the aortic valve ring with aortic valve insufficiency.

Question 8

Define what is meant by a sexually transmitted infection (STI).

Answer 8

• encompass a broad range of infectious diseases that are spread by sexual contact
• are spread by sexual contact and involve both male and female partners. Portals of entry include the mouth, genitalia, urinary meatus, rectum, and skin