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OBSTETRICS > CHAPTER 65 SEXUALLY TRANSMITTED INFECTIONS > Flashcards

CHAPTER 65 SEXUALLY TRANSMITTED INFECTIONS Flashcards

1
Q

Refers to the passage of infectious agent from the mother to the fetus via labor or breastfeeding

A

vertical transmission

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2
Q

the risk of higher syphilis infection is linked to?

A

inadequate prenatal care
black or hispanic
lack of treatment

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3
Q

causative agent for syphilis

A

spirochete bacteria called Treponema pallidum

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4
Q

point of entry of the bacteria that will cause syphilis

A

minute abrasions in the vaginal mucosa while cervical eversion, hyperemia and friability will raise the transmission risk

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5
Q

the incubation period of spirochete

A

3 to 4 weeks depending on the host factors and inoculum size

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6
Q

what are the early stages of syphilis

A

primary, secondary and early latent syphilis

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7
Q

how do maternal syphilis can cause infection to the fetus

A

they can readily cause the placenta

they can also contaminate the fetus during labor

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8
Q

what are the two clinical manifestations of maternal syphilis and congenital syphilis

A

maternal syphilis and congenital syphilis

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9
Q

how do primary syphilis diagnosed

A

by characteristic of chancre which develops at the inoculation site

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10
Q

what are chancre?

A

solitary painless lesion typically has a raised firm borer and red smooth ulcerated base without significant pus

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11
Q

when will the chancre resolve even if untreated?

A

2- 8 weeks

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12
Q

what is the reason for secondary syphilis?

A

dissemination from spirochetes to affect the multiple organs

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13
Q

when does secondary syphilis manifest?

A

4 to 10 weeks after the chancre appears

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14
Q

associated clinical manifestation of secondary syphilis

A

dermatological abnormalities such as macular rash, plantar and palmar targetlike lesions

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15
Q

what do you call the flesh colored papules and nodules found in the perianal and perineum that is steeming with spirochetes and highly infectious

A

condylomata lata

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16
Q

what are the associated constitutional symptoms

A 
fever
malaise
headache
myalgiass
hepatitis
neuropathy
ocular changes
anterior uveitis 
periostitis
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17
Q

when does latent syphilis develop?

A

when primary and secondary syphilis are not treated but clinical manifestations resolves

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18
Q

subclinical disease diagnosed within the preceeding 12 months

A

early latent syphilis

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19
Q

diagnosed beyond 12 months

A

late latent syphilis or latent syphilis of unknown duration

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20
Q

maternal infection of syphilis can lead to

A

preterm labor, fetal death, and fetal growth restrictions or fetal infection

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21
Q

when fetal infection is diagnosed what are the associated manifestations

A

fetal hepatic abnormalities followed by anemia, and thrombocytopenia then ascites and hydrops

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22
Q

what is the major complication of syphilis

A

stillbirth

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23
Q

during the syphilic infection, what are the characteristic can be found the placenta and cord and uterus

A

placenta becomes large and pale
villi lose their characteristic aborization and becom thicker and clubbed
blood vessels are dimisnhed
increased vascular resistance and umbilical arteries
cord may show evidence of infections

24
Q

how to diagnose syphilis

A

they cannot be cultured from clinical specimen but we can direct diagnosis of early stages of disease from exudate , tissue, body fluid by dark examination by PCR or DFA-TP

25
Q

what are the first type and second type of treponema testing

A

first is nontreponema testing and treponemal tetsing specific

26
Q

what are the test composed in first testing called nontreponemal testing

A

venereal disease research laboratory or the rapid plasma reagin

27
Q

what do first test measure?

A

measures the patient immunoglobulins M and G antibodies formed against cardiolipin that is released from damaged host cells and possibly also from treponema

28
Q

other possible conditions where IgM and IgG is also released that may misdiagnosed treponema

A 
recent vaccination
febrile illness
pregnancy
intravenous drug use
systemic lupus erythematosus
aging
leprosy 
cancer
29
Q

what do second type of serological testing measure?

A

treponema specific

30
Q

what are test included in the second testing

A

fluorescent treponemal antibody absorption tests and T pallidum passive particle agglutination

31
Q

when do sonographic evaluation performed?

A

fetuses >20 weeks

32
Q

what are the possible findings of positive sonographic evaluation of treponema infection

A 
abnormal sonographic findings
hepatosplenomegaly
placental thickening
hydramnios
ascites
hydrops fetalis
elevated middle cerebral artery
33
Q

the preferred treatment for syphilis for all stages in pregnancy

A

parenteral penicillin G

34
Q

when is the second dose administered?

A

given 1 week after the initial dose

35
Q

are there any alternatives to penicillin therapy to eradicate syphilis?

A

no

36
Q

drug that can eradicate maternal infection but it is limited only to the transplacental passage so these drugs do not prevent all congenital disease

A

erythromycin and azithromycin

37
Q

durg that can eradicate syphilis but are contraindicated in pregnancy because of risk of fetal deciduous teeth discoloration

A

tetracycline and doxycycline

38
Q

what is the next appropriate step for those woman who are penicillin allergy

A

oral stepwise penicillin dose challenge or skin testing

39
Q

what is the second most common STD infection?

A

gonorrhea caused by Neisseria gonorrhea

40
Q

the highest prevalence rate of Gonorrhea

A

between the ages of 15 to 24 years old

41
Q

the gonorrhea infection is only limited to what part?

A

lower genital tract- cervix, urethra and peri-uretheral and vestibular glands

42
Q

untreated gonococcal infection is associated with?

A

septic abortions after voluntary abortions

43
Q

other complications with gonococcal infection?

A

preterm delivery
prematurely ruptured membrane
chorioamnionitis
postpartum infections

44
Q

what way can the infant infected with gonococcal infection

A

vertical transmission fetal contact with the vagina during birth

45
Q

what is the dominant sequelae of gonococcal infection?

A

gonococcal opthalmia neonatorum

46
Q

clincal manifestation of gonococcal opthalmia neonatorum

A

corneal scarring
ocular perforation
blindness

47
Q

prophylaxis needed for newborn

A

ocular prophylaxis

48
Q

risk factors for gonococcal infection

A 
age of <25 years old
prior gonococcal infection
other STDs
prostitute
new or multiple sexual partners
drug abuse
black
hispanic or american indian or alaska native ethnicity
inconsistent condom use
49
Q

marker for concomintant chlamydial infection

A

gonococcal infection

50
Q

how to screen woman for gonorrhea

A

culture or by nucleic acid amplification test

51
Q

what is the preferred sample?

A

vaginal or cervical

52
Q

if urine is used what part is suitable?

A

initial urine stream not the midstream

53
Q

what is the current treatment for uncomplicated gonorrhea during pregnancy

A

250 mg ceftriazone intramuscularly plus 1 g of azithromycin orally

54
Q

px are needed to abstain sex how many days after they completed their treatment?

A

7 days

55
Q

what is the alternative regimen for gonococcal infection

A

single 400 mg oral dose of cefixime plus 1 g of azithromycin

56
Q

what is alternative treatment to cephalosporin allergy

A

240 mg intramuscular dose of gentamicin coupled with 2 g oral azithromycin dose

OBSTETRICS (3 decks)

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