CHAPTER 65 SEXUALLY TRANSMITTED INFECTIONS Flashcards
Refers to the passage of infectious agent from the mother to the fetus via labor or breastfeeding
vertical transmission
the risk of higher syphilis infection is linked to?
inadequate prenatal care
black or hispanic
lack of treatment
causative agent for syphilis
spirochete bacteria called Treponema pallidum
point of entry of the bacteria that will cause syphilis
minute abrasions in the vaginal mucosa while cervical eversion, hyperemia and friability will raise the transmission risk
the incubation period of spirochete
3 to 4 weeks depending on the host factors and inoculum size
what are the early stages of syphilis
primary, secondary and early latent syphilis
how do maternal syphilis can cause infection to the fetus
they can readily cause the placenta
they can also contaminate the fetus during labor
what are the two clinical manifestations of maternal syphilis and congenital syphilis
maternal syphilis and congenital syphilis
how do primary syphilis diagnosed
by characteristic of chancre which develops at the inoculation site
what are chancre?
solitary painless lesion typically has a raised firm borer and red smooth ulcerated base without significant pus
when will the chancre resolve even if untreated?
2- 8 weeks
what is the reason for secondary syphilis?
dissemination from spirochetes to affect the multiple organs
when does secondary syphilis manifest?
4 to 10 weeks after the chancre appears
associated clinical manifestation of secondary syphilis
dermatological abnormalities such as macular rash, plantar and palmar targetlike lesions
what do you call the flesh colored papules and nodules found in the perianal and perineum that is steeming with spirochetes and highly infectious
condylomata lata
what are the associated constitutional symptoms
fever malaise headache myalgiass hepatitis neuropathy ocular changes anterior uveitis periostitis
when does latent syphilis develop?
when primary and secondary syphilis are not treated but clinical manifestations resolves
subclinical disease diagnosed within the preceeding 12 months
early latent syphilis
diagnosed beyond 12 months
late latent syphilis or latent syphilis of unknown duration
maternal infection of syphilis can lead to
preterm labor, fetal death, and fetal growth restrictions or fetal infection
when fetal infection is diagnosed what are the associated manifestations
fetal hepatic abnormalities followed by anemia, and thrombocytopenia then ascites and hydrops
what is the major complication of syphilis
stillbirth
during the syphilic infection, what are the characteristic can be found the placenta and cord and uterus
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
how to diagnose syphilis
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
what are the first type and second type of treponema testing
first is nontreponema testing and treponemal tetsing specific
what are the test composed in first testing called nontreponemal testing
venereal disease research laboratory or the rapid plasma reagin
what do first test measure?
measures the patient immunoglobulins M and G antibodies formed against cardiolipin that is released from damaged host cells and possibly also from treponema
other possible conditions where IgM and IgG is also released that may misdiagnosed treponema
recent vaccination febrile illness pregnancy intravenous drug use systemic lupus erythematosus aging leprosy cancer
what do second type of serological testing measure?
treponema specific
what are test included in the second testing
fluorescent treponemal antibody absorption tests and T pallidum passive particle agglutination
when do sonographic evaluation performed?
fetuses >20 weeks
what are the possible findings of positive sonographic evaluation of treponema infection
abnormal sonographic findings hepatosplenomegaly placental thickening hydramnios ascites hydrops fetalis elevated middle cerebral artery
the preferred treatment for syphilis for all stages in pregnancy
parenteral penicillin G
when is the second dose administered?
given 1 week after the initial dose
are there any alternatives to penicillin therapy to eradicate syphilis?
no
drug that can eradicate maternal infection but it is limited only to the transplacental passage so these drugs do not prevent all congenital disease
erythromycin and azithromycin
durg that can eradicate syphilis but are contraindicated in pregnancy because of risk of fetal deciduous teeth discoloration
tetracycline and doxycycline
what is the next appropriate step for those woman who are penicillin allergy
oral stepwise penicillin dose challenge or skin testing
what is the second most common STD infection?
gonorrhea caused by Neisseria gonorrhea
the highest prevalence rate of Gonorrhea
between the ages of 15 to 24 years old
the gonorrhea infection is only limited to what part?
lower genital tract- cervix, urethra and peri-uretheral and vestibular glands
untreated gonococcal infection is associated with?
septic abortions after voluntary abortions
other complications with gonococcal infection?
preterm delivery
prematurely ruptured membrane
chorioamnionitis
postpartum infections
what way can the infant infected with gonococcal infection
vertical transmission fetal contact with the vagina during birth
what is the dominant sequelae of gonococcal infection?
gonococcal opthalmia neonatorum
clincal manifestation of gonococcal opthalmia neonatorum
corneal scarring
ocular perforation
blindness
prophylaxis needed for newborn
ocular prophylaxis
risk factors for gonococcal infection
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
marker for concomintant chlamydial infection
gonococcal infection
how to screen woman for gonorrhea
culture or by nucleic acid amplification test
what is the preferred sample?
vaginal or cervical
if urine is used what part is suitable?
initial urine stream not the midstream
what is the current treatment for uncomplicated gonorrhea during pregnancy
250 mg ceftriazone intramuscularly plus 1 g of azithromycin orally
px are needed to abstain sex how many days after they completed their treatment?
7 days
what is the alternative regimen for gonococcal infection
single 400 mg oral dose of cefixime plus 1 g of azithromycin
what is alternative treatment to cephalosporin allergy
240 mg intramuscular dose of gentamicin coupled with 2 g oral azithromycin dose
