CHAPTER 65 SEXUALLY TRANSMITTED INFECTIONS

Question 1

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

Answer 1

vertical transmission

Question 2

the risk of higher syphilis infection is linked to?

Answer 2

inadequate prenatal care
black or hispanic
lack of treatment

Question 3

causative agent for syphilis

Answer 3

spirochete bacteria called Treponema pallidum

Question 4

point of entry of the bacteria that will cause syphilis

Answer 4

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

Question 5

the incubation period of spirochete

Answer 5

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

Question 6

what are the early stages of syphilis

Answer 6

primary, secondary and early latent syphilis

Question 7

how do maternal syphilis can cause infection to the fetus

Answer 7

they can readily cause the placenta

they can also contaminate the fetus during labor

Question 8

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

Answer 8

maternal syphilis and congenital syphilis

Question 9

how do primary syphilis diagnosed

Answer 9

by characteristic of chancre which develops at the inoculation site

Question 10

what are chancre?

Answer 10

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

Question 11

when will the chancre resolve even if untreated?

Answer 11

2- 8 weeks

Question 12

what is the reason for secondary syphilis?

Answer 12

dissemination from spirochetes to affect the multiple organs

Question 13

when does secondary syphilis manifest?

Answer 13

4 to 10 weeks after the chancre appears

Question 14

associated clinical manifestation of secondary syphilis

Answer 14

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

Question 15

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

Answer 15

condylomata lata

Question 16

what are the associated constitutional symptoms

Answer 16

fever
malaise
headache
myalgiass
hepatitis
neuropathy
ocular changes
anterior uveitis 
periostitis

Question 17

when does latent syphilis develop?

Answer 17

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

Question 18

subclinical disease diagnosed within the preceeding 12 months

Answer 18

early latent syphilis

Question 19

diagnosed beyond 12 months

Answer 19

late latent syphilis or latent syphilis of unknown duration

Question 20

maternal infection of syphilis can lead to

Answer 20

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

Question 21

when fetal infection is diagnosed what are the associated manifestations

Answer 21

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

Question 22

what is the major complication of syphilis

Answer 22

stillbirth

Question 23

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

Answer 23

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

Question 24

how to diagnose syphilis

Answer 24

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

Question 25

what are the first type and second type of treponema testing

Answer 25

first is nontreponema testing and treponemal tetsing specific

Question 26

what are the test composed in first testing called nontreponemal testing

Answer 26

venereal disease research laboratory or the rapid plasma reagin

Question 27

what do first test measure?

Answer 27

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

Question 28

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

Answer 28

``` recent vaccination febrile illness pregnancy intravenous drug use systemic lupus erythematosus aging leprosy cancer ```

Question 29

what do second type of serological testing measure?

Answer 29

treponema specific

Question 30

what are test included in the second testing

Answer 30

fluorescent treponemal antibody absorption tests and T pallidum passive particle agglutination

Question 31

when do sonographic evaluation performed?

Answer 31

fetuses >20 weeks

Question 32

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

Answer 32

``` abnormal sonographic findings hepatosplenomegaly placental thickening hydramnios ascites hydrops fetalis elevated middle cerebral artery ```

Question 33

the preferred treatment for syphilis for all stages in pregnancy

Answer 33

parenteral penicillin G

Question 34

when is the second dose administered?

Answer 34

given 1 week after the initial dose

Question 35

are there any alternatives to penicillin therapy to eradicate syphilis?

Answer 35

no

Question 36

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

Answer 36

erythromycin and azithromycin

Question 37

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

Answer 37

tetracycline and doxycycline

Question 38

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

Answer 38

oral stepwise penicillin dose challenge or skin testing

Question 39

what is the second most common STD infection?

Answer 39

gonorrhea caused by Neisseria gonorrhea

Question 40

the highest prevalence rate of Gonorrhea

Answer 40

between the ages of 15 to 24 years old

Question 41

the gonorrhea infection is only limited to what part?

Answer 41

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

Question 42

untreated gonococcal infection is associated with?

Answer 42

septic abortions after voluntary abortions

Question 43

other complications with gonococcal infection?

Answer 43

preterm delivery prematurely ruptured membrane chorioamnionitis postpartum infections

Question 44

what way can the infant infected with gonococcal infection

Answer 44

vertical transmission fetal contact with the vagina during birth

Question 45

what is the dominant sequelae of gonococcal infection?

Answer 45

gonococcal opthalmia neonatorum

Question 46

clincal manifestation of gonococcal opthalmia neonatorum

Answer 46

corneal scarring ocular perforation blindness

Question 47

prophylaxis needed for newborn

Answer 47

ocular prophylaxis

Question 48

risk factors for gonococcal infection

Answer 48

``` 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 ```

Question 49

marker for concomintant chlamydial infection

Answer 49

gonococcal infection

Question 50

how to screen woman for gonorrhea

Answer 50

culture or by nucleic acid amplification test

Question 51

what is the preferred sample?

Answer 51

vaginal or cervical

Question 52

if urine is used what part is suitable?

Answer 52

initial urine stream not the midstream

Question 53

what is the current treatment for uncomplicated gonorrhea during pregnancy

Answer 53

250 mg ceftriazone intramuscularly plus 1 g of azithromycin orally

Question 54

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

Answer 54

7 days

Question 55

what is the alternative regimen for gonococcal infection

Answer 55

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

Question 56

what is alternative treatment to cephalosporin allergy

Answer 56

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