Female Repro L4: STI Flashcards
1
Q
Etiology of vaginitis
A
2
Q
GENITAL HERPES SIMPLEX
A
**Pathophysiology **
- Initial viral replication takes place in the epidermis and dermis at the site of viral entry
- – Incubation period is 2-7 days but can be longer
- Immunoglobulin IgM to type 2 virus develop within 21 days of exposure in 85% of patients
- Fetal infection
- – Transplacental infection seen in 50% of cases of maternal primary lesion
- – Complications include spontaneous abortion, symmetric IUGR, microcephaly, and cerebral calcifications
3
Q
SYPHILIS
A
- Transmission of syphilis
- – Direct contact with an infectious moist lesion
- – Transplacental transfer to a fetus from an infected mother
- Associated with a high rate of co-infection with HIV
Pathophysiology
- Resolution of chancre in 1-5 weeks
- Secondary syphilis occurs 2 weeks to 6 months after the primary lesion
- – A generalized cutaneous eruptions at sites of metastatic foci (heals within 2-6 weeks)
- – Generalized, non-tender, lymph node enlargement observed in patients with secondary syphilis (85%)
- Tertiary syphilis is characterized by the presence of gummas
- Treponemal organism cross the placenta at every stage of pregnancy
Sx
Primary
- Firm, painless, genital sore (labia, vulva, vagina, cervix, anus, lips, nipples)
- Painless, rubbery, regional lymph node enlargement
- Generalized lymph node enlargement 3-6 weeks after exposure
- Spirochetes found on dark-field microscopy of moist lesions
- Positive serology in 70% within 1-4 weeks after the development of primary chancre
Secondary
- Generalized, symmetric, extragenital papulosquamous eruptions
- Condyloma latum, mucous patches
- Positive dark-field findings in moist lesions
- Positive serologic tests for syphilis
- Lymphadenopathy
Latent
- Positive serologic tests for syphilis
- Absence of clinical manifestation
- Normal CSF examination
Tertiary
- Neurologic (general paresis, tabes dorsalis)
- Cardiovascular (asymptomatic aortitis, aortic aneurysm and regurgitation)
- Skin and mucous membrane (perforation of the nasal septum, indolent skin ulcers)
- Ophthalmic (blindness)
- ENT (sensorineural deafness)
- Bone (osteitis)
4
Q
CONGENITAL SYPHILIS
A
- History of maternal syphilis
- Positive serologic tests for syphilis
- Manifestation of early congenital syphilis
- – Non-immune hydrops
- – Macerated skin
- – Anemia
- – Thrombocytopenia
- – Hepatosplenomegaly
- – Jaundice
- Stillborn (50%) or premature
- Large and edematous placenta
- Other findings appear later (2 years) (Hutchison teeth, interstitial keratitis, eighth nerve deafness, saddle nose, saber shin, etc.)
5
Q
GENITAL CHLAMYDIAL INFECTION
A
C. trachomatis has tropism for columnar and transitional epithelium
Infection does not confer lasting immunity
Pathogenesis
- C. trachomatis serovars B and D through K
- – Attach only to columnar epithelial cells
- – No deep tissue invasion
- – Features of infection: discharge, swelling, erythema and pain are localized
- – Systemic manifestation of clinical infection may not be apparent
- Incubation period of symptomatic disease is 7 to 14 days
- Mechanism for pathogenesis of chlamydial diseases is immune-mediated response (lymphocytes and mononuclear cells )
- Major outer membrane protein (MOMP) plays a role in pathogenesis
- MOMP triggers cytokine release which promotes an inflammatory response
- Molecular mimicry is believed to exist between chlamydial antigen and ciliated epithelium of endosalpingeal cells
- Adverse sequelae are related to chronic inflammatory changes as well as fibrosis
Sx
CERVICITIS
- The most common chlamydial syndrome
- More than 50% are asymptomatic
- Symptoms, when present, include
- – Mucopurulent discharge
- – Intermenstrual bleeding
- – Post-coital bleeding
- – Lower abdominal pain
- – Cervical edema/ulceration
URETHRAL SYNDROME
- Results from urethritis
- Associated with frequency, dysuria and lower abdominal pains
PID
- Ascending infection of upper genital tract
- Seen in 30% of patients
- Clinicalfeaturesinclude – Lower abdominal pains
- – Vaginal discharge
- – Dysuria
- – Constitutional symptoms - fever, chills
- Less acutely symptomatic than PID due to GC
- Higher rates of infertility than GC
- Significant risk of ectopic pregnancy
REITER’S SYNDROME: Associated with HLA-B27
6
Q
Gonorrhea
A
Pathophysiology (partial)
- Mechanisms of evading the immune system
- – Inactivation of mucosal IgA1 by bacterial proteases
- – Blocking antigen by the binding of antibodies to a reduction modifiable protein (rmp)
- – Antigenic and phase variation o fOpa, Pil, and lipooligosaccharide (LOS)
- – Masking of gonococcal antigen (sialytion of LOS) which prevents phagocytosis
**Sx: **Similar clinical syndromes as C. trachomatis
DISSEMINATED INFECTION
- A clinical syndrome seen in asymptomatic carriers
- Consists of a triad of polyarthralgia, tenosynovitis and dermatitis ± septicemia
- Endocarditis and meningitis have been described
VULVOVAGINITIS IN CHILDREN
- Non-keratinized vaginal epithelium in children is particularly vulnerable to gonococcal infection
- Infection results in severe vulvovaginitis
- Genital mucous membrane is red and swollen
- Should raise suspicion of sexual abuse
7
Q
HIV INFECTION
A
An acute mononucleosis-like illness seen in 45-90% of patients in first few months of infection
**Pathophysiology: MATERNAL-TO-CHILD-TRANSMISSION (MTCT) OF HIV **
- Contact with infected genital secretion at time of vaginal delivery (most cases)
- Crossing the placenta or maternofetal transfusion during prenatal period
- Penetrating gut mucosa during breastfeeding , especially in a setting of inflammation
8
Q
HPV
A
HPV is a small, non-enveloped, double- stranded DNA virus
Pathogenesis
- E7 binds to and phosphorylates the Rb portion of E2F/Rb complex
