GENITAL TRACT INFECTIONS 1.2 (AB) Flashcards
1
Q
Which genital ulcers are painful?
A
HSV and Chancroid
2
Q
Which genital ulcers are painless?
A
Syphilis. Granuloma inguinale. LGV
3
Q
Which genital ulcer presents with vesicles?
A
Genital herpes (HSV)
4
Q
What is the primary lesion in syphilis?
A
Chancre
5
Q
What is the primary lesion in LGV and granuloma inguinale?
A
Bubo/Plague
6
Q
Which genital ulcer diseases present with bilateral lymphadenopathy?
A
HSV and Syphilis
7
Q
Which genital ulcer diseases present with firm
A
nontender bilateral lymphadenopathy?
8
Q
Which genital ulcer diseases typically lack lymphadenopathy?
A
Granuloma inguinale and Syphilis
9
Q
Which virus causes genital herpes?
A
HSV type 1 or type 2
10
Q
Which HSV type typically causes oral lesions?
A
HSV type 1
11
Q
Which HSV type typically causes genital ulcers?
A
HSV type 2
12
Q
How is genital herpes transmitted?
A
During asymptomatic viral shedding
13
Q
How often does asymptomatic shedding occur in genital herpes?
A
Once every 5 days
14
Q
What percentage of primary genital herpes infections are asymptomatic?
A
0.8
15
Q
What are the symptoms of primary genital herpes if symptomatic?
A
Local and systemic symptoms including fever. headache. malaise and lymphadenopathy
16
Q
How long does viral shedding last in primary genital herpes?
A
2-3 weeks
17
Q
What is a nonprimary HSV infection?
A
First episode of genital herpes in someone with prior exposure to the other HSV type
18
Q
How do nonprimary HSV infections compare to primary?
A
Fewer lesions. less systemic symptoms and shorter duration
19
Q
What is a recurrent HSV infection?
A
Reactivation of latent virus of the same serotype
20
Q
Where does HSV remain latent?
A
Dorsal root ganglia (S2-S4)
21
Q
What are the typical lesions in primary genital herpes?
A
Multiple. bilateral. painful anogenital vesicles or ulcers with erythematous base
22
Q
What are the typical systemic symptoms in primary HSV?
A
Fever. headache. malaise. lymphadenopathy
23
Q
What is the healing time for primary HSV lesions?
A
14-21 days
24
Q
What are the typical features of recurrent genital herpes?
A
Fewer. unilateral. less painful lesions with rare systemic symptoms
25
How long do recurrent genital herpes lesions last?
5-7 days
26
What is a prodrome in recurrent HSV?
Sacroneuralgia. vulvar burning. tenderness. pruritus
27
What is the test of choice for genital herpes diagnosis?
PCR (NAAT)
28
What is the sensitivity of viral cultures for primary HSV?
0.8
29
What is seen on a Tzanck smear?
Multinucleated giant cells
30
When is serologic testing for HSV indicated?
Recurrent or atypical lesions with negative virologic test. partner with HSV. STD evaluation
31
Is routine screening for HSV-1 or HSV-2 recommended?
No
32
What is the first-line treatment duration for first clinical episode of HSV?
7-10 days
33
List antiviral options for primary genital herpes treatmen
Acyclovir 400 mg TID. Valacyclovir 1g BID. Famciclovir 250 mg TID
34
List episodic therapy regimens for recurrent HSV
Acyclovir 800 mg BID x5d or TID x2d. Famciclovir 1g BID x1d or 125 mg BID x5d. Valacyclovir 500 mg BID x3d or 1g OD x5d
35
When is suppressive therapy indicated in HSV?
If ≥6 episodes per year
36
List suppressive therapy options for recurrent HSV
Acyclovir 400 mg BID. Valacyclovir 500 mg/1g OD. Famciclovir 250 mg BID
37
When should suppressive therapy be re-evaluated?
After 12 months
38
How can HSV transmission be reduced?
Consistent and correct condom use
39
What other STIs should be tested for in HSV patients?
HIV. HBsAg. RPR/VDRL
40
Should asymptomatic partners of HSV patients be tested?
Yes. offer specific serologic testing
41
What causes chancroid?
Haemophilus ducreyi
42
What is a key microscopic feature of H. ducreyi?
School of fish or chaining pattern on Gram stain
43
What condition increases risk of HIV transmission?
Genital ulcers like chancroid
44
Can H. ducreyi penetrate intact skin?
No. requires prior tissue trauma
45
Describe the chancroid ulcer
Soft chancre with ragged edge. dirty gray exudate. painful. no induration
46
How long after infection do chancroid symptoms appear?
Papule to pustule in 46-72 hours
47
What is bubo?
Unilateral tender lymphadenopathy seen in chancroid
48
What is the sensitivity of culture for H. ducreyi?
Less than 80%
49
What is the clinical diagnosis criteria for chancroid?
Painful vulvar ulcers after ruling out other STIs
50
What complications may occur in untreated chancroid?
Genital scarring.fistulas
51
List recommended treatments for chancroid per CDC
Azithromycin 1g PO SD. Ceftriaxone 250 mg IM SD. Ciprofloxacin 500 mg BID x3d. Erythromycin 500 mg TID x7d
52
When should chancroid patients be reexamined?
3-5 days after therapy
53
What is considered successful treatment of chancroid?
Ulcer improvement in 3 days. healing in 7 days
54
What if chancroid ulcer does not improve?
Evaluate for other STIs
55
When should partners of chancroid patients be treated?
If contact occurred within 10 days prior to symptom onset
56
What organism causes syphilis?
Treponema pallidum
57
What is the shape and oxygen requirement of Treponema pallidum?
Anaerobic elongated spirochete
58
How does Treponema pallidum enter the body?
Through a break in the skin or genital tract
59
What infections increase the risk of HIV transmission?
Early syphilis
60
How is syphilis acquired?
Sexual contact and transplacentally
61
What is the incubation period of syphilis?
10-90 days (average 3 weeks)
62
When is syphilis most infectious?
During the first 1-2 years of disease
63
What lesion is characteristic of primary syphilis?
Chancre
64
Is a syphilitic chancre painful or painless?
Painless
65
How does a chancroid differ from a chancre?
Chancroid is painful
66
What are the characteristics of a syphilitic chancre?
Solitary painless ulcer. 1-2 cm. indurated margin. nonexudative base. non-tender firm lymphadenopathy
67
How long does it take for a chancre to heal spontaneously?
2-6 weeks
68
When does secondary syphilis develop?
6 weeks to 6 months after primary infection
69
What are systemic symptoms of secondary syphilis?
Rash. fever. headache. malaise. anorexia. lymphadenopathy
70
What is the classic rash of secondary syphilis?
Red macules and papules on palms and soles
71
What are condyloma lata?
Raised
72
What defines latent syphilis?
Positive serology without symptoms
73
How long can the latent stage of syphilis last?
2-20 years
74
What is early latent syphilis?
Infection of ≤1 year
75
What is the risk with late latent or syphilis of unknown duration?
Progression to tertiary or neurosyphilis
76
What percentage of untreated syphilis cases develop tertiary syphilis?
0.33
77
What are signs of tertiary syphilis?
Optic atrophy. tabes dorsalis. generalized paresis. aortic aneurysm. gummas. Argyll-Robertson pupil
78
What is Argyll-Robertson pupil?
Small pupil that constricts poorly to light but briskly to accommodation
79
Can neurosyphilis occur in any stage?
Yes
80
What are early neurologic symptoms of neurosyphilis?
Cranial nerve dysfunction. meningitis. stroke. altered mental status. auditory/ophthalmic symptoms
81
What are late neurologic signs of neurosyphilis?
Tabes dorsalis and general paresis
82
How long after infection do late neurologic symptoms occur?
10-30 years
83
What is the gold standard diagnostic test for syphilis?
Darkfield microscopy
84
What are the nontreponemal screening tests for syphilis?
VDRL and RPR
85
What are the treponemal confirmatory tests for syphilis?
FTA-ABS. TPPA/TPHA. EIA
86
What conditions can cause false-positive syphilis tests?
Pregnancy
87
When should pregnant women be rescreened for syphilis?
28-32 weeks and at delivery
88
What is the treatment for primary
secondary
89
What is the treatment for late latent or tertiary syphilis?
Benzathine Penicillin G 2.4 million units IM weekly x 3 doses
90
What is the treatment for neurosyphilis?
Aqueous crystalline Penicillin G 18-24 million units/day IV every 4 hrs for 10-14 days
91
What is the Jarisch-Herxheimer reaction?
Acute febrile reaction after Penicillin G. resolves in 24-36 hrs
92
What symptoms occur with Jarisch-Herxheimer reaction?
Chills. headache. myalgia. hypotension. tachycardia. cutaneous lesion flare
93
When should sex partners be treated presumptively for syphilis?
If exposed within 90 days of diagnosis
94
What is the expected response to syphilis treatment?
Fourfold decrease in titers at 6 and 12 months
95
What organism causes granuloma inguinale?
Klebsiella granulomatis
96
What is a hallmark of granuloma inguinale?
Painless slowly progressing beefy red ulcer that bleeds easily
97
Are lymph nodes enlarged in granuloma inguinale?
No regional adenopathy
98
What are Donovan bodies?
Dark-staining bacteria with bipolar safety pin appearance in smears
99
What is the recommended treatment for granuloma inguinale?
Azithromycin 1g weekly or 500 mg daily for ≥3 weeks
100
Name 2 alternative treatments for granuloma inguinale
Doxycycline 100 mg BID or Ciprofloxacin 750 mg BID for ≥3 weeks
101
When should sexual partners of granuloma inguinale patients be examined?
If contact occurred within 60 days of symptoms
102
What causes lymphogranuloma venereum (LGV)?
Chlamydia trachomatis
103
What is the primary lesion in LGV?
Shallow painless ulcer
104
What is the secondary stage of LGV?
Painful unilateral lymphadenopathy 1-4 weeks after initial infection
105
What is the tertiary stage of LGV?
Ruptured buboes with draining sinuses and proctocolitis
106
What is the recommended treatment for LGV?
Doxycycline 100 mg BID x 21 days
107
What are alternative LGV treatments?
Azithromycin 1g weekly x 3 weeks. Erythromycin base 500 mg QID x 21 days
108
When should LGV sex partners be treated?
If contact occurred within 60 days before symptoms
109
What is the most common vulvar site infected in women with LGV?
Vulva
110
What diagnostic test is used for LGV?
Culture. direct immunofluorescence. NAAT or Chlamydia serology
111
What is a Bartholin’s cyst?
Obstruction of Bartholin duct causing fluid-filled swelling
112
Where are Bartholin glands located?
At 5 and 7 o’clock positions near vaginal opening
113
Is a Bartholin’s cyst usually painful?
No
114
What causes a Bartholin abscess?
Secondary infection of a cyst
115
What are signs of a Bartholin abscess?
Rapid enlargement. acute pain. erythema. edema. cellulitis
116
What is marsupialization?
Surgical creation of an opening to allow continuous drainage of Bartholin cyst
117
When is excision of Bartholin gland indicated?
Persistent infection. multiple recurrences. age ≥40
118
What is the main risk of Bartholin gland excision?
Hemorrhage. hematoma. scarring. dyspareunia
119
Why is biopsy needed for Bartholin cysts in women ≥40?
To exclude adenocarcinoma
120
What virus causes molluscum contagiosum?
Poxvirus
121
How is molluscum contagiosum transmitted?
Direct contact. autoinoculation. contact sports. fomites
122
What is the characteristic lesion of molluscum contagiosum?
White dome-shaped papules with central umbilication
123
Where is molluscum contagiosum usually located?
Labia majora. mons pubis. buttocks. inner thighs
124
What is the treatment for molluscum contagiosum?
Excisional curettage. cryotherapy. imiquimod or cantharidin
125
What histologic feature confirms molluscum contagiosum?
Henderson-Paterson bodies
126
Should sexual partners of molluscum patients be treated?
Yes
