GU: STIs - I Flashcards
STIs in general
- are most common / severe in what populations?
- usually present how?
- can lead to what complications?
adolescents/adults
- demographics
- m/c in adolescents / young adults
- complications typically more severe in women
- can lead to
- inc risk of acquiring HIV
- in women
- PID (which can cause → infertility/ectopic pregnancies)
- fetal STI
what STIs can cause genital ulcer? which is the m/c in the US?
- genital herpes, syphilis, chancroid, granuloma inguinale, lymphogranuloma venerum
- genital herpes = m/c in US
genital herpes is
- caused by what agents?
- transmitted how?
-
HSV-2 (m/c).
- transmitted either
- sexually
- from mother to newborn
- transmitted either
-
HSV-1
- transmitted by genital contact with infected saliva / oral lesions
genital herpes - presentation
- usually is asymptomatic
- if symptomatic, typically most severe in initial infection:
-
painful genital lesions progressing from red base → vesicles → ulcers
- in women: these lesions can cause “external dysuria” painful urination right at external urethra
- lymphadenopathy in inguinal / pelvic / femoral nodes
-
systemic affects
- headache/malaise myalgia
-
painful genital lesions progressing from red base → vesicles → ulcers
genital herpes - complications
HSV can be passed from a mother to her fetus during delivery
during delivery, newborns can develop disseminated infections from what etiological agents?
TORCH:
T- Toxoplasma gondii
O- other: HIV, VZV, Parvovirus, Syphilis, Borrelia
R- Rubella
C- CMV
H- HSV
transmission of HSV to neonate in HSV + pregnant women
- what makes transmission risk high/low?
- what measures are taken to prevent transmission?
- high vs low risk
- high risk:
- acquired HSV (primary infection) near delivery
- low risk: if mother has
- recurrent herpes
- acquired HSV (primary infection) in 1st half of pregnancy
- high risk:
- preventative measures
-
asymptomatic pt: cervicovaginal swab during delivery just to check
- if + for virus: treat neonate with antiviral
-
pt with genital herpes dx:
- if not currently active: treat neonate with antiviral
- if prodrome/active lesions: delivery by C-SECTION
-
asymptomatic pt: cervicovaginal swab during delivery just to check
what role does therapy have in the management of HSV?
- anti-virals
- do
- make recurrences less frequent/less severe
- reduce risk of sexual transmission of HSV-2 to another person
- do not
- have any affect on latency
- do
syphilis - etiological agent
treponema pallidum
syphilis - presentation
syphilis has 3 phases of presentations
- primary (right after infection)
-
chancre + regional lymphadenopathy
- chancre = PAINLESS, indurated (hard)
-
chancre + regional lymphadenopathy
- secondary (6-8 weeks after chance)
- non-systemic
- patchy alopecia
- mucous patches on tongue
- condyloma lata - wart like lesions
- systemic - malaise /arthralgia / fever
- non-systemic
- tertiary (if secondary not cured) - gummas, CV affects
syphilis - primary presentation
-
painless chancre + regional lymphadenopathy
- chancre = painless, hard, indurated
syphilis - secondary presentation
- non-systemic
- patchy alopecia
- mucous patches on tongue
- skin presentations
- maculopapular rashes on palms, soles
- condylomata lata (wart like lesions)
- systemic - malaise /arthralgia / fever
what can happen is syphilis is untreated and becomes latent?
- relapse of secondary
- tertiary syphilis
congenital syphilis - presentation
- stillborn, or
- is a “secondary” syphilis presentation that occurs in 2 phases
- early presentation
- skin manifestations: maculopapular rash / condyloma lata, tongue mucous patch
-
organ defects - liver/kidney/spleen/bone
- hepatosplenomegaly
- glomerulonepphritis
- osteochondritis
- late presentation = developmental defects
-
bone
- clutton’s joints
- saber shins
- saddle nose
-
teeth
- Hutchinson teeth
- mulberry molars
-
bone
- early presentation
congenital syphilis - early presentation
skin manifestations + organ defects
-
skin manifestations (same as adults)
- maculopapular rash
- condyloma lata
- tongue mucous patch
-
organ defects
-
liver / kidney / spleen/ bone
- hepatosplenomegaly
- glomerulonephritis
- osteochondritis
-
liver / kidney / spleen/ bone
congenital syphyllis - late presentation
= developmental defects
-
bone
- clutton’s joints
- saber shins
- saddle nose
-
teeth
- Hutchinson teeth
- mulberry molars
- rhagades
what is this image showing?
when is this seen?
chancre
primary syphilis in adult (painless)
what is this image showing?
when is it seen?
condyloma lata - wart like lesions
secondary syphilis / early presentation congenital syphilis
what is this?
when is it seen?
tongue lesion
secondary syphilis
what is this?
when is it seen?
Clutton’s joint
late presentation congenital syphilis
what is this?
when is it seen?
Hutchinson teeth
late presentation congenital syphilis
what is this?
when is it seen?
saber shins
late presentation congenital syphilis
what is this?
when is it seen?
saddle nose
late presentation congenital syphilis
what is this?
when is it seen?
mulberry molar
late stage congenital syphilis
what is this?
when is it seen?
rhagades
late presentation congenital syphilis
dx of syphilis
- first - do a reagin test: VDRL, RPR
- issue is these give a lot of false positives
- second - do confirmatory (treponemal) tests: FTA-AB
- much more accurate
chancre
- caused by what agent?
- is transmitted how?
- demographics?
- presentation?
- haemophilus ducreyi
- almost exclusively by sexual contact
- seen often in prostitution
- presentation
-
PAINFUL chancre + lymphadenopathy
- chancer is
- painful
- soft - NOT indurated/ hard
- ulcerated
- +/- present in multiples
- lymphadenopathy
- painful
- often significant
- chancer is
-
PAINFUL chancre + lymphadenopathy
granuloma inguinale
- cause?
- transmitted how?
- demographics?
- presentation?
- klebsiella granulomatous
- transmitted - sexually
- demographics
- seen mostly in the tropics: think of foreign travelers
- presentation
-
painless ulcers + subcutaneous granulomas
- ulcers
- are PAINLESS
- have rolled border on a beefy, cobblestone base
- bleed following contact
- subcutaneous granulomas
- are in inguinal region, but not in lymph nodes
- ulcers
-
painless ulcers + subcutaneous granulomas
klebsiella granulomatous has what
- characteristics?
- virulence factors?
- intracellular gram negative rod
- have a safety pin like appearance d/t bipolar staining: when they collect in vacuoles in WBCs, = donovan bodies
- virulence factors - prevent phagocytosis
- capsule
- polysaccharide
lymphogranuloma veneruem
- cause
- transmitted how?
- demographics?
- presentation?
- manifestations?
- chlamydia trachomatis
- transmitted - sexually
- demographics - tropic/subtropical Africa/Asia
- presentation - painless herpetiform lesions
- complications
- primary inguinal syndrome: lymphadenitis + systemic sx
- genito-anorectal syndrome: rectal strictures + genital elephantitis
- late manifestations
- draining fistulas
- abscess formation
- urethral destruction
what is primary inguinal syndrome
- cause
- presentation
- cause - LGV (clamydia trachomatis)
- = lymphadenitis that develops after LGV lesions heals
- presentation
- painful
-
systemic sx
- fever / chills + headache + anorexia
- hypergammaglobulemia
- splenomegaly
- presentation
genito - anorectal syndrome
- cause
- presentation
- cause - LGV (chlamydia trachomatis)
- presentation
- rectal stricture
- genital elephantitis
chance
soft, painless chance
d/t h. ducreyi
donovan bodies - WBCS containing vacuoles filled with klebsiella granulomatous - have a safety pin appearance d/t bipolar staining
seen in granuloma inguinale
subcutunaeous granulomas
granuloma inguinale
painless, herpetiform ulcers
lymphogranuloma venerum (LGV)
draining fistula
manifestation of LGV
genital elephantiasis
seen in genito-anorectal syndrome, a complication of LGV
rectal stricture
seen in genito-anorectal syndrome, a complication of LGV
tzanck cell
seen in HSV (genital herpes)
spirochetes (treponema pallidum)
seen in syphilis
granuloma inguinale
ulcer:
- painless
- beefy red on a rolled base
- bleed following contact
HSV
ulcers - (red → vesicular → ulcers); VERY painul & can cause external dysuria
granuloma inguinale
subcutnaeous granuloma not associated with lymph nodes
klebsiella granuloma
donovan bodies
ulcers:
- painless
- beefy red with rolled borders
- bleed following contact
granuloma inguinale
