GU: STIs - I Flashcards

1
Q

STIs in general

  • are most common / severe in what populations?
  • usually present how?
  • can lead to what complications?
A

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
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2
Q

what STIs can cause genital ulcer? which is the m/c in the US?

A
  • genital herpes, syphilis, chancroid, granuloma inguinale, lymphogranuloma venerum
    • genital herpes = m/c in US
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3
Q

genital herpes is

  • caused by what agents?
  • transmitted how?
A
  • HSV-2 (m/c).
    • transmitted either
      • sexually
      • from mother to newborn
  • HSV-1
    • transmitted by genital contact with infected saliva / oral lesions
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4
Q

genital herpes - presentation

A
  • 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
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5
Q

genital herpes - complications

A

HSV can be passed from a mother to her fetus during delivery

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6
Q

during delivery, newborns can develop disseminated infections from what etiological agents?

A

TORCH:

T- Toxoplasma gondii

O- other: HIV, VZV, Parvovirus, Syphilis, Borrelia

R- Rubella
C- CMV
H- HSV

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7
Q

transmission of HSV to neonate in HSV + pregnant women

  • what makes transmission risk high/low?
  • what measures are taken to prevent transmission?
A
  • 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
  • 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
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8
Q

what role does therapy have in the management of HSV?

A
  • 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
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9
Q

syphilis - etiological agent

A

treponema pallidum

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10
Q

syphilis - presentation

A

syphilis has 3 phases of presentations

  • primary (right after infection)
    • chancre + regional lymphadenopathy
      • chancre = PAINLESS, indurated (hard)
  • secondary (6-8 weeks after chance)
    • non-systemic
      • patchy alopecia
      • mucous patches on tongue
      • condyloma lata - wart like lesions
    • systemic - malaise /arthralgia / fever
  • tertiary (if secondary not cured) - gummas, CV affects
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11
Q

syphilis - primary presentation

A
  • painless chancre + regional lymphadenopathy
    • chancre = painless, hard, indurated
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12
Q

syphilis - secondary presentation

A
  • non-systemic
    • patchy alopecia
    • mucous patches on tongue
    • skin presentations
      • maculopapular rashes on palms, soles
      • condylomata lata (wart like lesions)
  • systemic - malaise /arthralgia / fever
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13
Q

what can happen is syphilis is untreated and becomes latent?

A
  • relapse of secondary
  • tertiary syphilis
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14
Q

congenital syphilis - presentation

A
  • 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
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15
Q

congenital syphilis - early presentation

A

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
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16
Q

congenital syphyllis - late presentation

A

= developmental defects

  • bone
    • clutton’s joints
    • saber shins
    • saddle nose
  • teeth
    • Hutchinson teeth
    • mulberry molars
  • rhagades
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17
Q

what is this image showing?

when is this seen?

A

chancre

primary syphilis in adult (painless)

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18
Q

what is this image showing?

when is it seen?

A

condyloma lata - wart like lesions

secondary syphilis / early presentation congenital syphilis

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19
Q

what is this?

when is it seen?

A

tongue lesion

secondary syphilis

20
Q

what is this?

when is it seen?

A

Clutton’s joint

late presentation congenital syphilis

21
Q

what is this?

when is it seen?

A

Hutchinson teeth

late presentation congenital syphilis

22
Q

what is this?

when is it seen?

A

saber shins

late presentation congenital syphilis

23
Q

what is this?

when is it seen?

A

saddle nose

late presentation congenital syphilis

24
Q

what is this?

when is it seen?

A

mulberry molar

late stage congenital syphilis

25
Q

what is this?

when is it seen?

A

rhagades

late presentation congenital syphilis

26
Q

dx of syphilis

A
  • 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
27
Q

chancre

  • caused by what agent?
  • is transmitted how?
  • demographics?
  • presentation?
A
  • 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
28
Q

granuloma inguinale

  • cause?
  • transmitted how?
  • demographics?
  • presentation?
A
  • 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
29
Q

klebsiella granulomatous has what

  • characteristics?
  • virulence factors?
A
  • 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
30
Q

lymphogranuloma veneruem

  • cause
  • transmitted how?
  • demographics?
  • presentation?
  • manifestations?
A
  • 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
31
Q

what is primary inguinal syndrome

  • cause
  • presentation
A
  • cause - LGV (clamydia trachomatis)
  • = lymphadenitis that develops after LGV lesions heals
    • presentation
      • painful
      • systemic sx
        • fever / chills + headache + anorexia
        • hypergammaglobulemia
        • splenomegaly
32
Q

genito - anorectal syndrome

  • cause
  • presentation
A
  • cause - LGV (chlamydia trachomatis)
  • presentation
    • rectal stricture
    • genital elephantitis
33
Q
A

chance

soft, painless chance

d/t h. ducreyi

34
Q
A

donovan bodies - WBCS containing vacuoles filled with klebsiella granulomatous - have a safety pin appearance d/t bipolar staining

seen in granuloma inguinale

35
Q
A

subcutunaeous granulomas

granuloma inguinale

36
Q
A

painless, herpetiform ulcers

lymphogranuloma venerum (LGV)

37
Q
A

draining fistula

manifestation of LGV

38
Q
A

genital elephantiasis

seen in genito-anorectal syndrome, a complication of LGV

39
Q
A

rectal stricture

seen in genito-anorectal syndrome, a complication of LGV

40
Q
A

tzanck cell

seen in HSV (genital herpes)

41
Q
A

spirochetes (treponema pallidum)

seen in syphilis

42
Q
A

granuloma inguinale

ulcer:

  • painless
  • beefy red on a rolled base
  • bleed following contact
43
Q
A

HSV

ulcers - (red → vesicular → ulcers); VERY painul & can cause external dysuria

44
Q
A

granuloma inguinale

subcutnaeous granuloma not associated with lymph nodes

45
Q
A

klebsiella granuloma

donovan bodies

46
Q
A

ulcers:

  • painless
  • beefy red with rolled borders
  • bleed following contact

granuloma inguinale