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IDIS > GU: STIs - II & III > Flashcards

GU: STIs - II & III Flashcards

1
Q

gonorrhea

  • cause
  • mode of transmission
  • presentation
  • manifestations
A
  • cause - neisseria gonorrhea
  • mode of transmission - sexual
  • presentation
    • asymptomatic 30% of the time
    • if not, can manifest with:
      • women
        • cervicitis
        • bartholinitis:
        • PID: → endometritis (uterus) → salpingitis (fallopian tubes) → tubo-ovarian (ovary) → peritonitis → Fitz-Hugh-Curtis syndrome (liver-abdomen adhesions)
      • men
        • urethritis
        • anorectal infection
      • both
        • pharyngitis
        • if disseminated:
          • poly-arthralgia - joint inflammation
          • tenosynovitis - skin rashes
      • neonates: opthalmia neonatorum
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2
Q

neisseria gonorrhea - characteristics

A
  • gram negative diplococcus
    • kidney-bean shaped
    • can be isolated on Thayer-Martin agar
    • killed by cotton - must be calcium agnate swabs (not common swabs) to dx
  • infects columnar epithelial cells
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3
Q

urethritis

  • cause
  • presentation
  • dx
A
  • causes
    • neisseria gonorrhea
    • chlamydia trachomatis
  • presentation:
    • mucopurulent/purulent discharge from penile urethra
    • +/- dysuria (painful urination)
  • dx
    • if gonorrhea: gram - diplococci (kidney bean shaped)
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4
Q

cervicitis

  • cause
  • transmission
  • presentation
  • dx
A
  • causes
    • neisseria gonorrhea
    • clamydia trachomatis
  • transmission - sexual
  • presentation
    • purulent / mucopurulent discharge in endocervical canal
    • +/-
      • abnormal vaginal discharge bleeding
      • external dysuria
      • urgency (rare)
    • dx - purulent discharge on endocervical swab
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5
Q

what is this?

cause?

A

Fitx-Hugh-Curtis Syndrome

  • liver-stomach adhesions resulting from ascending cervititis (d/t neisseria gonorrhea > chlamydia) that goes from → uterus (endometritis) → fallopian tubes (salpingitis)→ ovaries (tubovarian abcesses) → abdomen (peritonitis)
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6
Q

what manifestations can result from ascending cervicitis?

A
  • endometriosis
  • salpingitis
  • tubo-ovarian abscess
  • peritonitis
  • fitz-hugh-curtis syndrome
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7
Q

what manifestations can result from ascending cervicitis?

A
  • endometriosis
  • salpingitis
  • tubo-ovarian abscess
  • peritonitis
  • fitz-hugh-curtis syndrome
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8
Q

how does gonorrhea manifest in heterosexual males?

A
  • with urethritis: purulent/mucopurulent discharge from penile urethra
    • sx
      • usually symptomatic → dysuria
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9
Q

how does gonorrhea manifest in homosexual males?

A
  • urethritis: purulent/mucopurulent discharge from penile urethra
  • anorectal infection: mucopurulent discharge from rectum + rectal pain
  • pharyngitis:
    • sore throat
    • tonsillitis
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10
Q

how can disseminated gonococcal infections manifest?

A

usually asymptomatic

  • low grade fever
  • migratory polyarthralgia:
    • pain/swelling/purulent synovial fluid in joint
  • tenosynovitis
    • skin rashes
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11
Q

how can neisseria gonorrrhea present in newborns?

A
  • opthalmia neonatorum: conjunctiva infection
  • pharyngitis
  • respiratory tract / GI tract infection
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12
Q

dx of neisseria gonorrhea infection

A
  • patient hx
  • if on exam you see purulent discharge: collect a smear of the exudate and culture it:
    • on Thayer-Martin:
      • a positive: intracellular gram negative diplococci
      • undetermined test: if extracellular gram negative diplococci
      • negative test: no gram negative diplococci
    • NAAT techniques
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13
Q

what is this?

cause?

A

bartholinitis

manifestation of gonorrhea

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14
Q

what is this?

cause?

A
  • cervicitis
  • d/t
    • n. gonorrhea
    • c. trichomatus
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15
Q

what is this?

cause?

A

opthalmia neonatorum: conjuncitivitis in the neonate

d/t neisseria gonorrhea

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16
Q

what is this?

cause?

A
  • urethritis
  • cause
    • neisseria gonorrhea (m/c cause in heterosexual men)
    • chlamydia trachomatis
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17
Q

what is this?

what is the cause?

A

tenosynovitis

cause - disseminated gonorrhea

18
Q
A

n. gonorrrhoae - intracellular gram negative diplococci- are kidney bean shaped

19
Q

what is non-gonoccal urethritis (NGU)?

  • causes?
  • presentation?
A

= urethritis not d/t neisseria gonorrhea. caused by

  • causes
    • chlamydia trachomatis - m/c cause of urethritis in heterosexual men
    • mycoplasma genitalia
    • gardnerella vaginalis, trichomonas vaginalis
  • demographics
    • high risk = 15-30 w/multiple sexual partners
      • college campuses
      • rural america
  • presentation:
    • CLEAR urethral discharge (rather than purulent)
    • sx
      • itch in the meatal region
      • dysuria
20
Q

NGU - presentation

A
  • urethral discharge- clear rather than purulent
  • dysuria
  • itch in the meatal region
21
Q

in what population is NGU most prevalent?

A
  • men between the age of 15-30 that have multiple sexual partners are at most risk
    • college campuses
    • rural America
22
Q

m/c causes of NGU

A
  • chlamydia trachomatis (m/c)
  • mycoplasma genitalium
23
Q
A

NGU

clear urethral discharge

24
Q

list the manifestations of chlamydia trachomatis

A
  • in women
    • cervicitis
    • PID (from ascension)
  • in men
    • urethritis
    • epididymitis (from ascension)
  • neonates
    • opthalmia neunatorum (not as severe as gonorrhea
    • pneumonia
25
Q

manifestations/complications of chlamydia trachomatis in women

A
  • cervicitis → PID. can result in
    • infertility
    • ectopic pregnancy
  • conjunctivitis
  • arthritis/psorasis
26
Q

manifestations/complications of chlamydia trachomatis in men

A
  • urethritis → epididymitis
    • reiter’s syndrome
  • conjunctivitis
  • arthritis/psoriasis
27
Q

in what populations is chlamydia most prevalent?

A
  • sexually active persons under 25
  • AA > white
28
Q

manifestations of chlamydia trachomatis in neonates

A
  • 5-12 days postpartum: opthalmia neonatorum
    • presents later in gonorrhea
  • 1-3 mos: pneumonia
29
Q

PID

  • m/c
  • seen mostly in what populations
  • major complications
A
  • chlamydia trachomatis, neisseria gonorrhea
  • in adolescent/young women
  • complications
    • infertility
    • ectopic pregnancy
30
Q

neonatal pneumonia d/t chlamydia

  • presentation
  • dx
A
  • seen 1-3 months of age
    • staccoato cough
    • tachypnea
    • lung hyperinfiltration / diffuse infiltrates
  • Dx = nasopharyngeal aspirates
31
Q

A 25 YEAR OLD MALE, DYSURIA AND URETHRAL DISCHARGE. NO URGENCY OR INCREASED FREQUENCY. MOST APPROPRIATE DIAGNOSIS

Urethritis

Cystitis

Pyelonephritis

Prostatitis

A

urethritis

32
Q

MOST LIKELY CAUSE?

Treponema pallidum

Chlamydia trachomatis

Neisseria gonorrhoeae

Trichomonas vaginalis

Ureaplasma urealyticum

A

neisseria gonorrhea

33
Q

TREATED PATIENT FOR GONORRHEA.THEY CAME BACK WITH DYSURIA AND DISCHARGE. MOST LIKELY CAUSE?

Neiserria gonorrhoeae

Chlamydia trachomatis

Trichomonas vaginalis

Ureaplasma urealyticum

A

chlamydia trachomatis

34
Q

pelvic inflammatory disease (PID) - m/c etiologic agents

A
  • neisseria gonorrhoae
  • chlamydia trachomatis
35
Q

PID is most prevalent in what populations?

A

sexually active teenagers (3x more likely than 25-29)

36
Q

clinical presentation of PID

A

major:

  • bilateral lower abdominal pain
  • tenderness on cervical motion
  • tender adnexal masses

also could see:

  • moderate fever
  • inc vaginal discharge
  • irregular bleeding
  • nausea/vomiting
37
Q

PID manifestations/sequelae

A

manifestations:

  • cervicitis
    • sx
      • asx or vaginal discharge
  • salpingitis
    • sx
      • bilateral lower quadrant abdominal pain
      • adnexal tenderness
    • could result in/progress to
      • ovarian abscesses
      • tubal occlusion, scarring, adhesions, which could result in
        • ectopic pregnancy
        • infertility
  • peritonitis
    • sx
      • nausea / vomiting
      • abdominal tenderness / rigidly
    • could result in/advance to
      • peri-hepatitis
      • Fitz-Hugh Curtis syndrome (abdominal-hepatic adhesions)
38
Q

PID is the most common cause of?

A

involuntary infertility

39
Q

what constitutes the definitive and presumptive diagnosis of PID

A
  • definitive
    • direct visualization of inflammaed fallopian tubes (eg - laparaoscopy)
    • biopsy evidence of salpingitis
  • presumptive
    • made on clinical grounds: pt must be
      • sexually active with pelvic OR bilateral lower tenderness, with either
        • cervical motion tenderness
        • or
        • uterine tenderness,
        • or adnexal tenderness
40
Q

genital warts (HPV)

A
  • HPV

IDIS (12 decks)

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