GU: STIs - II & III Flashcards
gonorrhea
- cause
- mode of transmission
- presentation
- manifestations
- 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
- women
neisseria gonorrhea - characteristics
-
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
urethritis
- cause
- presentation
- dx
- causes
- neisseria gonorrhea
- chlamydia trachomatis
- presentation:
- mucopurulent/purulent discharge from penile urethra
- +/- dysuria (painful urination)
- dx
- if gonorrhea: gram - diplococci (kidney bean shaped)
cervicitis
- cause
- transmission
- presentation
- dx
- 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
what is this?
cause?
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)
what manifestations can result from ascending cervicitis?
- endometriosis
- salpingitis
- tubo-ovarian abscess
- peritonitis
- fitz-hugh-curtis syndrome
what manifestations can result from ascending cervicitis?
- endometriosis
- salpingitis
- tubo-ovarian abscess
- peritonitis
- fitz-hugh-curtis syndrome
how does gonorrhea manifest in heterosexual males?
- with urethritis: purulent/mucopurulent discharge from penile urethra
- sx
- usually symptomatic → dysuria
- sx
how does gonorrhea manifest in homosexual males?
- urethritis: purulent/mucopurulent discharge from penile urethra
- anorectal infection: mucopurulent discharge from rectum + rectal pain
-
pharyngitis:
- sore throat
- tonsillitis
how can disseminated gonococcal infections manifest?
usually asymptomatic
- low grade fever
-
migratory polyarthralgia:
- pain/swelling/purulent synovial fluid in joint
-
tenosynovitis
- skin rashes
how can neisseria gonorrrhea present in newborns?
- opthalmia neonatorum: conjunctiva infection
- pharyngitis
- respiratory tract / GI tract infection
dx of neisseria gonorrhea infection
- 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
-
on Thayer-Martin:
what is this?
cause?
bartholinitis
manifestation of gonorrhea
what is this?
cause?
- cervicitis
- d/t
- n. gonorrhea
- c. trichomatus
what is this?
cause?
opthalmia neonatorum: conjuncitivitis in the neonate
d/t neisseria gonorrhea
what is this?
cause?
- urethritis
- cause
- neisseria gonorrhea (m/c cause in heterosexual men)
- chlamydia trachomatis
what is this?
what is the cause?
tenosynovitis
cause - disseminated gonorrhea
n. gonorrrhoae - intracellular gram negative diplococci- are kidney bean shaped
what is non-gonoccal urethritis (NGU)?
- causes?
- presentation?
= 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
- high risk = 15-30 w/multiple sexual partners
- presentation:
- CLEAR urethral discharge (rather than purulent)
- sx
- itch in the meatal region
- dysuria
NGU - presentation
- urethral discharge- clear rather than purulent
- dysuria
- itch in the meatal region
in what population is NGU most prevalent?
- men between the age of 15-30 that have multiple sexual partners are at most risk
- college campuses
- rural America
m/c causes of NGU
- chlamydia trachomatis (m/c)
- mycoplasma genitalium
NGU
clear urethral discharge
list the manifestations of chlamydia trachomatis
- in women
- cervicitis
- PID (from ascension)
- in men
- urethritis
- epididymitis (from ascension)
- neonates
- opthalmia neunatorum (not as severe as gonorrhea
- pneumonia
manifestations/complications of chlamydia trachomatis in women
-
cervicitis → PID. can result in
- infertility
- ectopic pregnancy
- conjunctivitis
- arthritis/psorasis
manifestations/complications of chlamydia trachomatis in men
-
urethritis → epididymitis
- reiter’s syndrome
- conjunctivitis
- arthritis/psoriasis
in what populations is chlamydia most prevalent?
- sexually active persons under 25
- AA > white
manifestations of chlamydia trachomatis in neonates
-
5-12 days postpartum: opthalmia neonatorum
- presents later in gonorrhea
- 1-3 mos: pneumonia
PID
- m/c
- seen mostly in what populations
- major complications
- chlamydia trachomatis, neisseria gonorrhea
- in adolescent/young women
- complications
- infertility
- ectopic pregnancy
neonatal pneumonia d/t chlamydia
- presentation
- dx
-
seen 1-3 months of age
- staccoato cough
- tachypnea
- lung hyperinfiltration / diffuse infiltrates
- Dx = nasopharyngeal aspirates
A 25 YEAR OLD MALE, DYSURIA AND URETHRAL DISCHARGE. NO URGENCY OR INCREASED FREQUENCY. MOST APPROPRIATE DIAGNOSIS
Urethritis
Cystitis
Pyelonephritis
Prostatitis
urethritis
MOST LIKELY CAUSE?
Treponema pallidum
Chlamydia trachomatis
Neisseria gonorrhoeae
Trichomonas vaginalis
Ureaplasma urealyticum
neisseria gonorrhea
TREATED PATIENT FOR GONORRHEA.THEY CAME BACK WITH DYSURIA AND DISCHARGE. MOST LIKELY CAUSE?
Neiserria gonorrhoeae
Chlamydia trachomatis
Trichomonas vaginalis
Ureaplasma urealyticum
chlamydia trachomatis
pelvic inflammatory disease (PID) - m/c etiologic agents
- neisseria gonorrhoae
- chlamydia trachomatis
PID is most prevalent in what populations?
sexually active teenagers (3x more likely than 25-29)
clinical presentation of PID
major:
- bilateral lower abdominal pain
- tenderness on cervical motion
- tender adnexal masses
also could see:
- moderate fever
- inc vaginal discharge
- irregular bleeding
- nausea/vomiting
PID manifestations/sequelae
manifestations:
- cervicitis
- sx
- asx or vaginal discharge
- sx
- 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
- sx
- peritonitis
- sx
- nausea / vomiting
- abdominal tenderness / rigidly
- could result in/advance to
- peri-hepatitis
- Fitz-Hugh Curtis syndrome (abdominal-hepatic adhesions)
- sx
PID is the most common cause of?
involuntary infertility
what constitutes the definitive and presumptive diagnosis of PID
- 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
- sexually active with pelvic OR bilateral lower tenderness, with either
- made on clinical grounds: pt must be
genital warts (HPV)
- HPV
