1. Vulvovaginal yeast infection- thick and clumpy, itchy 2. Bacterial vaginosis- fishy smell, or no sx 3. Trichomonas- discharge with burning urination or no sx

Infectious Disease Flashcards by Claire Wilson

Infection of the Cervix and vagina

typically caused by 1 of 5 organisms/infections

Candida vulvovaginitis Candie’s
Trichomonas vaginitis Tricky
Chlamidia Clams (have)
Gonorrhea Gone
Bacterial vaginosis Bad

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Testing for infection of cervix and vagina

wet mount and gonorrhea/chlamydia test

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Bacterial Vaginosis

typically caused by Gardnerella vaginalis

NOT sexually transmitted

Most common reason for vaginitis

Results in off-white, thin, homogenous discharge with “fishy” odor

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Vaginal Candidiasis

Vaginal yeast infection

results in itching, white clumpy discharge that is not odorous

second most common reason for vaginitis

Not sexually transmitted

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Trichomonas vaginalis

caused by protozoan Trichomonas vaginalis
present with thin, frothy, green malodorous discharge in some, but not all, cases

Can be difficult to distinguish from other causes of vaginitis
Is Sexually transmitted

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chlamydia

caused by Chlamydia trachomatis
Can be asymptomatic (85%) or present with vaginal discharge, pelvic pain

Sexually transmitted disease

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Wet mount determined

Vulvovaginal yeast infection- thick and clumpy, itchy
Bacterial vaginosis- fishy smell, or no sx
Trichomonas- discharge with burning urination or no sx

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Normal Vaginal Wet Mount

small nuclei
transparent cytoplasm

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BV Wet Mount

with coccobacilli surrounding edges of cells

looks clumpy, CLUE CELLS

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Vulvovaginal candiasis Wet Mount

See the “Evil Eye”

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Gonorrhea

caused by bacteria Neisseria Gonorrhea

Can be asymptomatic, or cause discharge

difficult to determine visually

Sexually transmitted

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Trichomonas vaginalis wet mount

These move, have flagellum

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Whiff test

Before you do a wet mount exam

add one drop KOH onto the wet mount slide

if it smells like fish, it is BV

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Vaginal pH, normal

3.8-4.2

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Vaginal pH with BV/Trich infection

>4.5

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Vaginal pH with vaginal candida infection

around 4.5

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Preferred and Reccommeded identification method for Gonorrhea and Chlamydia

Nucleic acid amplification test (NAAT)

-where available

has increased sensitivity

faster vs culture

cheaper

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NAA Testing

Swab test- do NOT use a standard q-Tip

Swab vaginal for women

Swab urethra for men

Can also do a urine test, but this is not as sensitive for women.

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HIV-1

in the US and Europe

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HIV-2

in West Africa

HIV two types

are indistinguishable, clinically.

Detected by Virulogy tests and Serologic tests

Virologic test will show HIV RNA and HIV p24 antigen

Serologic test will show IgM, IgG

HIV detection timeline

1: RNA, early as 10-12 days
2. p24 antigen, 2.5 weeks
3. IgM, 4 weeks
4. IgG

HIV Viral Load test

This is testing the RNA levels.

Can be found as early as 10-12 days

Not recommened as identification method, less sensitive, only approved for HIV-1 and more false positives are possible.

This test is used more to measure a pts response to treatment

HIV p24 test

HIV p24 encoded by gag gene

measures aas early as 11-13 days post infection

less expensive than Viral Load testing

Serologic HIV testing

minimum IgG time: 2 weeks Median IgG time: 4 weeks Almost all infected persons have IgG by 6 months

4th generation HIV test

Came out in 2010 combo test for IgG and IgM and p24 antigen detects 5 days earlier than 3rd gen test. GOLD STANDARD for HIV testing

Syphilis

STI caused by treponema pallidium. sx begin with a single chancre- can be on genitals and the progress to feet and palms of hands.

4 stages of syphilis

1. Acute: develope chancre 2-3 weeks post exposure 2. Secondary: generalized rash 3. Latent: disease inactive, up to 5 years 4. Tertiary: CNS, cardiac, ocular involvement

Syphilis testing

cannot be cultured, so you have to either see a spirochete or do a blood treponema test.

Non-treponemal test

used for syphilis testing less expensive tests pts serum IgG IgM reaction with cardiolipin-cholesterol-licithin antigen- if pt has syph. there will be a cross-reaction Perfromed by the Venereal Disease Research Lab or Rapid Plasma Reagin (VDRL or RPR issues: lack of specificity, false positives from pregnancy, drug use, other diseases. False negatives if not long time. If negative and you suspect syph, retest in 2-3 wks

Treponemal ab test

for syph testing. Confirms a positive non-trep test. More expensive FTA-ABS, fluorescent treponemal antibody absorbtion

Syphilis direct observation

dark field microscopy from lesion sample. only used in clinics that specialize in STIs

Hepatitis A transmission

Fecal-oral possibly sexual rarely blood think outside countries

Hepatitis B transmission

Sexual Blood

Hepatitis C transmission

Sexual Blood

Hepatitis D transmission

Blood rarely sexual

Hepatitis E transmission

Fecal-oral possibly blood

Hepatitis A detection

IgM HAV antibodies present when symptomatic-up to six months GOLD STANDARD IgG can remain positive for decades

Hep C chronic cases

50-85% of Hep C cases become chronic cases.

Hep C Liver cirrhosis

u20-30% of patients with develop cirrhosis of the liver over a 20-30 year period

Primary cause of liver disease and liver transplant

Hep C infection

Earliest marker of Hep C

uHCV DNA first detectable within days to 2 months post-exposure →EARLIEST MARKER

Initial hep C testing

1. HCV DNA test 2. Anti-HCV antibody

Hep D

uHepatitis D virus uncommon in the United States uMore common in the Mediterranean Basin and Pacific Islands uRequires presence of Hepatitis B for complete viral assembly so always co-exists with HBV uDiagnosed through presence of HBsAg, total anti-HDV, and HDV RNA testing

Hep D Diagnosis

1. HBsAG 2. total anti-HDV 3. HDV RNA

Hep E

Highest in Africa, Asia, Middle east, Central America Diagnoses by HEV in stool, or serum Also, HEV IgM which is present until 4-5 mos

HSV

Herpes Simplex Virus Vessicles on genitals and mouth Vessicles need to be "deroofed" to test extremely painful- the Carroll test test is pretty good- 50-75% sensitivity and few false positives

IgG1

From HSV-1

IgG2

from HSV2