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Unit 2 Clin Med III > L13: STIs > Flashcards

L13: STIs Flashcards

1
Q

Make antibodies to attack antigens

A

B cells

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2
Q

Lymphocytes

A

WBCs that defends against protozoa, fungi, certain intracellular bacteria, and viruses

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3
Q

T4 cells

A

Helper T cells: enhance immune response, tell B cells to make Abs

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4
Q

T8 cells

A

killer T cells: destroy foreign agents

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5
Q

HIV is a _____

A

Retrovirus→ uses reverse transcriptase→ RNA→ incorporated into host cell DNA

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6
Q

HIV targets

A

CD4 T cells (helper)
B lymphocytes
Macrophages

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7
Q

An untreated HIV mom has a ____ risk of passing it to her infant

A

15-40%

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8
Q

Primary HIV infection

A

Acute retroviral syndrome”
Onset 2-6 weeks after exposure→ mono-like or flu-like illness→ resolves in 2 weeks
Routine HIV Ab test (-)
HIV RNA viral load measurable→ >100,000
Highly infectious→ diagnose to limit transmission to others

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9
Q

Primary HIV infection symptoms

A 
Fever
LAD
sore throat
 *rash* → upper trunk, neck, face, *mucocutaneous ulcers*
myalgia/arthralgia
HA
N/V/D
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10
Q

Primary HIV infection labs

A

Elevated transaminases
Anemia
Leukopenia
Thrombocytopenia

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11
Q

Clinical latency

A

mmune system responds→ seroconversion with 3 months
Viral load decreases to set point, slowly rises over time
HIV remains active in lymph nodes
CD4 count slowly declines
Asymptomatic, or LAD
Stage lasts ~10 years, approximately 5% a long term nonprogressors

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12
Q

Symptomatic HIV infection

A 
Immune system deteriorates
1. Lymph nodes & tissue damages
2. +/- Virus mutates→ more pathogenic
3. Body fails to keep up replacement of CD4 cells
◦ HIV RNA viral load ↑
◦ CD4 cell count ↓
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13
Q

Symptomatic HIV infection symptoms

A 
Fever, Night sweats, LAD
Fatigue/malaise, Arthralgias
Weight loss, Prolonged diarrhea
Mouth disorders
◦ Oral hairy leukoplakia* (viral - EBV)
◦ Thrush
Cervical dysplasia (HPV) 
Skin disorders
◦ Molluscum
◦ Chronic dermatophyte infection
◦ Seborrheic dermatitis
Kaposi’s sarcoma*
Recurrent HZV
Idiopathic thrombocytopenia
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14
Q

AIDS is defined as

A

CD4<200
OR
AIDS defining condition

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15
Q

Who should get screened for HIV?

A 
Everyone 13-64 years old→ voluntary opt-out testing
TB treatment initiation
Each presentation for STD
Annually→ high risk→ MSM
Pregnant women
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16
Q

Who should get diagnostic testing (not screening) for HIV?

A

Opportunistic infections, TB

Symptomatic for acute HIV (acute retroviral syndrome)

Symptomatic for established HIV: weight loss, fever, night sweats, tiredness, LAD, Diarrhea > 1 weeks, sores of mouth, anus, genitals, pneumonia, unexplained neurologic symptoms

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17
Q

HIV antibody test

A

Screening but only detect after seroconversion→ 4-12 weeks after
MISSES PRIMARY HIV INFECTION

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18
Q

Rapid HIV tests

A

Saliva or blood

(+) test requires confirmation

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19
Q

Combination HIV antibody + antigen testing

A

Tests for acute + established HIV

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20
Q

HIV RNA test

A

Tests for Acute HIV (high) + latency (lower)

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21
Q

Airborne fungus

Reactivated dormant infection

A

Pneumocystis jiroveci pneumonia (PCP)

formerly called Pneumocystis carinii

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22
Q

CMV is

A

Herpes virus

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23
Q

CMV transmission

A

Blood
Sex
Perinatal

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24
Q

Reactivated infection
Ingestion of cat feces, raw contaminated food/utensils
Immunocompetent pts don’t have symptom

A

Toxoplasmosis

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25
Q

Toxoplasma gondii is a

A

single celled parasite

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26
Q

Mycobacterium avium complex is either _____ or _______

A

Mycobacterium avium or mycobacterium intracellulare

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27
Q

Mycobacterium avium complex transmission

A

bacteria found in soil and dust is inhaled or ingested

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28
Q

Recurrent vaginal or esophageal infection

More invasive infection→ lower CD4+ count

A

Candidiasis

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29
Q

Vascular neoplasm which can occur at any CD4 T cell count

A

Kaposi’s sarcoma

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30
Q

Classic Kaposi’s sarcoma, which is not AIDS related, is seen in:

A

elderly Eastern European and Mediterranean males

31
Q

Kaposi’s sarcoma presentation

A

Multifocal and widespread lesions

LAD

32
Q

CMV retinitis presentation

A

Most common retinal infection in AIDS

Visual disturbances→ blindness (untreated)

33
Q

CMV retinitis diagnosis

A

Fundoscopic exam→ perivascular hemorrhages, white fluffy exudates (cotton wool spots)
Seropositive for CMV

34
Q

Mycobacterium avium complex presentation

A

Systemic disease→ night sweats, weight loss, abdominal pain, diarrhea, anemia

35
Q

Mycobacterium avium complex diagnosis

A

(+) Sputum acid fast bacillus
(+) sputum cultures
(+) blood cultures

36
Q

Toxoplasmosis presentation

A

Causes encephalitis
Most common intracranial lesion in HIV+
HA, focal neuro deficits, AMS
+/- Retinitis, pneumonitis

37
Q

Toxoplasmosis diagnosis

A

Brain CT or MRI→ multiple contrast enhancing lesions

Seropositive for toxoplasmosis

38
Q

Pneumocystis jiroveci pneumonia presentation

A

Fever, cough, SOB

Severe hypoxemia

39
Q

Pneumocystis jiroveci pneumonia diagnosis

A

Sputum sample
CXR→ diffuse or perihilar infiltrates
Elevated LDH

40
Q

Pneumocystis jiroveci pneumonia treatment

A

TMP-SMX (bactrim)

41
Q

HIV management

A 
Antiretroviral therapy (ART)
 *Clinical trial data suggest that individuals treated during early infection experience immunologic + virologic benefits→ refer ASAP

Genotypic drug resistance testing→ before starting regimen to guid selection of drug

Willing / able to commit to lifelong treatment with strict adherence
May postpone therapy, can be decided on case-by-case basis, but should start as soon as ready/possible

Treatment goal→ suppress plasma HIV-1 RNA levels to undetectable + prevent transmission

42
Q

Truvada

A

PrEP

43
Q

Can a primary care provider prescribe Truvada to be taken daily?

A

Yes

HIV specialists do too

44
Q

How quickly do you have to take POST-exposure prophylaxis?

A

72 hours

45
Q

Normal CD4 T cell count is

A

500-1400 cells per cubic/mm

46
Q

What could be seen at a normal CD4 T cell count?

A 
Thrush
Kaposi sarcoma (at any count)
47
Q

At what CD4 T cell count do people “do very well)

A

Greater than or equal to 350

48
Q

At what CD4 count are opportunistic infections seen?

A

CD4 < 200

Must consider prophylaxis for anyone with AIDS

49
Q

CD4 T cell < 200 prophylaxis

A

Bactrim DS→ prophylaxis for Pneumocystis jiroveci pneumonia

50
Q

CD4 T cell < 100 prophylaxis

A

Bactrim DS→ prophylaxis for Toxoplasma gondii encephalitis

51
Q

CD4 T cell < 50 prophylaxis

A

Azithromycin→ prophylaxis for disseminated Mycobacterium avium complex (MAC)

52
Q

Syphilis progression

A

Primary→ Secondary→ Latent→ Tertiary

53
Q

Primary syphilis

A

Painless chancre appears at location where syphilis entered body→ Persists for 4-6 wks, then resolves

54
Q

Secondary syphilis

A

Rash (very common)
• Non-pruritic
• Characteristically on palms & soles of feet
• Not contagious

Condyloma lata
• Moist, heaped, wart-like papules
• Intertriginous areas (most commonly gluteal folds, perineum, perianal area)
• Highly contagious

Mucous patches
• Painless flat patches involving the oral cavity, pharynx, genitals(pt may be unaware)
• Highly infectious

Systemic Symptoms→ Malaise, LAD

55
Q

Latent syphilis

A

Occurs 2-6 weeks after secondary syphilis
asymptomatic
lasts years
non contagious

56
Q

Congenital syphilis

A

Especially early syphilis

stillbirth, neonatal death, or infant

disorders such as deafness, neurologic impairment, and bone deformities

57
Q

Which 2 skin manifestations of secondary syphilis are contagious, and which one is not?

A

Contagious: condyloma lata, mucous patches

Noncontagious: rash

58
Q

Tertiary syphilis

A

Most do not develop tertiary syphilis
Appear 10-30 yrs after initial infection
Can damage heart, blood vessels, brain, nervous system

59
Q

Neurosyphilis

A

paralysis, difficulty with coordination, dementia

60
Q

Ocular syphilis

A

changes in vision, blindness

61
Q

Screen pregnant women at 1st prenatal visit

A

High risk→ screen + obtain sexual history again at 28 wks + at delivery

PCN allergic→ desensitization with oral PCN

Monitor serology closely to confirm successful treatment

62
Q

Syphilis diagnosis

A

Bacteria from chancre→ under dark field microscopy (NOT widely available)

Serology→ antibody tests
Rapid Plasma Reagin (RPR) or venereal disease research laboratory test (VDRL) test
Titer indicates disease activity
Low titer = 1:4; higher titer may be 1:128
Low titer may be a false positive
False positive can occur from: autoimmune disease, illness, possibly pregnancy

Confirm RPR with treponemal antibody test: FTA-ABS*
(Fluorescent treponemal antibody absorption)

63
Q

If neurosyphilis or ocular syphilis are suspected

A

Must do LP (lumbar puncture) and perform VDRL on spinal fluid

Refer to neurologist

64
Q

Syphilis treatment

A

Test + treat sexual partners

Benzathine pen G 2.4 mu IM x 1
→ Additional doses required if syphilis present for > 1 yr→ 3 doses at 1-week intervals

Obtain pt history + contact County Health Dept for advice
(have record if pt in system)

PCN allergic pts→ oral azithromycin or oral doxycycline

HIV or pregnant→ get PCN even if they’re allergic, must be sensitized

Check RPR titer to confirm treatment success→ 3, 6, 12, 24 months)
◦ 4 fold decrease = adequate response

65
Q

Benzathine pen G 2.4 mu IM x 1

A

syphilis treatment

66
Q

Syphilis treatment if PCN allergy

A

oral azithromycin or oral doxycycline

67
Q

Lymphogranuloma venereum

A

Serotype pf Chlamydia trachomatis

Rare in the US, more common in MSM

68
Q

Chancroid

A

Haemophilus ducreyi

Sporadic outbreaks in US

69
Q

Lymphogranuloma venereum presentation

A

Systemic infection
Unilateral inguinal bubo
Self limited ulcer/papule at site of inoculation
Anal discharge + rectal bleeding

70
Q

Lymphogranuloma venereum treatment

A

Erythromycin

Doxycycline

71
Q

Chancroid presentation

A 
Painful tender genital ulcer
Lesion produces foul smelling, contagious discharge
Inguinal adenitis (buboes)
72
Q

Chancroid treatment

A

Azithromycin
Ceftriaxone
Ciprofloxacin

73
Q

Chancroid diagnosis

A

Rule out syphilis + HSV

Contact County Health Department→ requires special culture, may treat presumptively

74
Q

Lymphogranuloma venereum diagnosis

A

Rule out syphilis
Contact Country Health Department
+/- genital, rectal or lymph node specimen swab

Unit 2 Clin Med III (9 decks)

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