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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
Toxoplasma gondii is a
single celled parasite
26
Mycobacterium avium complex is either _____ or _______
Mycobacterium avium or mycobacterium intracellulare
27
Mycobacterium avium complex transmission
bacteria found in soil and dust is inhaled or ingested
28
Recurrent vaginal or esophageal infection | More invasive infection→ lower CD4+ count
Candidiasis
29
Vascular neoplasm which can occur at any CD4 T cell count
Kaposi's sarcoma
30
Classic Kaposi's sarcoma, which is not AIDS related, is seen in:
elderly Eastern European and Mediterranean males
31
Kaposi's sarcoma presentation
Multifocal and widespread lesions | LAD
32
CMV retinitis presentation
Most common retinal infection in AIDS | Visual disturbances→ blindness (untreated)
33
CMV retinitis diagnosis
Fundoscopic exam→ perivascular hemorrhages, white fluffy exudates (cotton wool spots) Seropositive for CMV
34
Mycobacterium avium complex presentation
Systemic disease→ night sweats, weight loss, abdominal pain, diarrhea, anemia
35
Mycobacterium avium complex diagnosis
(+) Sputum acid fast bacillus (+) sputum cultures (+) blood cultures
36
Toxoplasmosis presentation
Causes encephalitis Most common intracranial lesion in HIV+ HA, focal neuro deficits, AMS +/- Retinitis, pneumonitis
37
Toxoplasmosis diagnosis
Brain CT or MRI→ multiple contrast enhancing lesions Seropositive for toxoplasmosis
38
Pneumocystis jiroveci pneumonia presentation
Fever, cough, SOB | Severe hypoxemia
39
Pneumocystis jiroveci pneumonia diagnosis
Sputum sample CXR→ diffuse or perihilar infiltrates Elevated LDH
40
Pneumocystis jiroveci pneumonia treatment
TMP-SMX (bactrim)
41
HIV management
``` 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
Truvada
PrEP
43
Can a primary care provider prescribe Truvada to be taken daily?
Yes | HIV specialists do too
44
How quickly do you have to take POST-exposure prophylaxis?
72 hours
45
Normal CD4 T cell count is
500-1400 cells per cubic/mm
46
What could be seen at a normal CD4 T cell count?
``` Thrush Kaposi sarcoma (at any count) ```
47
At what CD4 T cell count do people "do very well)
Greater than or equal to 350
48
At what CD4 count are opportunistic infections seen?
CD4 < 200 | Must consider prophylaxis for anyone with AIDS
49
CD4 T cell < 200 prophylaxis
Bactrim DS→ prophylaxis for Pneumocystis jiroveci pneumonia
50
CD4 T cell < 100 prophylaxis
Bactrim DS→ prophylaxis for Toxoplasma gondii encephalitis
51
CD4 T cell < 50 prophylaxis
Azithromycin→ prophylaxis for disseminated Mycobacterium avium complex (MAC)
52
Syphilis progression
Primary→ Secondary→ Latent→ Tertiary
53
Primary syphilis
Painless chancre appears at location where syphilis entered body→ Persists for 4-6 wks, then resolves
54
Secondary syphilis
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
Latent syphilis
Occurs 2-6 weeks after secondary syphilis asymptomatic lasts years non contagious
56
Congenital syphilis
Especially early syphilis stillbirth, neonatal death, or infant disorders such as deafness, neurologic impairment, and bone deformities
57
Which 2 skin manifestations of secondary syphilis are contagious, and which one is not?
Contagious: condyloma lata, mucous patches Noncontagious: rash
58
Tertiary syphilis
Most do not develop tertiary syphilis Appear 10-30 yrs after initial infection Can damage heart, blood vessels, brain, nervous system
59
Neurosyphilis
paralysis, difficulty with coordination, dementia
60
Ocular syphilis
changes in vision, blindness
61
Screen pregnant women at 1st prenatal visit
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
Syphilis diagnosis
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
If neurosyphilis or ocular syphilis are suspected
Must do LP (lumbar puncture) and perform VDRL on spinal fluid Refer to neurologist
64
Syphilis treatment
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
Benzathine pen G 2.4 mu IM x 1
syphilis treatment
66
Syphilis treatment if PCN allergy
oral azithromycin or oral doxycycline
67
Lymphogranuloma venereum
Serotype pf Chlamydia trachomatis | Rare in the US, more common in MSM
68
Chancroid
Haemophilus ducreyi | Sporadic outbreaks in US
69
Lymphogranuloma venereum presentation
Systemic infection Unilateral inguinal bubo Self limited ulcer/papule at site of inoculation Anal discharge + rectal bleeding
70
Lymphogranuloma venereum treatment
Erythromycin | Doxycycline
71
Chancroid presentation
``` Painful tender genital ulcer Lesion produces foul smelling, contagious discharge Inguinal adenitis (buboes) ```
72
Chancroid treatment
Azithromycin Ceftriaxone Ciprofloxacin
73
Chancroid diagnosis
Rule out syphilis + HSV | Contact County Health Department→ requires special culture, may treat presumptively
74
Lymphogranuloma venereum diagnosis
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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