Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SMP - SDR > Lectures 16 & 17 - Sexually Transmitted Diseases I & II > Flashcards

Lectures 16 & 17 - Sexually Transmitted Diseases I & II Flashcards

1
Q

What are the 4 modes of transmission of STDs?

A
  1. Sexual intercourse
  2. Oral-genital
  3. Anal-genital
  4. Hand-genital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Are there always signs and symptoms of STDs?

A

NOPE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is trichomoniasis caused by?

A

The protozoan trichomonas vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of trichomoniasis?

A
  1. Foamy, yellowish, unpleasant-smelling discharge
  2. Burning sensation
  3. Itching
  4. Painful urination
  5. Painful intercourse

Note: most carriers (70%) experience no symptoms, females more likely to have vaginitis, males have urethritis less often

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is trichomoniasis transmitted?

A
  1. Sexual contact

2. Items with discharged fluids on them: toilet seats, wet towels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does trichomoniasis increase the risk of?

A
  1. Increases the risk of other STIs
  2. Premature deliveries
  3. Low birth weights
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is trichomoniasis diagnosed?

A

Swab and wet mount slide or PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is trichomoniasis treated?

A

Oral metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is chlamydia caused by?

A

Chlamydia trachomatis bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Symptoms of chlamydia?

A

Often none but can induct significant inflammatory exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Does chlamydia affect more men or women?

A

Women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Consequences of untreated chlamydia?

A
  1. Affected cervix or fallopian tubes (pelvic inflammatory disease = PID)
  2. Scarring
  3. Infertility
  4. Affected prostate gland, seminal vesicles, epididymis
  5. Arthritis
  6. Conjunctivitis
  7. Urethritis
  8. Can infect newborns leading to blindness (trachoma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who should be screened for chlamydia?

A
  1. All sexually active women <25 yo

2. Women will new/multiple sex partners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How to test for chlamydia?

A

Culture or PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is chlamydia treated?

A
  1. Azithromycin: 1 dose
  2. Doxycycline: 1 week
  3. Tetracycline
  4. Erythromycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is gonorrhea caused by?

A

Neisseria gonorrhoeae bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does gonorrhea cause?

A

Infection of the linings of the urethra, genital tract, pharynx, and rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Patients at risk for gonorrhea?

A

Males 20-24 and females 15-19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is gonorrhea treated? What to note?

A

Antibiotics:

  1. Cephalosporins
  2. Injectable ceftriaxone + oral azithromycin (same drug as for chlamydia)

Note: high resistance rate because can incorporate cellular DNA = transformable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can untreated gonorrhea cause?

A

Infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How many types of herpes viruses are there?

A

8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 2 types of herpes simplex?

A
  1. Type 1: oral lesions

2. Type 2: genital lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Is there a cure for herpes? What to note?

A

NOPE, but some drugs greatly reduce lesions by interfering with viral DNA replication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Is there a vaccine for herpes?

A

NOPE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is herpes treated?

A
  1. Acyclovir
  2. Valacyclovir
  3. Famciclovir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Do the herpes virus affect fertility?

A

NOPE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is HIV?

A

Human immunodeficiency virus, a lentivirus, that causes acquired immune deficiency syndrome (AIDS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How is HIV transmitted? Describe the transmission.

A

HIV enters most efficiently via mucous membranes of the genitals and anus => once passing the mucus membrane, the virus binds and infects CD4 T helper cells, macrophages or dendritic cells => virus replication begins to destroy helper T-lymphocytes => cellular immune responses become compromised at late times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are high risk behaviors for HIV transmission?

A
  1. Exchange of body fluids
  2. Injecting drugs
  3. Receiving a blood transfusion prior to 1985
  4. Mother-to-infant transmission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Symptoms of acute HIV infection?

A
  1. Fever
  2. Weight loss
  3. Pharyngitis
  4. Malaise
  5. Headache
  6. Neuropathy
  7. Lymphadenopathy
  8. Skin rash
  9. Nausea
  10. Vomiting
  11. Enlargement of liver and spleen
  12. Myalgia
  13. Esophageal sores
  14. Mouth sores and thrush
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Symptoms of chronic HIV infection?

A

May experience a number of opportunistic infections with colds, sore throats, fever, tiredness, nausea, night sweats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

HIV test?

A
  1. ELISA detects antibodies

2. Western blot is a more expensive confirmatory test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How is HIV treatment?

A

Potent new drugs have slowed or blocked the progression from HIV infection to AIDS:

  1. Protease inhibitors block the HIV protease enzyme from cleaving precursor proteins to form mature virus proteins
  2. Other antivirals inhibit the HIV reverse transcriptase

=> Therapy currently consists of a cocktail of antiviral compounds (usually 3-4 drugs that inhibit viral reverse transcriptase and viral protease or Stribild (quad)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Has HIV ever been cured?

A

Once in an infant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Describe hepatitis B infections.

A

Acute and self-limited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Symptoms of hep B infection?

A
  1. Nausea
  2. Vomiting
  3. Aches
  4. Pains
  5. Decreased appetite
  6. Eventual jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Diagnosis of hep B infection?

A
  1. Acute infection is determined by detection of antibodies against HBsAG => sero-conversion
  2. Chronic infection is determined by ELISA against surface antigen and inability to clear it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Describe the progression of hep B infection. What to note?

A

Acute infection => chronic infection => fatty liver => liver fibrosis => cirrhosis => primary hepatocellular carcinoma (HCC) after decades

Note: progression from acute to chronic is rare but 15-25% with long term chronic infection develop cirrhosis and cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is special about the hep B virus?

A

BIG genome: 3.3 kB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How does hepatocellular carcinoma develop from chronic hep B infection?

A

Mechanism of tumor induction is not well understood, but may involve the HBV X protein and could be due to the constant inflammatory insult and induced cell regeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Treatment for chronic hep B? What to note?

A

There are interferon and antiviral treatments available for chronic disease, not curative

42
Q

Vaccine for hep B? Describe it.

A

Hepatitis B surface antigen, HBsAg: recombinant, non-infectious and 90% effective.

43
Q

What is syphilis caused by?

A

Trepona pallidum bacterial infection

44
Q

Stages of syphilis? Describe each.

A
  1. Primary: development of a chancre that disappears in three to six weeks
  2. Secondary: 1 to 12 months after chancre disappears, a rash or white patches on the skin appear which last a few weeks or months
  3. Latent: infectious lesions, infection can be passed on to fetus (congenital syphilis)
  4. Late: heart damage, CNS damage, blindness, paralysis, dementia
45
Q

How is syphilis treated?

A

Antibiotics: single intermuscular penicillin injection

46
Q

Can the treponema bacterium become resistant to penicillin?

A

NOPE

47
Q

What is a chancroid? Symptoms?

A

Bacterial infection with hemophilus ducreyi, a gram negative rod that induces well defined ulceration with undermined borders + tender lymph nodes

48
Q

In what populations are chancroids found?

A

Developing countries and prostitutes

49
Q

How are chancroids treated?

A

Antibiotics:

  1. Azithromycin
  2. Erythromycin
50
Q

What are chancroids often confused with? How to tell the difference?

A

Syphilis chancres

Need for biopsy/smear

51
Q

What is the most common STI?

A

HPV

52
Q

What is the shell of each HPV particle made of?

A

95% L1 capsid protein

5% L2 capsid protein

53
Q

What is the genetic information of HPV?

A

8 kb circular DNA in each HPV particle

54
Q

Which has a more complicated genome: HPV or herpes?

A

Herpes

55
Q

What are the early genes of the HPV virus involved in?

A

Regulating the replication of the virus

56
Q

What are the 2 oncogenes of the HPV virus? Describe their functions. What to note?

A

E6: p53 degradation (tumor-suppressor gene) and telomerase induction

E7: pRb degradation (tumor-suppressor gene) and transactivation of c-jun

Always present in human cancers

57
Q

How many types of HPV viruses? Which ones do I need to know?

A

More than 150

SKIN: never cause malignant tumors, only benign

  • HPV-1: feet
  • HPV-2: hands
  • HPV-4
  • HPV-5,7,8: rare clinical cases of epidermodysplasia

GENITAL, ANAL, and ORAL MUCOSA: can cause malignant tumors

  • Low risk: HPV-6, 11, 42, 43, 44
  • High risk: HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68
58
Q

How can some HPV viruses cause malignant tumors?

A

They have functioning E6 an E7 genes that allow them to live forever and keep replicating

59
Q

What are the 2 phases of the papillomavirus life cycle? Do both low and risk risk HPV viruses have these?

A

PHASE 1: PRODUCTIVE INFECTION, both low and high risk viruses
1. Affect basal epithelial cells so there has to have been abrasion or irritation (sexual intercourse) for the virus to access them

  1. The viral DNA then remains into the basal cells and replicates as episome until it starts to make capsid proteins and expresses early and late genes to assemble as virus particles in upper cells of the epithelium => pathognomic koilocytosis on PAP smear
  2. Virus infected cells desquamate from the epithelium and infect normal epithelial cells

PHASE 2: MALIGNANT PROGRESSION, only high risk viruses
Viral genome integrates into the genome due to E2 gene being knocked out, causing E6/E7 increased expression => eventual cancer phenotype to form well-differentiated tumors => dysplastic cervical lesions

60
Q

Does the HIV have a membrane envelop? What does this mean?

A

YUP - sensitive to detergents

61
Q

Does the HPV have a membrane envelop? What does this mean?

A

NOPE - insensitive to detergents

62
Q

Why are some HPV viruses only found in certain locations?

A

Replication requirements only found in certain locations

63
Q

What are 3 benign mucosal tumors caused by HPV? What are they caused by?

A
  1. Condyloma accuminata
  2. Flat genital warts
  3. Laryngeal papillomas

Caused by low risk HPVs: 6 and 11 mainly

64
Q

In which patients do laryngeal papillomas occur? Treatment? Complication?

A

Occur in newborns that aspirate fluid during birth

Treatment: surgical excision

If not treated can cause asphyxiation

65
Q

Does koilocytosis on a PAP smear indicate either a low or high risk HPV virus?

A

NOPE

66
Q

What do koilocytes represent on a PAP smear?

A

Acutely infected upper epithelial cells and capsid protein synthesis by the HPV virus

67
Q

What cancers are caused by HPV?

A
  1. Cervical
  2. Vaginal
  3. Penile
  4. Oral
  5. Tongue
  6. Throat
  7. Anal
  8. Skin (?)
  9. Vulval
  10. Oropharyngeal (mainly in males)
68
Q

What is important to note about the phase 2, malignant progression, of the HPV virus?

A
  1. No episomal viral DNA replication
  2. No late gene expressed: no longer infectious so no longer transmittable
  3. No capsid proteins synthesized
  4. No viral assembly
69
Q

How does a malignant HPV virus appear on a PAP smear?

A

Very large nuclear:cytoplasm ratio

70
Q

How do we grade the severity of a cervical cancer? What do we call these?

A

Cervical intraepithelial neoplasia

Based on how much of the epithelium is dysplastic: mild (CNI), moderate (CNII), or severe dysplasia (CNIII)

71
Q

Why do cervical cancers arise at the region of transition from the endocervical canal lined by simple columnar epithelium to the stratified squamous non-keratinized epithelium?

A

Because the non-keratinized stratified squamous epithelium is only one cell thick there and because they have the right sensitivity to be transformed (express different types of genes) => same proteins expressed in cervical cancer and junctional zone cells

72
Q

Why do HPV caused cancers arise at the anal/rectal junction and oralpharynx?

A

Transition from stratified squamous epithelium that decreases to a single cell layer to become

73
Q

How are head and neck cancers related to the HPV virus?

A

Associated traditionally with tobacco and alcohol consumption and exposure to chemicals in the workplace, but now recognized that about 60-80% are associated with HPV infection

74
Q

Are head and neck cancers more common in males or females? Any races? What to note?

A

More than twice as more common in males + males more than twice as likely to die

Disproportionately affects Blacks with younger age of incidence, increased mortality and more advanced disease at presentation

Increasing incidence of H&N cancers in younger age cohort of non-smoker, non-drinkers + several studies indicate that oral HPV is sexually acquired

75
Q

Where do most head and neck HPV cancers occur?

A
  1. Tonsils
  2. Hypopharynx
  3. Oral cavity
  4. Larynx
76
Q

Do HPV + patients with head and neck cancers respond better to chemotherapy/radiation than HPV- patients? Explain.

A

YUP

HPV cells make neoantigens , which are released during treatment so the cells have no immune response

77
Q

Are HPV + tumors a completely distinct epidemiological, biological and clinical subset of tumors? Implications?

A

Maybe

Implications for treatment (may be more amenable to anti-EGFR therapies) and prevention with HPV vaccination

Further positive implication for adding vaccination of boys to that of girls

78
Q

The incidence of which HPV tumor is increasing?

A

Oralpharynx cancers in men

79
Q

What are the 2 main types of cervical cancer HPV viruses? What to note?

A

16 (65%) and 18 (15%)

16 accounts for >90% of head and neck tumors

80
Q

Describe the timeline of the progression of cervical cancer.

A
  1. HPV infection
  2. Viral persistance and progression from 5 to 10 years
  3. Precancerous lesions after 10 years
  4. Cancer after about 20 years
81
Q

What are the different stages of cervical cancer? Which stages can be cured?

A
  • Stage 0: Carcinoma in situ, cervical intraepithelial neoplasia Grade III, but no invasion of basement membrane
  • Stage I: The carcinoma is strictly confined to the cervix (extension to the corpus would be disregarded)
  • Stage II: Cervical carcinoma invades beyond the uterus, but not to the pelvic wall or lower third of the vagina
  • Stage III: The carcinoma has extended to the pelvic wall. On rectal examination, there is no cancer-free space between the tumor and the pelvic wall. The tumor involves the lower third of the vagina. All cases with hydronephrosis or non-functioning kidney are included, unless they are known to be due to other causes
  • Stage IV: The carcinoma has extended beyond the true pelvis, or has involved (biopsy-proven) the mucosa of the bladder or rectum

All of them can be cured, but the earlier the better outcomes

82
Q

How to diagnose cervical cancer? 3 ways

A
  1. Pap smear and biopsy: koilocytosis and cell morphology, L1 expression by IHC, using antibodies which are not type-specific
  2. Colposcopy: gross appearance of papillomas, with or without acetic acid visualization, lesions, high neovascularization
  3. HPV diagnostic tests: Hybrid Capture II assay based on DNA:RNA hybridization - detects multiple types of HPVs + PCR test
83
Q

Usefulness of pap smears in diagnosing cervical cancers?

A

Once a year will insure you are safe, BUT if you have cancer only 50-80% chance it will be detected on pap smear

84
Q

2 types of pap screening? Which is better?

A
  1. Conventional Pap Smear: cervical cell sample manually “smeared” onto slide for screening
  2. Liquid-Based: cervical cell sample put into liquid medium for suspension before automated thin layer/monolayer slide preparation => much better, 80% sensitivity
85
Q

Limitations of the conventional pap smear?

A
  1. Majority of cells not captured
  2. Non-representative transfer
    of cells
  3. Clumping and overlapping of cells
  4. Obscuring material

=> high rate of false-negative results due to sampling and preparation errors

86
Q

Describe the quality of Hybrid Capture II assay to diagnosis cervical cancer and HPV.

A

Clinical sensitivity of 95-100% for CIN 2/3 and cancer

87
Q

Results of Hybrid Capture II assay and new PCR test to diagnosis cervical cancer and HPV?

A

High risk or low risk HPV viruses

88
Q

How can external genital HPV lesions be treated?

A
  1. Acids (salicylic or trichloroacetic, the latter as a 90% solution)
  2. Mitotic inhibitors (podophyllotoxin, available commercially as Condylox or Podofilox, 0.5% cream)
  3. 5-fluorouracil (5-FU, 5% cream, off-label use)
  4. Cryotherapy (liquid nitrogen)
  5. Excision
89
Q

How can internal genital HPV lesions (cervical, vaginal) be treated?

A
  1. Ablative
  2. Excisional
  3. Pharmaceutical
90
Q

What are the 2 ablative therapies to treat internal genital HPV lesions (cervical, vaginal)? Describe each. Limitations?

A
  1. Cryotherapy: use of a probe containing carbon dioxide or nitrous oxide to freeze the entire transformation zone and area of the lesion
  2. Laser Vaporization Therapy: use of a laser to vaporize the transformation zone containing the lesion and requires suction to remove smoke

For both: cannot tell whether or not all of it has been ablated

91
Q

What is the excisional technique to treat internal genital HPV lesions (cervical, vaginal)? How to do it best? What to note?

A

A cone of tissue is excised for further examination and/or to remove a lesion - tissue is usually stained with iodine (Lugol’s or Schiller’s solution) to demarcate the area of resection

Done with:

  1. Cold Knife
  2. Laser conization
  3. *LEEP (Loop Electrosurgical Excision Procedure): thin electric wire loop, which may have cutting and cautery currents

Note: 2 and 3 may be complicated by burn artifacts, and 3 can interfere with fertility and cause preterm births

92
Q

3 ways to prevent cervical HPV infection?

A
  1. Abstinence
  2. Condoms: incomplete protection because some of the virus is in the hair follicles
  3. HPV vaccine: immunogen is the L1 capsid protein with 3 injections to cause IgG response so that irritation/abrasion and vaginal secretions and saliva will release IgGs to protect against virus => cannot get infection of the basal cells
93
Q

How was the HPV vaccine created?

A
  1. Clone L1 gene into yeast or baculovirus
  2. Express and purify L1
  3. L1 protein self-assembles into a virus-like particle without any DNA
94
Q

What 2 HPV viruses by Gardasil first generation? What about Gardasil 9?

A
  • 16 and 18
  • most common first 7 types of high risks viruses: 16, 18, 45, 31, 33, 52, 58, 35 => protect against 90-95% of all cervical cancers + 6/11 benign types important for laryngeal papillomas
95
Q

Are vaccines against cervical infections also effective on oral infections?

A

YUP

96
Q

What are the acute effects of the HPV vaccine?

A
  1. Pain
  2. Swelling
  3. Erythema
  4. Pruritus
  5. Fever
97
Q

How many doses of the HPV vaccine are needed?

A

3 are given, but only 2 are needed before age 15, and new data even says maybe 1!

98
Q

Can HPV vaccination be used to treat HPV infection?

A

Maybe if the infection is producing L1

99
Q

How else can cervical neoplasia be treated (in progress)?

A

Artemisinin (active principle of the Chinese herb Artemisia annua) currently used clinically for treating drug-resistant malaria

100
Q

List all STDs covered in order of prevalence.

A
  1. Human Papillomavirus
  2. Trichomoniasis
  3. Chlamydia
  4. Gonorrhea
  5. Herpes simple virus-2
  6. HIV and AIDS
  7. Hepatitis B
  8. Syphilis

SMP - SDR (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions