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Bloc G - Infection > May10 M1-Sexually Transmitted Infections > Flashcards

May10 M1-Sexually Transmitted Infections Flashcards

1
Q

(important) how to differentiate if an ulcer on genitalia is caused by primary syphilis or HSV (herpes) (chancre)

A
  • painful chancre = HSV

- not painful chancre = syphilis

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2
Q

(important) rashes on soles and palms of your feet: think of what STI

A

secondary syphilis (not many STIs cause that so likely is secondary syphilis)

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3
Q

mechanisms STIs use to cause infection

A
  • pilli (long fibrous structures) that can elongate and retract to attach to mucosal surface (gonorrhea)
  • hide and replicate IC in epithelial cells and neutrophils, to evade immune system (gonorrhea)
  • disseminate systemically (gonorrhea)
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4
Q

Neisseria gonorrhea description

A

-gram- diplococci

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5
Q

Chlamydia trachomatis description

A

-IC, lack of normal cell wall (atypical organism). doesn’t have peptidoglycan wall. unusual cell cycle

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6
Q

treponema pallidum description

A
  • causes syphilis

- spirochette (spiral shaped, like borrelia, etc.) and small

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7
Q

HSV1 and 2 description

A
  • DNA virus of herpesviridae family (which includes HHVs, CMV, EBV, VZV, etc.)
  • infects for life
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8
Q

human papilloma virus (HPV) description and disease name

A
  • DNA virus

- disease name = genital warts

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9
Q

protozoa,parasites of STIs and description + disease name

A

trichomonas vaginalis

  • flagellated, motile eukaryote
  • disease name = trichomonas, or trich
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10
Q

3 clinical syndromes in STIs

A
  • urethritis/cervicitis (discharge, dripping)
  • genital ulcer disease
  • genital warts
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11
Q

(IMPORTANT) causative organisms for urethritis/cervicitis

A
  1. Neisseria gonorrhea
  2. Chlamydia trachomatis
  3. Trichomonas vaginalis (protozoa)
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12
Q

(IMPORTANT) causative organisms for genital ulcer disease

A
  1. HSV
  2. treponema pallidum
  3. (certain serovars of chlamydia trachomatis, causing LGV: lymphogranuloma venereum
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13
Q

(IMPORTANT) symptoms of urethritis/cervicitis

A
  • dysuria (urethritis)

- mucopurulent discharge (cervicitis)

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14
Q

(IMPORTANT) gonorrhea other things it causes than urethritis/cervicitis and include the 2 complications

A
  1. proctitis (inflammation of anus and rectum)
  2. pharyngitis (if oral sex)
  3. epididymitis (painful)
  4. pelvic inflammatory disease (PID) in females
  5. other less common things (systemic)
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15
Q

main reason to treat gonorrhea, which is easily treated, and description

A

pelvic inflammatory disease

  • pelvis = chronic inflammation, adhesions in genital tract and ultimately, infertility)
  • liver = perihepatitis and Fitz-Hugh Curtis Syndrome: hepatitis + chronic inflam and adhesions on liver capsule
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16
Q

2 most common causes of PID

A
  • Neisseria gonorrhea

- Chlamydia trachomatis

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17
Q

(IMPORTANT) other things that N. gonorrhea can cause and most common one

A
  1. by local extension: perihepatitis, peritonitis, proctitis, endometritis, vulvovaginitis
  2. by systemic spread (blood): ARTHRITIS**, IE, meningitis, dermatitis
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18
Q

classic triad of disseminated gonococcoal infection

A
  1. polyarthralgia/arthritis
  2. dermatitis (pustular lesions)
  3. tenosynovitis (inflammation of tendon sheath in hands or feet, making fingers hard to extend)
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19
Q

3 ways to dx gonorrhea

A
  1. culture + special media (Martin agar) to grow this only (2 days)
  2. gram stain (5 min)
  3. PCR (NAAT: nucleic acid amplif test) works on any kind of specimen
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20
Q

(IMPORTANT) treatment of gonorrhea (in acute urethritis) nowadays

A

combination of:

  1. ceftriaxone (1x IM) or cefixime (1x po)
  2. azithromycin 1x
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21
Q

bad complication of chlamydia trachomatis infection

A

PID

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22
Q

(important) symptoms of chlamydia

A
  • often asymptomatic
  • dysuria
  • discharge
  • cervicitis
  • dyspareunia
  • proctitis
  • lower abd pain
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23
Q

chlamydia diagnosis

A

one way: NAAT (PCR)

24
Q

treatment of chlamydia

A

AZYTHROMYCIN 1 dose po OR doxycycline 7 po 7 days

25
Q

(important) symptoms of trichomonas vaginalis (infection of men and women), protozoa. 3rd organism of urethritis/cervicitis (discharge)

A
  • asymptomatic (often men are asymptomatic)
  • vaginal discharge
  • erythema of uvula and cervix (strawberry appearance of cervix)
  • itch
  • dysuria
26
Q

how to diagnose trichomonas infection

A

microscopy of vaginal/urethral discharge

Ag test kit and NAAT also possible

27
Q

treatment of trichomonas vaginalis (trich, trichomonas)

A

metronidazole

28
Q

(IMPORTANT) symptoms of genital ulcer disease

A
  • rash
  • ulcer
  • craters and vesicles with erythematous
  • lesions anywhere in boxer short area
  • systemic symptoms (fever, muscle aches)
  • tender lymphadenopathy
29
Q

which of HSV1 and HSV2 causes orolabial disease (feux sauvages, cold sores) and which causes genital disease

A

both can cause orolabial and genital

30
Q

what is secondary herpes

A

periodic reactivation of the latent herpes infection that established in sacral sensory ganglia

31
Q

good test for HSV diagnosis and one that is less good

A
  • good: fluorescent MICROSCOPY or PCR or culture
  • bad: Ag staining (take SERUM ANTIBODIES). bc won’t know if HSV-1 or HSV-2 Ab in the blood are what’s causing current genital symptoms or if are just from old orolabial herpes
32
Q

how to treat HSV

A
  • not curable

- for first and recurrent episodes: acyclovir and vir drugs

33
Q

least common STI bacteria

A

syphilis (treponema pallidum)

34
Q

how syphilis is transmitted

A

vaginal, anal, oral OR ALSO vertically (congenital syphilis)

35
Q

why syphilis is hard to dx

A
  1. many stages of disease + can be present for decades + diff symptoms for diff stages
  2. can’t culture spirochetes. no PCR. Ab testing is bad
36
Q

(IMPORTANT) stages of syphilis

A
  1. primary syphilis 3 weeks after infection (chancre)
  2. secondary syphilis 2-12 weeks after primary (skin including palms and soles and lymph nodes
  3. up to 1 year after infection = early latent syphilis: lot of organism + very transmissible
  4. after 1 year after infection = late latent: low transmissibility
    (note: labelled latent of unknown duration if don’t know time of infection)
  5. tertiary syphilis years after infection (ascending aorta aneurysm)
37
Q

(important) how to differentiate if an ulcer on genitalia is caused by primary syphilis or HSV (herpes) (chancre)

A
  • painful chancre = HSV

- not painful chancre = syphilis

38
Q

(important) rashes on soles and palms of your feet: think of what STI

A

secondary syphilis (not many STIs cause that so likely is secondary syphilis)

39
Q

name of secondary syphilis lesions on genitalia (not the palms and soles lesions on skin)

A

condylomata lata (HPV is condyloma accuminata)

40
Q

what’s tertiary syphilis (what do you see)

A
  • aortitis, ascending aorta aneurysm

- gumma, serpiginous gummata = granulomatous lesions on the skin

41
Q

how to dx syphilis

A

serology (Ab testing): 2 algorithms

  1. screen with non treponemal test (VDRL, RPR) + confirm with treponemal test
  2. screen with treponemal test (EIA) + perform non-treponemal test + confirm with another treponemal test
42
Q

(IMPORTANT) what’s a non-treponemal test

A
  • screening test for syphilis (VDRL and RPR)
  • check if patient serum agglutinates with cardiolipin antigen of mushed cow heart
  • bad sensitivity and specificity
43
Q

(IMPORTANT) what’s a treponemal test

A

test for syphilis that measures patient Abs to specific T pallidum Ags (EIA, TPPA, LIA)

44
Q

(IMPORTANT) meaning of positive PRP or VDRL + positive TPPA

A
  • syphilis (at any stage)

- treated for syphilis in up to a year (SOON aftet tx)

45
Q

(IMPORTANT) meaning of positive VDRL or RPR and negative TPPA

A

false positive. patient is pregnant or autoimmune condition or something else

46
Q

(IMPORTANT) meaning of negative VDRL or RPR and negative TPPA

A

either:

  • no syphilis
  • window period in early period (few weeks after infection) where infected but tests still negative
47
Q

(IMPORTANT) meaning of negative VDRL or RPR and positive TPPA

A
  • old patient with syphillis (Abs to cardiolipin wane with time but Abs to T. pall. stay for life)
  • Argyll Robertson pupill
  • previously treated disease, LATE after treatment
  • some cases of late stage disease
48
Q

(IMPORTANT) how to treat primary, secondary or early latent (<1 year) syphilis

A

penicillin IM x 1

49
Q

(IMPORTANT) how to treat late latent (>1 year), latent of unknown duration or tertiary syphilis

A

penicillin IM weekly x 3 doses

50
Q

(IMPORTANT) how to treat neurosyphilis (Argyll Robertson Pupil, eye symptoms big pupil but eye can still accomodate, spinal cord problems, ataxia and gait problems)

A

penicillin IV for 10-14 days

51
Q

cause of LGV (lymphogranuloma venereum) and what this disease causes

A
  • Chlamydia trachomatis servoras L1, L2, L3

- genital ulcer disease

52
Q

symptoms of LGV

A
  • genital ulcers (PAINLESS papules)

- tender inguinal lymphadenopathy

53
Q

what causes genital warts (papular anal and genital lesions)

A

HPV

54
Q

name of the lesions in HPV

A

condylomata accuminata (clusters of warty lesions)

55
Q

treatment of HPV warts

A
  • cryotherapy
  • topical immunomodulatory agents
  • in cervix, remove if malignant

Bloc G - Infection (39 decks)

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