Micro: STD Overview Flashcards
1
Q
What is most common STD?
A
Chlamydia
2
Q
What is HPV incidence common to?
A
Chlamydia… super prevalent
3
Q
What % of people in 10-25 age group have HSV?
A
10-15%
4
Q
What are 4 causes of genital ulcers?
A
HSV 1 and 2
Primary syphilis
chlamydia trachomatas L1-L3 (LGV)
Haemophilis ducreyi: chancroid
5
Q
What are 3 causes of drips?
A
chlamydia trachomatas D-K Neisseria ghonorhea Ureaplasma urelyticum Trichomonas Candidiasis: drug induced BV: gardnerella vaginalis and other anaerobes
6
Q
What are 3 causes of warts?
A
HPV
Secondary syphilis
Molluscum contagiousum (Pox virus)
7
Q
HSV 1 typically located? 2 located?
A
1: above belt
2: below belt
8
Q
HSV diagnosis?
A
blood PCR is #1
Fab assay
Tzanck smear
9
Q
HSV tx?
A
Acyclovir
10
Q
Multinucleated giant cells seen in?
A
Tzanck smear:
HSV
CMV
RSV
11
Q
*S: WHY DOESNT ACYCLOVIR WORK ON HUMAN DNA POLYMERASE?
A
Needs viral thymidine kinase
12
Q
*S: WHAT IS UNIQUE ABOUT ACYCLOVIR BIOAVAILABILITY?
A
Acy. bioavailability goes down with HIGHER doses
13
Q
*S: What are the AEs of acyclovir?
A
- Crystaline nephrophathy (HYDRATE!)
2. CNS toxicity
14
Q
What do you take for ACV resistant strains? (HIV pts.)
A
Foscarnet: does not need thymidine kinase
pyrophosphate analog, jams up without using thymidine kinase
15
Q
Can you tell the difference between primary and secondary herpes?
A
No… lesions look the same
16
Q
What are the hallmarks of primary, secondary, and tertiary syphilis?
A
1: painless Chancre
2 maculopapular rash
3: granulomas (gummas), demensia, aortic aneurism (tree bark)
17
Q
What are the diagnostic tests for syphilis?
A
Non-treponemal:
RPR
VDRL
Treponema:
FTA-ABS
Dark field microscopy
18
Q
What is the drug for syphilis?
A
Penicillin
19
Q
*S: What is the difference between the benzadine preparation of penicillin and others?
A
Slower release from a intramuscular injection
20
Q
What is important difference between syphilis and herpes lesions?
A
Herpes=Hurts
Syphilis=no pain
21
Q
What is interesting about syphilis secondary rash?
A
HANDS AND FEET!
Tracts in
22
Q
What is LGV?
A
Lymphogenital venarium:
23
Q
What if a chancre is painful?
A
Haemophilis ducryum…?
24
Q
How many chancres present with primary syphilis?
A
One chancre! If multiple, and painful, think herpes
25
If you have a primary infection, what is the likely history?
Flu-like symptoms?
26
What is a feared complication of HSV 1 and 2?
Meningitis
27
What is the hallmark of meningitis?
Neck soreness
28
How do you diagnose meningitis?
CSF:
viral: aseptic->HSV=Acyclovir/no tx… it will go away
bacterial: terrible!
29
What is the risk for fetus in primary HSV vs. secondary HSV?
Primary: less antibody protection, fetus is more likely to get HSV
Secondary: more antibody protection
30
What type of response do you need to HSV?
Cellular, then humoral (antibodies) if it gets out of hand
31
Is acyclovir efficacious at clearing HSV?
No, since herpes is latent in neurons
32
What is the last place for a secondary syphilis rash to show up?
Palms and soles -- could present like something else!
33
What rash has a similar appearance to secondary syphilis, but no palms and soles?
Neisseria meningitidis
34
TEST: RYAN: How do you visualize spirochetes without using antibodies?
DARK FIELD MICROSCOPY
| Too thin to gram stain
35
Can you culture syphilis?
No, extremely hard to culture.
| Run RPR/VRPL non treponemal test
36
Would syphilis symptoms go away?
Yes, then return and be secondary or tertiary
37
TEST: RYAN: Oxidase + gram negative diplococcus (kissing kidney beans) ([ut hydrogen peroxide and it makes bubbles)
Neisseria gonorrhoeae
38
Can humans have permanent immunity to nneisseria gonorheoae?
No, antigenic variation of pillis (attachment structure)
39
Growth medium for neisseria gonorheoae?
```
Thayer martin (type of chocolate agar with antibiotics that select ng)
Gram stain
```
40
Tx of neisseria gonorrhoeae?
Ceftriaxone (plus azithromicin or doxycycline)
41
What does neisseria gonorrhoeae cause?
urethritis
cervicitis
pelvic inflamatory disease
42
*S: WHAT DRUG OPTION FOR TX OF N. GONORRHOEAE IS CONTRAINDICATED IN PREGNANCY?
DOXYCYLINE
| OTHERS ARE CEFTRIAXINE AND AZITHROMYCIN
43
Why do we do dual therapy with antibiotics?
Treat confections, 50% of people have chlamydia
44
What is the street name of gonorrhoeae?
The clap
45
What is the guaranteed symptom of gonorhoeae?
Doc, it hurts to pee
46
What is the two types of chlamydia?
Elementary body: infecting agent: exits
| Reticulate body: replication inside cell
47
What is unique about chlamydia's structure?
No cell wall (has muramic acid?)
| Penicillin doesn't work!
48
What are the subtypes of chlamydia?
A-C: eyes
D-K: groin
L1-L3: LGV
49
What does chlamydia cause?
urethritis
cervicitis
PID
50
How do we diagnose chlamydia?
Urine dipstick
51
What is tx for chlamydia?
Axithromycin or doxycycline AND Ceftriaxone
52
What mentioned is not a bacteria or virus?
Trichimonas vaginalis
53
What is trichomonad vaginalis?
A parasite protozoan
54
What does trichomonad cause?
Vaginitis
| Dysuria
55
How do we diagnose trichomona?
Wet mount looking for twitching motility of flaggellates
56
Drug for trichomonad?
metronidazole (SWEAT; Tinidazole also)
57
*S: Drugs for tichimonas are CI in what?
Pregnancy
| Breast feeding
58
*S: What is an unusual effect of trichimonas tx?
Metronidazole/tinidazole CI with alcohol
| secondary malignancies in animals
59
*S: What is the name of the effect of metronidazole/tinidazole with alcohol?
Disulfiram effect
60
*S: what is a drug used for alcoholics?
Disulfram: makes people nauseous
61
What is very typical of trichimonas exudate?
Frothy
62
What is seen in trichimonas wet mount?
Flagella
63
What is typical of yeast infection history?
Antibiotic tx causes overgrowth
Immunosuppression
Diabetes mellitus
64
What is tx. for yeast?
Azoles or nystatin
65
What is diagnosis for yeast?
KOH prep
66
*S: What is Ci of azoles?
Pregnancy
67
*S: What do azoles cause?
Condom/Diaphragm degradation:
| Birth defects
68
What does yeast infection look like grossly?
Cottage cheese
69
What is notable about bacterial vaginosis?
Low pain, looks like gross dischage
70
What is microscopically present in BV?
CLUE CELLS: Epithelioid cell sloughing with bacteria on surface
71
What is another clue for BV?
Stinky… with clue cells
72
What is smelling test for BV?
Whiff test: KOH-->amines smell fishy
73
What does absence of lymphadenopathy help rule out?
LBV
74
What do cervical swabs tell us in pelvic pain?
Neisseria gonorrhea
75
What is the base treatment for STD?
Azithromycin and ceftriaxone
76
Why do neisseria gonorhea fluctuate?
Antigenic variation (NOT mutations, just different assortments of genes)
77
What is the structure of HPV?
Nonenveloped CIRCULAR ds DNA
78
What does non-envelped structure tell us?
Will not die off quickly
79
What does HPV do in non-permissive/proliferating cells?
Cannot make "late" structural proteins to release, but still lives inside and replicate.
Causes overgrowth of cell.
Causes cancer in time: transformation.
80
What is interesting about a wart?
It is a benign tumor, and still sheds virus.
| This is why they are in clusters.
81
What stage in skin does HPV begin to shed virus?
Keratinocyte stage as it moves out from germinal layers.
82
What layer of skin is HPV latent in?
Basal germinal layer, does not shed virus.
83
What does HPV do in permissive cells?
Keratinocytes: Sheds virus
84
What is one of the leading causes of HPV death?
Cervical cancer
85
What is important in the diagnosis of HPV?
Regular Pap smears
| Vaccine
86
*S: BOARDS: What is the bivalent HPV Vaccine? treats?
HPV ___ and ___
87
*S: BOARDS: What is the quadrivalent HPV vaccine? Treats?/
HPV ___ and ___
| ___ and ___
88
*S: What is treatment for HPV squamous cell cancer?
Imiquimod (unlikely q on boards)
89
TEST: What is the HPV structure in non-malignant tumors?
Circular
full length
extra-chromosomal
90
TEST: What is the HPV structure in malignant tumors?
Partial genome
Integrated to host dna
Lost E2 gene
91
TEST: What does loss of HPV E2 lead to?
High level expression of E6 and E7,
E6: degrades p53
E7: inactivates Rb
Cell cycle control is lost (brakes removed)
92
TEST: What is the difference between and malignant and non-malignant HPV wart?
E2 presence: lost=cancer via E6(p53)/E7(Rb)
93
What is verucca plana caused by?
HPV ___ and ___
94
What is condylata accumulate caused by?
HPV ___ and ___
95
TEST: What does HPV microscopy look like?
Koilocytotic: Vaculated around the cytoplasm
| Acetic acid on gross cervix: turns white
96
After visualizing koilocytotic cells on HPV slide, what do you do?
Brush cervix with 5% acetic acid. Infected regions become white
97
What is STI warts caused by?
HPV 16 18 33
98
What is the antigen used in HPV vaccines?
L1 protein, a capsid protein
99
What complications are we trying to prevent in STDs?
Congenital infecitons->encephalitis/still birth
| CNS infections
100
Syphilis congenital appearance?
Saddle nose
Serrated incisors
Saber shins
101
Neisseria gonorrhea congential infections?
Eye infections
| Blood: Rash, arthritis, fever, PID` in mom
102
Chlamydia congential infections?
Eyes
| Pneumonia
103
*S: Erythromycin during pregnancy can cause what in the child?
Hypertrophic pyloric stenosis
