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Pathophysiology I > Pathophysiology: STIs > Flashcards

Pathophysiology: STIs Flashcards

1
Q

What are Sexually Transmitted Infections? (STI’s)

A

sexual contact that result in pathogen spread

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2
Q

Overall STI epidemiology and Etiology

A
  • 1 in 5 people in the US
  • 20,000 women become infertile each year due to undiagnosed infections
  • $16 billion annual direct medical costs for new infections
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3
Q

What is the most common STD in the US?
a) Chlamydia
b) Gonorrhea
c) Syphilis
d) Herpes

A

a) Chlamydia
- 1.6 million cases (2020)
- 1.2% decrease since 2016

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4
Q

Herpes Simplex Virus (HSV) and Statistics:

A
  • ~50 million in the US are infected by genital herpes
  • seroprevalence of HSV2 in those age 14 to 49 years = ~12%
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5
Q

Trichomoniases Statistics

A
  • ~3.7 million cases per year
  • prevalence estimated to be 2.1% in females and 0.5% in males
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6
Q

What are the Risk factors and Determinants of Frequency for STI’s?

A
  • number of sexual partners
  • unprotected sexual activities
  • age
  • prostitution
  • illicit drug use
  • health disparities
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7
Q

STI Complications

A
  • more frequent and more severe in women
  • damage to reproductive organs
  • increased risk of cancer
  • pregnancy complications
  • transmission of disease to fetus or newborn
  • increased risk of HIV transmission
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8
Q

Which pathogen causes Gonorrhea

A

Neisseria gonorhoeae

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9
Q

Does gonorrhea stain gram positive or gram negative?

A

stains gram negative diplococcus

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10
Q

Neisseria gonorhoeae

A
  • gram negative diplococcus
  • grows best in warm, mucus secreting epithelia
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11
Q

Gonorrhea: Pathophysiology

A

1) Gonococci attach to cell membranes of mucosal epithelium by surface pili
2) N. gonorrhoeae penetrates through epithelial cells to submucosal tissue
3) Mucosal damage occurs (sloughing of epithelium)
4) Polymorphonuclear (PMN) leukocytes invade the tissue
5) Submucosal abscesses form and purulent exudates (pus) are secreted

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12
Q

Where does Gonococci attach to?

A

it attaches to cell membranes of mucosal epithelium by surface pili

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13
Q

What is N.gonorhoeae’s MOA?

A

it penetrates through epithelial cells to submucosal tissue

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14
Q

What happens when gonococci aka N.gonorrhoeae enters through the submucosal tissue?

A

mucosal damage occurs (sloughing of epithelium)

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15
Q

What kind of other foreign materials invade the tissue in Gonorrhea?

A

Polymorphonuclear (PMN) leukocytes invade the tissue

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16
Q

What is the incubation period for Gonorrhea in males?

A

1-14 days

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17
Q

what is the incubation period for Gonorrhea in females?

A

1-14 days

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18
Q

When is the symptom onset of Gonorrhea for males?

A
  • 2-8 days
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19
Q

When is the symptom onset of Gonorrhea for females?

A

10 days

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20
Q

What is the most common site of infection of Gonorrhea for males?

A

Urethra

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21
Q

What is the most common site of infection of Gonorrhea in females?

A

Endocervical canal

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22
Q

Where are the other sites of infection of Gonorrhea in males?

A

rectum, eye, oropharynx

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23
Q

Where are other sites of infection of Gonorrhea in females?

A

urethra, eye, rectum, oropharynx

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24
Q

What are the symptoms of Gonorrhea in males?

A
  • Urethral infection: dysuria, urinary infection
  • Anorectal infection: severe rectal pain
  • Pharyngeal infection: mild pharyngitis
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25
Q

What are the signs of Gonorrhea in males?

A
  • purulent urethral or rectal discharge (scant to profuse)
  • anorectal: pruritis mucopurulent discharge, bleeding
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26
Q

What are the symptoms of Gonorrhea in females?

A
  • Endocervical infection: asymptomatic to mildly asymptomatic
  • Urethral infection: dysuria, urinary frequency
  • Anorectal and pharyngeal infection: same as for males
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27
Q

What are the signs of Gonorrhea in females?

A
  • abnormal vaginal discharge
  • uterine bleeding
  • purulent urethral or rectal discharge (scant to profuse)
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28
Q

What are the complication of Gonorrhea in males?

A
  • Rare: Epididymitis, prostatitis, inguinal lymphadenopathy, urethral stricture
  • disseminated gonnorrhea
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29
Q

What is 3x more likely in females than males (Gonorrhea complication)?

A

disseminated gonorrhea

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30
Q

What are Gonococcal complications in females?

A
  • pelvic inflammatory disease
  • disseminated gonorrhea
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31
Q

pelvic inflammatory disease

A
  • may lead to ectopic pregnancy
  • infertility
  • 15% of cases
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32
Q

What is the Gonococcal infection in pregnancy?

A
  • neonates may go through the birth canal during passage
  • neonatal conjunctivitis
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33
Q

Neonatal conjunctivitis

A
  • aka ophthalmia neonatorum
  • may result in blindness if not treated promptly
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34
Q

What is the diagnosis for Gonorrhea?

A
  • the use of Nucleic acid amplications tests (NAAT’s)
  • cultures
  • Gram stain
  • screening
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35
Q

Nucleic acid amplications tests (NAAT’s) for Gonorrhea

A
  • most sensitive
  • use endocervical, vaginal, urethral (for men only), or urine specimens
  • also from rectal or pharyngeal specimens
  • self-collected specimens (vaginal, urine, rectal, or pharyngeal)
  • point-of-care (POC) NAATs also available
  • NO antimicrobial susceptibility testing
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36
Q

Cultures (Gonorrhea)

A
  • Females: endocervical
  • Males: urethral
  • use for suspected treatment failure
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37
Q

Gram stain (Gonorrhea)

A
  • used for males with symptomatic urethritis (discharge)
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38
Q

(Gonorrhea) Screening recommended for:

A
  • sexually active women <25 years of age
  • men and women at risk
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39
Q

What is the cause of Chlamydia?

A
  • caused by Chlamydia trachomatis
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40
Q

Chlamydia trachomatis

A
  • obligate intracellular bacterium
  • shares properties of viruses and bacteria
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41
Q

What is required for Chlamydia trachomatis for replication?

A
  • requires material from host cells for replication, but maintains cellular identity throughout the development
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42
Q

Chlamydia trachomatis cellular characteristics

A
  • do NOT have a cell wall peptidoglycan
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43
Q

Describe the outer membrane of Chlamydia trachomatis

A
  • it is similar to a gram negative bacteria
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44
Q

How many forms does Chlamydia exists in?

A

Two form:
- the Elementary body (EB)
- the Reticulate Body (RB)

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45
Q

Elementary bodies (EBs)

A
  • are infectious particles
  • capable of entering uninfected cells
  • they are adapted for extracellular survival
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46
Q

Reticulate Bodies (RBs)

A
  • not infectious
  • metabolically active and can replicate
  • adaptive for intracellular survival
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47
Q

Chlamydia:
How long does incubation period take in males?

A
  • 35 days
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48
Q

Chlamydia:
How long does incubation period take in females?

A

7-35 days

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49
Q

Chlamydia:
Symptom onset in males

A

7-21 days

50
Q

Chlamydia:
Symptom onset in females

A

7-21 days

51
Q

Chlamydia:
Most common site of infection for males

A
  • Urethra
52
Q

Chlamydia:
Most common site of infection for females

A

Endocervical canal

53
Q

Chlamydia:
Other sites of infection for males

A
  • rectum, eye, oropharynx
54
Q

Chlamydia: other site(s) of infection for females

A
  • urethra, eye, rectum, oropharynx
55
Q

Chlamydia:
Symptoms in males

A
  • Asymptomatic: more than 50% of urethral and rectal
  • Urethral infection: mild dysuria, discharge
  • Pharyngeal infection: mild pharyngitis
56
Q

Chlamydia:
Symptoms for females

A
  • Asymptomatic for more than 66% of endocervical infection
  • urethral infection: dysuria and urinary frequency uncommon
  • pharyngeal infection: same as for males
57
Q

Chlamydia:
Signs in Males

A
  • scant to profuse, mucoid to purulent urethral or rectal discharge
  • rectal: pain, discharge, bleeding
58
Q

Chlamydia:
Signs in Females

A
  • abnormal vaginal discharge
  • uterine bleeding
  • scant to profuse purulent or urethral or rectal discharge
59
Q

Chlamydia complications in males

A
  • epididymitis
  • reactive arthritis
60
Q

Chlamydia complications in females

A
  • pelvic inflammatory disease
  • reactive arthritis
61
Q

Chlamydia infection during pregnancy

A
  • may be transferred to an infant who comes in contact with cervicovaginal secretions
    = 2/3 acquire infection after contact
  • may manifest in eyes, nasopharynx, rectum, or vagina:
    = conjunctivitis - develops in ~50%
    = pneumonia - develops in ~16%
62
Q

Chlamydia: Diagnosis

A
  • NAATs
  • Culture
  • Screening
63
Q

NAATs (Chlamydia)

A
  • most sensitive and most recommended for: women and men
  • women: endocervix or vaginal swabs or urine
  • men: urethral swab or urine
  • can also obtain rectal or pharyngeal specimens
  • may use self-collected specimens (urine, vaginal, rectal, or pharyngeal
  • POC also available
64
Q

Culture (Chlamydia)

A

uncommon use

65
Q

Chlamydia screening

A

Recommended for:
- sexually active women <25 years of age
- men and women at risk

66
Q

Syphilis is caused by?

A
  • a spirochete
  • Treponema pallidum
67
Q

Syphilis MOA

A
  • typically spread by sexual contact with infected mucus membranes or skin lesions
  • T.pallidum penetrates intact mucus membrane or break in epithelium
  • spirochetes enter blood
68
Q

4 stages of syphilis

A

1) Primary Syphilis
2) Secondary Syphilis
3) Latent Syphilis
4) Tertiary Syphilis
Other: Neurosyphilis, Ocular Syphilis, and Otosyphilis

69
Q

Primary syphilis

A
  • Chancre develops at site of exposure
  • Common locations of chancre:
    = external genitalia, perianal region, mouth, throat
  • usually painless
  • Lymphadenopathy may also occur
  • ## highly contagious
70
Q

Which stage is syphilis the most contagious?

A
  • primary syphilis
71
Q

How long does chancre usually heals for?

A
  • within 1 to 8 weeks
72
Q

Secondary syphilis

A
  • occurs after initial infection if untreated or inadequately treated
  • Multisystem involvement:
    = rash, mucocutaneous eruptions, lymphadenopathy, malaise, headache, arthralgia, fever, sore throat, stomatitis, nausea, loss of appetite, inflamed eyes, alopecia, condylomata lata
73
Q

Latent Syphilis

A
  • positive serologic test + no evidence of disease
  • asymptomatic
  • Early latent
  • Late latent
74
Q

Early Latent Syphilis

A
  • aka syphilis, early non-primary non-secondary
  • initial infection occurred within the previous 12 months
75
Q

Late latent Syphilis

A
  • aka syphilis of unknown duration
  • aka syphilis, unknown duration or late
  • initial infection occurred more than 12 months ago or insufficient evidence that infection was acquired during the previous 12 months
76
Q

Tertiary Syphilis

A
  • aka late clinical manifestations
  • Gumma
  • Cardiovascular: aortitis or aortic insufficiency
77
Q

Gumma

A
  • occurs in tertiary syphilis
  • rubbery, necrotic, destructive lesions
  • can infiltrate any organ or tissue
  • most common in skin, bone, soft tissue, and liver
78
Q

Syphilis with Neurologic Manifestation or Neurosyphilis

A
  • may occur at any stage of syphilis
  • stage reported as “ with neurologic manifestations”
  • T.pallidum invades the CNS
  • CSF abnormalities consistent with CNS infection
  • meningitis, general paresis, dementia, tabes dorsalis, deafness, blindness, ataxia, sensory loss
79
Q

Ocular Syphilis and Otosyphlis

A
  • can occur at any stage of syphilis
  • commonly presents in early stages with or without CNS involvement
  • Ocular syphilis: may result in permanent vision loss
  • Otosyphilis: may result in permanent hearing loss
80
Q

Congenital Syphilis

A
  • T.pallidum can cross the placenta anytime during pregnancy
  • may result in: death, prematurity
  • symptoms may be seen in: 1st months of life, later in childhood or adolescence
81
Q

Syphilis diagnosis

A
  • microscopic examination
  • serologic testing: nontreponemal, treponemal
82
Q

Microscopic examination (Syphilis)

A
  • specimens collected from lesions or enlarged lymph nodes
  • Identifies: T.pallidum spirochete, Antibodies to T.pallidum
83
Q

Nontreponemal Tests and Traditional Algorithm

A
  • venereal disease research laboratory test (VDRL)
  • rapid plasma reagin test (RPR)
  • positive = presence of any stage of syphilis or congenital syphilis
  • may see false positives/negatives
  • reported quantitatively: decline with treatment and may become nonreactive
  • traditionally used for screening
  • used for following progression of disease, recovery after therapy, and reinfectioin
84
Q

Treponemal Tests and Reverse Sequence Algorithm

A
  • more sensitive
  • used for confirming diagnosis
  • not used for following treatment
  • remain reactive for life in most patients
85
Q

Herpes Simplex Virus

A

Types:
- Genital Herpes
- Neonatal Herpes

86
Q

Genital Herpes

A
  • caused by HSV
  • transmitted when infection secretions come in contact with mucosal surfaces through:
    = urethra, oropharynx, cervix, conjunctivae, abraded skin
87
Q

Type 1 Genital Herpes

A
  • usually associated with oropharyngeal disease
  • “cold sores”
88
Q

Type 2 Genital Herpes

A
  • usually associated with genital disease
89
Q

Genital Herpes MOA

A
  • virus replicates in skin and mucus membranes at site of infection
90
Q

5 stages of Genital Herpes

A

1) Primary mucocutaneous infection
2) infection of the ganglia
3) establishment of latency
4) reactivation
5) recurrent infection

91
Q

Genital Herpes:
Incubation Period?

A

2-14 days

92
Q

Primary- 1st episode (Genital Herpes)

A
  • initial genital infection
  • seronegative for antibodies to HSV-1 or 2
  • eruption of multiple pustular ulcerative lesions on external genitalia
  • itching, pain in the genital area, fever, headache, malaise, vaginal or urethral discharge, tender inguinal adenopathy, urine retention, parasthesias
  • viral shedding
93
Q

Non-primary-1st episode (Genital Herpes)

A
  • initial genital infection
  • clinical or serologic evidence of prior HSV (usually HSV-1)
94
Q

Recurrent (Genital Herpes)

A
  • 2nd or subsequent outbreaks
95
Q

Development of eruption of multiple pustular ulcerative lesions on external genitalia

A
  • develop over 7-10 days
  • heal within 2-4 weeks
96
Q

viral shedding in genital herpes

A
  • Primary: ~11-12 days
  • Non-primary: ~7 days
97
Q

Genital Herpes Symptoms – Recurrent

A
  • Prodrome
  • fewer lesions
  • shorter duration (heal within 7 days)
  • milder symptoms
  • viral shedding: ~4 days
98
Q

Asymptomatic viral shedding

A
  • can occur during 1st episode or recurrent episodes
99
Q

Genital Herpes complications

A
  • lesions at extragenital sites: eye, rectum, pharynx, fingers
  • CNS involvement
100
Q

Neonatal herpes

A
  • high morbidity and mortality: Fatality rate of 50%
  • may lead to permanent neurologic damage
101
Q

How is neonatal herpes typically transmitted?

A
  • via exposure to HSV in the birth canal
102
Q

Which stage is Neonatal Herpes the greatest risk?

A
  • during 1st episode of primary infections
103
Q

Genital Herpes Diagnosis

A
  • Type-specific virologic tests
  • Type-specific serologic tests
104
Q

Type-specific virologic test (Genital Herpes)

A
  • if genital lesions present:
    -> Culture or NAAT
  • NAAT is the most sensitive
105
Q

Type-specific serologic tests

A
  • if genital lesions are not present
106
Q

Trichomoniasis

A
  • caused by Trichomonas vaginalis
  • flagellated, motile protozoan
  • more common in females than males
107
Q

Trichomonads MOA

A
  • attach to vaginal or urethral mucosa
  • elicit an inflammatory response
  • manifests as discharge containing large numbers of PMN leukocytes
108
Q

Trichomoniasis Incubation period

A
  • 3-28 days
  • the same for males and females
109
Q

Trichomoniasis:
Most common site of infection

A
  • Urethra: males
  • Endocervical canal: females
110
Q

Trichomoniasis:
Other Sites of Infection

A
  • Males: Rectum, eye, oropharynx
  • Females: Urethra, eye, rectum, oropharynx
111
Q

Trichomoniasis symptoms in males

A
  • asymptomatic or minimally symptomatic
  • clear to purulent urethral discharge, dysuria, pruritus
112
Q

Trichomoniasis symptoms in females

A
  • asymptomatic or minimally symptomatic
  • scant to copious, malodorous, yellow-green vaginal discharge, pruritus, dysuria, dysparenunia
113
Q

Trichomoniasis signs in males

A
  • urethral discharge
114
Q

Trichomoniasis signs in females

A
  • vaginal discharge
  • vaginal pH = 4.5-6
  • inflammatory/erythema of vulva, vagina, and/or cervix, urethritis
115
Q

Trichomoniasis Complication in males

A
  • epididymitis and chronic prostatitis
  • infertility
116
Q

Trichomoniasis Complication in females

A
  • pelvic inflammatory disease
  • premature labor, premature rupture of membranes, low birth weight infants
  • cervical neoplasia
117
Q

Trichomoniasis Diagnosis

A
  • vaginal discharge pH
  • wet-mount microscopic examination of vaginal discharge
  • cultures
  • NAATs and antigen detection tests
118
Q

Vaginal discharge pH (Trichomoniasis)

A
  • T. vaginalis requires pH range = 4.9 to 7.5 for survival
  • pH >5 vaginal discharge = presence of T.vaginalis or Gardnerella vaginallis
119
Q

Wet-mount microscopic experiments of vaginal discharge (Trichomoniasis)

A
  • confirmed if presence of pear-shaped, flagellating organisms
  • inexpensive; can be performed in clinic
120
Q

Cultures (Trichomoniasis)

A
  • highly specific and sensitive; but not as sensitive as NAATs
  • may use for confirming diagnosis
121
Q

NAATs and antigen detection tests (Trichomoniasis)

A
  • highly sensitive and specific
  • preferred testing method
  • POC available for women with vaginal or urine specimens

Pathophysiology I (4 decks)

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