Sec 32 Sexually Transmitted Diseases Flashcards
1
Q
Etiologic agent: Syphilis
A
Treponema pallidum pallidum
2
Q
Etiologic agent: Chancroid
A
Haemophilus ducreyi
3
Q
Etiologic agent: Lymphogranuloma venereum
A
Chlamydia trachomatis
4
Q
Etiologic agent: Granuloma inguinale
A
Klebsiella granulomatis
5
Q
Etiologic agent: Gonorrhea
A
Neisseria gonorrheae
6
Q
Etiologic agent: Chlamydia
A
Chlamydia trachomatis
7
Q
Etiologic agent: Genital mycoplasma
A
Mycoplasma sp.
Ureaplasma sp.
8
Q
Etiologic agent: Trichomoniasis
A
Trichomonas vaginalis
9
Q
Etiologic agent: Bacterial vaginosis
A
Polymicrobial
10
Q
Characterized by one or more chancres in presence of laboratory evidence
A
Primary syphilis
11
Q
Starts as a dusky red macule that evolves into a papule then to a round-to-oval ulcer with sharply demarcated regular, raised borders that are indurated giving a cartilaginous feel
A
Chancre
12
Q
Retraction of the foreskin when a chancre is present on the underside causes foreskin to flip suddenly
A
Dory flap
13
Q
Unilateral labial swelling with rubbery consistency and intact surface indicative of deep-seated chancre
A
Edema induratum
14
Q
Characterized by localized or diffuse mucocutaneous lesions, often with generalized lymphadenopathy in the presence of laboratory evidence from tissues or sera
A
Secondary syphilis
15
Q
Lesions of secondary syphilis that erupts 3-12 weeks after the chancre erupts
A
Syphilids
16
Q
Erythematous macules in secondary syphilis
A
Roseola syphilitica
17
Q
A white scaly ring on the surface of papulosquamous lesions in secondary syphilis
A
Biette’s collarette
18
Q
Seborrheic dermatitis-like lesions around the hairline in secondary syphilis
A
Crown of Venus
corona veneris
19
Q
Plantar lesions mistaken for calluses in secondary syphilis
A
Clavi syphilitici
20
Q
Confluence of mucous patches on the tongue in secondary syphilis
A
Plaques fauches en prairie
21
Q
Rare manifestation that presents as crusted or scaly papules and plaques that can ulcerate or become necrotic with lesions described as rupioid
A
Malignant lues
22
Q
Without treatment, the secondary stage recedes in
A
4-12 weeks
23
Q
Hallmark of late benign syphilis
A
Gumma
24
Q
Nontender pink to dusky red granulomatous nodular lesion with variable central necrosis which commonly affect skin or mucous membranes common in scalp, forehead, buttocks, presternal, supraclavicular or pretibial areas
A
Gumma
25
Two syndromes commonly associated with late neurosyphilis
1. Dementia paralytica
| 2. Tabes dorsalis
26
Presents with sensory ataxia and bowel & bladder dysfunction resulting from damage to the posterior columns of the spinal cord which can be accompanied by an Argyll-Robertson pupil (accommodates but does not react to light)
Tabes dorsalis
27
Presents as a rapidly progressive dementia accompanied by personality changes in late tertiary syphilis
Dementia paralytica
28
Treatment: Primary or Secondary or Early latent syphilis
Benzathine penicillin G 2.4 M units IM single dose (both HIV-uninfected and -infected)
Alt - Doxycycline 100mg orally BID for 14 days
29
Etiologic agent: Pinta
Treponema carateum
30
Etiologic agent: Yaws
Treponema pallidum pertenue
31
Etiologic agent: Bejel or Endemic syphilis
Treponema pallidum endemicum
32
Treatment: Nonvenereal treponematoses
Benzathine penicillin G 1.2 M units IM single dose (>10 years old
Benzathine penicillin G 0.6 M units IM single dose(<10 years old)
33
Treatment: Chancroid
Azithromycin 1g orally single dose
Ceftriaxone 250mg IM single dose
Ciprofloxacin 500mg orally BID for 3 days
Erythromycin 500mg orally QID for 7 days
34
Treatment: Lymphogranuloma venereum
Doxycycline 100mg orally BID for 3 weeks (1st line)
Erythromycin 500mg orally QID for 3 weeks (2nd line)
Azithromycin 1g orally once weekly for 3 weeks (3rd line)
35
Treatment: Granuloma inguinale
Doxycycline 100 BID orally for 3 weeks or until lesions heal (CDC)
Azithromycin 1g on Day 1 then 500mg OD for 3 weeks or until lesions heal (WHO)
36
Treatment: Uncomplicated Gonococcal infection
Ceftriaxone 125mg IM single dose or
| Cefixime 400mg PO single dose
37
Treatment: Disseminated Gonococcal infection
Ceftriaxone 1g IM or IV every 24 hours until improvement noted
38
Treatment: Gonococcal infection in Neonates
Ceftriaxone 25-50 mkday IV or IM OD for 7 days (10-14 days if with meningitis)
39
Treatment: Chlamydia
Azithromycin 1g PO single dose or
| Doxycycline 100mg PO BID for 7 days
40
Treatment: Trichomoniasis
Metronidazole 2g PO single dose or
| Tinidazole 2g PO single dose
41
Treatment: Bacterial vaginosis
Metronidazole 500mg PO BID for 7 days
or
Metronidazole gel 0.75% 5g intravaginal OD for 5 days
or
Clindamycin cream 5% 5g intravaginal OD for 7 days
42
Ranges in diameter from a few millimeters to 2 cm and is sharply demarcated with regular, raised borders that are indurated, giving the lesion a cartilaginous feel; base is usually clean, and is classically not painful
Hunterian chancre or “ulcus durum” (hard
| ulcer)
43
Relapses of primary syphilis
Monorecidive syphilis or chancre redux
44
Present as moist, flat, well-demarcated papules or plaques with macerated or eroded surfaces in intertriginous areas, commonly in the labial folds in females or in the perianal region in all patients
Condyloma lata
45
Pigmentary changes in Syphilis from inhibition of melanogenesis
Leukoderma colli syphiliticum or, if on the neck, “necklace of Venus”
46
A type of mucous patch of secondary syphilis that can be present at the angle of the mouth, with a characteristic slit traversing its center
Split papule
47
An asymptomatic stage with no clinical findings, with seroreactivity by definition the only evidence of infection; which is a diagnosis of exclusion
Latent syphilis
48
Refers to a solitary gumma of the penis
Pseudochancre redux
49
Responsible for most deaths caused by syphilis
Cardiovascular manifestations:
Syphilitic aortitis leading to aortic regurgitation
Coronaryostial stenosis
Saccular aneurysm
50
Any stage of infection and a reactive CSF-VDRL
Confirmed Neurosyphilis
51
Any stage of infection, a nonreactive CSF-VDRL, elevated protein or white blood count without other known causes of those abnormalities, and clinical symptoms or signs of neurosyphilis without other known causes for those symptoms or signs
Probable Neurosyphilis
52
Most common ophthalmic manifestation of early neurosyphilis, presenting as eye pain, redness, and photophobia
Uveitis
53
Most common manifestation of otologic syphilis
Sensorineural hearing loss
54
Refers to syphilis caused by infection in utero with T. pallidum
Congenital syphilis
55
Signs of disease in an infant or child with specific laboratory evidence of infection with T. pallidum
Confirmed Congenital syphilis
56
Condition affecting an infant whose mother had
untreated or inadequately treated syphilis at delivery,
regardless of signs in the infant, or an infant or child
who has a reactive treponemal test for syphilis and evidence of congenital syphilis on physical examination
or radiographs of long bones, a reactive CSF-VDRL,
an elevated CSF cell count or protein (without other
known cause), or a reactive FTA-ABS IgM antibody
test or IgM enzyme-linked immunosorbent assay
Probable Congenital syphilis
57
Probability of transmission of Syphilis infection
70-100% in primary syphilis
40% for early latent syphilis
10% for late latent syphilis
58
Syphilis in a child aged <2 years
Early congenital syphilis
59
Early congenital syphilis
```
Persistent rhinitis (“snuffles”)
Hydrops fetalis (edema)
Lymphadenopathy
Neurosyphilis,
Leukocytosis, thrombocytopenia
Periostitis and osteochondritis, with the pain
associated with osteochondritic lesions causing the infantto refuse to move the affected anatomic area (“pseudoparalysis of Parrot”)
Bullous rash (“syphilitic pemphigus”)
```
60
Child with Syphilis at least 2 years old that typically
| manifests over the first two decades of life
Late congenital syphilis
61
Late congenital syphilis
Scars (“rhagades”) resulting from cutaneous fissures
Saddle-nose deformity, resulting from destruction of nasal cartilage from snuffles
Frontal bossing (Olympian brow)
Thickening of the sternoclavicular portion of the clavicle (Higoumenakis sign)
Anterior bowing of the midtibia (saber shins),
Scaphoid scapula
Peg-shaped notched central incisors (Hutchinson teeth) Mulberry molars
62
Hutchinson triad
Hutchinson teeth
Interstitial keratitis
Eighth nerve deafness
63
Diagnostic test of choice in chancres, moist lesions of secondary syphilis (condylomata lata and mucous patches), and the discharge from rhinitis in congenital syphilis
Darkfield microscopy
64
Histopathology: granulomas with central zones of acellular necrosis; endarteritis obliterans
and angiocentric plasma cell infiltrates of dermal
blood vessels can also be present
Tertiary syphilis
65
Nontreponemal tests
Venereal Disease Research Laboratory (VDRL)
| Rapid plasma reagin (RPR)
66
In a small percent of secondary syphilis cases, very high antibody titers inhibit test reactivity, producing a false-negative result called
Prozone phenomenon
67
Treponemal tests
T. pallidum particle agglutination (TPPA) test
Microhemagglutination assay for T. pallidum (MHA-TP)
Fluorescent treponemal antibody absorption assay
(FTA-ABS)
T. pallidum haemagglutination test (TPHA)
Treponemal enzyme immunoassays (EIAs)
Immunochemiluminescence assays
68
Treatment: Penicillin-allergic persons with syphilis who are not pregnant and do not have neurosyphilis
Doxycyline
69
Treatment success in Syphilis is generally defined as
A fourfold decline in serologic nontreponemal titer (or reversion to nonreactive result) following appropriate treatment
70
A fourfold titer increase following appropriate treatment
| indicates
Reinfection or treatment failure
71
Self-limited clinical syndrome consisting of fever, headache, flare of mucocutaneous lesions, tender lymphadenopathy, pharyngitis, malaise, myalgias, and leukocytosis which occurs within 12 hours of initiating therapy and resolves within 24–36 hours
Jarisch–Herxheimer reaction
72
Most benign of the endemic treponematoses with the skin being the only organ of involvement
Pinta
73
Most prevalent nonvenereal treponematosis and the most destructive and disfiguring skeletal involvement
Yaws
74
Second line treatment for Nonvenereal treponematoses
Erythromycin
Doxycyline
Tetracycline
75
Incubation period of chancroid
3-7 days no more than 10 days
76
Usually tender and or painful not indurated (soft chancre) with diameter varying from 1 mm to 2 cm
and most are found on the external or internal
surface of the prepuce, on the frenulum, or on the glans
Chancroid
77
Painful inguinal adenitis occurs in up to 50% of patients within a few days to 2 weeks after onset of the primary lesion usually unilateral with erythema
of the overlying skin
Buboes
78
The three classic etiologic agents for genital ulceratio
1. H. ducreyi
2. Treponema pallidum
3. Herpes simplex
79
Single lesion extends peripherically and shows extensive ulceration
Giant chancroid
80
Lesion that becomes confluent, spreading
| by extension and autoinoculation. The groin or thigh may be involved.
Large Serpiginous Ulcer
| Ulcus molle serpiginosum
81
Variant caused by superinfection with
fusospirochetes. Rapid and profound
destruction of tissue can occur.
Phagedaenic Chancroid
| Ulcus molle gangraenosum
82
Small ulcer that resolves spontaneously in a few days may be followed 2–3 weeks later by acute regional lymphadenitis.
Transient Chancroid
| Chancre mou volant
83
Multiple small ulcers in a follicular distribution.
Follicular Chancroid
84
Granulomatous ulcerated papule may
| resemble donovanosis or condylomata lata.
Papular Chancroid
| Ulcus molle elevatum
85
Most frequent complaint in Chancroid
Local pain
86
Complications of Chancroid
Painful inguinal adenitis (up to 50%)
Spontaneous ruptures of inguinal buboes with occurrence of large abscesses and fistula formation
Spreading of Haemophilus ducreyi to distant sites
(kissing ulcers and/or extragenital lesions due to autoinoculation)
Esophageal lesions in HIV patients
Acute conjunctivitis
Bacterial superinfection (including anaerobs) leading
to extensive destruction
Scarring leading to phimosis
Erythema nudism
Enhanced HIV transmission
87
DOC for pregnant patients with Chancroid
Ceftriaxone
88
A sexually transmitted disease due to specific Chlamydia variants contracted by direct contact with infectious secretions
Lymphogranuloma venereum (LGV)
89
Two distinct morphologic forms of Chlamydiae
1. the small metabolically inactive and infectious elementary body
2. the larger metabolically active and noninfectious
reticulate body
90
5-to-8-mm painless erythematous papule(s) or small
| herpetiform ulcers appear at the site of inoculation; heals within a few days, and may go unnoticed
Primary stage of LGV
91
Marked LN involvement and hematogenous dissemination
Secondary stage of LGV
92
Characterized by inguinal and/or femoral LN involvement and is the major presentation in
men
Acute genital syndrome (GS) or inguinal syndrome
93
Pathognomonic of LGV
Nodal enlargement on either side of the inguinal ligament, the “groove sign,”
94
Characterized by perirectal nodal involvement, acute hemorrhagic proctitis, and pronounced systemic symptoms
Acute anorectal syndrome
95
In women with untreated ArS, and includes rectal
strictures (most common) and abscesses, perineal
sinuses, rectovaginal fistulae (leading to “watering
can perineum”), and “lymphorrhoids” (perianal
outgrowths of lymphatic tissue)
Tertiary stage of LGV
96
Diagnostic of LGV
Positive on lymph node aspirate
97
Most commonly used test with titers greater than 1:256 are highly suggestive of LGV and titers below 1:32 exclude the diagnosis
Complement fixation test
98
The earliest diagnostic modality to identify LGV which consists of an intradermal skin test assessing delayed hypersensitivity to chlamydial antigens but no longer used because of its low sensitivity and limited specificity due to cross reaction with C. trachomatis D-K
Frei test
99
In Donovanosis, single or multiple papules or
| nodules later develop and grow into a painless ulcer that may extend to the adjacent tissues and moist folds, forming
Kissing lesions
100
Commonly presents as beefy red, easily bleeding, foul-smelling ulcer, which may have hypertrophic or verrucous borders, with granulation tissue; may also present as soft, red nodules that eventually ulcerate
Granuoma inguinale
101
The infectious form in Chlamydiawhich enters host cells through endocytosis
Eelementary body
102
Most common manifestation of Chlamydia which is
characterized by a watery or mucoid discharge
from the urethra that may be accompanied by variably
severe dysuria in both men and women
Urethritis
103
Gonorrhea can also be transmitted vertically from
mother to child during normal vaginal birth, characteristically causing an inflammatory eye infection characterized by profuse, purulent ocular discharge
Ophthalmia neonatorum
104
The most common manifestation of gonococcal infection in men, characterized by a spontaneous, often
profuse, cloudy or purulent discharge from the penile
meatus
Urethritis
105
In some cases, there is so much soft tissue
inflammation that the entire distal penis becomes
swollen, so-called
Bull head clap
106
A manifestation of gonococcal infection
manifesting in those who practice unprotected
anoreceptive intercourse; symptoms may include a rectal mucopurulent discharge, pain on defecation, constipation, and tenesmus
Proctitis
107
Occurs in about 10-40% of uncomplicated
gonorrheal infections in women and is characterized
by fever, lower abdominal pain, back pain, vomiting,
vaginal bleeding, dyspareunia, and adnexal or cervical
tenderness during movement associated with a pelvic
examination
Pevic inflammatory disease
108
This involves inflammation of the liver capsule associated with genitourinary tract infection and may be present in up to one-fourth of women with PID caused by either N. gonorrhoeae or C. trachomatis. Presenting symptoms include right upper quadrant pain and tenderness with abnormal liver function tests.
Fitz-Hugh-Curtis syndrome
109
Spread of infection from the primary site of inoculation to other parts of the body through the bloodstream leads to this which occurs in 0.5-3% of cases and is associated with a classic triad of dermatitis,
migratory polyarthritis, and tenosynovitis.
Disseminated gonococcal infection (DGI), also known as gonococcemia
110
The cutaneous lesions of DGI with concurrence of some degree of hemorrhage and necrosis
Gun metal gray
111
Considered diagnostic for infection with N. gonorrhoeae in symptomatic men
Gram stain of a urethral specimen that demonstrates
polymorphonuclear leukocytes with intracellular
Gram-negative diplococci
112
Gold standard diagnostic test for years for N. gonorrhoeae
Bacterial culture
113
Media for bacterial culture of N. gonorrhoeae
Modified Thayer-Martin medium
114
Permanent sequelae of gonococcal infection in women
Infertility
115
The area most commonly affected in men and women with Chlamydia
Urogenital tract infection
116
Can occur up to 1 month after symptoms of nongonococcal urethritis (NGU) with classic triad associated with this syndrome is NGU, arthritis, and conjunctivitis.
Reactive arthritis
117
Individuals with the haplotype are at increased risk of developing the reactive arthritis syndrome.
HLA-B27
118
Smallest, free-living, self-replicating bacteria, developed
by degenerative evolution from lactobacilli, and lack
a cell wall
Mycoplasma
119
STD caused by parasitic protozoan that infects mucosal epithelium, causing microulceration
Trichomoniasis
120
Specific sign of trichomoniasis with punctate hemorrhages may be seen on the vaginal wall and cervix
Colpitis macularis or “strawberry cervix”
121
Most common diagnostic test in Trichomoniasis
Saline wet mount
122
Drug-drug interaction with Imidazoles
Cimetidine
Warfarin
Phenytoin
Lithium
123
Most common vaginal infection in women of
| childbearing age
Bacterial vaginosis
124
Apolymicrobial syndrome that occurs when
there is an imbalance of the bacterial flora normally
present in the vagina. The shift occurs from hydrogen
peroxide-producing lactobacilli to a greater concentration of bacterial organisms.
Bacterial vaginosis
125
Presents with fishy odor and thin, white or gray vaginal discharge; on physical examination, a milky, homogenous vaginal coating may be seen adherent to the vaginal wall
Bacterial vaginosis
126
Amstel criteria for diagnosing Bacterial vaginosis (3 of 4)
1. thin, homogenous vaginal discharge
2. a positive whiff test, which involves the production of a fishy odor when mixing vaginal fluid with 10% potassium hydroxide
3. vaginal fluid pH greater than 4.5
4. the presence of clue cells (epithelial cells covered with bacteria) on microscopic examination
