Sex-transmitted infections-Shapiro Flashcards
1
Q
Which gender tends ot have fewer symptoms?
Which gender spreads STIs more?
A
Women (less likely to seek care)
Men
2
Q
T or F
Condoms break less often than our will to use them
and
none of the available diagnostic tests are perfect
A
T
3
Q
How does disease prevalence of a disease relate to the PPV of that disease?
A
low prevelance-> low PPV
4
Q
What are the diseases characterized by urethritis and cervicitis?
A
Gonococcal infections
Chlamydial infections
Nongonococcal urethritis
5
Q
What are the diseases characterized by vaginal discharge?
A
Bacterial Vaginosis
Trichomonasis
Vulvovaginal Candidiasis
6
Q
What are the diseases characterized by ulcerations?
A
Chancroid and Syphilis
Genital herpes Infections (HSV-2 and HSV-1)
Granuloma inguinale
7
Q
What other genitourinary infections?
A
pelvic inflammatory disease
genital warts
8
Q
What is the most common STI in men and women?
What is it characterized by?
What is it classified as?
A
Urethritis and cervicitis
Urethral inflammation
Gonococcal and nongonococcal urethritis
9
Q
How should treat urethrtisis and cervicits?
A
Antibiotics for N. gonorrhoeae (50-90% cause of infection)
Antibiotics for chlamydia trachomatis (commonly occurs with N. gonorrhoae)
10
Q
What are all the bacteria that cause urethritis and cervicitis?
A
Chlamydia trachomatis (20-50%) Ureaplasma urealyticum (20-80%) Mycoplasma genitalium (10-30%) Trichomonas vaginalis (1-70%)
11
Q
What is this: gram-neg non motile non spore forming diplococci oxidase positive Does this present extracellularly or intracellulary? How do you culture it?
A
N. Gonorrhoeae
intracellularly in the PMN
-fastidious, requiring CO2, special media, inhibited by fatty acids (such as on cotton swabs)
12
Q
What are the clinical features of urethritis and cervicits: what sex does it affect? How is it transmitted? What is the incubation period? What are the symptoms in males?
A
Affects urethra in both sexes.
Transmission – sexual contact; during birth (eye involvement)
Incubation period: 2-5 days.
Intense burning sensation, fever and malaise.
In men urethritis is characterized by either clear, mucopurulent or purulent urethral discharge.
13
Q
Men with gonococcal urethritis has a (blank) discharge and (blank) percent of males are mild or asymptomatic while (blank) percent of females may be asymptomatic
A
purulent discharge
15%
50%
14
Q
What is the primary site of gonococcal infection in a female? what are the symptoms in a female?
A
Primary site - endocervical canal Symptoms of urethritis includes: - Discharge - scanty, mucopurulent cervical discharge. - Vaginal pruritus - Dysuria
15
Q
What are the complications of N. gonorrhoeae urethritis or cervicitis?
A
- Disseminated gonococcal infection (DGI)
- Acute arthritis-dermatitis syndrome
- Gonococcal arthritis
- Endocarditis (uncommon)
- Meningitis (rare)
16
Q
All men suspected of urethritis should be tested for (blank and blank).
Diagnostic approaches in men begin with distinguishing patients who have urethral discharge: (blank discharge vs blank discharge)
If you have n. gonorrhea what will the gram stain of the urethra secretions show, and is this a good test?
A
gonorrhea and Chlamydia.
mucopurulent or purulent.
gram-negative diplococci: >90% sensitive in symptomatic men
17
Q
Why dont you gram stain the cervix to check for N gonorrhaea? What are other tests you can use?
A
cuz there are other gram neg bacteria in there so this isn’t helpful
PCR, other nucleic acid amplification testing
Culture (less common now than moleculartesting)
18
Q
What is the Tx for n. gonorrhea?
A
Ceftriaxone (for N. gonorrhoeae) in combo with azithromycin or doxycycline (for C. trachomatis cuz its common)
- abstain for sexual activity
- undergo other STD tests and HIV
19
Q
IN MEN:
C. trachomatis will cause what diseases locally?
Complications?
Sequelae?
A
locally: -Conjunctivitis -Urethritis -Prostatitis Complications: -Reiter’s syndrome -Epididymitis Sequelae: -Chronic arthritis (rare) -Infertility (rare)
20
Q
IN WOMEN:
C. trachomatis will cause what diseases locally?
Complications?
Sequelae?
A
Locally: Conjunctivitis Urethritis Cervicitis Proctitis Complications: Endometritis Salpingitis Perihepatitis Reiter’s syndrome Sequelae: Infertility Ectopic pregnancy Chronic pelvic pain Chronic arthritis (rare)
21
Q
IN INFANTS:
C. trachomatis will cause what diseases locally?
Complications?
Sequelae?
A
Locally: Conjunctivitis Pneumonitis Pharyngitis Rhinitis Complications: Chronic Lung disease Sequelae: rare if any
22
Q
C trachomatis is gram (blank). Obligate (intracellular/extracellular) bacteria that preferentially infects (blank) epithelium.
What is the incubation period?
What will this cause?
What are the symptoms like in urethritis caused by c. trachomatis?
A
negative
intracellular (i.e needs living cells to grow)
squamo-colomunar epithelium
-1-3 weeks
-urethritis and post-gonnococal urethritis
-Low grade urethritis with moderate mucoid or mucopurulent urethral discharge & variable dysuria.
Subclinical urethritis are also common.
23
Q
Cervix as 2 types of cells, what are these?
A
flat, squamous cells and glandular cells, which secrete mucus
24
Q
Cervicitis is the inflammation of cervix, which is caused by (blank and blank).
What are the 2 types?
What are the distinct signs of acute cervicits?
A
gonorrhea and chlamydia
acute and chronic
-purulent and mucopurulent endocervical exudate visible in the endocervical canal, sustained cervical bleeding, discharge and bleeding
25
How do you diagnose cervicitis?
gross evidence of purulent material from an inflamed cervix AND 10 or more polymorphonuclear (PMN) leukocytes per microscopic field (oil immersion).
26
What are the main symptoms of chronic cervicits? What are other signs
leukorrhea-> purulent-variable in color
- bleeding, itching, irritation in the external genital; pain during intercourse.
- Cervical polyps (small, smooth, red, fingerlike growth in the passage extending from the uterus.)
27
What are the diseases characterized by vaginal dishcarge?
Bacterial Vaginosis
Trichomonasis
Vulvovaginal Candidiasis
28
(blank) discharge accounts for approx. 6-10 millions office visits per year.
Characterized by a vaginal discharge and/or vulvar itching and irritation and vaginal odor.
Since vaginits and cervicitis cause discharge, how can you tell the difference?
Vaginitis
| pH and microscopic exam of discharge
29
What is this:
A condition where the normal balance of bacteria in the vagina is disrupted and replaced by an outgrowth of certain bacteria. It is accompanied by discharge, odor, pain, itching and burning.
Bacterial vaginosis (BV)
30
How do you diagnose BV?
- Presence of clue cells (epithelial cell with bacteria present)
- Elevated pH
- + KOH test
- White discharge on vaginal wall
31
How do you transmit BV?
What is the most causative agent? How does this affect your pH? Why do you get a foul smelling vagina?
How can you diagnose it?
sexually (more common) and non sexually
- Gardnerelle vaginalis
- increases pH DUE TO DECREASED LACTOBACILLI
- overgrowth of anaerobes ass. with increased enzyme breakdown of vaginal peptides into amines, which cause malodors.
Diagnosis:
Wet mount evaluation (20% of cells are clue cells (vaginal ells with indistinct borders)
Culture of the vaginal secretions
DNA probe
32
What is this:
diffuse, malodorous, YELLOW GREEN FROTHY vaginal discharge with vular irriation( patchy redness) dysuria. Increased pH of vagina
-colonizes male urethra ais is mostly asymptomatic, but can cause NGU
What causes it?
HOw do you diagnosis?
trichomonas vaginalis
Diagnosis:
-culture, rapid assays, pap smear, DNA probes
33
What is this:
Symptoms include pruritis, dysuria, and thick curdy discharge (10-20% are asymptomatic)
What causes this?
Is it sexually transmitted?
Vulvovaginal candidasis
C. albicans (80-90%), C glabrate and C tropicalis too
NO
34
How do you diagnosis vulvovagina candidiasis?
| How do you treat?
```
KOH wet mount (97% specific) w/ hyphae or spores
Vaginal cultures (for recurrent symptoms ie. 4 or more infections a year)
oral and topical therapies = effective
```
35
What are the four diseases characterized by ulcerations and what causes them?
Chancroid: Haemophilus ducreyi
Syphilis: Treponema pallidum
Genital HSV Infections: HSV-2 and HSV1
Granuloma inguinale: Klebsiella granulomatis
36
If you have rashes on your palms and sole of feet and balding what do they have?
syphilis
37
What is this:
Rare in U.S.
Over 25 cases reported in the US in 2008.
Caused by Haemophilus ducreyi (difficult to isolate).
A papule develops initially but goes on to erode into a painful ulcer.
Chancrois
38
```
What stage of syphilis is this:
acute menignitis
menigovascular
general paresis
tabes dorsalis
gumma
```
tertiary
39
What stage of syphilis is this:
| Rash, fever, malaise, lymphadenopathy, mucus lesions, conydloma, alopecia, meningitis, headaches
Secondary
| incubations period is 2-6 months
40
What stage of syphilis is this:
| chancre, regional lymphadenopathy
primary
41
What is this:
| fulminant disseminated infection, mucocutaneous lesions, osteochondritis, anemia, hepatosplenomegaly, neurosyphilis
congenital syphilis early
42
What is this:
interstitial keratitis, lymphadenopathy, hepatosplenomegaly, bone involvement, condylomata, anemia. Hutchinsonian teeth, eight nerve deafness, recurrent arthropathy, neurosyphilis
Late congenital syphilis
43
how does syphilis progress? How is it transmitted?
What stages are syphilis most contagious?
What is an important at risk population?
In stages and may beome chronic w/out tx caused by treponema pallidum
- sexual (via skin and mucous membranes) and vertical (transplacentally)
- primary and secondary
- gay men and blacks
44
what is the etiologic agent of syphlis?
What is its shape? is it motile?
Can you culture or look at it?
treponema pallidum
corkscrew shaped, motile microaerophilic bacterium
cannot be cultured in vitro and can be viewed with DARKFIELD microscopy
45
How does T. pallidum (syphilis) disseminate?
-travels via circulatory system and lymphatics
and
-Can invade CNS
46
What is this:
Primary lesion or "chancre" develops at the site of inoculation. Regional lymphadenopathy (classically rubbery, painless bilateral)
What does the chancre progress to? Is it contangous? Is it painful? How long does it take for chancre to heal?
What will a serologic test show?
Primary syphilis
- Macule to papule to ulcer (multiple lesions can occur)
- highly infectious
- painless
- 3 to 6 weeks
may not be postive during early primary syphilis
47
In secondary syphlis, secondary lesions occur over (blank) after the primary chancre appears and may persist for weeks to months. Primary and secondary stages may (blank).
(blank) lesions are most common. What are the clinical manifestations? What will a serologic test show?
several weeks
overlap
mucocutaneous
- Rash (75-100%)
- Lymphadenopathy (50-80%)
- Mucous patches (6-30%)
- Condylomata lata (10-20%)
- Alopecia (5%)
-Usually higest in titer during this stage
48
What are all the rashes you can get in secondary syphilis?
- papulosquamos rash
- palmar/plantar rash
- generalized body rash
- papulo-pustular rash
- condylomata late
- nickel/dime lesions
49
What type of syphilis is this:
Host suppresses infection, but no lesions are clinically apparent
How can you tell it is present?
When does it occur?
What are the 2 catergories of latent syphilis?
latent syphilis
pos serologic test
b/w primary and secondary stages, between secondary relapses, and after secondary stages
-Early latent: 1 year duration
50
Neurosyphilis occurs when T. pallidum invades the CNS. What stage of syphillis does this occur? Early neurosyphilis occurs a few months to a few years after infection, the clinical manifestations of this can include (blank x 3)
any stage (may be asymptomatic)
-early: acute syphilitic meningitis, meningovascular syphilis, and ocular involvement
51
Neurologic syphilis involvement can occur decades after infection and is rarely seen, the clinical manifestations of this are (blank x 3)
general paresis, tabes dorsalis, and ocular involvement
52
Ocular involvement can occur when in neurosyphilis? If you have spirochetes in a SILVER STAIN in neural tissues what do you have?
early or late
| neurosyphilis
53
App. 30% of untreated syphilis patients progress to the teritiary stage within (blank) years. Why is this rare?
What are the clinical manifestations of this?
1-20
antibiotics
gummatous lesions
CV syphilis
54
What can congenital syphilis lead to?
| When does transmission occur?
stillbirth
neonatal death
deafness, neurologic impairment and bone deformities
-during any stage of syphilis (risk is higher during primary and secondary) and during any stage of pregnancy
55
There is a wide spectrum of severity associated with congenital syphilis. What lesions are more common, early or late lesions, who gets these and how are they characterized?
Who do late lesions present in and what are they characterized by?
most common-early lesions, infants 2 years old; tend to be immunologic and destructive
56
What are some common findings in congenital syphilis?
mucous patches
Hutchinson's teeth
perforation of palate
57
What are the 2 types of serologic tests for syphilis?
treponemal (qualitative)
nontreponemal (qualitative and quantitative)
Need both for diagnosis
58
What are the principles of nontreponemal serologic tests?
What do high titers indicate?
What are the specific test names?
The nontreponemoal serologic test may show (blank) activity
- antibody against cardiolipinlecthin cholesterol antigen
- increased disease activity
- VDRL, RPR
- "serofast"
59
What are the advantages to nontreponemal serologic tests?
Rapid and inexpensive
Easy to perform and can be done in clinic or office
Quantitative
Used to follow response to therapy
Can be used to evaluate possible reinfection
60
What are the disadvantages to nontreponemal serologic tests?
May be insensitive in certain stages
False-positive reactions may occur
Prozone effect may cause a false-negative reaction (rare)
61
What are the principles of treponemal serologic tests?
| What are the treponemal tests?
- measures antibody against T. palidum antigens
- qualitative
- reactive for life
- shouldnt be used to assess tx response
TP-PA, FTA-ABS, EIA
62
What are the most sensitive tests for all stages of syphilis?
RPR
FTA-ABS
EIA
63
What is the criteria for early latent syphilis?
MUST have the symptoms below within the year prior to evaluation:
- doumented seroconversion or 4 fold increase in comparison with a serologic titer
- unequivocal symptoms of primary or secondary syphilis reported by patient
- contact to an infectious case of syphilis
- only possible exposure occured within past 12 months
64
Patients with latent syphilis of unknown duration should be managed (Blank) as if they have late latent syphilis
clinically
65
What are the public health laws about syphilis?
requires that all cases of syphilis must be reported to the state/local health department
66
CNS diseases can occur during (blank) stage of syphilis. (blank) is effective for the vast majority of immuno-competent patients with asymptomatic CNS involvement in primary and secondary syphilis
any
| Conventional therapy
67
Patients with syphilis who demonstrate any of the folowing criteria should have a prompt CSF evaluation:
-(blank X 4)
- neurologic or opthalmic signs or symptoms
- evidence of active tertiary syphilis (e.g. gummatous lesions)
- treatment failure
- HIV infection with a CD4 count < 350 and/or a nontreponemal serologic test titer of >1:32
68
T or F
| a test can be used alone to diagnose neurosyphilis
F
| NO test can be used to diagnose neurosyphilis
69
Is VDRL-CSF, specific or sensitive?
highly specific, but insensitive
70
Diagnosis of CNS disease caused by syphilis depends on what factors?
- Reactive serologic test results
- Abnormalities of CSF cell count or protein
- A reactive VDRL-CSF with or without clinical manifestations
71
In diagnosis of CNS disease caused by syphilis, the CSF leukocyte count is (blank) in patients with neurosyphilis
elevated (>5 WBCs)
72
The (blank) is the standard serologic test for CSF and when reactive in the absence of contamination of the CSF with blood, it is considered diagnostic of neurosyphilis.
VDRL-CSF
73
Syphilis and (blank) infections commonly coexist. Clinical course is similar to non-HIV-infected patients.
HIV
74
People with HIV and syphillis, can sometimes have unusual serologic responses. If clinical suspicion of syphillis is high and the serologic tests are negative, then use other test such as (blank). How do you treat it?
biopsy of the lesion or rash
| conventional therapy
75
What is the therapy for primary, seconary, tertiary and early latent syphilis? What if they are allergic to this medication?
Benzathine penicillin G IM in a single dose
- Doxycycine (2x daily)
- tetracycline (4X daily)
76
What is the therapy for neurosyphilis?
IV aqueos crystalline penicillin G
Or
Procaine penicillin IM + probenecid
77
How do you treat syphilis in pregnancy?
Penicillin
| -if pnts are allergy they should be skin sensitized and then give penicillin
78
What is a Jarisch-Herxheimer reaction?
| Is it an allergic reaction to penicillin?
self-limited reaction to antitreponemal therapy that occurs 24 hours after therapy
(fever, malaise, N/V, may be associated with chills and exacerbation of secondary rash)
NO
79
Jarish-Herxheimer reactions are more frequent after treatment with (blank) and treatment of (Blank). How do you manage symptoms of Jarisch Herxheimer reaction?
penicillin
early syphilis
-antipyretics (cant prevent this reaction)
80
Pregnant women should be informed of the possiblity of getting a Jarish-Herxheimer reaction because it can (Blank) labor and should call an obstetrician if problems develop
precipitate early labor
81
HIV infected persons with primary, secondary and early latent shyphilis should receive a single IM dose of (blank). Pencillin allergic patients with syphillis and HIV whose compliance cannot be ensured should be (blank) and treated with (Blank)
benzathine pencillin
| desensitized and treated with penicillin
82
For neurosyphilis, repeat (blank) exmination at 6 month intervals until normal
CSF
83
Indications of probable treatment failure for syphillis or reinfection include,,,?
What should you do next?
- persistent or recurring clinical signs or symptoms
- sustained 4 fold increase in titer
- titer fails to show a 4-fold decrease within 6-12 months
Retreat and re-evaluate for HIV infection
CSF exam can be considered
84
How should you treat partners of a syphilis pnt in any stage?
draw syphilis serology
| perform physical exam
85
For sex partners of patients with primary, secondary, or early latent syphilis, how do you treat them? What are the exceptions?
treat presumptively as for early syphilis at the time of exam
-nontreponem test result is known and negative and the last sexual contact with the patient is > 90 days prior to exam
86
How should you screen pregnant women?
- first prenatal visit
- if in high prevalence communities or patients at risk, test twice during the third trimester, at 28 weeks and at delivery, in addition to routine early screening
87
Any woman who delivers a still born infant after (blank) weeks gestation should be tested for syphilis
20
88
(blank) is the most common cause of genital ulceration worldwide.
Increase in relative prevalence of genital herpes in developing countries is probably due to high rates of (blank) and associated immunosuppression.
Genital herpes
| HIV infection
89
How do you get genital HSV infection? Where do you have HSV latency?
Mucocutaneous infection; retrograde migration along sensory nerves
In dorsal root or trigeminal ganglia
90
HSV-(blank): most infections are orolabial, 20% genital
| HSV-(blank): almost always genital infection, orolabial rare
1
| 2
91
```
Primary infection of Genital herpes:
80-90% is due to HSV (blank)
The incubation period is (short/long)
What does genital herpes look like?
Is the first episode mild or severe?
```
- 2
- short
- Erythema, blisters, ulcerations
- Severe
92
What is this:
multiple painful vesicles, shallow ulcers, heals in 2-3 weeks
What will recurrence of genital herpes look like and what percent of pnts get this?
What will increase reactivation?
Primary infection of genital herpes
Less severe lesions
80%
HIV infection or immune suppression
93
What are the features of a primary HSV-2 infection:
how long does it last?
does it have mucosal involvement and are there a lot of lesions?
is lymphadenopathy common?
Systemic symptoms?
Headache?
- 3 weeks illness
- multiple lesions, mucosal involvement
- pain may be severe
- lymphadenopathy is common
- systemic symptoms are common
- headache is common: viral meningitis may occur in primary genital infections
94
```
In recurrent genital herpes:
how long does it last?
are there a lot of lesions?
is there mucosal involvement?
Is lymphadenopathy common?
are systemic symptoms common?
```
```
5-10 days
fewer lesions
mucosal involvement is uncommon
Lymphadenopathy is uncommon
systemic symptoms are uncommon
```
95
Mean number of outbreaks in first year after initial genital HSV infection:
Men- (blank) outbreaks/year
Women- (blank) outbreaks/year
What happens to this rate as time goes on?
Rates are lower in HSV (Blank) infection.
HSV 2 shed virus (Blank), more in the first year after infection.
Viral (blank) is responsible for most transmission
5. 2
4. 0
rate declines over time
1
subclinically
shedding
96
How do you diagnose genital herpes?
- Tzanck smear is insensitive (~50%)
- direct immunofluorescence
- culture
- PCR (distinguishes HSV1 and HSV2)
- type specific serology (ELISA and Western blot)
97
Primary and recurrent infections of genital herpes are treated with antiviral agents (blank x 3)
- Ayclovir
- Valaciclovir
- Famciclovir
98
What causes resistance of acyclovir to genital herpes/
mutations in the tymidine kinase gene
(thymidine kinase catalyzes the conversion of deoxythymidine (THM) to deoxythmidine 5 phosphate (THMP) with the conversion of ATP to ADP)
99
(blank) is a genital ulcerative disease caused by intracellular gram negatie bacteriume (Blank)
Granuloma inguinale
| Klebsiella granulomatis
100
Granuloma inguinale is rare in US and endemic in tropic and subtropical developing countries. Spreads through (blank)
sexual contact (vaginal or anal)
101
What is this:
Characterized by painless, slowly progressive ulcerative lesions on the genitals and perineum without regional lymphadenopathy.
Painless lesions, highly vascular and bleed easily on contact.
Granuloma inguinale
102
Symptoms of granuloma inguinale occurs (blank) weeks after contact with bacterium. Based on symptoms, small (Blank) on genitals. In the beginning it is hard to differentiate from chancroid. Culutre of tissue samples and use (blank) for treatment
1-12 weeks
small beefy red bumps
antibiotics
103
(blank) comprise a spectrum of inflammatory disorders of upper female genital tract.
10-20% women with gonorrheal or chlamydial infection develop this.
Pelvic Inflammatory Disease
104
Pelvic inflammatory disease usually refers to ascending infection from (Blank). Other agents causing (blank and blank) can cause PID
cervix/vagina
vaginosis and urethritis
105
What are the symptoms of PID? What can this lead to?
low fever, abdominal pain, unilateral and bilateral.
Uterine tenderness of pelvic exam
-infertility
106
How do you diagnose and treat PID?
-endocervical discharge test for N. gonorrhoeae and C. trachomatis
-broad spectrium antimicrobial, oral in mild cases and IV in severe cases and rest from 1-3 days
Abstain from sex
107
What is the most commonly acquired STD affecting 50-70% sexually active men and women? what are the causes of genital warts? Cervical warts?
genital warts - HPV 6/11
cervical warts - HPV 16/18
Treating HPV related genital warts may reduce infectivity but will not eliminate it
108
How do you screen for genital warts?
Pap smear (papanicolaou test)
cytology
HPV based DNA testing
109
Start to screen (Pap smear) for HPV-related cervical lesions in (blank) women.
Perform cervical cytology screening in women under age (blank) on annual basis.
Repeat HPV DNA testing and cervical cytology testing at (Blank) months in women who are high risk HPV DNA positive.
sexually active
30
6-12
110
What are the symptoms of genital or cutaneous warts?
pruritis, burning, vaginal bleeding and post-coital bleeding.
Frequent recurrences.
Warts may be pigmented, fixed to underlying tissues
111
HPV vaccine is approved for use in me and women. It is recommended it people ages (blank) and it is a 3 series vaccine (0,1-2, 6 months)
Is it effective?
Targets?
11-12
efficacy 90+ percentile for reduction of type specific dysplasia
Targets: primary capsid proteins on HPV 6/11 and 16/18
112
```
What is the structure of HPV?
How many diff types are there?
Which are anogenital?
What cause the
majority of worldwide cervical cancers?
What cause external anogenital warts?
```
```
nonenveloped double stranded DNA virus
>100 types identified
-30-40 anogenital
-16 and 18
-6 and 11
```
113
HPV is most commonly associated with which types of cancer?
- cervical
- nonmelanoma skin/cutaneous squamos cell
- anal
- vulvar
114
Give me the timeline of HPV infection turning into invasive cancer
-transient infection less than 1 year-> persistent infection (2-5 years)-> low grad dysplasia CIN I (4-5 years)-> high grade dysplasia CIN 2-3 years -> (9-15 years)-> invasive cancer
115
What is this:
| area of immature metaplasia between the original and current squamocolumnar junction (SCJ).
Cervical transformation zone
116
99% of HPV-related genital cancers arise within the (blank)
transformation zone of the cervix
117
HPV (blank) responsible for >90% of anogenital warts
Peak prevalence:
Women (blank) years of age
Men (blank) years of age
6 and 11
20–24
25–29
118
Genital warts have an infectivity greater than (Blank). UP to 40% spontaneously remit. Treatment can be painful and embarrassing.
75%
119
How do you treat genital warts?
- patient applied-imiquimod
| - provider applied-podophyllin resin and TCA
120
How does imiquimod work?
cell-mediated immune response modifier-induce interferon production
121
How does podophyllin resin work?
it is cytotoxic and antimitotic
122
What are the surgical treatments for genital warts?
- cryotherapy: destruction by thermal induced cytolysis
- excision
NOTE: choice of therapy is based on the number, size and site of lesions
123
Individuals infected with STD are 2-5 fold more likely to acquire (blank) if they are exposed to virus through sexual contact.
Individuals with STI and HIV are more likely to do what?
They are have increased susceptibility to (blank) and increased (blank)
HIV infection
transmit HIV
syphilis, herpes, chancroid due to genital ulcers having a break in genital tract lining
infectiousness
124
Lymphogranulom venereum is a sexually transmiited infection caused by a different serotype of (blank)
C. trachomatis
125
(blank) starts as a small painless sore on the penis, vagina, or rectum. Pain may last for 30 days followed by swollen, painful lymph nodes in the groin area.
(blank) may occur which appears 2-6 weeks after infection. Infection can cause (blank and blank) pain. Where is it most common?
Lymphogranuloma venereum
anal bleeding
diarrhea and abdominal pain
tropics and sub tropics and up to 6% STD in Africa and Southeast Asia.
126
Diagnosis of Lymphogranuloma venereum is based on what symptoms?
What will a biopsy of a lymph node possibly show?
What are commonly used antibiotics on this?
an oozing, abnormal connection in the rectal area.
Swollen lymph nodes in the groin.
Swelling of the vulva or labia in women.
chlamydia
tetracycline,
doxycycline, erythromycin.
