Sexually Transmitted Bacterial Infections

Question 1

Chlamydia trachomatis &
N. Gonorrhea

• epi
• age groups
• risk factrs

Answer 1

C and G are the two most commonly reported bacterial infections in the US

• Chlamyida – men are more aysmptomatic
• Gonorrhea – women are more asymptomatic

15-30 year olds at highest riskk
sexual risk factors
african americans

Question 2

Uncomplicated disease manifestations of Chlamydia and gonorrhea

Answer 2

Urethritis/acute urethral syndome – easier to dx in males and more likely to be chlamydia

Cervicitis –

Barthonlinitis – inflmmation of the glands lining the labia

Conjunctivitis – usually from digital contamination. A lot of purulence = gonoccoal infxn

Pharyngitis – oral sex; usually Gonorrhea

Proctitis

Question 3

complicated disease manifestations of Chlamydia and gonorrhea

males vs females

complications

Answer 3

Males : Epidydimitis – Clinically cannot determine if chlamydia or gonoccoal

Women: PID
Asymptomatic, or non sepcific lower abd pain, cervical motion tenderness; adnexal tenderness

complications:
immeidate:
perihepatitis (Fitz Hugh Curtis Syndrome),
pelvic peritonitis
Late complications of PID: pelvic pain, ectopic pregnancies; infertility

Reiter’s Syndrome (Reactive arthritis) – mostly with Chlamydia
Urethritis, conjunctiviits, reactive arthritis, skin lesions

Disseminated Gonococcal infections —Arthritis and erythematous Skin lesions; no genital symptoms;

Question 4

Dx of C & G

Answer 4

Rapid dx:
urethritis in the male (gram stain), and conjunctivitis (purulence enables gram stain).

Definitive testing by PCR

Question 5

Treatment of C & G

length of treatment: complicated vs uncomplicated

Answer 5

uncomplicated – shorter course

Complicated – longer course

30% co infection rate between the two

Gonorrhea: ceftriaxone
+
Chlamydia: azithro single dose OR 7 days of Doxy

Question 6

What are the bugs which cause the following three sexually transmitted disease:

Syphillis
Chancroid
Lymphogranuloma venereum

Answer 6

Syphllius – T. Pallidum (spirochete)

Chancroid – H ducreyi

LGV – C. trachomatis serotypes L1-L3

Question 7

Syphillis -
describe the stages of the disease?
what are the characteristic findings

Answer 7

Primary disease – painless genital ulcer

Secondary syphillis – ulcer may heal, but spirochete disseminates in the blood stream; and may manifest as diffuse Nickel and Dime Rash

Rash on PALMS and SOLES are specific for syphillis

may also be alopecia; mucocutaneous vaginal lesions

Question 8

Chancroid – manifestations of the disease?

how is this different than syphillis

Answer 8

Painful lesions of the genitalia
can have multiple which are painful and at different stages of development

Syphillis – PAINLESS

Painful (inguinal) LAD; can increase in size and rupture (bubo)

Question 9

Lymphogranuloma venereum (LGV)

manifestations of disease

Answer 9

May have initial genital ulcer
but typically heals quickly

mainly a lymphatic disease

Late stage: anal fistulas, recto vaginal fistulas, and rectal strictures

Question 10

Dx of Syph, Chancroid, LGV –

Answer 10

Syphillis: darkfield microscopy, you can look for syphilitic chancres for spirochete

Syphillis: RPR (100% sensitive for secndary syphilis)

Chancroid – gram stain “school of fish”

non rapids:
RPR, PCR, culture, serology

Question 11

Treatment for Syph, Chancroid, LGV

Answer 11

Syphillis Primary/Second: Benzathine PCN vs Doxy

Chancroid: azithro, ceftriaxone, cipro, erythromycin

LGV: Doxy

Question 12

What other test should be conducted on any persons with STDs? why?

Answer 12

HIV serology:

Treating the STD in HIV patients reduces the sheding of the HIV in the genital tract

Treating the STD Reduces suscptibility to HIV in non HIV pts