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PHRM 835 > Sexually Transmitted Diseases > Flashcards

Sexually Transmitted Diseases Flashcards

1
Q

Ways Sexually transmitted diseases facilitate HIV transmission

A
  • Disruption of epithelial/mucosal barriers
  • Increase the number of HIV target cells in the genital tract
  • Increase the expression of HIV co-receptors
  • Induce secretion of cytokines (increase HIV shedding)
  • HIV alters the natural history of some STDs
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2
Q

STDs of concern can be classified as

A
  • Sores
  • Drips
  • Other
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3
Q

Sores (ulcers)

A
  • Syphilis

- Genital herpes

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4
Q

Drips (discharges)

A
  • Gonorrhea
  • Chlamydia
  • Nongonococcal urethritis/mucopurulent cervicitis
  • Trichomonas vaginitis/urethritis
  • Bacterial vaginosis
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5
Q

Other major concerns

A

Genital HPV and cervical/anal/oral cancer

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6
Q

Gonorrhea causative agent

A

Neisseria gonorrhea

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7
Q

Neisseria gonorrhea

A
  • Gram negative diplococcus
  • Intracellular parasite
  • Humans are only known host
  • Grows in warm, moist areas of the reproductive tract and in mouth, throat, anus and eyes
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8
Q

Is gonorrhea curable?

A

It is curable

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9
Q

Onset of gonorrhea in men

A

1-14 days after infection, some have no symptoms but men are more likely to have symptoms

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10
Q

Site of infection of gonorrhea in men

A

Urethra, rectum, oropharynx, and eyes

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11
Q

Signs and symptoms of gonorrhea in men

A
  • Purulent urethral or rectal discharge
  • Burning sensation when urinating
  • Painful and swollen testicles
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12
Q

Complications of gonorrhea in men

A
  • Rare b/c signs and symptoms will lead men to treatment
  • Epididymitis
  • Postatitis
  • Urethral Stricture
  • Inguinal lymphadenopathy
  • Disseminated gonorrhea
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13
Q

Onset of gonorrhea in women

A

Most women have no symptoms; if symptoms occur they are often mild

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14
Q

Site of infection of gonorrhea in women

A
  • Endocervical canal

- Rectum, oropharynx, eye

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15
Q

Signs and symptoms of gonorrhea in women

A
  • Painful, burning sensation when urinating

- Abnormal vaginal discharge, uterine bleeding

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16
Q

Complications of gonorrhea in women

A
  • 30-60% do not have recognizable symptoms until complications occur
  • Pelvic Inflammatory disease
  • Fitz-High-Curtis syndrome
  • Disseminated gonorrhea
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17
Q

Pelvic inflammatory disease

A
  • Occurs in 15% of women

- Can lead to infertility and ectopic pregnancy

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18
Q

Fitz-High-Curtis syndrome

A

can lead to perihepititis

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19
Q

Disseminated Gonococcal Infection (DGI) classic presentation

A
  • Joint / Tendon Pain with Low-Grade Fever (< 39°C)
  • Migratory Polyarthralgia, especially of the Knees, Elbows, and Distal Joints
  • Tenosynovitis
  • Dermatitis
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20
Q

Disseminated Gonococcal Infection (DGI) second stage

A
  • Septic arthritis
  • Knee most common affected joint
  • Typically, skin lesions disappear, and blood cultures come back negative
  • RARELY progresses to Meningitis and Endocarditis
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21
Q

How to diagnose gonorrhea?

A
  • Gram stain smear
  • Culture
  • Nucleic acid hybridization test
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22
Q

Gram stain smear for gonorrhea diagnosis

A
  • Positive when gram negative diplococci are identified within PMNs
  • In men with symptomatic urethritis, highly sensitive and specific
  • Specific but insensitive for endocervical, pharyngeal or rectal specimens
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23
Q

Culture for gonorrhea diagnosis

A

most reliable in non-symptomatic pts and for specimens from rectum or pharynx

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24
Q

Treatment for Uncomplicated Gonococcal Infections of the Cervix, Urethra, Pharynx and Rectum

A

Ceftriaxone 500 mg IM in a single dose

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25
Q

Is chlamydia curable?

A

It is curable

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26
Q

Chlamydia causative agent

A

chlamydia trachomatis

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27
Q

Background info of chlamydia

A
  • Most common cause of bacterial STDs
  • Typically co-infection with gonorrhea
  • Associated with a 5-fold increased risk of acquiring HIV
  • Causes genital, ocular, pharyngeal, and rectal infections
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28
Q

Onset of chlamydia in men

A

7-21 days

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29
Q

Signs and symptoms of chlamydia in men

A
  • Over 50% of infections are asymptomatic
  • Urethra:mild dysuria, discharge
  • Rectum: bleeding, pain and discharge
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30
Q

Complications of chlamydia in men

A

Epidydmitis and reiter’s syndrome

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31
Q

Onset of chlamydia in women

A

7-21 days

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32
Q

Signs and symptoms of chlamydia in women

A
  • Over 66% of infections are asymptomatic
  • Cervix: abnormal discharge and bleeding
  • Rectum: bleeding, pain and discharge
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33
Q

Complications of chlamydia in women

A
  • Pelvic inflammatory disease

- Reiter’s syndrome

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34
Q

Neonatal chlamydia infections

A
  • Transmitted to infant by infected cervicovaginal secretions
  • 50% develop neonatal conjunctivitis
  • 16% develop pneumonia
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35
Q

How to diagnose chlamydia?

A

DNA amplification

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36
Q

DNA amplification

A
  • Nucleic acid ampplification tests
  • Can detect small amounts of DNA
  • Highly sensitive 96% and specific >98%
  • Vaginal, cervical, or urethral swabs or first void urine
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37
Q

Treatment of chlamydia

A
  • Doxycycline 100 mg PO BID x 7 days

- Azithromycin 1 gm PO x 1 dose

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38
Q

Which treatment is preferred for gonorrhea?

A

Doxycycline had better outcomes in patient with anal chlamydia so it is preferred

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39
Q

Is syphilis curable?

A

It is curable

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40
Q

Syphilis causative agent

A

Treponema pallidum, a spirochete bacterium

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41
Q

Syphilis background information

A
  • Highly contagious

- Associated with an increased risk of HIV

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42
Q

Syphilis routes of transmission

A
  • Sexual contact
  • Congenital-transmission from mother to child
  • Rarely by non-sexual contact
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43
Q

4 primary stages of syphilis

A
  1. Primary syphilis
  2. Secondary syphilis
  3. Latent syphilis
  4. Tertiary syphilis
44
Q

Primary syphilis

A
  • Manifests after an incubation period of 10-90 days (avg 21 days)
  • Highly contagious, but individuals are asymptomatic
  • Sore (chancre) can appear on on penis, vagina, or rectum
45
Q

Primary syphilis sores (chancres)

A
  • Can be single or multiple
  • Usually painless
  • Chancre may persist 4-6 weeks and heal spontaneously
46
Q

Secondary syphilis

A
  • MOST Contagious period; Non-Specific Symptoms
  • Results from Hematogenous (from the Blood) and Lymphatic spread
  • Characterized by skin rash; 1 – 6 months after Primary Infection
  • Non-Specific Symptoms
  • If left untreated, will disappear in 4 – 10 weeks
47
Q

Secondary syphilis skin rash infections

A
  • Symmetrical, reddish-pink, non-itchy on trunk and extremities
  • Involves the palms of the hands and soles of the feet
48
Q

Secondary syphilis non-specific symptoms

A

Malaise, Fever, Pharyngitis, Headache (HA), Weight

Loss, and Arthralgia (Joint Pain)

49
Q

Latent Syphilis

A

Positive Syphilis serology; Asymptomatic. Divided into 2 stages

50
Q

Latent syphilis early stage

A
  • Less than 1 year from Secondary Syphilis

- Infectious – 25% Mucocutaneous Relapse

51
Q

Latent syphilis late stage

A
  • More than 1 year from Secondary Syphilis
  • Generally considered non-infectious EXCEPT in Pregnancy
  • 25% of patients will Progress to Tertiary Syphilis
52
Q

Tertiary syphilis

A
  • Not infectious
  • Occurs 3 – 15 years after initial infection
  • Without treatment, 1 in 3 Syphilis patients develop Tertiary Syphilis
53
Q

Tertiary syphilis can be divided into 3 forms:

A
  1. Cardiovascular Syphilis
  2. Gummatous Syphilis
  3. Neurosyphilis
54
Q

Cardiovascular Syphilis

A

Aortic Insufficiency, Aneurysm Formation

55
Q

Gummatous Syphilis

A
  • Non-specific Granulomatous lesion

- Defined by Chronic, Destructive Lesions (Skin, Bone, Soft Tissue, Liver, and fatal if on Heart or Brain)

56
Q

What is the treatment of choice for syphilis?

A

parenteral penicillin G

57
Q

Syphilis infections that last for more than 1 year should receive?

A

3 consecutive

weekly doses if of Parenteral Penicillin G

58
Q

Treatment for Primary, Secondary, or Early Latent (< 1 year) syphilis

A

Benzanthine Penicillin G, 2.4 mU IM x 1 dose

59
Q

Treatment for Primary, Secondary, or Early Latent (< 1 year) syphilis with PCN allergy

A

Doxycycline, 100 mg, PO BID x 14 days

60
Q

Treatment for Late Latent (>1 year) or Unknown Duration syphilis

A

Benzanthine Penicillin G, 2.4 mU IM x 1 dose per week for 3 weeks (7.2 mU total)

61
Q

Treatment for Late Latent (>1 year) or Unknown Duration syphilis with PCN allergy

A

Doxycycline, 100 mg, PO BID for 28 days

62
Q

Treatment of Neurosyphilis

A

Aqueous, Crystalline Penicillin G (18 – 24 mU) daily by Continuous infusion (or 3-4 mU IV, q4h for 10 – 14 days

63
Q

Management of syphilis patients with PCN allergy

A

-Skin testing
-If Negative, administer Penicillin (PCN) regimen appropriate for the stage
of Syphilis
-If Positive, patients should be desensitized to Penicillin

64
Q

Jarisch–Herxheimer Reaction (Rxn) for syphilis

A
  • Idiosyncratic response to therapy; NOT a Penicillin allergy
  • Usually occurs with the first 24 hours after any therapy for syphilis
  • Resolves within 12–24 hours
  • Occurs most frequently among patients who have Early Syphilis
65
Q

Jarisch–Herxheimer Reaction (Rxn) for syphilis self limiting rxn’s

A

Headache, Fever, Chills, Malaise, Arthralgia, Myalgia, Tachypnea, Peripheral Vasodilation, Aggravation of Syphilic lesion

66
Q

Diagnosing syphilis

A

-Perform a blood test called TPAB – Treponema pallidum Antibody
-If Non-Reactive, a person will test Negative for Syphilis
-If Reactive, a person will progress to Reflex and yield an RPR Titer, with the
results ranging from 1-8 (highly concentrated) to 1-64 (less concentrated)`

67
Q

Is genital herpes curable?

A

It is incurable

68
Q

Causative agent of genital herpes

A

herpes simplex virus - DNA viruses whose only known hosts is humans

69
Q

Herpes Simplex Virus Type 1 (HSV-1)

A
  • Acquired in childhood and causes orolabial ulcers

- Can cause genital herpes

70
Q

Herpes Simplex Virus Type 2 (HSV-2)

A

Transmitted sexually and causes anogenital ulcers

71
Q

Pathophysiology of genital herpes

A

transmission via virus from secretions onto mucosal surface or abraded skin

72
Q

HSV life Cycle 5 stages

A
  1. Primary mucocutaneous infection
  2. Infection of the ganglia
  3. Establishment of latency
  4. Reactivation
  5. Recurrent infection
73
Q

When an outbreak of herpes has passed, is the virus still present?

A

It is only present in the nerve body

74
Q

Why is it difficult to treat herpes?

A

dormancy of virus

75
Q

Are men or women more susceptible to acquiring genital HSV-2?

A

Women are more susceptible than men

76
Q

Clinical presentation of genital herpes occur as:

A
  • First episode infections

- Recurrent infections

77
Q

First Episode infections

A
  • Treated the longest
  • Multiple painful or ulcerative lesions on external genitalia develop
  • Viral shedding lasts longer in first episode (15-16 days)
  • Women have more sever disease
78
Q

First episode ulcerative lesions

A
  • Appear 6 days after sexual contact and can last 2-6 weeks

- Contain numerous HSV particles

79
Q

First episode infections for women

A
  • Cervical ulcerative lesions are common
  • Can have intermittent bleeding and vaginal discharge
  • Dysuria and urinary retention syndromes may occur
80
Q

Recurrent herpes infections

A
  • 50% of pts will have prodrome: mild burning, itching, or tingling
  • Fewer, localized lesions
  • Duration of infection is shorter and symptoms are milder
  • Viral shedding occurs at lower concentration for 3 days
81
Q

Which typer of genital herpes is more sever and higher rate of occurance

A

HSV-2

82
Q

Complications with genital herpes

A
  • Result from genital spread or autoinoculation to eye, rectum, pharynx, fingers
  • CNS infections can occur
  • Neonatal herpes
83
Q

Neonatal herpes

A
  • Exposure to HSV in birth canal
  • Risk is greater for first episode infections
  • Mortality rate of 50%
  • Significant morbidity including permanent neurologic damage
84
Q

How to diagnose herpes?

A
  • Tissue culture
  • Serological tests
  • PCR
85
Q

Tissue culture for herpes diagnosis

A

most specific and sensitive for first episode genital herpes

86
Q

Serological tests for herpes diagnosis

A

require seroconversion before tests can differentiate between HSV-1 and HSV-2

87
Q

PCR for herpes diagnosis

A
  • More sensitive than tissue culture

- Choice for CNS infections

88
Q

Treatment of initial episode of genital herpes

A

administered within 24 hours of appearance of first lesion

89
Q

Treatment of episodic genital herpes

A
  • Administered within 24 hours of appearance of first lesion

- Patients with prolonged episodes or severe symptoms may benefit

90
Q

Treatment of suppressive genital herpes

A
  • Benefit of reducing vial shedding and risk of transmission

- Reduces frequency of recurrences by 70-80% in patients with >6 occurrences a year

91
Q

First episode therapy

A

Acyclovir / Valacyclovir / Famciclovir for 7-10 days

92
Q

Episodic Therapy

A

Acyclovir / Valacyclovir / Famciclovir for 1-5 days

93
Q

Suppressive Therapy

A

Acyclovir / Valacyclovir / Famciclovir (#30 11 refills)

94
Q

Most common viral STD in the US

A

Human Papillomavirus (HPV)

95
Q

Symptoms of HPV

A
  • Most pts have subclinical disease
  • <1% have visible warts
  • Warts occur on penis, scrotum, perianal skin, uterine cervix, vagina, urethra, anus, mouth
96
Q

Goal of treatment of HPV warts

A

Removal, can spontaneously resolve

97
Q

Patient applied therapies for HPV warts

A
  • Podofilox 0.5% solution or gel
  • Imiquimod 3.75% or 5% cream
  • Sinecatechins 15% ointment
98
Q

Provider administered therapy for HPV warts

A
  • Cryotherapy
  • Trichloracetic acid or bichloroacetic acid 80-90%
  • Surgical removal
99
Q

G.M. is a 26-year-old female who presents after a mild febrile illness with painful vesicular lesions on her labia. This is the first time she has had this illness. She states that she has had sex 6 times in the past 2 months with 2 different men and a woman, none of which had any lesions that she knew of. She denies any discharge or itching.

This patient’s presentation most likely represents which STD?
A. Herpes
B. Gonorrhea
C. Chlamydia
D. Human Papillomavirus (HPV)
E. Syphilis
A

A. Herpes

100
Q

Mary K presents to the Public Health Clinic with thick, cheesy looking, foul
smelling, vaginal discharge. She had several partners in the last week, and did not practice “safe sex” every time. A vaginal discharge Gram-Stain is performed and reveals Gram-Negative diplococci.

While awaiting further results, what would be the most appropriate empiric treatment for Mary K?

A. Acyclovir, 400 mg, PO TID for 10 days
B. Ceftriaxone, 250 mg, IM x 1 + Azithromycin, 1 g, PO x 1
C. Azithromycin, 1 g, PO x 1
D. Ceftriaxone, 2 g, IV q24h
E. Valacyclovir, 1 g, PO BID for 7 days
A

B. Ceftriaxone, 250 mg, IM x 1 + Azithromycin, 1 g, PO x 1

101
Q

CS is a 26-year-old complaining of a non-painful sore on his penis. He
noticed it about 3 weeks ago and though nothing of it. It is not going away and now he’s worried as he recently had sex with a new partner

What’s the most likely diagnosis?

A

Syphilis

102
Q

CS is a 26-year-old complaining of a non-painful sore on his penis. He
noticed it about 3 weeks ago and though nothing of it. It is not going away and now he’s worried as he recently had sex with a new partner

What’s an appropriate therapy for him?

A

Benzanthine PCN G 2.5 mU IM x1

103
Q

CS is a 26-year-old complaining of a non-painful sore on his penis. He
noticed it about 3 weeks ago and though nothing of it. It is not going away and now he’s worried as he recently had sex with a new partner

What are the possible etiologic agents that should be considered in the
differential diagnosis?

  1. Neisseria gonorrhea / Chlamydia trachomatis
  2. Herpes Simplex Virus
  3. Treponema pallidum
A. I only
B. III only
C. I and II
D. II and III
E. I, II, and III
A

D. – II and III only

104
Q

CS is a 26-year-old complaining of a non-painful sore on his penis. He
noticed it about 3 weeks ago and though nothing of it. It is not going away and now he’s worried as he recently had sex with a new partner

The results of the laboratory tests showed the following:

Treponema pallidum Antibody: Reactive RPP titer: 1:128

What is the appropriate treatment?

A. Acyclovir, 400 mg PO TID x 10 days
B. Benzathine Penicillin 2.4 million units IM once per week for 3 weeks
C. Benzathine Penicillin 2.4 million units IM x 1
D. Ceftriaxone, 2 g IV, q24h
E. Valacyclovir, 1 g PO, BID x 7 – 10 days

A

B. Benzathine Penicillin 2.4 million units IM once per week for 3 weeks

105
Q

TD, CS’s partner from last month, comes to clinic. You take his history and
learn he hasn’t had any sores for “a long time, like, maybe 2 years.” He was never treated and he did not worry about it as the sore disappear

The results of the laboratory tests showed the following:

  1. Treponema pallidum Antibody: Reactive
  2. RPR Titer: 1:16

What is appropriate treatment?

A. Acyclovir, 400 mg PO, TID x 10 days
B. Benzathine Penicillin 2.4 million units IM once per week for 3 weeks
C. Benzathine Penicillin 2.4 million units IM x 1
D. Ceftriaxone, 2 g IV, q24h
E. Valacyclovir, 1 g PO, BID x 7 – 10 days

A

B. Benzathine Penicillin 2.4 million units IM once per week for 3 weeks

PHRM 835 (5 decks)

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