Sexually Transmitted Diseases Flashcards
What are the main types of STDs?
Chlamydia
Gonorrhea
Syphilis
Herpes
What is the pathogen of Chlamydia
Chlamydia trachomatis (an obligate intracellular parasite CAN BE GROWN IN TISSUE CULTURE BUT NOT ON ARTIFICIAL MEDIA
What is the mechanism of transmission of chlamydia?
Sexual Contact
Perinatal
What is the frequency of chlamydia?
most common STD in western countries
3-5x as common as gonorrhea
Prevalence varies with population
What are the usual clinical manifestations of chlamydia in men?
Urethritis- most common in all men
Proctitis- most common in gay men
Epididymitis
What are the usual clinical manifestations of chlamydia in women?
Urethritis Endocervicitis Proctitis (anal intercourse) PID Perihepatitis (inflammation of the capsule of the liver, violent string adhesions; pelvis to the liver)
What is the classic clinical diagnosis of chlamydia and gonorrhea?
discharge from the cervix
How do you make a diagnosis of chlamydia?
clinical examination (exudate) culture (tissue culture; BIOHAZARD) Nucleic acid probe- PCR or NAAT (nucleic acid amplification test)- can be done on urine
What is the treatment for chlamydia?
Patient and partner should be treated
- Doxycycline (100mg 2x daily for 7 days)
- Erythromycin (250mg (4 tablets)
- AZITHROMYCIN- 1000MG P.O. in a single dose (Zithromax)
What is the pathogen that causes Gonorrhea?
Neisseria gonorrhea
a gram (-) diplococcus
CAN BE CULTURED IN SELECTIVE MEDIA
Thayer-Martin Agar (inexpensive)
What is the mechanism of transmission of gonorrhea?
Sexual contact
Perinatal
What is the typical presentation of gonorrhea in men?
Urethritis (2nd most common cause)
Epididymitis
Proctitis
Pharyngitis
What is the typical presentation of gonorrhea in women?
Urethritis (2nd most common cause) Endocervicitis Proctitis PID Pharyngitis
What types of problems can gonorrhea present with a disseminated infection?
ARTHRITIS DERMATITIS Pericarditis and endocarditis Meningitis Perihepatitis
If you have a single infected joint what disease should come to mind?
Gonorrhea
How do you make a diagnosis of gonorrhea?
Clinical examination
Culture
Nucleic acid probe
What is the treatment for gonorrhea?
Patient and partner should be treated
Drugs of choice:
Ceftriaxone (250mg IM x 1) PLUS Azithromycin (1000mg PO x 1)
This also cover Chlamydia
Azithromycin aids in the decreased impact of resistance
What are consequences of chlamydia and gonorrhea?
Infertility
Ectopic pregnancy
Chronic pelvic pain
Disrupts the fallopian tube cells in PID
What is the pathogen that causes syphilis?
Treponema pallidum
CANNOT BE CULTURED IN VITRO
What are the classifications of syphilis?
Primary (50 percent perinatal transmission)
Secondary (50 percent perinatal transmission)
Latent- early and late (40 percent perinatal transmission)
Tertiary (10 percent perinatal transmission)
How do you diagnose syphilis?
Clinical examination (visible lesions)
Dark Field Microscopy
Serology (VDRL/RPR -screening test; MHA/FTA -confirmatory test)
What are you looking for in the screening tests for syphilis?
Non-specific anti-body
What is something important to remember when screening someone who may be reinfected?
FTA stays positive after 1st infection for life; NEED TO LOOK AT VDRL
What is a principal clinical finding of primary syphilis?
PAINLESS chancre
With what STD is the chancre painful?
Herpes
What is a principal clinical finding of secondary syphilis?
Condyloma Latum (genital warts), lesions on the feet
What are principal clinical manifestations of late stage syphilis?
DESTRUCTIVE GUMMAS
Aortic valve injury
CNS MANIFESTATIONS (dementia, tabes dorsalis- wobble posture, pupillary abnormalities- ARGOYLE ROBINSON PUPIL- doesn’t react but does accommodate)
What are manifestations of congenital syphilis?
fetal death growth restriction multiple anomalies (immediately apparent at birth or delayed appearance)
What is the treatment for syphilis?
PENICILLIN- preferred, especially during pregnancy - only one proven to protect the fetus, give it even if allergic, dose depends on stage of the disease Doxycycline Tetracycline Ceftriaxone Sexual partner should be treated
What are the types of herpes simplex virus?
HSV 1- oral herpes
HSV 2- genital herpes
What is the classification of HSV?
Primary- no antibodies to either HSV 1 or 2 (bad outbreak, painful)
Initial, non-primary- antibodies to HSV 1 (mild 1st breakout)
Recurrent- antibodies to HSV 2 (milder outbreak, fewer lesions, less discomfort)
How do you make a diagnosis of HSV?
Clinical examination
Viral culture (3 days)
PCR- more sensitive
What is the progression of HSV?
Start as little raised red bumps, then blisters
More advanced lesions, less suitable for culture
What is the treatment/management for HSV?
ACYCLOVIR- 400mg PO TID x 7 days
Valacyclovir- 1000 mg PO BID x 7 days
What is the risk of pregnancy with HSV?
Patients with active lesions or prodrome at the time of labor require a cesarean delivery
In primary care practice what is the most likely stage of syphilis at the time of diagnosis?
Latent
