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Medicine II: OBGYN > Sexually Transmitted Diseases > Flashcards

Sexually Transmitted Diseases Flashcards

1
Q

What are the main types of STDs?

A

Chlamydia
Gonorrhea
Syphilis
Herpes

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2
Q

What is the pathogen of Chlamydia

A 
Chlamydia trachomatis (an obligate intracellular parasite
CAN BE GROWN IN TISSUE CULTURE BUT NOT ON ARTIFICIAL MEDIA
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3
Q

What is the mechanism of transmission of chlamydia?

A

Sexual Contact

Perinatal

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4
Q

What is the frequency of chlamydia?

A

most common STD in western countries
3-5x as common as gonorrhea
Prevalence varies with population

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5
Q

What are the usual clinical manifestations of chlamydia in men?

A

Urethritis- most common in all men
Proctitis- most common in gay men
Epididymitis

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6
Q

What are the usual clinical manifestations of chlamydia in women?

A 
Urethritis
Endocervicitis
Proctitis (anal intercourse)
PID
Perihepatitis (inflammation of the capsule of the liver, violent string adhesions; pelvis to the liver)
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7
Q

What is the classic clinical diagnosis of chlamydia and gonorrhea?

A

discharge from the cervix

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8
Q

How do you make a diagnosis of chlamydia?

A 
clinical examination (exudate)
culture (tissue culture; BIOHAZARD)
Nucleic acid probe- PCR or NAAT (nucleic acid amplification test)- can be done on urine
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9
Q

What is the treatment for chlamydia?

A

Patient and partner should be treated

  1. Doxycycline (100mg 2x daily for 7 days)
  2. Erythromycin (250mg (4 tablets)
  3. AZITHROMYCIN- 1000MG P.O. in a single dose (Zithromax)
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10
Q

What is the pathogen that causes Gonorrhea?

A

Neisseria gonorrhea
a gram (-) diplococcus
CAN BE CULTURED IN SELECTIVE MEDIA
Thayer-Martin Agar (inexpensive)

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11
Q

What is the mechanism of transmission of gonorrhea?

A

Sexual contact

Perinatal

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12
Q

What is the typical presentation of gonorrhea in men?

A

Urethritis (2nd most common cause)
Epididymitis
Proctitis
Pharyngitis

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13
Q

What is the typical presentation of gonorrhea in women?

A 
Urethritis (2nd most common cause)
Endocervicitis
Proctitis
PID
Pharyngitis
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14
Q

What types of problems can gonorrhea present with a disseminated infection?

A 
ARTHRITIS
DERMATITIS
Pericarditis and endocarditis
Meningitis
Perihepatitis
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15
Q

If you have a single infected joint what disease should come to mind?

A

Gonorrhea

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16
Q

How do you make a diagnosis of gonorrhea?

A

Clinical examination
Culture
Nucleic acid probe

17
Q

What is the treatment for gonorrhea?

A

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

18
Q

What are consequences of chlamydia and gonorrhea?

A

Infertility
Ectopic pregnancy
Chronic pelvic pain

Disrupts the fallopian tube cells in PID

19
Q

What is the pathogen that causes syphilis?

A

Treponema pallidum

CANNOT BE CULTURED IN VITRO

20
Q

What are the classifications of syphilis?

A

Primary (50 percent perinatal transmission)
Secondary (50 percent perinatal transmission)
Latent- early and late (40 percent perinatal transmission)
Tertiary (10 percent perinatal transmission)

21
Q

How do you diagnose syphilis?

A

Clinical examination (visible lesions)
Dark Field Microscopy
Serology (VDRL/RPR -screening test; MHA/FTA -confirmatory test)

22
Q

What are you looking for in the screening tests for syphilis?

A

Non-specific anti-body

23
Q

What is something important to remember when screening someone who may be reinfected?

A

FTA stays positive after 1st infection for life; NEED TO LOOK AT VDRL

24
Q

What is a principal clinical finding of primary syphilis?

A

PAINLESS chancre

25
Q

With what STD is the chancre painful?

A

Herpes

26
Q

What is a principal clinical finding of secondary syphilis?

A

Condyloma Latum (genital warts), lesions on the feet

27
Q

What are principal clinical manifestations of late stage syphilis?

A

DESTRUCTIVE GUMMAS
Aortic valve injury
CNS MANIFESTATIONS (dementia, tabes dorsalis- wobble posture, pupillary abnormalities- ARGOYLE ROBINSON PUPIL- doesn’t react but does accommodate)

28
Q

What are manifestations of congenital syphilis?

A 
fetal death
growth restriction
multiple anomalies (immediately apparent at birth or delayed appearance)
29
Q

What is the treatment for syphilis?

A 
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
30
Q

What are the types of herpes simplex virus?

A

HSV 1- oral herpes

HSV 2- genital herpes

31
Q

What is the classification of HSV?

A

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)

32
Q

How do you make a diagnosis of HSV?

A

Clinical examination
Viral culture (3 days)
PCR- more sensitive

33
Q

What is the progression of HSV?

A

Start as little raised red bumps, then blisters

More advanced lesions, less suitable for culture

34
Q

What is the treatment/management for HSV?

A

ACYCLOVIR- 400mg PO TID x 7 days

Valacyclovir- 1000 mg PO BID x 7 days

35
Q

What is the risk of pregnancy with HSV?

A

Patients with active lesions or prodrome at the time of labor require a cesarean delivery

36
Q

In primary care practice what is the most likely stage of syphilis at the time of diagnosis?

A

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Medicine II: OBGYN (18 decks)

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