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Endo Repro Exam > Sexually Transmitted Infections 1 > Flashcards

Sexually Transmitted Infections 1 Flashcards

1
Q

STIs - epidemiology

A

*STIs are very common and very expensive
*most STIs are asymptomatic
*people of all backgrounds and economic levels affected

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2
Q

examples of bacterial STIs

A

*syphilis
*gonorrhea
*Chlamydia trachomatis
*chancroid
*agents of NGU
*shigellosis
*salmonellosis
*campylobacteriosis
*MRSA

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3
Q

examples of fungal STIs

A

*candida species
*blastomycosis

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4
Q

examples of viral STIs

A

*hepatitis (A, B, C, E)
*HSV
*HIV
*CMV
*HPV
*Kaposi’s sarcoma (HHV-8)

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5
Q

STIs - prevalence/incidence

A

*most common STI = HPV
*most common BACTERIAL STI = Chlamydia
*most common parasitic STI = Trichomoniasis

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6
Q

urethritis - clinical presentation

A

*typically presents with urethral discharge (mucoid, mucopurulent, or purulent)
-mucoid = NGU (Chlamydia)
-purulent = Gonorrhea
*often accompanied by dysuria
*asymptomatic in 10% of cases

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7
Q

urethritis - common causes

A

1. Gonorrhea
2. Chlamydia
3. Trichomonas vaginalis
4. Mycoplasma genitalium
5. Ureaplasma urealyticum
6. HSV (herpes simplex virus)
7. adenovirus

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8
Q

cervicitis - clinical syndrome

A

*clinical findings:
-mucopurulent or purulent cervical discharge
-easily induced cervical bleeding
*nonspecific symptoms: abnormal vaginal discharge, intermenstrual bleeding, dysuria, lower abdominal pain, dyspareunia
*50% of women with clinical cervicitis have no symptoms

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9
Q

cervicitis - common causes

A

1. Gonorrhea
2. Chlamydia
3. Trichomonas vaginalis
4. HSV

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10
Q

most common bacterial STI in the US

A

*Chlamydia (C. trachomatis)

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11
Q

Chlamydia trachomatis - risk factors

A

*women > men
*young age (<25) [due to risky behaviors & cervical ectopy - columnar epithelial cells on ectocervix]
*new or multiple sex partners
*oral contraceptive use (cervical ectopy)
*inconsistent use of barrier contraceptives
*history of STI
*presence of another STI

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12
Q

Chlamydia trachomatis - transmission

A

*highly transmissible (infection rates in partners > 50%)
*incubation period 7-21 days
*significant asymptomatic reservoir
*re-infection is common
*thought to be more efficient transmission from man to woman
*perinatal (vertical) transmission:
-neonatal conjunctivitis in 30-50% of exposed babies
-neonatal pneumonia in 3-16% of exposed babies

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13
Q

Chlamydia - genus & species

A

*genus: Chlamydia
*species:
1. C. psittaci → psittacosis
2. C. pneumoniae → pneumonia, bronchitis, pharyngitis
3. C. trachomatis → trachoma, oculogenital infection (Serotypes D-K), LGV

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14
Q

human diseases caused by Chlamydia trachomatis: serotypes A, B, Ba, C

A

*hyperendemic blinding trachoma

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15
Q

human diseases caused by Chlamydia trachomatis: serotypes D-K

A

*oculogenital infections:
1. inclusion conjunctivitis
2. nongonococcal urethritis
3. cervicitis
4. salpingitis
5. proctitis
6. epididymitis
7. pneumonia of the newborn

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16
Q

human diseases caused by Chlamydia trachomatis: serotypes L1, L2, L3

A

*lymphogranuloma venereum (LGV)

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17
Q

Chlamydia - microbiology

A

*obligate intracellular bacteria:
-needs host ATP
-gram negative-like cell wall
-not visible on gram stain
*target = columnar, squamocolumnar epithelium:
-cervix, upper genital tract, conjunctiva, urethra, rectum
*immunity: re-infection common with little protection from antibody response

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18
Q

Chlamydia - life cycle

A
  1. EB attaches to and enters a cell to replicate
  2. strong immune response results → damage and scarring at site
  3. within 8 hours, EB transforms into a RB, which begins to multiply within an isolated area called an inclusion
  4. within 24 hours, some RBs change back to EBs
  5. eventually, the cell wall bursts and the EBs are released into adjacent cells or transmitted to infect another partner/site

EB (elementary body) - attach to cells
RB (reticulate body) - multiply in cells

19
Q

Chlamydia - elementary bodies (EB)

A

*elementary body (EB): small, infectious particle found in secretions
*ENTER the cells

20
Q

Chlamydia - reticulate bodies (RB)

A

*metabolically active, non-infectious form of the bacteria that REPLICATE inside of the host cell

21
Q

Chlamydia - diagnosis

A

*nucleic acid amplification test (NAATs):
-amplify and detect organism-specific genetic material (nucleic acids)
-high sensitivity and specificity
-can detect N. gonorrhea in same specimen

*collection of sample:
-first catch urine (males or females)
-urethral swabs (males)
-endocervical or vaginal swabs (female)
-rectal swab (males or females)

22
Q

Chlamydia - screening

A

*screen all sexually active women aged < 25 and those at increased risk (any age) using NAATs
*increased risk of infection:
-new sex partner
-more than one sex partner
-sex partner with concurrent partners
-sex partner who has an STI

23
Q

Chlamydia - treatment

A

*DOXYCYCLINE is treatment of choice

24
Q

Chlamydia - reactive arthritis

A

*a systemic disease complication associated with Chlamydia (others: yersinia, campylobacter)
*classic triad: inflammatory arthritis of large joints, inflammation of eyes (conjunctivitis or uveitis), urethritis/cervicitis
*other sx: swelling of digits, rash (can involve palms and soles), oral ulcerations

25
Q

Chlamydia - neonatal considerations

A

*ophthalmia neonatorum / conjunctivitis 5-12 days after birth
*subacute afebrile pneumonia onset 1-3 months

*best prevention = prenatal screening and treatment of pregnant women

26
Q

Neisseria gonorrhoeae (GC) - epidemiology

A

*2nd most common bacterial STI pathogen
*commonly overlaps with Chlamydia
*resurgence in high risk groups
*can have antibiotic resistance

27
Q

Neisseria gonorrhoeae (GC) - microbiology

A

*gram-negative intracellular diplococcus
*infects mucus-secreting epithelial cells
*evades host response through alteration of surface structures

*contrast to Chlamydia: GC can be seen on gram stain (gram neg), Chlamydia can not

28
Q

Neisseria gonorrhoeae (GC) - diagnostic tests

A
  1. culture = “gold standard”
    -appropriate for multiple sites (including rectal, oropharyngeal, conjuctiva)
    -susceptibility testing can be done
  2. gram stain (gram negative)
  3. amplified tests (NAATs) = most common (also tests for Chlamydia); performed on swab of site or urine
29
Q

Neisseria gonorrhoeae (GC) - treatment

A

*CEFTRIAXONE is treatment of choice

30
Q

GC additional syndrome: Gonococcal conjunctivitis

A

*ophthalmia neonatorum (erythromycin ointment for all newborns)
*usually autoinoculation in adults
*s/s: eye irritation with purulent conjunctival exudate
*treatment: ceftriaxone

31
Q

GC additional syndrome: pharyngeal infection

A

*may be sole site of infection if oral-genital contact is the only exposure
*most often asymptomatic ( > 90%)
*sx, if present, may include pharyngitis, tonsillitis, fever, cervical adenitis
*perform test-of-cure after treatment

32
Q

disseminated gonococcal infection (DGI)

A

*occurs infrequently; women > men
*associated with gonococcal strains that produce bacteremia without associated urogenital sx
*clinical manifestations: skin lesions (eschar), ARTHRALGIAS, tenosynovitis, ARTHRITIS, hepatitis, meningitis, endocarditis (rare)
*screen all mucosal sites
*TERMINAL COMPLEMENT DEFICIENCY is a risk factor (including acquired form seen in SLE)
*requires extended treatment

33
Q

gonorrhea/chlamydia additional syndromes: anorectal infection

A

*usually acquired by anal intercourse
*often asymptomatic (>90%)
*sx: anal irritation, painful defecation, constipation, scant rectal bleeding, painless mucopurulent discharge, tenesmus, anal pruritis
*evaluate utilizing anoscopic examination
*signs: mucosa may appear normal, or purulent discharge, erythema, or easily induced bleeding
*dx: NAAT testing for GC/Chl

34
Q

gonorrhea/chlamydia additional syndromes: epididymitis

A

*epididymitis and epididymo-orchitis
*characterized by exquisitely tender or swollen testicles
*more common in young males (70% chlamydia, 30% GC); in older males, E.coli + STIs

35
Q

pelvic inflammatory disease (PID) - overview

A

*encompasses endometritis and salpingitis
*most often due to chlamydia and gonorrhea (often polymicrobial: strep, gram negs, anaerobes)
*incidence decreasing due to screening
*clinical manifestations:
-lower abdominal pain
-adnexal tenderness
-cervical motion tenderness
-fever
-leukocytosis

36
Q

pelvic inflammatory disease (PID) - long term sequelae

A

*tubal infertility
*ectopic pregnancy
*chronic pelvic pain

37
Q

perihepatitis (Fitz-Hugh-Curtis Syndrome)

A

*complication of GC/chlamydia
*occurs in women
*complicates 10% of PID
*inflammation of the LIVER CAPSULE with adhesions, causing RUQ pain
*thought to be direct extension of pathogens

38
Q

pelvic inflammatory disease (PID) - treatment

A

*ceftriaxone PLUS doxycycline PLUS metronidazole

39
Q

Trichomonas vaginalis - microbiology

A

*flagellated anaerobic protozoa
*almost always sexually transmitted
*may persist for months to years in epithelial crypts and periglandular areas
*may be symptomatic or asymptomatic
*untreated trichomoniasis associated with pre-term rupture of membranes and pre-term delivery

40
Q

Trichomonas vaginalis - clinical manifestations in women

A

*may be asymptomatic
1. vaginitis:
-frothy gray or yellow-green vaginal discharge
-pruritis
2. cervicitis:
-cervical petechiae (strawberry cervix) = classic presentation, occurs in minority of cases
*may also infect Skene’s glands and urethra

41
Q

Trichomonas vaginalis - clinical manifestations in men

A

*cause of nongonococcal urethritis in males
*urethral trichomoniasis has been associated with increased shedding of HIV in HIV-infected men
*frequently asymptomatic

42
Q

Trichomonas vaginalis - diagnosis

A

*vaginal pH > 4.5 often present
*positive amine test
*motile trichomonads seen on saline wet mount (low sensitivity)
*CULTURE has increased sensitivity
*Molecular tests (NAAT) have best performance characteristics

43
Q

Trichomonas vaginalis - treatment

A

*METRONIDAZOLE is treatment of choice

Endo Repro Exam (56 decks)

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