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MICRO > Sexually Transmitted Infections > Flashcards

Sexually Transmitted Infections Flashcards

1
Q

what are reportable STIs?

A

chlamydia, syphilis, gonorrhoea

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2
Q

what are non reportable STIs?

A

herpes simplex virus (HSV) and human papillomavirus (HPV)

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3
Q

what percentage of people have HPV in their life?

A

75

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4
Q

are rates of syph, gonorrhoea and chlamydia increasing or decreasing?

A

increasing

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5
Q

what is the sequele for STIs?

A

sterility, miscarriage, ectopic pregnancy, congenital defects, cancer, chronic pain an psychiatric disorders

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6
Q

what is the most common bacterial STI in Canada?

A

chlamydia

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7
Q

are men or women more prone to getting chlamydia?

A

women

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8
Q

is chlamydia trachomatis gram neg or pos and what type of bacteria is it?

A

gram neg, obligate intracellular bacteria

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9
Q

how is chlamydia trachomatis transmitted?

A

vaginal, oral or anal

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10
Q

how does chlamydia trachomatis enter the body?

A

enters body through microscopic brakes in mucosal membranes and infects mucosal epithelial cells of pharynx, urethra, cervix, uterus, Fallopian tubes, anus or rectum

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11
Q

what may occur as a complication of chlamydia trachomatis?

A

autoinculation
- may occur when infected genital site to conjunctiva or rectum

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12
Q

what are symptoms of autoinculation?

A

headache, fever, muscle aches

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13
Q

what are symptoms of chlamydia?

A

dysuria, proctitis (inflamed rectal lining), conjunctivitis (tearing, discharge, inflammation, swelling)

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14
Q

is chlamydia usually asymptomatic or symptomatic?

A

asymptomatic

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15
Q

symptoms in women for chlamydia?

A

vaginal discharge, vaginal bleeding, dyspareunia (painful intercourse), cervicitis

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16
Q

symptoms in men for chlamydia?

A

urethral discharge, urethritis, urethral itch and testicular pain

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17
Q

what people should be annually screened?

A

all sexually active people younger than 30 and gay, bisexual and transgender people

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18
Q

when should targeted screening be done?

A

sexually active people over 30 (drug use, sex work, sex w out protection, sdoh)

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19
Q

how can you determine which specimens should be collected and type of test used?

A

clinical picture and sexual history

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20
Q

how should asymptomatic people be tested for chlaymida?

A
  • naats
  • first void urine (person should not void for at least 2 hours prior to specimen collection)
  • vaginal swab (conjunctival, pharyngeal and rectal swabs
  • physical exam when STI is suspected
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21
Q

how should symptomatic people be tested for chlaymida?

A

naats, first void urine, vaginal/cervical swab, urethral swab, conjunctival, rectal and pharyngeal swabs, swab of any visible lesions

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22
Q

who should be treated for chlamydia?

A

pos lab results, suspected chlamydia or ppl with symptoms, or pos lab results for neisseria gonorrhoea, or Dx of sexual partners

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23
Q

what pharmalogical Tx is required? (Chlamydia)

A

doxycycline (2x/day), azithromycin (single dose)

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24
Q

what is pelvic inflammatory disease (PID)?

A

infection and inflammation of upper genital tract

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25
Q

symptoms of PID?

A

fever upper abdominal pain or tenderness, adnexal and cervical motion tenderness

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26
Q

what is the sequele for PID?

A

chronic pelvic pain, ectopic pregnancy and infertility

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27
Q

how to diagnose PID?

A

abdominal or pelvic exam and microbiology (gram stain)

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28
Q

once PID is treated, when should symptoms resolve?

A

48-72 hours post Tx

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29
Q

what pharmacological Tx is required for PID?

A

ceftriaxone, doxycycline (2x/day), metronidazole (2x/day)

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30
Q

can PID be managed?

A

no, must be Tx

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31
Q

what is the second most reported bacterial STI in Canada?

A

gonorrhoea

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32
Q

what is the sequele for gonorrhoea?

A

PID, ectopic preg, infertility, chronic pelvic pain. Reiters syndrome, dissimenated infection, transmission to new borns

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33
Q

is niesseria gonorrhoea gram neg or pos and what type of bacteria?

A

gram neg diplococci, faucultative intracellular bacteria
- develops antimicrobial resistance

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34
Q

how is gonorrhoea transmitted?

A

via vaginal, anal or oral

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35
Q

how does gonorrhoea enter the body?

A

adheres via fimbriae and capsules to mucosal epithelial cells of pharynx, urethra, cervix, uterus, Fallopian tubes, anus and rectum
- fimbriae allow N. gonorrhoea to attach to sperm cells

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36
Q

what happens if phagocytized bacteria survives?

A

multiply in neutrophils traveling to distal sites in body such as joints, meningitis and heart

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37
Q

how long does gonorrhoea last for?

A

2-7 days but can last up to 1-14 days

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38
Q

what are symptoms of gonorrhoea?

A

dysuria, proctitis

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39
Q

is gonorrhoea symptomatic or asymptomatic in men and women?

A

asymptomatic in women
symptomatic in men

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40
Q

symptoms of women for gonorrhoea?

A

cervicitis, vag discharge, lower abdominal pain, vagina bleeding, painful intercourse and bartholinitis

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41
Q

symptoms of men for gonorrhoea?

A

urethral discharge, itch, testicular pain, epididymo orchitis

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42
Q

when being screened for gonorrhoea, what else should you be screened for?

A

chlamydia, syph, HIV

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43
Q

what people should be annually screened for gonorrhoea?

A

sexually active ppl <30, gay, bisexual and trans

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44
Q

what people should have targeted screening in gonorrhoea?

A

sexually active ppl >30, all preg ppl at first prenatal visit - rescreen at 3rd trimester for who tested pos, screen at delivery for those who haven’t been tested , neonates born to ppl with gonorrhoea

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45
Q

what lab tests should be done for gonorrhoea?

A

cultures, NAAT and microscopy (gram stain)

46
Q

how should asymptomatic be tested for gonorrhoea?

A
  • first void urine (person should not void for at least 2 hours prior to specimen collection)
  • urethral swabs for men, vaginal/cervical swabs for women (vaginal preferred)
47
Q

how should symptomatic be tested for gonorrhoea?

A

pharyngeal and rectal swabs
- men need urethral swab for gram stain an culture and urine specimen for NAAT
- women need cervical swab for NAAT and culture

48
Q

what is a culture strongly recommended for in gonorrhoea?

A
  • as a test of cure for suspected Tx failure
  • if infection was acquired in countries w high rates of antimicrobial resistance
    AS WELL AS..
    symptomatic pt, PID, preg women, sexual abuse
49
Q

who should be treated for gonorrhoea?

A
  • pos lab results for N. gonorrhoea
  • sexually active and symptomatic
  • Dx of gonorrhoea in sex partner
50
Q

what is the pharmalogical treatment for gonorrhoea?

A

ceftriaxone IM, doxycycline 2x/day over 7 days

51
Q

what should be obstained from until treated for gonorrhoea?

A

unprotected sex

52
Q

antimicrobial resistance - gonorrhoea

A

Tx complicated by worldwide spread of gonococcal strains resistant to many antibiotics

53
Q

how can people be infected multiple times?

A

high variability in surface antigens across strains

54
Q

what is the third most reported bacterial STI in Canada?

A

Syphilis

55
Q

can congenital syphilis be transmitted to fetus during pregnancy or delivery?

A

yes

56
Q

what type of bacteria is treponema pallidum?

A

helical shaped bacteria

57
Q

how is syphilis transmitted?

A

vaginal, oral and anal

58
Q

how does syphilis enter the body?

A

enters host through breaches in mucosal membranes

59
Q

what phases of syphilis are infectious?

A

primary, secondary and early latent stages

60
Q

how is syphilis transmitted in pregnancy?

A

through vertical transmission
- can also occur through contact with genital lesion

61
Q

what characterizes PRIMARY syphilis?

A

(infectious)
- small, hard, painless ulcers occurring at site
- cervix, vulva wall, penis, mouth and anus
- manifests 3 weeks post infection
- symptoms resolve w out Tx

62
Q

what characterizes SECONDARY syphilis?

A

(infectious)
- systemic symptoms
- rash, fever, malaise, headaches, mucosal lesions, lymphadenopathy, alopecia, candylomata late, meningitis, retinitis

63
Q

what characterizes the early latent phase?

A
  • asymptomatic phase
  • less then 1 year post secondary stage
64
Q

what characterizes the late latent phase?

A
  • asymptomatic phase
  • over 1 year post secondary stage
  • pt may never develop any long term complications
65
Q

what characterizes the Tertiary phase?

A
  • can occur decades after initial infection
  • CV syphilis, neurosyphilis, gumma
66
Q

what characterizes neurosyphilis?

A
  • can occur at any stage of syphilis (untreated primary infection, up to 20 years or more after infection)
  • headaches, ataxia, vertigo, dementia, personality changes
67
Q

what people should be screened for syphilis?

A

gay, bisexual, trans
- screen pregnant ppl in first trimester, then again at 28-32 weeks an again at delivery

68
Q

people being screened for syphilis should also be screened for?

A

chlamydia, gonorrhoea and HIV

69
Q

diagnostic testing for syphilis may include?

A

blood specimens, lesion, sampling and or samples of CSF

70
Q

should serologic testing be done for syphilis?

A

yes, to detect antibodies

71
Q

what is lesion sampling for in syphilis?

A

NAAT to detect T. pallidum in mucosa and skin from lesions of suspected cases of primary and secondary syphilis

72
Q

when is CSF used in cases of syph?

A

used in suspected cases to neurosyphilis

73
Q

what pharmalogical Tx is used for primary, secondary and early latent syphilis?

A

Benzathine Penicillin G-LA (IM, single dose)

74
Q

what pharmalogical Tx is used for late latent syphilis, cardiovascular syphilis and gumma?

A

Benzathine Penicillin G-LA (IM weekly for 3 doses)

75
Q

is genital herpes a reportable infection?

A

no

76
Q

what is genital herpes caused by?

A

HSV 1 an 2

77
Q

how is genital herpes transmitted?

A

oral, anal and vaginal

78
Q

is shedding of genital herpes asymptomatic?

A

yes

79
Q

HSV 1 an 2 can lead to what?

A

transmitted vertically and lead to neonatal disease

80
Q

what is the incubation period for genital herpes?

A

1-26 days (6-8)

81
Q

how does HSV enter the body?

A

enters the mucocutaneous tissues and replicates
- after initial replication, HSV enters a latent phase where it may remain dormant for years

81
Q

how does HSV enter the body?

A

enters the mucocutaneous tissues and replicates
- after initial replication, HSV enters a latent phase where it may remain dormant for years

82
Q

what does genital herpes look like?

A

clear, straw coloured fluid filled vesicles appear first then develop into painful, burning ulcers as they rupture

83
Q

symptoms of genital herpes?

A

systemic symptoms of fever, malaise, myalgia

84
Q

how long does herpes last without Tx?

A

17-20

85
Q

complications of primary infection (genital herpes)?

A

extragenital lesions, meningitis/encephalitis

86
Q

what are prodromal symptoms of genital herpes?

A

pain, tingling, burning, itching and skin sensitivity where new vesicles form (unilateral, localized small erythematous patch, painful genital vesicles an ulcers along distribution of sacral nerves)

87
Q

when is screening for HSV not recommended?

A

ppl with no hx of anogenital lesions

88
Q

ppl being screened for HSV should also be screened for?

A

syph, gonorrhoea, chlamydia and HIV

89
Q

what treatment is needed in first episode of genital herpes in pregnancy?

A

oral antiviral therapy

90
Q

when should c section be considered when pregnant with genital herpes?

A

if first episode occurs in the 3rd trimester of pregnancy

91
Q

how is genital herpes diagnosed?

A

NAAT or viral culture of fresh lesions (viral culture could fail to detect HSV)

92
Q

what does a viral culture allow for in genital herpes?

A

typing and sensitivity testing

93
Q

how is genital herpes managed?

A

psychological support an counselling to help them understand and cope with chronic infection

94
Q

what is the pharmalogical Tx for genital herpes?

A

antiviral medications - reduce viral shedding, time of crusting and healing of lesions and duration of pain

95
Q

what is the medication for (Antiviral Therapies- First episode, Non pregnant Adult)

A

acyclovir 400 mg 3 times/day for 7-10 days

96
Q

what is the medication for (Antiviral Therapies- Recurrent Episodes, Non pregnant Adult)

A

acyclovir 800 mg 2 times/day for 5 days

97
Q

is human papillomavirus (HPV) a reportable virus?

A

no

98
Q

which two strains of human papillomavirus (HPV) cause 70% of angiogenital cancers?

A

16, 18

99
Q

which strains of human papillomavirus (HPV) cause 14% of angiogenital cancers?

A

31, 33, 45, 52 and 58

100
Q

which two strains of human papillomavirus (HPV) cause 90% of angiogenital warts?

A

6 & 11

101
Q

what are genital warts?

A

painful lesions that present 3-4 months post exposure

102
Q

what is the Gardasil-9 immunization?

A

consists of VLPs assembled from recombinant HPV proteins
- antibodies protect and prevent infection caused by viral strains covered in the vaccine

103
Q

Gardasil-9 targets which HPV genotypes?

A

16, 18, 6, 11, 31, 33, 45, 52 and 58

104
Q

what ages is Gardasil-9 vaccine for?

A

9-45

105
Q

Gardasil-9 is provincially funded for which grade?

A

gade 7

106
Q

in what intervals should Gardasil-9 be given?

A

two doses at least 6 months apart
- 15 an older: 3 doses

107
Q

what are the symptoms of a uti?

A

dysuria, urgency, frequency, abdominal pain, fever and incontinence

108
Q

how to diagnose a UTI?

A
  • midstream urine first thing in the morning
  • positive culture identifies organism
109
Q

what shows in a urinalysis?

A

leukocyte esterase, enzyme produced by neutrophils, indicative of an active infection, WBCs, nitrites, protein levels

110
Q

what are complications of UTI?

A

pyelonephritis, ascending infection, severe abdominal flank and back pain, fever for >3days, chills, nausea/vomiting, fatigue, pyuria, kidney damage sepsis

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