Sexually transmitted infections Flashcards
STIs
- Reporting not accurate
- Person-to-person transfer: oral, genitalia, urinary meatus, rectum, skin, mother to fetus
- Increasing frequency in teenage population: often more than one type
- Resistance is developing
- Viral forms are not curable as yet
- Organisms don’t survive long outside host!
STI Treatment
- Sexual partners must be identified and treated
- Abstinence during therapy
Genital Warts (condylomata acuminata) & transmission
- Human papillomavirus (HPV)
- Increased incidence
Transmission - Fomites
- Mother to newborn
- Mucosal/skin to mucosal/skin
- Mother to newborn
Genital Warts Risk Factors and Progression
Risk Factors
- <25 years old
- Early first intercourse (<16 years old)
- Increased number of partners
Progression
- Transient or persistent
- Incubation is 1-8 months
- May be asysmptomatic
- Cervical is rare
Genital Warts Appearance
External
- Soft raised fleshy lesions, or small bumps or flat rough surfaced areas on external genitalia (male & female)
Internal
- Cauliflower-shaped lesions causing discomfort, bleeding, painful intercourse
Genital Warts Tx.
- Vaccine recently developed
- Antimitotic agent necrosing wart tissue
- Cryotherapy: treatment of choice (freezing)
- Surgical excision
- Laser vaporization
- Electrocautery
- Notification of partners
Genital Herpes
- Herpes Simplex Virus (HSV) - 2
- Incubation is 2 – 12 days
- Neurotropic virus
- Grows in neurons
- Latent form moves up via peripheral nerves; dormant in dorsal root ganglia
- Reactivates and spreads down neuron
- Alters when replicating from dormant state
Genital Herpes Risk Factors
- Highly contagious!
- Spread by people unaware they have it
Risk Factors
- Women
- Increased sexual partners
- Compromised immune system
Genital Herpes: symptoms, primary infection, triggers
Symptoms - itching, tingling, painful to touch - Dysuria, dyspareunia - “Wet” vesicle eventually crusts over Primary Infection - h/a, malaise, muscle aches, lymphadenopathy Recurring episodes – less severe Triggers - stress, sleep loss, overexertion, other infections, prolonged coitus, menstrual distress
Genital Herpes Tx.
acyclovir
Candidiasis
- Candida albicans
Yeast infection/Thrush/Moniliasis - Present in healthy women
- Activated when vaginal environment altered
- 75% of women
- Usually not transmitted sexually (not an “official” SDI)
Candidiasis Risk factors, manifestations, treatment
Risk Factors
- Decreased normal bacterial flora (antibiotics)
- Altered hormonal levels (BCPs, pregnancy)
- Decreased immune system
- Diabetes Mellitus
- HIV infection
Manifestations
- thick, white, odorless discharge
- Irritation, erythema, swelling, dysuria
Treatment: antifungal
Trichomoniasis & Risk factors
- Trichomonas vaginalis Transmitted via: - Sexual contact - Fomites (hot tubs, swimming pools) - Currently very prevalent - Men harbor organism but are asymptomatic
Risk Factors - Diagnosed with other STIs
Trichomoniasis: Manifestations
Women
- Sometimes asymptomatic
- Frothy, malodorous green/yellow discharge
- Erythema/edema of mucosa
- Itching, irritation
- Hemorrhagic cervical “strawberry spots”
Men
- Harbour organisms in urethra & prostate but are almost always asymptomatic
Trichomoniasis complications
- Human Immunodeficiency Virus (HIV)
- Infertility, PID & premature births (women)
- Infertility, chronic prostatitis & urethritis (men)
Chlamydia Trachomatis
- Bacterial infection but can behave like a virus
- Has two distinct morphologies:
Elementary body (survives outside the cell) attaches and is ingested & activates the reticulate body (can’t survive outside the cell) which divides and forms new “elementary bodies” released when cell bursts - Difficult to treat!
- Most common STI in North America
Chlamydia: Manifestations
Women - Can be asymptomatic - Frequency, dysuria, vaginal discharge - Mucopurulent cervical discharge - Cervix becomes hypertrophied, edematous, friable (falls apart easily) Men - urethritis, meatal erythema/tenderness, itchiness, - discharge - Dysuria, prostatitis, epididymitis.
Chlamydia: Complications
Women - PID (40%) - Infertility (20%) - Chronic pain (18%) - Conjunctivitis - Damaged Fallopian tubes - Tubal pregnancy (9%) Men - Infertility - Reiter’s syndrome: reactive arthritis, conjunctivitis, urethritis
Gonorrhea
- Neisseria gonorrhoeae
- Transmission
- Entry via genitals, urinary tract, eyes, oropharynx, rectum, skin
- Neonates born to infected mothers
- Gonorrhea conjunctivitis/blindness
- Amniotic infection syndrome
- Likes warm mucus membranes
- Highest rate in adolescents & young adults
Gonorrhea symptoms
- May be asymptomatic
- Men have more symptoms than women
Men: urethra pain, creamy yellow/bloody discharge; rectal infections from male-to-male contact
Women: genital or urinary discharge, dysuria, dyspareunia, pelvic pain, bleeding, fever, proctitis
Gonorrhea complications
Males: spread to prostate, epididymis
Females: uterine infection, salpingitis (fallopian tubes), scarring/infertility
- Pharyngitis if oral-genital contact
- Conjunctivitis
Bloodstream (bacteremia): joint, heart valves, meninges
Syphilis (Treponema pallidum) Transmission
Increasing incidence as of 2001
Transmission
- Direct contact with infectious moist lesion during sexual intimacy, kissing
Mother to fetus invitro/transplacental
- Prematurity, stillbirth, congenital defects, active infection
Syphilis: 3 stages (first stage)
- Primary Stage
- Chancre at site of exposure (within 3 wks, but can incubate longer)
- Buttonlike papule erodes skin
Male: usually obvious, penis or scrotum
Women: cervix, vagina, sometimes external
- Often painless
- Mild symptoms of infection
- Heals within 3-12 weeks
Syphilis stage 2
- Secondary Stage
- 2-6 wks after initial chancre, lasts1 wk to 6 months
- Rash on palms/soles
- Fever, sore throat, malaise, stomatitis, nausea, eye inflammation, arthralgias
- Alopecia
- Elevated lesions on genitals: highly infectious
Syphilis Stage 3 & 4
3. Latent Phase (1-2-20 years) Symptoms resolve but still seroreactive 1 in 3 progress to this stage - Others have minimal symptoms or spontaneous cure 4. Tertiary Stage (can be 20 yrs after initial infection!) Gumma lesions: CV: aortic valve, aortic aneurysm CNS (neurosyphilis): dementia, blindness Skin/Liver/Bone
Treatment: penicillin +
