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Block 10 Week 3 > Shapiro > Genital Infxns > Flashcards

Shapiro > Genital Infxns Flashcards

1
Q

which gender is likely to have fewer sx & seek care later & have more complications?

A

women

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2
Q

what dzs are characterized by urethritis & cervicitis?

A

gonococcal infxn
chlamydial infxn
nongonococcal urethritis

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3
Q

what dzs are characterized by vaginal discharge?

A

bacterial vaginosis
trichomoniasis
vulvovaginal candidiasis

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4
Q

what dzs are characterized by ulcerations?

A

chancroid & syphillis
genital herpes infxn (HSV 2 & 1)
granuloma inguinale

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5
Q

what are the 4 categories of infxn of the genitals & urinary tract?

A
  1. dz char by urethritis & cervicitis
  2. dz char by vaginal discharge
  3. dz char by ulcerations
  4. other genitourinary infxns
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6
Q

what are the 2 “other” genitourinary infxns?

A

PID

genital warts

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7
Q

T/F: an individual can have more than one cause of urethritis

A

TRUE

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8
Q

what 4 bugs are responsible for non-gonococcal urethritis?

A
  1. chlamydia trachomatis
  2. ureaplasma urealyticum
  3. mycoplasma genitalium
  4. trichomonas vaginalis
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9
Q

what sex does gonococcal urethritis affect?

A

both sexes

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10
Q

how is gonococcal urethritis transmitted?

A

sexual contact or during birth

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11
Q

what is the incubation pd of gonococcal infxn?

A

2-5 days

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12
Q

what are the general sx of gonococcal infxn?

A

intense burning
fever
malaise

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13
Q

what characterizes urethritis in MALES?

A

clear, mucopurulent, or purulent discharge

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14
Q

what characterizes GONOCOCCAL urethritis in MALES?

A

purulent discharge

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15
Q

what % of males have a mild or asymptomatic presentation of urethritis?

A

15%

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16
Q

what % of females w/ gonococcal urethritis may be asymptomatic?

A

50%

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17
Q

what is the primary site of infxn of gonococcal urethritis in females?

A

endocervical canal

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18
Q

what are the sx of urethritis in females?

A

scant mucopurulent cervical discharge
vaginal pruritis
dysuria

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19
Q

what are the complications of gonococcal urethritis in both sexes?

A
  1. disseminated gonococcal infxn
  2. acute arthritis-dermatitis syndrome
  3. gonococcal arthritis
  4. endocarditis (unc)
  5. meningitis (rare)
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20
Q

if you have a male pt & you suspect urethritis, what 2 things should you test for?

A

gonorrhea & chlamydia

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21
Q

how should you begin your diagnostic approach w/ males w/ urethral discharge?

A

purulent vs. mucopurulent

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22
Q

how sensitive is gram stain of urethral secretions for gonoccocal infxn in symptomatic men?

A

> 90%

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23
Q

can you use gram stain for cervix?

A

NOPE

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24
Q

what other 2 things besides gram stain can you use to dx gonococcal infxn?

A

PCR

culture (less common)

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25
Q

why is treatment of gonorrhea complicated?

A

anti-microbial resistance

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26
Q

how do you treat gonorrhea?

A

ceftriaxone (N. gonorrhoeae)

+ azithro or doxy (C. trachomatis)

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27
Q

what should you tell your pt to do if you are treating that pt for urethritis?

A

don’t have sex until you complete your treatment regimen

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28
Q

what other tests should you do for your pt if you treat them for gonorrhea?

A

other STDs incl syphilis & HIV

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29
Q

what 3 local infxns can c. trachomatis cause in men?

A

conjunctivitis
urethritis
prostatitis

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30
Q

what 4 local infxns can c. trachomatis cause in women?

A

conjunctivitis
urethritis
cervicitis
proctitis

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31
Q

what 4 local infxns can c. trachomatis cause in infants?

A

conjunctivitis
pneumonitis
pharyngitis
rhinitis

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32
Q

what tissue does C. trachomatis preferentially infect?

A

squamo-columnar epithelium

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33
Q

how many serological variants of c. trachomatis are there, & what is that based on?

A

18

based on monoclonal ab assay

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34
Q

what is the incubation period for c. trachomatis?

A

1-3 wks

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35
Q

what are the sx of c. trachomatis?

A

low grade urethritis
mod mucoid or mucopurulent urethral discharge
variable dysuria

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36
Q

how is ureaplasma urealyticum transmitted?

A

sexual contact

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37
Q

what does ureaplasma urealyticum cause in males?

A

urethritis

proctitis

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38
Q

whta does ureaplasma urealyticum cause in females?

A

cervicitis

vaginitis

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39
Q

mycoplasma genitalium accounts for (?%) of sexually transmitted urethritis

A

30%

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40
Q

if you have c. trachomatis-NEG urethritis, what is it probably d/t?

A

mycoplasma genitalium

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41
Q

what bug is common in recurrent urethritis?

A

mycoplasma genitalium

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42
Q

what things cause VIRAL urethritis?

A

adenovirus & HSV

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43
Q

what is cervicitis & what causes it?

A

inflammation of the cervix

d/t gonorrhea & chlamydia

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44
Q

what are the 2 types of cervicitis?

A

acute

chronic

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45
Q

how do you treat cervicitis?

A

w/ abx after you ID the underlying cause of infxn

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46
Q

what are the 2 major dx signs of acute cervicitis?

A
  1. purulent & mucopurulent endocervical exudate

2. sustained cervical bleeding induced w/ gentle swabbing

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47
Q

what do most women complain of if they have acute cervicitis?

A

abn vaginal discharge & intermenstrual vaginal bleeding

can be asymptomatic

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48
Q

how do you dx acute mucopurulent cervicitis?

A

gross evidence of purulent material from an inflamed cervix w/ 10+ PMN leukocytes per micro field

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49
Q

what are the 3 main sx of CHRONIC cervicitis?

A
  1. leukorrhea
  2. ext genital sx: bleeding, itching, irritation, pain
  3. cervical polyps
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50
Q

what is a cervical polyp?

A

small, smooth, red, fingerlike growth in the passage extending from the uterus

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51
Q

what are the sx of vaginitis?

A

vaginal discharge &/or vulvar itching & irritation & vaginal odor

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52
Q

why is it hard to differentiate btwn vaginitis & cervicitis?

A

they both can have vaginal discharge

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53
Q

how can you determine the cause of vaginal sx?

A

pH & micro examination of discharge

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54
Q

what is bacterial vaginosis?

A

normal balance of bacteria in vagina is disrupted & replaced by an outgrowth of certain bacteria

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55
Q

what are the sx of bacterial vaginosis?

A 
discharge
odor
pain
itching
burning
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56
Q

what are the 2 ways you can dx bacterial vaginosis?

A
  1. gram stain

2. clinical criteria (YOU NEED 3)

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57
Q

what are the clinical criteria for bacterial vaginosis?

A

YOU NEED 3 OF THESE:

  1. homogeneous thin white discharge that smoothly coats vaginal wall
  2. clue cells
  3. pH >4.5 of vaginal fluid
  4. fishy odor of vaginal discharge before or after add’n of 10% KOH
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58
Q

what is the whiff test?

A

fishy odor of vaginal discharge before or after add’n of 10% KOH

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59
Q

is the prevalence of bacterial vaginosis higher or lower in women w/ no sexual exposure?

A

LOWER

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60
Q

what group has higher prevalence of bacterial vaginosis?

A

women w/ new or multiple sex partners

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61
Q

what is one of the main causes of bacterial vaginosis?

A

gardnerella vaginalis

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62
Q

dec or absence of THIS species causes inc vaginal pH

A

lactobacillus

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63
Q

why is there malodor w/ bacterial vaginosis?

A

overgrowth of anaerobes > inc enzymes > inc breakdown of vaginal peptides into amines > malodor

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64
Q

can you make a dx of bacterial vaginosis based on pt hx only?

A

nope

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65
Q

what are 3 ways you can dx bacterial vaginosis OTHER THAN HX?

A
  1. wet mount eval
  2. vaginal secretion culture
  3. DNA probe
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66
Q

what are clue cells?

A

vaginal epithelial cells w/ indistinct borders d/t lots of adherent bacteria

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67
Q

what is the clue cell threshold for dx of bacterial vaginosis?

A

more than 20% of cells must be clue cells

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68
Q

what allows you to see clue cells?

A

wet mount

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69
Q

what causes trichomoniasis?

A

trichomonas vaginalis > flagellated protozoan parasite w/ multiple strains

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70
Q

what are the sx of trichomoniasis?

A

vulvar irritation
AND
diffuse malodorous yellow-green vaginal discharge
(or asymptomatic)

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71
Q

what is trichomoniasis like in males?

A

colonizes male urethra

mostly asymptomatic but can cause NGU (non-gon urethritis)

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72
Q

what is the discharge like in trichomoniasis?

A

profuse
frothy
foul smelling
yellow-green

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73
Q

what do the external genitalia look like in trichomoniasis?

A

patchy redness on the labia & vagina

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74
Q

what happens if urine touches inflamed tissues in trichomoniasis?

A

painful dysuria

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75
Q

how do you culture & ID trichomonads?

A

rapid assay or Pap

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76
Q

what vaginal pH is indicative of trichomoniasis?

A

pH >5

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77
Q

what species most commonly causes vulvovaginal candidiasis?

A

C albicans causes 80-90%

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78
Q

what other 2 species are capable of causing vulvovaginal candidiasis?

A

c. glabrata

c. tropicalis

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79
Q

what % of women have asymptomatic colonization w/ C. albicans?

A

10-20%

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80
Q

what are sx of vulvovaginal candidiasis?

A

pruritis
dysuria
thick curdy discharge

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81
Q

T/F: vulvovaginal candidiasis is an STI

A

FALSE

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82
Q

what is the BEST way to dx vulvovaginal candidiasis?

A

KOH wet mount

specificity of 97%

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83
Q

whom should receive vaginal cultures of vulvovaginal candidiasis?

A

in pts w/ persistent or recurrent sx

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84
Q

what defines “recurrent infxn”?

A

4 or more infxns in 1 year

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85
Q

what routes of treatment are best for vulvovaginal candidiasis?

A

oral or topical

equal efficacy

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86
Q

what are the diffs in physical exam findings btwn bacterial vaginosis, candidiasis, & trichomoniasis?

A

BV: thin, whitish gray discharge
C: curdy discharge
T: yellow, frothy discharge

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87
Q

what causes chancroid?

A

haemophilus ducreyi

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88
Q

what causes syphilis?

A

treponema pallidum

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89
Q

what causes genital HSV infxn?

A

HSV2 & HSV1

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90
Q

what causes granuloma inguinale?

A

klebsiella granulomatis

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91
Q

T/F: chancroid is common in the US

A

FALSE

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92
Q

what is the course of chancroid?

A

papule > erosion > painful ulcer

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93
Q

why do all these clinicians love osler

A

i don’t fucking know

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94
Q

what are the stages of syphilis?

A 
primary
secondary
latent
tertiary
or congenital
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95
Q

T/F: latent syphilis is asymptomatic

A

TRUE

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96
Q

what are the sx of primary syphilis?

A

chancre

LAD

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97
Q

what are the sx of latent syphilis?

A 
rash 
fever
malaise
LAD
mucus lesions
condyloma lata
alopecia
meningitis 
HA
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98
Q

what are the 2 systemic manifestations of tertiary syphilis?

A

CVS

neuro

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99
Q

what is a gumma?

A

monocytic infiltrate w/ tissue destruction of any organ

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100
Q

how do you get syphilis?

A

sex or vertical spread

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101
Q

what happens if you don’t treat syphilis?

A

may become chronic

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102
Q

when is syphilis most contagious to sex partners?

A

primary & secondary stages

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103
Q

why did syphilis decline rapidly in the 1940s?

A

penicillin & public health

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104
Q

when did syphilis have an all-time low in the US?

A

2000

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105
Q

what population is an important risk pop for syphilis?

A

men who have sex with men (MSM)

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106
Q

what type of syphilis increased in incidence btwn 1986-1990?

A

primary & secondary

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107
Q

which sex has more syphilis?

A

males

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108
Q

what race is most affected by syphilis?

A

blacks (then hispanics)

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109
Q

what does treponema pallidum look like?

A

corkscrew

motile, microaerophilic

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110
Q

can you culture treponema pallidum in vitro?

A

nope

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111
Q

can you view treponema via normal light micro?

A

nope

darkfield or electron photomicrograph

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112
Q

how does treponema penetrate?

A

enters via skin & mucous membranes thru abrasions during sexual contact
OR
transmitted transplacenta

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113
Q

how does treponema disseminate?

A

circulatory system (incl lymph) > invades CNS

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114
Q

when does treponema invade the CNS?

A

any stage of syphilis

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115
Q

where do you get a chancre?

A

at the site of inoculation

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116
Q

what is the progression of a chancre?

A

macule > papule > ulcer

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117
Q

how do you describe a chancre?

A

indurated w/ a clean base

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118
Q

T/F: chancres are painful

A

FALSE

painLESS

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119
Q

how long does it take for a chancre to heal?

A

3-6 wks

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120
Q

T/F: you can only have one chancre at a time

A

FALSE

multiples can occur

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121
Q

what kind of LAD do you get w/ primary syphilis?

A

regional, rubbery, painless, bilateral

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122
Q

what happens if you do a serological test for syphilis if it’s early primary?

A

may not be +

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123
Q

what stage of syphilis has chancres?

A

primary

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124
Q

T/F: chancres are highly infectious

A

TRUE

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125
Q

T/F: you can get a primary syphilitic chancre on your TONGUE

A

true

gross

126
Q

when do you get a secondary lesion?

A

several weeks after the primary chancre appears

127
Q

how long will you have a secondary lesion?

A

weeks to months maybe

128
Q

T/F: primary & secondary stages of syphilis might overlap

A

TRUE

129
Q

what type of lesion is the most common in secondary syphilis?

A

mucocutaneous

130
Q

what stage has the highest serologic titer for syphilis?

A

secondary

this is poorly worded but you get the buzzwords

131
Q

what TYPE of rash do you get w/ secondary syphilis?

A

papulosquamous rash
or
papulo-pustular

132
Q

WHERE do you get a rash w/ secondary syphilis?

A

body rash

palmar/plantar

133
Q

what stage of syphilis has nickel & dime lesions?

A

secondary

134
Q

what is happening in latent syphilis?

A

host is suppressing infxn

no lesions are clinically apparent

135
Q

when does latent syphilis occur?

A 
btwn primary & secondary
OR
btwn secondary relapses
OR
after secondary
136
Q

what is the ONLY evidence of latent syphilis?

A

positive serological test

137
Q

what are the 2 categories of latent syphilis?

A

early latent

late latent

138
Q

what are the time parameters for early & late latent syphilis?

A

early <1yr

late 1+ yr

139
Q

what happens when t. pallidum invades the CNS?

A

neurosyphilis!

140
Q

what stage of syphilis is assoc w/ neurosyphilis?

A

any!

141
Q

when do you get early neurosyphilis?

A

a few months to years after infxn

142
Q

what are the clinical manifestations of early neurosyphilis?

A

acute syphilitic meningitis
meningovascular syphilis
ocular involvement

143
Q

when do you get neurologic involvement?

A

decades after infection

rarely seen

144
Q

what are the clinical manifestations of neurologic involvement of syphilis?

A

general paresis
tabes dorsalis
ocular involvement

145
Q

what stain can you use to see spirochetes in neural tissue?

A

silver

146
Q

what is tabes dorsalis?

A

syphilitic invasion of the DORSAL COLUMNS of the spinal cord

147
Q

what % of untreated syphilis pts progress to the tertiary stage w/i 1-20yrs?

A

30%

148
Q

why is tertiary syphilis rare?

A

abx!

149
Q

what are the 2 manifestations of tertiary syphilis?

A

gummatous lesions

CVS syphilis

150
Q

T/F: gumma can ulcerate

A

TRUE

yucko

151
Q

how do you get congenital syphilis?

A

t. pallidum is transmitted from a pregnant woman to her fetus

152
Q

what can congenital syphilis cause (while the baby is still in utero)?

A
  1. stillbirth
  2. neonatal death
  3. infant deafness, neuro impairment, bone deformities
153
Q

when can transmission of syphilis from mom to baby occur (what stage of syphilis)?

A

any stage!

risk is HIGHEST during primary & secondary!

154
Q

in what stage of pregnancy can syphilis be transferred to the fetus?

A

any

155
Q

T/F: all congenital syphilis cases are severe

A

FALSE

only the severe cases are apparent at birth, but there is a wide spectrum of severity

156
Q

what type of congenital syphilitic lesions are msot common?

A

early
infants <2 yo
usu inflammatory

157
Q

what do late congenital syphilitic lesions do?

A

kids >2yo

immunologic & destructive

158
Q

what are the oral manifestations of congenital syphilis?

A
  1. mucus patches
  2. Hutchinson’s teeth
  3. palate perforation
159
Q

what are Hutchinson’s teeth?

A

small, widely spaced incisors w/ notches on the biting surface

160
Q

what are the 3 main aspects of syphilis dx?

A

clinical hx
physical exam
lab dx

161
Q

what 4 things do you need to ask about when you assess a clinical hx for syphilis?

A
  1. hx of syphilis
  2. known contact to an early case of syphilis
  3. typical sx in past 12 mos
  4. most recent sero test for syphilis
162
Q

what areas should you pay particular attn to when doing your physical exam for syphilis? (7 areas)

A
  1. oral cavity
  2. lymph nodes
  3. torso skin
  4. palms & soles
  5. genitalia & perianal area
  6. neuro
  7. abdomen
163
Q

what serological tests allow a presumptive dx of syphilis?

A

nontreponemal or treponemal

164
Q

how do you ID t. pallidum in lesion exudate or tissue?

A

darkfield micro
or
other tests (?)

165
Q

what are the 2 advantages of darkfield micro?

A
  1. definitive immediate dx

2. rapid results

166
Q

what are you looking for on darkfield micro?

A

t. pallidum morphology & motility

167
Q

what are the 5 disadvantages of darkfield micro?

A
  1. special equipment & microscopist
  2. confusion w/ other spirochetes
  3. must be done immediately
  4. not for oral lesions
  5. false-negs
168
Q

which type of sero test for syphilis is qualitative AND quantitative?

A

nontreponemal

treponemal is ONLY quaLitative

169
Q

can you use only 1 sero test to dx syphilis?

A

nope

that’s insufficient

170
Q

what does the nontreponemal sero test measure?

A

ab against cardiolipin-lecithin-cholesterol ag

171
Q

is nontreponemal sero test specific for t. pallidum?

A

nope

172
Q

what do titers of the nontreponemal sero test correlate w/?

A

disease activity

173
Q

how are results of the nontreponemal sero test reported?

A

quantitatively

174
Q

what does “serofast” mean?

A

syphilitic pts may be reactive for life on a nontreponemal sero test

175
Q

what are the nontreponemal sero tests?

A

VDRL & RPR

176
Q

what are the 5 advantages of a nontreponemal sero test?

A
  1. fast & cheap
  2. easy to do
  3. quantitative
  4. used for following response to therapy
  5. can be used to evaluate reinfection
177
Q

what are the 3 disadvantages of nontreponeaml sero test?

A
  1. can be insensitive in certain stages
  2. false posi
  3. prozone effect can cause false neg (rare)
178
Q

what does a treponemal sero test measure?

A

ab against t. pallidum ag

179
Q

can you use titers of a treponemal sero test to assess treatment response?

A

NO

only nontreponemal!

180
Q

what are the treponemal tests?

A

TP-PA
FTA-ABS
EIA

181
Q

what stage will ALWAYS be detected by ALL the sero tests for syphilis?

A

secondary

182
Q

what sero test is best for primary syphilis?

A

EIA

183
Q

what sero test is best for latent syphilis?

A

FTA-ABS or EIA

184
Q

what sero test is best for tertiary syphilis?

A

FTA-ABS

185
Q

i’m skipping slide 93 bc fuck that

A

p much

186
Q

what are the 4 criteria for early latent syphilis?

A

if w/i the year preceding the eval…

  1. documented seroconversion or 4x inc in cp w/ a serological titer
  2. sx of primary or secondary syphilis
  3. contact w/ an infectious case of syphilis
  4. only possible exposure occurred w/i the last year
187
Q

how should you manage latent syphilis of unk duration?

A

as if they have late latent syphilis

188
Q

what do public health laws require about syphilis?

A

you MUST report ALL cases to the state/local health dept

189
Q

what are the criteria for CSF exam in syphilis pts?

A
  1. neuro or ophthalmic signs/sx
  2. evidence of tertiary syphilis (gumma)
  3. treatment failure
  4. HIV infxn w/ CD4 1:32
190
Q

what test is considered diagnostic of neurosyphilis?

A

reactive VDRL-CSF

191
Q

can you use VDRL-CSF alone to dx neurosyphilis?

A

nope

192
Q

what 3 factors does dx of neurosyphilis depend on?

A
  1. reactive sero test
  2. abn CSF cell count or protein
  3. reactive VDRL-CSF w/ or w/o clinical manifestations
193
Q

what happens to CSF leukocytes in pts w/ neurosyphilis?

A

usu elevated (>5 WBCs/mm^3)

194
Q

what is the specificity & sensitivity of VDRL-CSF?

A

highly specific

insensitive

195
Q

what does syphilis commonly coexist w/?

A

HIV

196
Q

T/F: you can use conventional therapy on pts infected w/ both syphilis & HIV

A

TRUE

197
Q

what is the therapy for primary, secondary, & early latent syphilis?

A

benzathine penicillin G 2.4 million units IM, 1 dose

Bicillin L-A

198
Q

what do you give your pt w/ primary, secondary, or early latent syphilis if they are allergic to penicillin?

A

doxy 100 mg oral 2x/day for 14 days
OR
tetracycline 500 mg oral 4x/day for 14 days

199
Q

what is the therapy for late latent syphilis?

A

benzathine penicillin G 7.2 million units total

admin as 3 doses of 2.4 million units IM at 1 wk intervals

200
Q

what is the therapy for late latent syphilis if the pt is allergic to penicillin?

A

doxy 100 mg oral 2x/day for 28 days
OR
tetra 500mg oral 4x/day for 28 days

201
Q

what is the therapy for tertiary syphilis?

A

SAME AS LATE LATENT!

same things if penicillin allergic too!

202
Q

how do you treat neurosyphilis?

A

aqueous crystalline penicillin G 18-24 million units/day

admin as 3-4 million units IV q4 hours or continuous infusion for 10-14 days IV

203
Q

what is the alternative regimen for neurosyphilis if you can ensure compliance?

A

procaine penicillin 2.4 million units IM 1x/day
+
probenecid 500 mg oral 4x/day
BOTH for 10-14 days

204
Q

how do you treat syphilis in pregnancy?

A

treat w/ penicillin according to stage of infxn

do NOT use erythro

205
Q

what do you do w/ a pregnant pt w/ syphilis if they have a reactive skin test to penicillin?

A

desensitize them in the hospital & treat them w/ penicillin

206
Q

the fuck is a Jarisch-Herxheimer rxn???

A

self-limited rxn to antitreponemal therapy

207
Q

what are the sx of a Jarisch-Herxheimer rxn?

A 
fever
malaise
N/V
chills
exacerbation of secondary rash
208
Q

when does a Jarisch-Herxheimer rxn occur?

A

w/i 24 hours after therapy

209
Q

is a Jarisch-Herxheimer rxn the same thing as an allergic rxn to penicillin?

A

nope

210
Q

when is a Jarisch-Herxheimer rxn most common?

A

after treatment w/ penicillin & treatment of early syphilis

211
Q

what can manage but not prevent a Jarisch-Herxheimer rxn?

A

antipyretics

212
Q

what can happen if a pregnant pt gets a Jarisch-Herxheimer rxn?

A

it can precipitate early labor, so call your OB if probs develop

213
Q

what do you give HIV pts w/ primary, secondary, or early late syphilis?

A

single IM dose of 2.4 MU benzathine penicillin (conventional therapy)

214
Q

what do you give your pt w/ HIV & syphilis if they are allergic to penicillin & compliance can’t be ensured?

A

desensitize them & treat them w/ penicillin

215
Q

all pts who have syphilis should be tested for (__?__)

A

HIV infxn

216
Q

when should you reexamine a pt w/ primary or secondary syphilis?

A

6 & 12 mos

217
Q

what should you cp follow-up titers to?

A

max or baseline nontreponemal titer obtained on day of treatment

218
Q

when should you reexamine a pt w/ latent syphilis?

A

6, 12, & 24 mos

219
Q

when should you reexamine an HIV pt w/ syphilis?

A

primary or secondary: 3, 6, 9, 12, 24 mos

latent: 6, 12, 18, 24

220
Q

when should you repeat CSF exam in pts w/ neurosyphilis?

A

6 mo intervals until normal

221
Q

what are the 3 indications of probably treatment failure or reinfection?

A
  1. persistent/recurrent clinical signs/sx
  2. sustained 4x inc in titer
  3. titer fails to show a 4x decrease w/i 6-12 mos
222
Q

what should you do for sex partners of pts w/ syphilis in any stage? (2 things)

A
  1. draw syphilis serology

2. perform physical exam

223
Q

what should you do for sex partners of pts w/ primary, secondary, or early latent syphilis?

A

treat presumptively as for early syphilis at the time of exam, unless…

  1. nontreponemal test result is neg
  2. last sex contact w/ pt is >90 days prior to exam
224
Q

what are the 2 screening recommendations for syphilis?

A
  1. screen pregnant women at least at 1st prenatal visit

2. screen other pops based on local prevalence & pt’s risk behaviors

225
Q

how often should you test pregnant pts in high prevalence communities or pts at risk?

A

2x during 3rd trimester
at 28 wks
at delivery
in add’n to early routine screening

226
Q

T/F: any woman who delivers a stillborn infant after 20 wks gestation should be tested for syphilis

A

TRUE

227
Q

what is the most common cause of genital ulceration worldwide?

A

genital herpes

228
Q

why are there increases in relative prevalence of genital herpes in dvlping countries?

A

HIV infxn & assoc immunosuppression

229
Q

what kind of migration does HSV have?

A

retrograde migration along sensory nerves

230
Q

where does HSV infect?

A

mucocutaneous

231
Q

where is HSV latent?

A

dorsal root or trigeminal ganglia

232
Q

where are most HSV1 infxns?

A

orolabial

only 20% are genital

233
Q

where are most HSV2 infxns?

A

almost always genital

234
Q

how long is the incubation period of genital herpes?

A

short

235
Q

what are the sx of genital herpes primary infxn?

A 
erythema 
blisters
ulcerations
first episode is severe
multiple painful vesicles
shallow ulcers
236
Q

how long do the ulcers of primary genital herpes infxn take to heal?

A

2-3 weeks

237
Q

upon recurrence of genital herpes, are the lesions more or less severe?

A

LESS

238
Q

what % of ppl w/ primary HSV genital infxn have recurrences?

A

80%

239
Q

what can increase reactivation of genital herpes?

A

HIV infxn or immunosuppression

240
Q

how long does primary HSV2 infxn last?

A

3 weeks

241
Q

t/f: LAD & systemic sx are common w/ HSV2 infxn

A

true

242
Q

why is HA common w/ primary HSV2 infxn?

A

viral meningitis can occur in primary genital infxns

243
Q

what are the biggest diffs btwn primary & recurrent genital herpes?

A

recurrent lasts 5-10 days
recurrent has fewer lesions
recurrent generally does NOT have LAD or systemic sx or mucosal invovlement

244
Q

what is responsible for most transmission of herpes?

A

viral shedding

245
Q

what are the mean # of outbreaks in the 1st year after initial genital HSV infxn for men & women?

A

men: 5.2 outbreaks/yr
women: 4 outbreaks/yr

246
Q

T/F: the rate of recurrence of HSV outbreaks increases over time

A

FALSE

it declines

247
Q

outbreak recurrence rates are lower in HSV1 or HSV2 genital infxn?

A

genital HSV1 infxn

248
Q

pts infected w/ HSV2 shed virus subclinically, when?

A

more in the 1st yr after infxn

249
Q

how do you distinguish HSV1 from HSV2?

A

real time PCR

250
Q

how do you do a type specific serology for HSV?

A

ELISA & western blot

251
Q

is a microscopy Tzanck smear good for diagnosing HSV?

A

no, it’s only ~50% sensitive

252
Q

what test can you do on the day you collect a sample of HSV?

A

direct immunofluorescence

253
Q

how long does it take to get a posi result if you do tissue culture followed by immunofluorescent staining?

A

one to several days

254
Q

how do you treat primary & recurrent genital herpes infxns?

A

antiviral agents
Acyclovir
Valaciclovir
Famciclovir

255
Q

what happened to HSV2 isolates in 1980?

A

resistance to acyclovir assoc w/ long term therapy, esp in HIV pts, d/t THYMIDINE KINASE gene mutations

256
Q

what does thymidine kinase do?

A

catalyzes conversion of THM to THMP w/ conversion of ATP to ADP

257
Q

what is granuloma inguinale?

A

genital ulcerative dz d/t Klebsiella granulomatis

258
Q

where is granuloma inguinale endemic?

A

tropical & subtropical developing countries

259
Q

how does granuloma inguinale spread?

A

sexual contact (vaginal or anal)

260
Q

what are the sx of granuloma inguinale?

A

painless, slowly progressive ulcerative lesions on genitals & perineum that bleed on contact w/o LAD

261
Q

how long after contact w/ bacterium will you see sx of granuloma inguinale?

A

1-12 weeks

262
Q

what is the grossest possible description you can think of for granuloma inguinale?

A

small BEEFY red bumps on genitals

263
Q

what is granuloma inguinale difficult to differentiate from?

A

chancroid

264
Q

what 2 things can you do to dx granuloma inguinale?

A

culture of tissue samples (difficult)
OR
scrapings or biopsy of lesion

265
Q

how do you treat granuloma inguinale?

A

abx

266
Q

what is pelvic inflammatory dz (PID)?

A

spectrum of inflammatory disorders in the upper female genital tract

267
Q

what % of women w/ gonorrheal or chlamydial infxn develop PID?

A

10-20%

268
Q

to what does PID usu refer?

A

ascending infxn from cervix/vagina

269
Q

what are the sx of PID?

A

low fever
abd pain (uni or bilat)
uterine tenderness on pelvic exam

270
Q

what is a sequela of PID?

A

infertility (sometimes)

271
Q

what should you test endocervical discharge for?

A

G & C

272
Q

how do you treat PID?

A

broad-spectrum abx (oral if mild, IV if hospitalized)
rest for 1-3 days until sx resolve
DON’T HAVE SEX

273
Q

what is the most commonly acquired STD?

A

genital warts

274
Q

what happens if you treat HPV-related genital warts?

A

reduces infectivity but doesn’t eliminate it

275
Q

what types of HPV cause general warts?

A

6 & 11

276
Q

what types of HPV cause cervical warts?

A

16 & 18

277
Q

what are the 3 screening modalities you can use for HPV?

A

Pap smear
cytology
HPV-based DNA testing

278
Q

what population should be screened for HPV-related cervical lesions?

A

sexually active women

279
Q

who should receive cervical cytology screening on an annual basis?

A

women under 30 yo

280
Q

how often should you repeat HPV DNA & cervical cyt testing in women who are high risk HPV DNA +?

A

6-12 months

281
Q

what are the sx of genital warts?

A

pruritis
burning
vaginal bleeding
post-coital bleeding

282
Q

what do HPV genital warts look like?

A

maybe pigmented

fixed to underlying tissues

283
Q

T/F: genital warts frequently recur

A

TRUE

284
Q

what is the recommended age for the HPV vax?

A

11-12 yo

285
Q

how many shots are in the HPV series & when should you get them?

A

3 vax series

1st, then 2nd 1-2 mos later, then 3rd 6 mos later

286
Q

why does the HPV vax target types 6, 11, 16, & 18?

A

primary capsid proteins

287
Q

what is the structure of HPV?

A

nonenveloped double stranded DNA virus

288
Q

what is the cervical transformation zone?

A

area of immature metaplasia btwn the original & current squamocolumnar jxn

289
Q

where do ~99% of HPV-related genital cancers arise?

A

w/i the transformation zone of the cervix

290
Q

what HPV types are responsible for >90% of anogenital warts?

A

6 & 11

291
Q

what age groups have the peak prevalence of anogenital warts?

A

women 20-24 yo

men 25-29 yo

292
Q

what % of the sexually active US adult population has clinically apparent anogenital warts?

A

only ~1%

293
Q

what % of anogenital warts spontaneously remit?

A

up to 40%

294
Q

how do you treat genital warts?

A

topical or surgical therapy

295
Q

what is a pt-applied therapy for HPV?

A

imiquimod

296
Q

what are 2 provider-applied therapies for HPV?

A

podophyllin resin

TCA

297
Q

what is the mechanism for imiquimod?

A

cell-mediated immune response modifier

induces interferon pdtion

298
Q

how does podophyllin resin work?

A

cytotoxic & antimitotic

299
Q

how does TCA work?

A

protein coagulation of wart tissues

300
Q

what types of surgical therapy are there for HPV?

A

cryotherapy

excision

301
Q

how do you choose a therapy for HPV?

A

number, size, & site of lesions

302
Q

individuals w/ STDs are 2-5x more likely to dvlp what?

A

HIV

if exposed to virus thru sexual contact

303
Q

individuals w/ STI & HIV are more likely to transmit what?

A

HIV

304
Q

what increases your susceptibility to HIV?

A

genital ulcers that break the genital tract lining (like syphilis, herpes, chancroid)

305
Q

how do pts w/ STDs & HIV have increased infectiousness?

A

more likely to shed HIV in genital secretions if they are infected w/ other STDs

306
Q

what is lymphogranuloma venereum?

A

an STI d/t diff serotype of C. trachomatis

307
Q

how does lymphogranuloma venereum start?

A

small painless sore (on penis, vag, or rectum) > pain for ~30 days > swollen painful lymph nodes in groin

308
Q

can you get anal bleeding w/ lymphogranuloma venereum?

A

yes, 2-6 weeks after infxn

309
Q

what are sx of lymphogranuloma venereum infxn?

A

diarrhea

abd pain

310
Q

where is lymphogranuloma venereum most common?

A

tropics & subtropics

311
Q

how do you dx lymphogranuloma venereum?

A

oozing, abn connection in rectal area
swollen LN in groin
swelling of vulva or labia in women

312
Q

what abx can you use for lymphogranuloma venereum?

A

tetracycline
doxy
erythro

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