SM_202b: Reproductive Impact of STIs Flashcards
Sexually active w/ swollen, painful joints and sore throat is likely ____
Sexually active w/ swollen, painful joints and sore throat is likely gonorrhea
Number of new cases: ____ > ____ > ____
Number of new cases: HPV > chlamydia > HIV
Describe epidemiology of STIs
Epidemiology of STIs
- Half occur in young people: screen sexually active young women and men 15-24 for STIs annually)
- Women are disproportionately impacted by STIs
- African Americans
- Men who have sex with men account for 3/4 of all primary and secondary syphillis cases
Components of the disease transmission tetrahedron of STIs are ____, ____, ____, and ____
Components of the disease transmission tetrahedron of STIs are pathogen, vector (sexual behavior), environment, and host
- Rate of spread = efficiency of transmission * rate of partner change * duration of infectiousness
Prevalence of STIs ____ with the number of lifetime sexual partners especially if ____
Prevalence of STIs increases with the number of lifetime sexual partners especially if concurrent
___ have the shortest duration of shedding in an infected but untreated person
Non-latent infections (syphillis, chlamydia, etc) have the shortest duration of shedding in an infected but untreated person
- HSV and HIV are latent infections
Percentage of HIV-infected persons engaging in continuum of care ____ as they go father down the continuum
Percentage of HIV-infected persons engaging in continuum of care decreases as they go father down the continuum
Risk of sexual transmission of STDs per episode of unprotected heterosexual intercourse is highest in ____
Risk of sexual transmission of STDs per episode of unprotected heterosexual intercourse is highest in women
Neisseria gonorrhea has ____
Neisseria gonorrhea has pili
HIV has ____ ligands
HIV has CD4 ligands
A 15 yo girl is more susceptible to acquisition of chlamydia than a 55 yo woman because ____, ____, and ____
A 15 yo girl is more susceptible to acquisition of chlamydia than a 55 yo woman because
- 15 yo has more exposed cervical columnar cells
- 55 yo has more robust mucosal immune response
- 15 yo is less likely to use a condom
Describe sexual transmission of HIV-1
Sexual transmission of HIV-1
STI pathogens have different efficiency of transmission due to a variety of factors such as ____ and ____
STI pathogens have different efficiency of transmission due to a variety of factors such as duration of infectivity and phenotypic and genetic variants
____ partially explains differences in HIV acquisition by type of sexual contact
Disproportionate sharing of body fluids partially explains differences in HIV acquisition by type of sexual contact
____ is the race / ethnicity with greatest rate of STIs
African American is the race / ethnicity with greatest rate of STIs
Human ____ influence HIV infection and disease
Human genes influence HIV infection and disease
____ intercourse is associated with the highest risk of HIV transmission
Receptive anal intercourse is associated with the highest risk of HIV transmission
- Larger pathogen load in semen is deposited over a larger surface area (rectum) with more target cells (monocytes and macrophages in the sub-epithelium): explains higher risk for MSM
____ is the act with the greatest risk of HIV acquisition
Blood transfusion is the act with the greatest risk of HIV acquisition
Recent trauma is associated with ____ HIV risk
Recent trauma is associated with increased HIV risk
HIV prevalence is highest at ____ income
HIV prevalence is highest at lowest income
Describe approaches for prevention of HIV
Approaches for prevention of HIV
- Behavior change initiatives (abstinence, monogamy, condoms) are not really effective
- Test and treat efforts (PreP, PeP, microbicides, and circumcision) are more effective
Describe the impact of STIs on reproductive health of women
Impact of STIs on reproductive health of women
- Maternak acquisition -> maternal disease
- Fetal acquisition -> fetal disease
- Neonatal acquisition -> neonatal disease
(perinatal transmission)
STIs can cause ____, ____, and ____
STIs can cause acute and chronic illness, death, and fetal / neonatal effects
HPV produces ____
HPV produces a chronic infection causing genital warts, dysplasia, and cervical / vaginal / vulvar cancer
Gonorrhea and chlamydia can produce ____, ____, ____, ____, and ____
Gonorrhea and chlamydia can produce acute ascending infection, pain, infertility, ectopic pregnancy, and death
HBV can produce ____ and ____
HBV can produce acute and chronic illness and death
Describe effects of passing STIs to fetuses / neonates
Passing STIs to fetuses / neonates
- Congenital abnormalities (syphilis)
- Diminished growth (syphilis)
- Fetal death (syphilis)
- Neonatal morbidity (syphilis, gonorrhea, chlamydia, HIV)
Perinatal transmission of STIs can be ____ or ____
Perinatal transmission of STIs can be transplacental or transvaginal
Describe approaches to reduce perinatal transmission of STIs
Approaches to reduce perinatal transmission of STIs
- Maternal: reduce pathogen load, upregulate immune response, treat infection
- Obstetrical: different route of delivery, preventing rupture of membranes
- Fetal: preventing prematurity, peri-exposure prophylaxis
___, ___, ___, and ___ are transmitted transplacentally
HIV, syphilis, Zika, and HSV are transmitted transplacentally
____, ____, ____, and ____ are transmitted transvaginally
HIV, chlamydia, HSV, and HBV are transmitted transvaginally
____ and ____ are transmitted via breastfeeding
HIV and HBV are transmitted via breastfeeding
Describe fetal and neonatal disease caused by STIs
Fetal and neonatal disease caused by STIs
- Fetal: fetal infection, spontaneous abortion, congenital anomalies, premature birth, growth restriction, fetal death / stillbirth
- Neonatal: congenital infection, death
Describe approaches to prevent perinatal transmission of STIs
Approaches to prevent perinatal transmission of STIs
- Maternal acquisition: primary prevention (vaccinate, safer sex, treat male partner)
- Maternal disease: maternal screening, maternal treatment, obstetrical interventions
- Fetal acquisition: prenatal diagnosis, pregnancy interruption, fetal treatment
- Neonatal acquisition: vaccination, screening, treatment
Most perinatal transmission of HIV is ____
Most perinatal transmission of HIV is at birth
Describe factors affecting mother to child transmission of HIV
Mother to child transmission of HIV
- Maternal: viral load, antiretroviral therapy, seroconversion
- Placental: chorioamniotis, abruption
- Obstetrical: route of delivery, duration of membrane rupture
- Fetal: gestational age, post-exposure prophylaxis, breastfeeding
Risk of perinatal HIV transmission is directly related to ____ of mother
Risk of perinatal HIV transmission is directly related to viral load of mother
Risk of perinatal HIV transmission is highest in the ____ mode of delivery
Risk of perinatal HIV transmission is highest in the vaginal mode of delivery
(next is emergent c-section)
____ can reduce the risk of perinatal HIV transmission even if given at time of delivery or after birth
Antiviral therapy can reduce the risk of perinatal HIV transmission even if given at time of delivery or after birth
Describe strategy to prevent perinatal HIV transmission
Preventing perinatal HIV transmission
Chlamydia is primarily transmitted at ____
Chlamydia is primarily transmitted at birth (and intrapartum)
Chlamydia is transmitted ____
Chlamydia is transmitted transvaginally
Describe outcomes of perinatal transmission of chlamydia
Perinatal transmission of chlamydia outcomes
- Ectopic pregnancy
- Chronic pain
- Infertility
- Maternal death
- Congenital infection (conjunctivitis, pneumonia)
