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BDS4 Oral Medicine > STD 1 > Flashcards

STD 1 Flashcards

1
Q

What are STDs?

A

Diseases which are capable of being spread from person to person through sexual contact and not only

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2
Q

How can STDs be transmitted?

A
  • Sexual Intercourse
    vaginal
    anal
    oral
  • Blood-to-blood contact
  • Sharing needles or other drug-use equipment
  • Tattoo or body piercing
  • Infected mother to her baby
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3
Q

Which body fluids are considered high risk for STD transmission?

A
  • Semen
  • Vaginal fluid
  • Blood
  • Fluid in sores or blisters
  • Cerebrospinal fluid, Amniotic fluid, Pleural fluid, Synovial fluid, and Peritoneal and Pericardial fluids
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4
Q

Which fluids are considered low risk for STD transmission?

A
  • Saliva
  • Tears
  • Sweat
  • Urine
  • Feces
  • Ear wax
  • Nasal secretion
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5
Q

What are the features of Trichomonas Vaginalis?

A

Anaerobic

Parasitic Protozoa

Pyriform/amoeboid shape

10-20um length x 2-14um width

4 flagellum pointing anterior, 1 posterior

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6
Q

What part does Trichomonas attach to and replicate?

A

Squamous epithelium of genital tract
-> replicates in lower genital tract, urethra, prostate

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7
Q

What happens when Trichomonas attaches to tissue?

A

Lyses host epithelial cells

Triggers immune response causing inflammation

Pathogenic disruption of vaginal bacteria

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8
Q

What area is Tricomoniasis most prevalent in?

A

Western pacific region

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9
Q

What percentage of patients with Trichomoniasis are asymptomatic?

A

Men- 77%

Females- 85%

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10
Q

What are the symptoms of Trichomoniasis in females?

A
  • Heavy, unpleasant smelling green-yellow discharge
  • Itching and burning at the outside of the opening of the vagina and vulva
  • Painful and frequent urination
  • Vulvar irritation and abdominal pain.
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11
Q

What are the symptoms of Trichomoniasis in males?

A
  • Mild discomfort in urethra
  • Minimal urethral discharge
  • Dysuria
  • Inflamed head of the penis.
    -> Complications can also include epididymitis, prostatitis, and decreased sperm cell motility
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12
Q

What are the features of oral ulcers seen in patients with Trichomonas present?

A

Large- 1-1.5cm in diameter

Circumscribed with elevated edges

Necrotic centre- with yellowish colour

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13
Q

How is Trichomoniasis diagnosed?

A

Direct Microscopic examination- wet mount

Isolation- gold standard but higher cost

Rapid tests
-> OSOM
-> GeneXpert
-> Xenostrip

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14
Q

How is Trichomoniasis treated?

A

Avoid sexual intercourse and tell partners

Metroniazdole/Tinidazole- single dose 2g orally

Metronizadole- 400-500mg x 2 daily for 7 days
-> mostly for HIV patients

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15
Q

What must patients on metronidazole and tinidazole abstain from?

A

Alcohol
-> M- until 24 hours after last dose
-> T- until 72 hours after last dose

Prevents disulfiram reaction

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16
Q

What type of bacteria is Chlamydia?

A

Gram negative obligate anaerobe

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17
Q

What are the forms of Chlamydia?

A

Elementary body- 300nm, extracellular, metabolically inactive

Reticulate body- 400nm, intracellular, replicative

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18
Q

What happens to elementary body as it enters host cell?

A

It transforms it to Reticulate body form
-> it returns to EB form when released by host cell as a result of inclusion extrusion or lysis

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19
Q

What causes Chlamydia to become non-infectious persistent form?

A

Exposure to:
* IFN gamma
* Pencillin G
* Iron depletion

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20
Q

What is the incubation period in Chlamydia?

A

7-21 days

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21
Q

What are some of the symptoms that can occur in patients who have asymptomatic genital Chlamydia?

A

Fever

Weight loss

Lymphadenopathy

Fatigue

Diarrhoea

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22
Q

What are the female symptoms of Chlamydia?

A

Vaginal discharge (white or grey)

Burning with urination

Lower abdominal pain

Bleeding between menstrual periods

Cervicitis that can progress to pelvic
inflammatory disease

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23
Q

What are the male symptoms of Chlamydia?

A

Urethritis, or less commonly epididymitis

Discharge from the penis

Painful and burning urination

Burning and itching around the opening of the penis

Pain and swelling around the testicles

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24
Q

How may chlamydia present orally?

A

Tonsillopharyngitis

Oropharyngeal Lymphogranuloma

25
Q

What tests can be done for Chlamydia?

A

PCR/SDA/TDA- high sensitivity, can be done from urine/vaginal swabs, automated

Cell culture

EIA

DFA

Serology- if other specimens not obtainable

26
Q

How is Chlamydia treated?

A

Abstain from sex until regimen is completed

Azithromycin- single dose 1g orally

Doxycycline- 100mg x 2 daily for 7 days

27
Q

What are the features of Neisseria Gonorrhoeae?

A

Gram Negative

Non-motile cocci

0.8um

Can be in pairs

28
Q

What are the steps in the pathogenesis of gonorrhoea?

A
  1. Adherence to urogenital epithelium
  2. Competition with resident microbiota- colinsation and invasion of epithelium
  3. Release of peptidogylycan, LOS, OMVs- causes NOD/TLR activation , triggering innate immunity
  4. Cytokine chemokine and inflammatory transcription factor activation
  5. Influx of neutrophils causing phagocytosis
  6. Formation of neutrophil rich purulent exudate (facilitates transmission)
29
Q

What is the incubation period for Gonorrhea?

A

2-8 days

30
Q

What are the non-genital symptoms of Gonorrhea?

A

Fever

Chills

Nausea

Vomiting

Leukocytosis

Tonsillar infection

31
Q

What are the female symptoms of Gonorrhea?

A

Cervicitis- discharge, bleeding, dysuria

Urethritis

Pelvic inflammatory disease

32
Q

What are the male symptoms of gonorrhoea?

A

Urethritis

Urethral discharge

Dysuria

33
Q

What are the complications for males of gonorrhoea?

A

Acute unilateral epididymitis

Penile oedema (“bull-headed clap”)

Penile lymphangitis

Periurethral abscess

Acute and chronic prostatitis

Seminal vesiculitis

Swollen testicles

34
Q

What type of specimens can be used for Gonorrhea?

A

Urine

Urethral swab

Rectal swab

Pharyngeal swab

Conjunctival swab

35
Q

What are the different testing methods for Gonorrhea?

A

Microscopy

Culture

Nucleic acid amplification- BEST

36
Q

What treatment is used for Gonorrhea?

A

Ceftriaxone

37
Q

What is Syphillis caused by?

A

Treponema Pallidum- spirochete bacterium

38
Q

What are the features of Treponema Pallidum?

A

Helical shape

Micro-aerophillic bacterium

6-20um length, 0.1-0.18um in diameter

Central protoplasmic cylinder bound by cytoplasm membrane with overlying peptidoglycan then out membrane

Flagelar motors and filaments

39
Q

Where is syphilis most incident?

A

Africa

40
Q

How is syphilis spread?

A

Direct contact lesion

Blood transfer

Sexual contact

41
Q

What are the steps in the pathogenesis of Syphilis?

A

Spirochetes adhere to epithelial cells or ECM allowing them to penetrate mucous membranes or enter through abrasions

Spirochetes then penetrate ECM and intercellular junctions- invasion

Tissue destruction occur due to immune response elicited by spirochetes

42
Q

How long does the primary syphilitic lesion take to appear?

A

3 weeks after inoculation

43
Q

How does primary syphillis present?

A

As a chancre
-> Painless ulcer or papule
-> Typically single
-> Lasts 3-6 weeks then heals on its on without scarring

Lympadenopathy

Resolves with tx

44
Q

How does secondary syphilis present?

A

Occurs many weeks after primary infection

Fever

Weight loss

Fatigue

Myalgias

Athralgias

Sore throat

Headache

Hairloss

Rash- macular, papular, follicular, scarring
-> can occur orally

45
Q

When does latent syphilis occur?

A

If primary and secondary manifestations resolve without treatment

46
Q

What are the stages of the latent phase of syphilis?

A

Early latent- within first year
-> T.pallidum can be present in tissues and give recurrence
-> responds to tx

Late- after first year
-> does not respond to treatment

47
Q

What occurs after the latent stage of syphilis?

A

Tertiary stage (15% of untreated patients)

48
Q

What are the lesions that occur in tertiary syphillis?

A

Neurological
-> Meningeal syphilis
-> Meningovascular
-> General paresis
-> Tabes Dorsalis

CV

Muco-cutaneous

49
Q

What are some of the signs and symptoms od early congenital syphilis?

A

Still birth
Lymphadenopathy
Anaemia
Leukopenia/leukocytosis
Rhinitis
Rash
Long bone lesions
Aseptic meningitis
Retinitis

50
Q

What are the signs and symptoms of late congenital syphillis?

A

Hutchinson’s teeth

Mulberry Molars

Interstitial keratitis of eye

CN8 damage- deafness

Saddel nose

Impaired maxillary growth

51
Q

What are the features of hutchinson’s teeth? (upper incisors)

A

Present at 6 years

Centrally notched

Widely spaced

Peg shaped

52
Q

What are the features of mulberry molars?

A

Surface has poorly developed cusps giving dome shaped tooth

53
Q

What are the differential diagnoses for Primary syphillis?

A
  • HSV
  • RAS
  • Penile cancer
  • TB
  • Behcets
  • LP
  • Traumatic ulceration
  • Reiters
  • Scabies
54
Q

What are the methods for diagnosis Syphilis? (detection of T.Pallidum)

A

Darkfield Microscopy

Direct fluorescent antibody staining

PCR

Immunohistochemisty

55
Q

What are the types of serodiagnostic tests for syphillis?

A

Nontreponemal
-> measures IgM and IgG produced in response to lipoidal material released from bacterium/dying host cells
-> becomes positive 10-15 days after lesion

Treponemal- detects antibodies agains TP proteins (highly specific)
-> not useful for treatment effectiveness
-> Becomes positive 6-14 days after primary lesion
-> Good if missed by NTT

56
Q

What treatment is used for Primary, Secondary, Early latent syphillis?

A

Penicillin- 2.4 million units of penicillin
-> 2 IM injections

Doxycycline- 100mg 2 x per day for 14 days

Tetracycline- 500mg 4 x per day for 14 days

57
Q

What treatment is used for late latent, Cardiovascular, mucocutaneous syphillis?

A

Penillin- 7.2 million units IM
-> 2.4 at 7 day intervals for 21 days

Doxycycline- 100 mg x2 per day for 28 days

Tetracycline- 500mg x4 per day for 28 days

58
Q

What is the treatment for symptomatic or asymptomatic neurosyphilis?

A

2-4 million units of aqueous penicillin G IV every 4 hours for 10 days

2-4 million units of procaine penicillin IM and probenecid 500mg x 4 daily for 10-14 days

Ceftriaxone- 2g IM or IV for 10-14 days

BDS4 Oral Medicine (28 decks)

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