STD Flashcards
Reportable disease means what
required by statute to be reported to public health authorities
most STDs are reportable
Local health departments do what
local tracing once something has been reported
Sexually transmitted vs. transmissible
transmitted = it has been transmitted transmissible = it is transmissible (can be transmitted)
STD vs. STI
STD = symptomatic STI = asymptomatic
Features of STDs
Diverse biological types Can be bacterial or viral Most bacteria are hard to culture Humans = natural host Few STDs are vaccine prevented Antimicrobial resistant!
Important characteristics of STDs
production of ulcers of the genital tract epithelium
increased HIV risk
Bacterial STDs - major bacteria
chlamydia trachomatis
neisseria gonorrhoreae
treponema pallidum
Chlamydia
most prevalent in US
Damage to women reproductive organs - salpingitis (infertility), blindness of child
Chlamydia enters host how
through minor abrasions in mucosal surface
drug needs to be able to get into the affected cell (need to get through the membrane)
Chlamydia - description
Energy parasite - takes up a lot of energy
Various infections - genital, eye, lymph node
Chlamydia - treatment
Sensitive only to antibiotics that enter the infected cells!
Clinical syndromes and complications caused by chlamydia - men
Urethritis, epididymitis, proctitis, conjunctivitis
systemic spread, Reiters
Clinical syndromes and complications caused by chlamydia - women
Urethritis, cervicitis, bartholinitis, salpingitis, conjunctivitis
Ectopic pregnancy, infertility!!, systemic spread, perihepatitis arthritis dermatitis
Clinical syndromes and complications caused by chlamydia - neonates
conjunctivitis
interstitial pneumonitis
Chlamydia treatment
Cell wall inhibiting antibiotics are NOT useful - antimicrobial agent has to penetrate inside the tissue to be effective!
Doxycycline, azithromycin
Tetracycline - but be careful of teeth stain (not in pregnant or children)
Alternative therapy can be quinolones
Gonorrhea (the clap) is what
A sexually transmitted non ulcerative inflammatory disease of mucosal epithelium (genitals, eyes, mouth, rectum, urethra)
Gonorrhea is caused by what organism
gram negative diplococcus (gonoccocus)
Gonorrhea can disseminate to form what
skin lesions and arthritis
Gonorrhea - sequelae includes what
dissemination to upper reproductive tract in F- salpingitis, tubo-ovarian abscess, peritonitis
Epididytimis in M
Neonates born via birth canal may develop blinding conjunctivitis
Pathogenesis with gonorrhea - tranmission
Direct mucosal contact
Primary infection sites - female cervical epithelium, male urethra, oro pharynx, rectum
Secondary - autoinoculation of eyes with fingers
Infection of infant conjunctiva during vaginal delivery
Pathogenesis with gonorrhea - Dissemination
1% cases spread to blood stream
Can lead to arthralgia, septic arthritis is most common
Skin rash on trunk, arms, palms, and soles
Pathogenesis with gonorrhea - what type of transmission is most effective
male to female
Pathogenesis with gonorrhea - female vs. male
female infection more likely to be asymptomatic compared to males
Gonorrhea - features in male
Urethritis - usually painful with pus present
Dysuria and frequent micturation
Infection can inclue epididymitis with scrotal swelling
Sympt 2-5 days after infection but can take as long as 30 days
Gonorrhea - features in females
Dysuria, lower pelvic pain, vaginal discharge
Primary infection in cervix - often asymptomatic
20% develop endometritis - upper tract invasion and damage
Primary infection in eye due to vaginal delivery of infected mother - bilateral, adults is unilateral
If primary site is oral cavity or rectum, symptoms are mild
Gonorrhea - treatment
Drug resistance inc (penicillin, tetracycline, azythromycin, cipro)
Travel history and sex hx are important
Most people also have chlamydia so antibiotics for both can be given together
Gonorrhea - drug therapy
for uncomplicated primary in adults - broad spectrum sephalosporins or wuinolones - ceftriaxone, cefixime, ciprofloxacin, ofloxacin, levofloxacin
For neonates with bacterial conjunctivits - silver nitrate or antibacterial eye drops (ceftriaxone)
Chlamydia and Gonorrhea Prevention
NO vaccine available
Antimicrobial prophylaxis is not practical
Avoid exposure, safe sexual practice!!!
CDC recommends testing for all 25 or younger if sexually active, older women with multiple sex partners, preganant women
Genital herpes - herpes simplex virus - lesion progression from
macules papules vesicles pustules ulcers
Genital herpes - herpes simplex virus - what s/s
often fever, inguinal adenopathy, malaise
symptoms are more severe in women
Genital herpes herpes simplex virus - lesion duration is
about 3 weeks
Genital herpes - herpes simplex virus common lesion sites
vulva, cervix
peritoneum
penis, thighs
buttocks
Genital herpes - herpes simplex virus - recurrent lesions
3-5 discreet lesions
vulvar irritation
prodrome - tingling, pain
heal within 7 to 10 days
Genital herpes - herpes simplex virus - Other issues
Viral meningitis/encephalitis
Bells palsy
Herpetic keratitis
Genital herpes treatments - herpes infections last how long
lifelong!
antivirals inhibit lytic replication in epithelial cells but do not clear the latent infection in neurons
viral shedding can occur in the absence of lesions (infectious)
Genital herpes - herpes simplex virus - primary infection - treatment
oral acyclovir treatment
Valcyclovir, gancyclovir
Genital herpes - herpes simplex virus - frequent recurrences -
long term oral acyclovir treatment to suprress herpes outbreaks
Genital herpes - neonatal herpes infection description
Highest risk is infants born to mothers experiencing primary infection
rarely asymptomatic
often lethal
Genital herpes - neonatal herpes infection and herpes simplex virus - disease localized to skin, eyes, mouth
Not lethal
present at 10-11 days following birth
recurrences in first 6 months
30% untreated more serious consequences - blindness, microcephaly, spastic quadriplegia
Genital herpes - neonatal herpes infection Encephalitis +/- skin lesions
1/3 of neonate infections
symptoms - seizures, lethargy, irritability, tremors, poor feeding, temp instability, bulging fontanel
50% mortality if untreated
survivors often have impairments
Genital herpes - neonatal herpes infection - disseminated infection
can go to visceral organs and skin
symptoms - irritable, seizure, resp distress, jaundics, bleeding diathesis, shock
80% mortality rate in untreated, 23% with tx
complications = hsv pneumonia, disseminated intravascular coagulation
Genital herpes - neonatal herpes infection - prevention
physical exam for lesions
caesarian sections
health care provider precautions in neonatal wards
Genital herpes - neonatal herpes infection - treatment
IV adminstration of acyclovir or similar antivirals for all neonate herpes cases
Genitral warts (human papillomavirus - HPV) - description
Hyperkeratotic, firm, exophytic papules
1mm-2 cm diameter
Symp - itching, pain, burning - 75% asymptomatic
Divided into low and high risk groups
Genitral warts (human papillomavirus - HPV) - Genital warts - treatment
cryotherapy
CO2 laser
Genitral warts (human papillomavirus - HPV) - prevention
gardasil vaccine - recommendation is universal vaccination for girls between ages of 11 and 12
