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Community And Wellness > STD Part One > Flashcards

STD Part One Flashcards

1
Q

What is the bacteria that causes chlamydia?

A

Chlamydia Trachomatis

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2
Q

What is the most frequently reported STD in the US

A

Chlamydia

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3
Q

What are the risk factors of chlamydia?

A

adolescence
New or multiple sex partners
History of STI
Ectopy

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4
Q

What is an ectopy?

A

Columnar epithelial cells on the ectocervix

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5
Q

What is the transmission of chlamydia?

A

Gram-negative obligatory intracellular bacteria
*Sexual or vertical (mom to child)
*asymptomatic reservoir

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6
Q

What are clinical syndromes caused chlamydia trachomatis? (Men)

A

Local infections
*Urethritis
*Proctitis
*Conjunctivitis

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7
Q

What are clinical syndromes caused chlamydia trachomatis? (Women)

A

Local infections
*Cervicitis
*Urethritis
*Proctitis
*Conjunctivitis

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8
Q

What are clinical syndromes caused chlamydia trachomatis? (Infants)

A

Local infection
*Conjunctivitis
*Pneumonitis
*Pharyngitis
*Rhinitis
Complications
*Chronic lung disease

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9
Q

What are the common effects of chlamydia in men?

A

Urethritis
*NGU (nongonococcal urethritis)
*>50% asymptomatic
Epididymitis
*Unilateral scrotal pain
*Epididymal swelling
*Tenderness at the affected region

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10
Q

What are the signs and symptoms of urethritis caused by chlamydia? (Men)

A

mucopurulent
Mucoid or clear urethral discharge
Dysuria

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11
Q

What are the signs of infection of chlamydia in women (Cervicitis)

A

Majority asymptomatic
*mucopurulent endocervical discharge
*Edematous Cervicitis with erythema and friability

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12
Q

What are the signs of infection of chlamydia in women? (Urethritis)

A

Usually asymptomatic
Signs/symptoms
*Dysuria
*frequency
*Dyspareunia
*Hematuria

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13
Q

What does a normal cervix look like?

A

Pink, smooth
Cervical os is small and oval-like or slit-like
Covered with squamous epithelium

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14
Q

What does the cervical os look like before and after birth?

A

Oval (before)
Slit-like (after)

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15
Q

What does a cervix that is infected with chlamydia look like?

A

Reddened, inflamed surface
Mucopurulent discharge coming from the os

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16
Q

What are the complications of chlamydia that can happen in women?

A

Pelvic inflammatory disease (PID)
-endometritis
-salpingitis
-Tubo-ovarian abscess
-Peritonitis
Perihepatitis (Fitz-Hugh-Curtis Syndrome)
-inflammation of the serous or peritoneal coating of the liver
Reactive arthritis

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17
Q

What is LGV lymphadenopathy? (Lymphogranuloma venereum)

A

Inflammation of the lymph nodes surrounding the genitals
S/Sx
*Initially painless ulcer
*Multiple enlarged
*Tender inguinal lymph nodes (buboes)
*Suppurative (pus-containing)

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18
Q

What are the common reasons for chlamydia in preadolescent males and females?

A

Urogenital infections
*asymptomatic
*vertical transmission
*Sexual abuse

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19
Q

What is the preferred way to diagnose chlamydia?

A

nucleic acid amplification test (NAATs)

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20
Q

What is the purpose of NAATs/

A

can detect organism-specific DNA
*significantly more sensitive than other tests 80-90%
*Specificity is >99%

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21
Q

When are cultures used?

A

In legal investigations
*$$
*sensitivity is 50-80%
*Historically the “gold-standard”

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22
Q

What is the treatment of chlamydia in non-pregnant women?

A

Doxycycline 100mg orally twice daily for 7 days or
*Azithromycin 1g orally in a single dose

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23
Q

What is the treatment for chlamydia in pregnant women?

A

Azithromycin 1g orally in a single dose or
*Amoxicillin 500mg orally 3 times a day for 7 days

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24
Q

What is the treatment of neonatal conjunctivitis/Pneumonia?

A

Erythromycin base or ethylsuccinate 50mg/kg/day orally 6hrs for 14 days

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25
Q

Are prophylactic antibiotics recommended for infants born to mothers with untreated chlamydia infection?

A

NO

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26
Q

What is the treatment for chlamydia in children who weigh <45kg?

A

Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 days

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27
Q

What is the treatment for chlamydia in children who weigh > or equal to 45kg, but are <8 yoa

A

Azithromycin 1 g orally in a single dose

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28
Q

What is the treatment for chlamydia in children who are >8yoa

A

Azithromycin 1 g orally in a single dose, or
Doxycycline 100 mg orally twice a day for 7 days

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29
Q

What is the recommended treatment of lymphogranuloma venereum (LGV)

A

Doxycycline 100mg orally twice a day for 21 days

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30
Q

When should pregnant women be tested after treatment for chlamydia?

A

NAAT 4 weeks after completion of therapy
Re-test 3 months after treatment
<25 yo and high risk retest 3rd trimester

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31
Q

When should non-pregnant women and men by tested after treatment for chlamydia?

A

Retest 3 months after treatment
*if not possible repeat testing should be performed at next appointment within 12 months

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32
Q

Why do we screen for chlamydia?

A

B/c most infections are asymptomatic
*can reduce the incidence of PID by more than 50%

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33
Q

What are the screening recommendations for chlamydia in nonpregnant women?

A

Sexually active < 25
*screened annually
>25
*screened if risk factors are present

Re-test after 3 months of completion of treatment

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34
Q

What are the screening recommendations for chlamydia in pregnant women?

A

Screen all pregnant women at the first prenatal visit
Younger than 25yo and at an increased risk screened again 3rd trimester

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35
Q

What are the screening recommendations for chlamydia in men?

A

Screen where there is a high prevalence
MSM
*annual screening

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36
Q

What is expedited partner therapy (EPT)

A

Delivery of therapy to sex partners

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37
Q

Is chlamydia a reportable STI?

A

Yes
*HCP report to the local or state STI program

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38
Q

What can effective treatment of chlamydia reduce?

A

HIV transmission

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39
Q

What must a patient do if they are infected with chlamydia?

A

Abstain from sexual intercourse until partners are treated; for the 7 days

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40
Q

What can reduce the transmission of chlamydia?

A

Latex condoms when used consistently and correctly

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41
Q

What does the increasing proportion of gonococcal infections caused by?

A

Resistant organisms is increasing

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42
Q

What are some risk factors of gonorrhea?

A

Multiple or new sex partners
Urban residence
Lower socio-economic status

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43
Q

How is gonorrhea transmitted?

A

Male to female via semen
Vagina to male urethra
Rectal intercourse
Fellatio
Perinatal (mom to infant)

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44
Q

What is gonorrhea associated with?

A

The increased transmission of and susceptibility to HIV infection

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45
Q

What is the etiologies agent of gonorrhea?

A

Neisseria gonorrhea
*Gram-negative intracellular diplococcus
*infects mucus-secreting epithelial cells

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46
Q

What are the common signs of gonorrhea in men?

A

Urethritis
*inflammation of the urethra
Epididymitis
*Inflammation of the epididymis

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47
Q

What are the symptoms of male urethritis from gonorrhea?

A

Purulent or mucopurulent urethral discharge
*accompanied by Dysuria
*discharge may be clear or cloudy

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48
Q

What are the symptoms of Epididymitis from gonorrhea?

A

Unilateral testicular pain and swelling

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49
Q

What are the common complications of gonorrhea in women?

A

Most infections are asymptomatic
*cervicitis-inflammation of the cervix
*Urethritis-inflammation of the urethra

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50
Q

What are the symptoms of Cervicitis from gonorrhea

A

Non-specific symptoms
*vaginal discharge
*Inter-menstrual bleeding
*dysuria
Clinical findings
*Mucopurulent or purulent discharge
*easily induced cervical bleeding

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51
Q

What is the incubation period of gonorrhea?

A

Unclear

52
Q

What are some syndromes of gonorrhea in men and women?

A

Anorectal infection
*acquired by anal intercourse
*asymptomatic
Pharyngeal infection
*fever, pharyngitis, tonsillitis

53
Q

How can gonococcal ophthalmia occur?

A

Result of autoinoculation
*the gonorrhea is transferred to the eye

54
Q

What is disseminated gonococcal infection

A

Systemic gonococcal infection
Women>men
Associated with a gonococcal strain that produces bacteremia
*skin lesions

55
Q

If there is a gonococcal infection in children where would it occur?

A

Girls
*vulvovaginitis
Boys
*anorectum or pharynx

56
Q

What are the non-culture diagnostic methods for gonorrhea?

A

Amplified tests NAATS
Gram-stained smear
*reliable to diagnose or exclude symptomatic urethritis in males

57
Q

What are culture tests primarily used for?

A

Antimicrobial resistance

58
Q

If there is suspected sexual abuse what is the preferred diagnostic method?

A

Adults
-NAATs
Children
-Culture preferred for boys
-NAATs can be used as an alternative to culture with vaginal specimens or urine from girls

59
Q

What is the recommended treatment for gonorrhea if chlamydia has been excluded?

A

Ceftriaxone
*500mg IM as a single dose
*People weighing <150kg

60
Q

What treatment do you give for gonorrhea when chlamydia has be excluded for people weighing more than 150kg

A

1g of IM ceftriaxone

61
Q

What is the recommended treatment for gonorrhea is chlamydia has NOT been excluded

A

Ceftriaxone
*500mg IM as a single dose
* people weighing less then <150kg
AND
Doxycycline
*100mg orally twice daily for 7 days

62
Q

What is the recommendation to treat gonorrhea if a women is pregnant and chlamydia has NOT been excluded?

A

Azithromycin
*1g single dose

63
Q

Should pregnant women be treated with quinolones or tetracyclines?

A

NO

64
Q

When should a pregnant women be re-tested for gonorrhea?

A

A test or cure should be performed after 1 week after treatment

65
Q

If someone has a penicillin-allergy what is the recommended treatment for that?

A

IM gentamicin 240mg plus a single dose of oral azithromyxin 2 grams

66
Q

When is a test of cure recommended for gonorrhea in non-pregnant women and men?

A

Recommend if an alternative regimen is administered
*repeat testing in 3 months after treatment

67
Q

What is the recommendation of screening for gonorrhea in pregnant women?

A

Performed at the 1st prenatal visit for women <25, >25 with an increased risk
Repeat 3rd trimester if increased risk

68
Q

What is the recommendation for gonorrhea testing in non-pregnant women?

A

Screen all sexually active women 25 years and younger annually

69
Q

What is the recommendation for gonorrhea screening in MSM?

A

Annual screening at the site of exposure

70
Q

Is gonorrhea a reportable STI?

A

Yes

71
Q

Which gender has symptoms from gonorrhea and which gender doesn’t have symptoms from gonorrhea?

A

Males: symptomatic
Women: asymptomatic

72
Q

What is PID a combination of?

A

Endometritis
Salpingitis
Turbo-ovarian abscess
Pelvic peritonitis
*Ascending spread of organisms from the vagina or cervix to the structures of the upper female genital tract

73
Q

Do you need to report PID?

A

No

74
Q

What are some risk factors of PID?

A

History of PID
Infected with a history of gonorrhea
Multiple sex partners
Current douching (destroys vaginal flora)
Bacterial vaginosis

75
Q

What is the microbial etiology behind PID?

A

most cases are polymicrobial
MC pathogens
*N. Gonorrhea
*C. Trachomatis

76
Q

What is the sequelae associated with PID?

A

Approx 25% of women with PID will experience
*Ectopic pregnancy
*INFERTILITY
*Chronic pelvic pain

77
Q

What are the ranges of symptoms of PID

A

-range from asymptomatic to severe debilitating symptoms
-during the PE there can be
*Lower abdominal tenderness
*Fever
*Purulent cervical Discharge
*cervical motion tenderness (chandelier sign)

78
Q

What is the diagnostic criteria for PID?

A

Pelvic or lower abdominal pain if there is no other cause AND
*Uterine tenderness OR
*Adnexal (fallopian tubes) tenderness OR
*Cervical motion tenderness

79
Q

What are more diagnostic criteria for PID diagnosis

A

WBC on saline microscopy
Cervical friability
Elevated erythrocyte sedimentation rate
Elevated C-reactive protein

80
Q

What are some PID management tips?

A

The regimens must provide empiric broad-spectrum coverage of likely pathogens
*N. Gonorrhoeae
*C. trachomatis
*Gram-negative bacteria
*Streptococci
Treatment should be ASAP

81
Q

What are the recommended PID oral treatments?

A

Ceftriaxone 500mg IM single dose PLUS
Doxycycline 100mg orally 2x a day for 14 days PLUS
Metronidazole 500mg orally 2x a day for 14 days

82
Q

When should a follow-up happen for patients with PID?

A

Within 72 hours (re-examine)
*offer HIV testing

83
Q

What are the parenteral regimens for PID?

A

-Ceftriaxone 1G IV every 24 hrs
PLUS
-Doxycycline 100 mg PO or IV q12 hrs
PLUS
-Metronidazole 500 mg PO or IV q 12 h

84
Q

After 24 hours of clinical improvement what can the patient now take?

A

PO: doxycycline 100 mg 2 times/day and metronidazole 500 mg 2 times/day x 14 days

85
Q

How do you screen for PID?

A

Same way as chlamydia and gonorrhea

86
Q

What is the most prevalent non viral STD?

A

Trichomoniasis

87
Q

What is the prevalence of trichomoniasis in females?

A

3.1%

88
Q

How is Trichomoniasis transmitted

A

Sexually transmitted
Females and males may be asymptomatic

89
Q

What is the etiologic agent of Trichomoniasis

A

Trichomonas vaginalis
*flagellated protozoan
Can cause
*Preterm rupture of membranes and pre-term delivery
*Increased risk of HIV

90
Q

How would the effects of Trichomoniasis be presented in women>

A

vaginitis
*copious, frothy gray or yellow-green vaginal discharge, fishy smell
*Cervical petechiae
Infect the skene’s glands and urethra

91
Q

How would the effects of Trichomoniasis be presented in men?

A

Usually asymptomatic
*can cause nongonococcal urethritis (NGU)
*itching or irritation inside the penis
*burning after urination or ejaculation

92
Q

How to diagnosis Trichomoniasis in females?

A

-Saline wet mount: mobile protozoan trophozoites
-Ph>4.5 WBC
-DNA probe (Affrim VPIII)
-Rapid test (antigen detection test, OSOM)
-NAAT (urine or vaginal swab) (aptima)

93
Q

How to diagnose Trichomoniasis in men?

A

Culture testing of urethral swab, urine or semen NAATs

94
Q

What is the treatment of trichomoniasis in women?

A

metronidazole 500mg 2x a day for 7 days

95
Q

What is the treatment for trichomoniasis for men?

A

Metronidazole 2g orally in a single dose

96
Q

What is the treatment for Trichomoniasis in pregnant women?

A

Metronidazole 500mg orally 2x a day for 7 days

97
Q

What is a common reason that treatment fails?

A

Reinfection
*re-test after 3 months after initial treatment

98
Q

How long should patients wait to have sex/

A

Wait 7 days
*all sexual partners need to be cured and asymptomatic

99
Q

What is contraindicated with the treatment metronidazole?

A

Alcohol consumption

100
Q

What can reduce the risk of T. Vaginalis parasite?

A

Latex condoms

101
Q

What is the etiologic agent of syphilis/

A

Treponema pallidum
*disease progresses in stages

102
Q

What is the transmission of syphilis?

A

Direct contact of a mucocutaneous lesion
Sexual and vertical
*most contiguous during the primary and secondary stages

103
Q

What are the most important risk factors of syphilis?

A

MSM
Individuals with HIV

104
Q

What is the etiologic agent of syphilis?

A

Treponema pallidum
*corkscrew-shaped, motile
*cannot be cultured in vitro

105
Q

How does T.Pallidum enter the body?

A

Enters via skin and mucus membranes through abrasions during sexual contact

Transmitted transplacentally from mother to fetus during pregnancy

106
Q

How does T.Pallidum get into the CNS

A

Travels via the circulatory system throughout the body

Invasion of the CNS can occur during any stage of syphilis

107
Q

What are the signs of primary syphilis?

A

A chancre develops
*painless, indurated, well circumscribed, has a clean base
*highly infectious
Regional lymphadenopathy
*classically rubbery
*Painless, bilateral

108
Q

Will a serologic test for syphilis be positive during primary syphilis ?

A

Might not be positive

109
Q

What are the signs of secondary syphilis?

A

-secondary lesions occur several weeks (4-8) after the primary chancre
-rash (nonpruritic)
-condylomata lata (genital warts)
-alopecia
Nickel/dime lesions

110
Q

At what stage of syphilis are the titers the highest?

A

Secondary syphilis

111
Q

What is the Dx criteria of latent syphilis

A

Seroreacitivty indicating infection with T.pallidum
No evidence of active primary, secondary, tertiary syphilis
*host suppresses infection, but no lesions are clinically apparent

112
Q

What are the classification of syphilis?

A

Early latent (<1 year)
Late latent (>1 year)

113
Q

How does neurosyphilis occur?

A

T.Pallidum invades the CNS
*Can occur at any stage

114
Q

When does early neurosyphilis occur?

A

Occurs a few months to a few years after infection

115
Q

What happens if syphilis is left untreated?

A

Gummatous lesions
Cardiovascular syphilis
*very rare for late syphilis to occur

116
Q

How does congenital syphilis occur?

A

When T.Pallidum is transmitted from a pregnant women to her fetus
*stillbirth, neonatal death, infant disorder etc
Transmission can happen at any stage
*risk is higher during primary and secondary syphilis

117
Q

What are some common symptoms of congenital syphilis

A

Mucous patches
Hutchinson teeth
perforation of palate

Early lesions (most common): Infants <2 years old; usually inflammatory
Late lesions: Children >2 years old; tend to be immunologic and destructive

118
Q

What are the diagnosis tests for syphilis?

A

Screening:
*VDRL, RPR, TRUST, USR
*not specific for T. Pallidum
*quantitative
Confirmatory:
*TP-PA, FTA-ABS, EIA, CIA
*Measure directly against T.Pallidum
*Qualtitative

119
Q

What is treatment for primary secondary, and early latent syphilis?

A

Benzathine penicillin G 2.4 million units IM in a single dose (Bicillin L-A®)

If penicillin allergic
*Doxycycline 100 mg orally twice daily for 14 days

120
Q

What is the treatment for tertiary or late latent syphilis?

A

Benzathine penicillin G 2.4 million units intramuscularly once weekly x 3 weeks (Bicillin L-A®)

121
Q

What is the treatment for neurosyphilis?

A

IV aqueous crystalline penicillin G 3-4 million units q4hrs x 10-14 days

122
Q

When should you re-test patients who had syphilis?

A

6 and 12 months after treatment

123
Q

What is Jarisch-Herxheimer Reaction

A

Acute, self-limited reaction associated with initiation of therapy
*fever, malaise, nausea, vomiting
*Due to the release of cytokines and immune complexes from killed organisms

124
Q

What is the screening protocol for syphilis in women and pregnant women

A

Women: no routine screening
Pregnant: 1st prenatal visit, again at 28 weeks if high risk

125
Q

What is the screening protocol for heterosexually men and MSM

A

Heterosexually men: no routine screening
MSM: annually

Community And Wellness (39 decks)

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