STD Part One Flashcards
1
Q
What is the bacteria that causes chlamydia?
A
Chlamydia Trachomatis
2
Q
What is the most frequently reported STD in the US
A
Chlamydia
3
Q
What are the risk factors of chlamydia?
A
adolescence
New or multiple sex partners
History of STI
Ectopy
4
Q
What is an ectopy?
A
Columnar epithelial cells on the ectocervix
5
Q
What is the transmission of chlamydia?
A
Gram-negative obligatory intracellular bacteria
*Sexual or vertical (mom to child)
*asymptomatic reservoir
6
Q
What are clinical syndromes caused chlamydia trachomatis? (Men)
A
Local infections
*Urethritis
*Proctitis
*Conjunctivitis
7
Q
What are clinical syndromes caused chlamydia trachomatis? (Women)
A
Local infections
*Cervicitis
*Urethritis
*Proctitis
*Conjunctivitis
8
Q
What are clinical syndromes caused chlamydia trachomatis? (Infants)
A
Local infection
*Conjunctivitis
*Pneumonitis
*Pharyngitis
*Rhinitis
Complications
*Chronic lung disease
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
10
Q
What are the signs and symptoms of urethritis caused by chlamydia? (Men)
A
mucopurulent
Mucoid or clear urethral discharge
Dysuria
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
12
Q
What are the signs of infection of chlamydia in women? (Urethritis)
A
Usually asymptomatic
Signs/symptoms
*Dysuria
*frequency
*Dyspareunia
*Hematuria
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
14
Q
What does the cervical os look like before and after birth?
A
Oval (before)
Slit-like (after)
15
Q
What does a cervix that is infected with chlamydia look like?
A
Reddened, inflamed surface
Mucopurulent discharge coming from the os
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
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)
18
Q
What are the common reasons for chlamydia in preadolescent males and females?
A
Urogenital infections
*asymptomatic
*vertical transmission
*Sexual abuse
19
Q
What is the preferred way to diagnose chlamydia?
A
nucleic acid amplification test (NAATs)
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%
21
Q
When are cultures used?
A
In legal investigations
*$$
*sensitivity is 50-80%
*Historically the “gold-standard”
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
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
24
Q
What is the treatment of neonatal conjunctivitis/Pneumonia?
A
Erythromycin base or ethylsuccinate 50mg/kg/day orally 6hrs for 14 days
25
Are prophylactic antibiotics recommended for infants born to mothers with untreated chlamydia infection?
NO
26
What is the treatment for chlamydia in children who weigh <45kg?
Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into 4 doses daily for 14 days
27
What is the treatment for chlamydia in children who weigh > or equal to 45kg, but are <8 yoa
Azithromycin 1 g orally in a single dose
28
What is the treatment for chlamydia in children who are >8yoa
Azithromycin 1 g orally in a single dose, or
Doxycycline 100 mg orally twice a day for 7 days
29
What is the recommended treatment of lymphogranuloma venereum (LGV)
Doxycycline 100mg orally twice a day for 21 days
30
When should pregnant women be tested after treatment for chlamydia?
NAAT 4 weeks after completion of therapy
Re-test 3 months after treatment
<25 yo and high risk retest 3rd trimester
31
When should non-pregnant women and men by tested after treatment for chlamydia?
Retest 3 months after treatment
*if not possible repeat testing should be performed at next appointment within 12 months
32
Why do we screen for chlamydia?
B/c most infections are asymptomatic
*can reduce the incidence of PID by more than 50%
33
What are the screening recommendations for chlamydia in nonpregnant women?
Sexually active < 25
*screened annually
>25
*screened if risk factors are present
Re-test after 3 months of completion of treatment
34
What are the screening recommendations for chlamydia in pregnant women?
Screen all pregnant women at the first prenatal visit
Younger than 25yo and at an increased risk screened again 3rd trimester
35
What are the screening recommendations for chlamydia in men?
Screen where there is a high prevalence
MSM
*annual screening
36
What is expedited partner therapy (EPT)
Delivery of therapy to sex partners
37
Is chlamydia a reportable STI?
Yes
*HCP report to the local or state STI program
38
What can effective treatment of chlamydia reduce?
HIV transmission
39
What must a patient do if they are infected with chlamydia?
Abstain from sexual intercourse until partners are treated; for the 7 days
40
What can reduce the transmission of chlamydia?
Latex condoms when used consistently and correctly
41
What does the increasing proportion of gonococcal infections caused by?
Resistant organisms is increasing
42
What are some risk factors of gonorrhea?
Multiple or new sex partners
Urban residence
Lower socio-economic status
43
How is gonorrhea transmitted?
Male to female via semen
Vagina to male urethra
Rectal intercourse
Fellatio
Perinatal (mom to infant)
44
What is gonorrhea associated with?
The increased transmission of and susceptibility to HIV infection
45
What is the etiologies agent of gonorrhea?
Neisseria gonorrhea
*Gram-negative intracellular diplococcus
*infects mucus-secreting epithelial cells
46
What are the common signs of gonorrhea in men?
Urethritis
*inflammation of the urethra
Epididymitis
*Inflammation of the epididymis
47
What are the symptoms of male urethritis from gonorrhea?
Purulent or mucopurulent urethral discharge
*accompanied by Dysuria
*discharge may be clear or cloudy
48
What are the symptoms of Epididymitis from gonorrhea?
Unilateral testicular pain and swelling
49
What are the common complications of gonorrhea in women?
Most infections are asymptomatic
*cervicitis-inflammation of the cervix
*Urethritis-inflammation of the urethra
50
What are the symptoms of Cervicitis from gonorrhea
Non-specific symptoms
*vaginal discharge
*Inter-menstrual bleeding
*dysuria
Clinical findings
*Mucopurulent or purulent discharge
*easily induced cervical bleeding
51
What is the incubation period of gonorrhea?
Unclear
52
What are some syndromes of gonorrhea in men and women?
Anorectal infection
*acquired by anal intercourse
*asymptomatic
Pharyngeal infection
*fever, pharyngitis, tonsillitis
53
How can gonococcal ophthalmia occur?
Result of autoinoculation
*the gonorrhea is transferred to the eye
54
What is disseminated gonococcal infection
Systemic gonococcal infection
Women>men
Associated with a gonococcal strain that produces bacteremia
*skin lesions
55
If there is a gonococcal infection in children where would it occur?
Girls
*vulvovaginitis
Boys
*anorectum or pharynx
56
What are the non-culture diagnostic methods for gonorrhea?
Amplified tests NAATS
Gram-stained smear
*reliable to diagnose or exclude symptomatic urethritis in males
57
What are culture tests primarily used for?
Antimicrobial resistance
58
If there is suspected sexual abuse what is the preferred diagnostic method?
Adults
-NAATs
Children
-Culture preferred for boys
-NAATs can be used as an alternative to culture with vaginal specimens or urine from girls
59
What is the recommended treatment for gonorrhea if chlamydia has been excluded?
Ceftriaxone
*500mg IM as a single dose
*People weighing <150kg
60
What treatment do you give for gonorrhea when chlamydia has be excluded for people weighing more than 150kg
1g of IM ceftriaxone
61
What is the recommended treatment for gonorrhea is chlamydia has NOT been excluded
Ceftriaxone
*500mg IM as a single dose
* people weighing less then <150kg
AND
Doxycycline
*100mg orally twice daily for 7 days
62
What is the recommendation to treat gonorrhea if a women is pregnant and chlamydia has NOT been excluded?
Azithromycin
*1g single dose
63
Should pregnant women be treated with quinolones or tetracyclines?
NO
64
When should a pregnant women be re-tested for gonorrhea?
A test or cure should be performed after 1 week after treatment
65
If someone has a penicillin-allergy what is the recommended treatment for that?
IM gentamicin 240mg plus a single dose of oral azithromyxin 2 grams
66
When is a test of cure recommended for gonorrhea in non-pregnant women and men?
Recommend if an alternative regimen is administered
*repeat testing in 3 months after treatment
67
What is the recommendation of screening for gonorrhea in pregnant women?
Performed at the 1st prenatal visit for women <25, >25 with an increased risk
Repeat 3rd trimester if increased risk
68
What is the recommendation for gonorrhea testing in non-pregnant women?
Screen all sexually active women 25 years and younger annually
69
What is the recommendation for gonorrhea screening in MSM?
Annual screening at the site of exposure
70
Is gonorrhea a reportable STI?
Yes
71
Which gender has symptoms from gonorrhea and which gender doesn’t have symptoms from gonorrhea?
Males: symptomatic
Women: asymptomatic
72
What is PID a combination of?
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
Do you need to report PID?
No
74
What are some risk factors of PID?
History of PID
Infected with a history of gonorrhea
Multiple sex partners
Current douching (destroys vaginal flora)
Bacterial vaginosis
75
What is the microbial etiology behind PID?
most cases are polymicrobial
MC pathogens
*N. Gonorrhea
*C. Trachomatis
76
What is the sequelae associated with PID?
Approx 25% of women with PID will experience
*Ectopic pregnancy
*INFERTILITY
*Chronic pelvic pain
77
What are the ranges of symptoms of PID
-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
What is the diagnostic criteria for PID?
Pelvic or lower abdominal pain if there is no other cause AND
*Uterine tenderness OR
*Adnexal (fallopian tubes) tenderness OR
*Cervical motion tenderness
79
What are more diagnostic criteria for PID diagnosis
WBC on saline microscopy
Cervical friability
Elevated erythrocyte sedimentation rate
Elevated C-reactive protein
80
What are some PID management tips?
The regimens must provide empiric broad-spectrum coverage of likely pathogens
*N. Gonorrhoeae
*C. trachomatis
*Gram-negative bacteria
*Streptococci
Treatment should be ASAP
81
What are the recommended PID oral treatments?
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
When should a follow-up happen for patients with PID?
Within 72 hours (re-examine)
*offer HIV testing
83
What are the parenteral regimens for PID?
-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
After 24 hours of clinical improvement what can the patient now take?
PO: doxycycline 100 mg 2 times/day and metronidazole 500 mg 2 times/day x 14 days
85
How do you screen for PID?
Same way as chlamydia and gonorrhea
86
What is the most prevalent non viral STD?
Trichomoniasis
87
What is the prevalence of trichomoniasis in females?
3.1%
88
How is Trichomoniasis transmitted
Sexually transmitted
Females and males may be asymptomatic
89
What is the etiologic agent of Trichomoniasis
Trichomonas vaginalis
*flagellated protozoan
Can cause
*Preterm rupture of membranes and pre-term delivery
*Increased risk of HIV
90
How would the effects of Trichomoniasis be presented in women>
vaginitis
*copious, frothy gray or yellow-green vaginal discharge, fishy smell
*Cervical petechiae
Infect the skene’s glands and urethra
91
How would the effects of Trichomoniasis be presented in men?
Usually asymptomatic
*can cause nongonococcal urethritis (NGU)
*itching or irritation inside the penis
*burning after urination or ejaculation
92
How to diagnosis Trichomoniasis in females?
-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
How to diagnose Trichomoniasis in men?
Culture testing of urethral swab, urine or semen NAATs
94
What is the treatment of trichomoniasis in women?
metronidazole 500mg 2x a day for 7 days
95
What is the treatment for trichomoniasis for men?
Metronidazole 2g orally in a single dose
96
What is the treatment for Trichomoniasis in pregnant women?
Metronidazole 500mg orally 2x a day for 7 days
97
What is a common reason that treatment fails?
Reinfection
*re-test after 3 months after initial treatment
98
How long should patients wait to have sex/
Wait 7 days
*all sexual partners need to be cured and asymptomatic
99
What is contraindicated with the treatment metronidazole?
Alcohol consumption
100
What can reduce the risk of T. Vaginalis parasite?
Latex condoms
101
What is the etiologic agent of syphilis/
Treponema pallidum
*disease progresses in stages
102
What is the transmission of syphilis?
Direct contact of a mucocutaneous lesion
Sexual and vertical
*most contiguous during the primary and secondary stages
103
What are the most important risk factors of syphilis?
MSM
Individuals with HIV
104
What is the etiologic agent of syphilis?
Treponema pallidum
*corkscrew-shaped, motile
*cannot be cultured in vitro
105
How does T.Pallidum enter the body?
Enters via skin and mucus membranes through abrasions during sexual contact
Transmitted transplacentally from mother to fetus during pregnancy
106
How does T.Pallidum get into the CNS
Travels via the circulatory system throughout the body
Invasion of the CNS can occur during any stage of syphilis
107
What are the signs of primary syphilis?
A chancre develops
*painless, indurated, well circumscribed, has a clean base
*highly infectious
Regional lymphadenopathy
*classically rubbery
*Painless, bilateral
108
Will a serologic test for syphilis be positive during primary syphilis ?
Might not be positive
109
What are the signs of secondary syphilis?
-secondary lesions occur several weeks (4-8) after the primary chancre
-rash (nonpruritic)
-condylomata lata (genital warts)
-alopecia
Nickel/dime lesions
110
At what stage of syphilis are the titers the highest?
Secondary syphilis
111
What is the Dx criteria of latent syphilis
Seroreacitivty indicating infection with T.pallidum
No evidence of active primary, secondary, tertiary syphilis
*host suppresses infection, but no lesions are clinically apparent
112
What are the classification of syphilis?
Early latent (<1 year)
Late latent (>1 year)
113
How does neurosyphilis occur?
T.Pallidum invades the CNS
*Can occur at any stage
114
When does early neurosyphilis occur?
Occurs a few months to a few years after infection
115
What happens if syphilis is left untreated?
Gummatous lesions
Cardiovascular syphilis
*very rare for late syphilis to occur
116
How does congenital syphilis occur?
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
What are some common symptoms of congenital syphilis
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
What are the diagnosis tests for syphilis?
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
What is treatment for primary secondary, and early latent syphilis?
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
What is the treatment for tertiary or late latent syphilis?
Benzathine penicillin G 2.4 million units intramuscularly once weekly x 3 weeks (Bicillin L-A®)
121
What is the treatment for neurosyphilis?
IV aqueous crystalline penicillin G 3-4 million units q4hrs x 10-14 days
122
When should you re-test patients who had syphilis?
6 and 12 months after treatment
123
What is Jarisch-Herxheimer Reaction
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
What is the screening protocol for syphilis in women and pregnant women
Women: no routine screening
Pregnant: 1st prenatal visit, again at 28 weeks if high risk
125
What is the screening protocol for heterosexually men and MSM
Heterosexually men: no routine screening
MSM: annually
