Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FM3-2: Parasites, STDs, etc > STDs > Flashcards

STDs Flashcards

1
Q

STDs that increase risk of HIV (7)

A

Chlamydia, gonorrhea, bacterial vaginosis, herpes, syphilis, chancroid, Klebsiella granulomatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Gonococcal urethritis
Incubation period
Dysuria
Discharge

A

Less than 4 days
Severe
Profuse yellow / green

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Incubation period for nongonococcal (chalmydial) urtheritis

A

7-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Severity of dysuria w/ gonococcus

A

Severe. Like peeing out glass shards.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Severity of dysuria w/ non gonococcus

A

Mild / moderate / intermittent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Type of male discharge w/ gonococcus

A

Profuse yellow or green

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Type of male discharge w/ nongonococcus

A

Slight, grey, can be mixed w/ mucous. May only be noticed in underwear upon wakening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What stain is used for urethritis?

Diagnostic criteria

A
  • Gram stain / methylene blue / gentian violet stain of discharge
  • > 2 WBC per oil immersion field + gram neg intracellular diplococci (GNID)
  • > 2 WBC per oil immersion field w/o GNID = NGU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diagnosing urethritis (4)

A

Discharge seen on exam
Gram stain
Urinalysis: >10 WBC/HPF or positive leukocyte esterase (LE) on first void urine
PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treating urethritis
GC
NGU

A
  • N gonorrhoeae: ceftriaxone + azithromycin or doxycycline (if allergic to azithro)
  • NGU: azithromycin or doxycycline
  • ALL pxs treated for GC should be treated for Chlamydia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is most common cause of persistent / recurrent NGU? What do you use to treat?

A

Mycoplasma genitalium is most common cause of persistent / recurrent NGU. Tx w/ azithro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Follow up for urethritis

A

Repeat testing in 3 months to check for reinfection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of urethritis (2)

A

C teach may cause epididymitis or reactive arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sxs of cervicitis

A
  • Asymptomatic is common
  • Sxs include abnormal vaginal discharge and intermenstrual bleeding (especially after sex). Usually NOT painful (pain may indicate PID).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 most common causes of cervicitis

A

Neisseria gonorrheae and Chlamydia trachomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnosing cervicitis
2 major
3 others

A
  • Major diagnostic criteria (need at least one): (Muco)purulent endocervical exudate or sustained endocervical bleeding induced by cotton swab through os.
  • Others – leucorrhea, gram stain, PCR of cervical / vaginal / urine specimens
  • Neg gram stain does not rule out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What must always be done in the case of cervicitis?

A

Must ALWAYS evaluate for upper tract disease (PID), looking for adnexal / uterine tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treating cervicitis

A
  • Treatment – same as urethritis
  • N gonorrhoeae: ceftriaxone + azithromycin or doxycycline (if allergic to azithro)
  • NGU: azithromycin or doxycycline
  • ALL pxs treated for GC should be treated for Chlamydia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Follow up for cervicitis

A
  • No test of cure, except for pregnancy or if GC regimen did not include ceftriaxone
  • Repeat testing at 3-6 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the #1 bacterial STD in the US?

A

Chlamydia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pxs at risk of Chlamydia

A

Women 2x risk. Women under 25 y/o should be screened yearly.
Most common in ages 15-24. South.
AA’s at highest risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Serotypes of Chlamydia

A
  • D-K: urethritis, cervicitis, neonatal infection

* L1-L3: lymphogranuloma venerum (LGV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Elementary Body vs Reticulate Body

A
  • Elementary body (EB) – Enters & Exits the cell

* Reticulate Body (RB) – Replicates in the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Gram stain for Chlamydia

A

Abundant WBCs but not intracellular diplococci (gonorrhea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What percentage of pxs w/ Chlamydia are asymptomatic?

A

Men 42%, women 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Sxs of Chlamydia

A

Men: dysuria, discharge, pruritis
Women: discharge, bleeding, painful sex, dysuria
Both: proctitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Complications of Chlamydia

A

Men: epididymitis, prostatitis, reactive arthritis
Women: PID (occurs in 20%), tubal infertility, ectopic pregnancy, chronic pelvic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q 
Neonatal inclusion conjunctivitis
Other name
Cause
Onset
Treatment
A
  • aka Opthalmia neonatorum
  • Caused by Chlamydia
  • Acquired during birth. Onset 5-12 days after birth.
  • Tx w/ oral erythromycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Neonatal C trach pneumonia
Onset
Associated sxs
Treatment

A
  • Acquired during birth. Onset w/in 8 weeks.
  • 50% of pxs will also have conjunctivitis. Peripheral eosinophilia may be present.
  • Tx w/ ORAL erythromycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Diagnosing Chlamydia
Women (3)
Men (2)
Both (1)

A
  • Women – Mucopurulent discharge from cervix, sustained bleeding via cotton swab through os, always evaluate for PID
  • Men – gram stain, UA on first void urine looking for nucleic acids
  • PCR for both
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Screening for Chlamydia

A
  • Annual screening for sexually active women less than 25 y/o, or > 25 y/o w/ risk factors (new partner, poor condom use, sex work)
  • Screening in 3rd trimester for pregnant women
  • Annual screening for syphilis, Chlamydia, gonorrhea, and HIV for men at adolescent clinics, STD clinics, jail, or MSM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

STD screening for men

A

Annual screening for syphilis, Chlamydia, gonorrhea, and HIV for men at adolescent clinics, STD clinics, jail, or MSM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Treating Chlamydia

A

Azithromycin or doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Follow up for Chlamydia

A

No test of cure unless pregnant

Repeat testing in 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

2nd most common bacterial STD in US

A

Gonorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Epidemiology of gonorrhea

A

More common in women.
Age 15-24 is highest.
AA’s at highest risk.
South.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Risk of gonorrhea transmission (male vs female)

A
  • Male → female 50-70% per exposure

* Female → male 20% per exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Mechanism of gonorrhea infection

A

Infects columnar / cuboidal epithelium. Pili help w/ attachment. Internalized, then released via basolateral membrane to disseminate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What percentage of pxs w/ gonorrhea are symptomatic?

A

Men 90%

Women only 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

1 complication of gonorrhea in men

A

Epididymyitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How common is pharyngeal gonorrhea?

A

25% of pxs w/ urogenital gonorrhea. Almost always asymptomatic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Sxs of anorectal gonorrhea (4)

A

Pruritis, tenesmus, discharge, bleeding

43
Q

Disseminated Gonoccocal Infection (DGI)
How common?
Underlying predisposition
2 main syndromes

A

•Occurs in 1-3% of pxs
•13% of complement deficiency
1) Arthritis Dermatitis - asymmetric polyarthritis, papules / pustules (full of bacteria, contagious)
2) Septic arthritis - Usually involves only 1 joint, most often on knee.

44
Q

Most common presentation of DGI (disseminated gonococcal infection)

A

Arthritis-dermatitis

45
Q 
Gonococcal conjunctivitis
Onset
Prevention
Treatment
Complication
A

Occurs 2-3 days after birth.
Prevented w/ erythromycin ointment (does not work for Chlamydia)
Treat w/ ceftriaxone
Untreated may cause blindness

46
Q

4 neonatal gonococcal diseases

A

Opthalmia neonatorum (aka gonococcal conjunctivitis)
Scalp abscess
Meningitis
Bacterial sepsis

47
Q

Diagnosing gonorrhea (3)

A
  • GS / MB / GV (gentian violet) / culture. Look for gram neg intracellular diplococci on gram stain
  • PCR: superior to culture in asymptomatic pxs
48
Q

Screening for gonorrhea (4)

A
  • Annual screening for women less than 25 y/o or > 25 y/o w/ risk factors (new partner, poor condom use, sex work). Same as Chlamydia.
  • Pregnant women.
  • Annual screening for MSM
49
Q

Treating gonorrhea

A
  • Treatment – always treat for Chlamydia as well, even if there’s no evidence of it.
  • Urethritis / cervicitis: Ceftriaxone + azithromycin or doxycycline (if allergic to azithro)
  • Disseminated: hospitalization + AB susceptibility testing. Ceftriaxone + azithro
  • GC is often resistant to tetracycline, so azithro is preferred to doxy
50
Q

Definition of PID

A

Any combo of cervicitis, endometritis, salpingitis, tubo-ovarian abscess, or peritonitis including peri-hepatitis (Fitz-Hugh-Curtis Syndrome)

51
Q

Fitz-Hugh-Curtis Syndrome

A

Direct extension of N gon or C trach from fallopian tube to liver). “Violin strings” seen b/w liver capsule and parietal peritoneum.

52
Q

Bacteria that cause PID

A

Polymicrobial: C trachomatis or N gonorrhoeae + normal vaginal flora (Strep agalactiae, H flu, E coli, Bacteroides fragilis, Gardnerella vaginalis)

53
Q

How common is PID in pxs w/ Chlamydia or Gonorrhea?

A

10-40% of women w/ C trach or N gon develop PID

54
Q

Risk factors for PID

A
  • Teenagers, new partner, prior episode of PID, IUD (usually w/in first 3 weeks), douching (changing vaginal flora and pushing bacteria up).
  • Pxs w/ HIV have higher rate of tubo-ovarian abscess
55
Q

Sxs of PID (6)

What percentage are asymptomatic?

A
  • Lower abdominal pain, fever, vaginal discharge w/ foul odor, dysuria, painful sex, peri-hepatitis
  • 2/3 are asymptomatic
56
Q 
Diagnosing PID
3 Major criteria
Supportive findings
Imaging
Histo
A
  • High index of suspicion is required. Diagnosis is clinical, not lab-based.
  • Major criteria (need at least 1): cervical motion tenderness, uterine tenderness, adnexal tenderness
  • Supportive findings: WBC vaginal secretions, mucopurulent cervicitis, cervical friability, fever, high ESR / CRP, lab proof of C trach or N gon
  • Transvaginal US may show thickened, fluid filled fallopian tubes
  • Endometrial biopsy may show endometritis
57
Q

Treating PID

A
  • Broad spectrum AB’s against C trach, GC, Strep, enteric GNRs, anaerobes. Start as soon as diagnosis is made.
  • Partner notification / testing
  • No sex until AB’s are finished
  • Repeat testing for Chlamydia and gonorrhea in 3 months
58
Q

Complications of PID

A
  • Infertility – risk increases w/ each episode (15%, 30%, 60%)
  • Ectopic pregnancy and chronic pelvic pain
59
Q

1 cause of vaginal discharge

A

Bacterial Vaginosis

60
Q

Risk factors for BV (4)

A

New partner, poor condom use, douching, loss of lactobacillus species

61
Q

Cause of BV

A

Loss of H2O2 producing lactobacillus → increase in Gardnerella vaginalis and anaerobes.

62
Q

What does BV increase the risk of? (4)

A

Increased risk of C trach, N gon, HSV2, HIV

63
Q

Clinical manifestations of BV (3)

A
  • Vaginal discharge – gray / white, FISHY ODOR (mainly occurs after sex or menstruation)
  • NO inflammation of vaginal walls / cervix. No cervicitis or tenderness. If tenderness is present, it may indicate coinfection w/ other STD.
  • Pregnancy – All pregnant women should be treated due to association w/ premature rupture of membranes (PROM), early labor, preterm birth, and postpartum endometritis.
64
Q

Diagnosing BV

A
  • Gram stain is gold standard. Used to determine relative concentration of lactobacilli to other bacteria. However, most physicians use clinical criteria.
  • Clinical criteria (3/4 must be met)
  • Discharge
  • Positive “whiff test” w/ addition of 10% KOH to discharge
  • Vaginal pH > 4.5 (due to lack of lactobacilli)
  • Clue cells – vaginal epithelial cells coated w/ coccobacilli. “Salt and pepper” appearance.
65
Q

Treating BV

A
  • Metronidazole or clindamycin
  • Avoid sex during therapy
  • Male partners do NOT need to be treated
66
Q

Complications of BV

A
  • Does not cause PID, but is associated w/ PID.

* BV increases risk for post-op infection after gyn surgery

67
Q

5 infections that cause genital ulcers

A 
H ducreyi (Chancroid)
K granulomatis (Donovanosis)
Lymphogranuloma venereum (C trach L1-3)
T palladum
Herpes
68
Q

Most common cause of herpes transmission

A

Subclinical shedding

69
Q

Herpes DNA

A

Remains episomal. Does not integrate.

70
Q

Herpes primary infection

A

Asymptomatic is most common

Ab neg

71
Q

Herpes non-primary 1st episode

A
  • Ab positive
  • Systemic sxs: fever, headache, malaise, myalgia
  • Local sxs: pain / itching, dysuria, clear urethral discharge, bloody / purulent vaginal discharge, tender inguinal adenopathy, tender ulcers (eventually crust), proctitis
72
Q

How common is herpes recurrence?

A

90% in 1st year for HSV2
55% in 1st year for HSV1
Most pxs have 4-5 recurrences / year

73
Q

Herpes Diagnosis

A
  • PCR is gold standard
  • IgG serology: glycoprotein G1 for HSV1. Glycoprotein G2 for HSV2.
  • Culture – lower sensitivity than PCR. May see cytopathic effects.
  • Tzanck prep – Shows giant cells w/ intranuclear inclusions. Rarely used anymore. Can’t differentiate b/w HSV and VZV.
74
Q

Tx for pregnant women w/ prior history of herpes

A

Acyclovir at 36 weeks

75
Q

Complication of herpes

A

Increased risk of HIV. Neonatal herpes may be lethal.

76
Q

Syphilis epidemiology

A

Much more common in males, especially MSM.
Western / southeastern US
Age 20-29 is highest

77
Q

Syphilis associated with?

A

HIV

78
Q

Syphilis mechanism of invasion

A

Spirochete – penetrates skin, enters blood / lymphatics to disseminate. Lesions occur in areas with >10^7 organisms / mg tissue.

79
Q

Hallmark pathologic lesion of syphilis

A

Obliterative endarteritis

80
Q

Primary syphilis

A
  • Chancre - painless ulcer, often unnoticed. Multiple if immunocompromised. Heal in 2-8 weeks if untreated.
  • Lymphadenopathy
81
Q

Secondary syphilis (5)

A
  • Constitutional sxs: fever, chills, malaise, poor appetite
  • Maculopapular / pustular rash – red / pink, 3-10 mm. Start on trunk / proximal extremities and then spread. Hallmark is on the palms / soles.
  • Alopecia of scalp, eyebrows, beard. May be patchy.
  • Mucous patches – superficial painless erosion of tongue / lips
  • Condyloma lata – painless plaques in intertriginous areas
82
Q

Tertiary syphilis

A
  • 1/3 of untreated pxs
  • Progressive neural / vascular destruction 5-30 years after infection
  • Neuro: meninges, brain, eye, ear damage
  • Argyll Robertson pupil - Small irregular pupil that accommodates to near vision but does not react to light
  • Aneurysm of ascending aorta
  • Gummatous: granulomatous inflammation / destruction of bones and mucocutaneous tissues.
83
Q

Syphilis in pregnancy

A
  • All pregnant women should be screened for syphilis early in pregnancy. Transmission may occur at any time during pregnancy, but is most common early when spirochetemia is most common.
  • May result in abortion, still birth, neonatal death, or neonatal disease.
84
Q

Diagnosing Syphilis

A

Serology is gold standard
PCR, DFA
Cannot be cultured

85
Q

Syphilis serology

A
  • Non-treponemal tests: VDRL and RPR are used for screening. If positive, use FTA (fluorescent trichonemal Ab) test. These are also used for monitoring response to therapy.
  • Positive diagnosis requires positive nontreponemal and treponemal tests
  • Follow efficacy of treatment w/ nontreponemal tests. Don’t use treponemal tests b/c these are positive for life.
86
Q

Treating syphilis

Testing partners?

A
  • Penicillin is DOC for all stages, even in allergic pxs (desensitize first)
  • RPR or VDRL titers are monitored periodically. 4 fold or 2-dilution is significant.
  • Partners w/in last 90 days should be presumptively treated. > 90 days should be tested.
87
Q 
Chancroid
Cause / morphology
Sxs
Diagnosis
Treatment
A
  • Haemophilus ducreyi. Gram neg coccobacillus.
  • Papules → Pustule → Central necrosis → Painful ulcer with ragged & undermined edges that easily bleeds.
  • 50% of pxs have enlarged inguinal LN’s (bubos). Usually unilateral. May rupture spontaneously.
  • Diagnosis is clinical. Must meet all 4 criteria: at least 1 painful ulcer, looks like a chancroid, no evidence of syphilis or HSV
  • Treatment – azithromycin or ceftriaxone
88
Q 
Donovanosis
Scientific / unscientific name
Morphology / tropism of bug
Sxs
Diagnosis
Treatment
A
  • Klebsiella granulomatis / Granuloma inguinale
  • Encapsulated GNR that infects mononuclear cells
  • Papule → painless beefy red ulcer with rolled edges and easily bleeds on contact. Usually on penis or labia (not vagina / cervix). No LAD. No bubos. No constitutional sxs. Untreated may cause extensive scarring / lymphatic obstruction → elephantiasis.
  • Diagnosis – Clinical appearance and Donovan bodies (bacteria) in mononuclear cells
  • Treatment – azithromycin for > 3 weeks.
89
Q

Lymphogranuloma venereum (LGV)
Cause
Diagnosis
Treatment

A
  • Caused by C trachomatis serovars L1-3
  • Diagnosis – clinical presentation, serology, PCR
  • Treatment – doxycyclin + / - bubo aspiration
90
Q

3 stages of LGV

A
  • I (primary): painless papule / ulcer. Self-limited. Often unnoticed.
  • II (secondary): painful bubo (usually unilateral; may be above and below the inguinal ligament, known as the GROOVE SIGN).
  • III (tertiary): fibrosis / scarring, possible elephantiasis, destruction of external genitalia
91
Q

What is the most common STD in the US?

A

HPV
75% of Americans
90% are asymptomatic

92
Q

Recurrent Respiratory Papillomatosis

A

HPV 6 / 11 transmitted at childbirth. Altered cry, hoarseness, stridor, respiratory distress.

93
Q

How long do most HPV infections last?

A

Most are cleared w/in 2 years

94
Q

Which HPV genotypes cause warts vs cancer?

A

6/11 cause warts. No integration.

16 / 18 cause cervical cancer. Does integrate.

95
Q

Condyloma acuminata

A

Anogenital warts.
Mainly HPV 6 / 11.
Hyperkeratotic, exophytic papules.
15% of pxs have spontaneous remission in 3-4 months.

96
Q

HPV Diagnosis

A
  • Anogenital warts – visual inspection

* Cervical HPV infection: pap smear, acetowhitening, colposcopy, biopsy

97
Q 
Pubic lice
Bug
Sxs
Diagnosis
Treatment
A
  • Pediculosis pubis
  • Pxs notice nits or itching.
  • Diagnose by physical exam.
  • Tx w/ permethrin 1% cream or pyrethrins (wash off after 10 min)
  • Decontaminate bedding / clothing by washing in hot water or dry cleaning
  • Tx parters from last 30 days
98
Q 
Scabies
Bug
Transmission
Sxs
Treatment
A
  • Sarcoptes scabiei
  • Often sexually acquired in adults
  • Itching – often worse at night. Hypersensitivity to mite Ags
  • Nodules – dark / tender, usually on penis / scrotum. Burrow seen on top.
  • Tx w/ permethrin 5% cream applied to entire body neck down (wash off after 8-14 hrs)
  • Decontaminate just like lice
  • Tx partners from last 30 days
99
Q

Crusted scabies

Treatment

A

•Immunocompromised pxs may develop severe form called crusted scabies. Tx w/ Ivermectin.

100
Q

STDs that can be transmitted via pregnancy (7)

A

Chlamydia, GC, herpes, syphilis, HIV, Hep B / C, HPV

101
Q

Non-STD infections that can be transmitted via pregnancy (4)

A

CMV, Toxoplasma, Rubella, and group B strep

102
Q

3 common causes of vaginitis

Treat partner?

A
  • BV (most common), vulvovaginal candidiasis, Trichomonas vaginalis
  • Partner does not need to be treated for VVC or BV. Yes for Trichomonas.
103
Q

Which herpes viruses cause meningitis / encephalitis

A

HSV2 may cause meningitis (photophobia). HSV1 is more likely to cause encephalitis.

FM3-2: Parasites, STDs, etc (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions