STDs Flashcards
Gonorrhea
STI by Neisseria gonorrhea (gram negative cocci)
what pt population is most likely to get gonorrhea?
15-19 yo
what is the incubation period of gonorrhea?
2-8 days after exposure
what are the symptoms of men? (G)
may be asx,
- dysuria
- penile discharge that is serous or milkly
- then 1 to 3 days later the urethral pain is more pronouced and the discharge is yellow, creamy, profuse, and occassionally tinged with blood
what may happen if males aren’t treated? (Gonorrhea)
the infxn may regress and become chronic or progress to involve the prostate, epididymis, and periurethral glands with acute, painful inflammation
- progress to chronic infextion: prostatitis and urethral strictures
- rarely, sterility
what happens to females w/ gonorrhea?
- typically asx
- low-grade sx like dysuria, increased vag discharge or bleeding btw periods
what are some serious complications if gonorrhea is left untx?
PID/abscess and increased rik for ectopic preganancy, infertility
what are sx of an anal gonorrhea infection?
asx, or have bleeding, burning, discharge
*think purulent urethral discharge
sx of gonorrhea throat infx?
asx, sore throat
what is gonoccoccal bactermia (disseminated infxn) associated with?
peripheral skin lesions or septic arthritis of the knee, ankle or wrist
what are sx of gonococcal conjunctivites?
results from direct inoculation
-copius discharge, usually unilateral, global rupture is a risk if not treated adequately
untreated gonorrhea can increase the risk of what infection?
the risk of transmitting HIV if infected or becoming co-infected with HIV
who should be tested for gonorrhea?
anyone who is sexually active is at risk (vaginal, anal, oral)
Those with symptoms, pregnant women or those with a partner who has recently tested positive
Those with a positive test need to be tested for other STIs
Chlamydia testing often done in conjunction
what is the gold standard for testing for gonorrhea?
Nucleic acid amplification test (same for chlamydia)
others in clude culture, gram stain, DNA probe w/ amplification
what will gram stain of urethral discharge typically show in gonorrhea?
gram-neg intracellular diplocci
- smears are less often postitive in women
tx of gonorrhea?
IM ceftriaxone or oral cefixime with azithromycin (doxy can also be used, but reserved as 2cd line for pts who are allergic to axithromycin bc of increasing resistance)
all partners must be treated
chlamydia?
Chlamydia trachomatis
- obligate intracellular parasite
- trachoma (inner surface of eyelids), inclusion conjuntivitis, pna, genital infections
what is the most frequeently reported bacterial STI?
chlamydia
-often a silent infection, so underreported
what other organisms are in the clhamydia family?
- chlamydia psittaci (bird infect than can be transmitted to humans
- Chlamydia pneumoniae (respiratory)
how is chlamydia transmitted?
oral, anal or vaginal sex or via vaginal childbirth when pregnant woman infected
Increased risk with greater number of partners
who is most at risk for chlamydia?
teen girls and young women due to immature (open) cervix
what is the incubation period for chlamydia
7-21 days
what are clinical features of chalmydia? (when it affects the lymphnodes)
lymphogranuloma venereum
- starts with a vesicular or Ulcerative lesion, which may go unnoticed
- spreads to lymph nodes causing inguinal buboes that may fuse and break downleading to multiple draining sinuses and scarring
what are sx of an anorectal disease (chlamydia)
tenesmus, discharge, fistulae
what are female clinical features when infected with chlamydia?
: asymptomatic, or may depend on infection: vaginal discharge, dysuria or if spreads to fallopian tubes may develop fever, abdominal pain, low back pain, nausea, pain during intercourse, bleeding between periods
what is a leading cause of infertility?
chlamydia infections
what are male clinical features of chlamydia?
penile discharge, dysuria, pain or pruritus around meatus
what is the most common cause of nongonococcal urethritis?
chlamydia
what helps differentiate a gonococcal vs nongonococcal urethritis?
nongonococcal: discharge is more painful and watery
what is the preferred method of testing for chlamydia?
NAAT due to high sensitive and specificity of molecular testing
*can also use : direct fluorescent antibody (DFA) stain, DNA probe (less sensitive than NAAT), rapid test being evaluated for widespread use
what is the tx for chlamydia?
azithromycin (single dose) or doxycycline
what are complications of untreated chlamydia? in women
PID, ectopic pregnancy, infertility
Also increases risk of developing HIV if exposed
what are complications of untx chlamydia in men?
occasionally epididymitis which can result in pain, fever, rarely, sterility
chlamydia complications in prego women?
child at risk of chlamydial pneumonia or conjunctivitis
Possible link with premature delivery
when should you recommend retesting after STI treatment?
3 mnths
syphilis?
caused by Treponema pallidum
-spirochete that can affect any oran or tissue
what is syphilis also known as?
the great imitator bc it has many stages where it might look like something else
what are the stages of syphilis
primary, secondary, late/latent
what is congenital syhpilis?
trasmitted via the placenta from the mother to the fetus and can result in severe defects
how is syphilis transmitted?
direct contact with a syphilis lesion
Vagina, penis, anus, rectum, mouth
Can also be transmitted by pregnant woman to child
Not spread by contact with inanimate objects
what are the symptoms of primary syphilis?
-heralded by a chancre
what is the incubation period of syphilis
10-90 days (median 21)
what is a syphilis chancre?
a firm, round, painless lesion which may be single or multiple (entry point)
what can be an issue when first infected with syphilis?
may be infected and not know it, at risk for latent infection if not treated
how long does it take a chancre to heal?
will typically heal w/o tx in 3-6 weeks, but infection will progress if not treated
what are early (primary and secondary) and late (tertiary) syphilis separated by?
a sx free latent phase during which the infectious stages may reoccur
what other sx may be seen with primary syhpilis?
regional lymphandemoaprhy (rubbery, discrete, nontender)
what are sx of secondary syphilis?
- development of a non-pruritic body rash after a chancre heals
- can invlove the skine, mucous membrane, eye bone kidneys, CNS or liver
-fever, lymphdenopathy, sore throat, alopeica, HA, weight loss, muscle aches, fatigue
when does secondary syphilis occur?
2-8 wks after primary infection
what does a secondary syphilis rash look like?
rash varies from faint to reddish brown spots, but unlike many rashes, affects palms of hands and soles of feet
what is latent syphilis infection?
asx, but seropositive
when does late syphilis occur?
about 10-20 years after the initial infection aka tertiary syphilis
what are tertiary syphilis legions?
gummatous lesions that invovle the skin, bonees, and viscera,
how else does tertiary syphilis manifest itself?
internal organ damage: brain, CNS, eyes, heart & vascular system, liver, bones, and joints
what is neurosyphilis?
can be asx, meningovascular syphilis (chornic meningitis), generalized paresis, or tabes dorsalis
what is tabes dorsalis
chronic progressive degenration of parenchyma
- imparied proprioception
- loss of vibratory sense
- argyll robertson pupil
- tabes orsalis crises
what is argyll robertson pupil
reacts to light but does no accommodate
what is a tabes dorsalis crises?
sever pain and neurological decompensation
what are sx of congenital syphilis?
- abnormalities in the skin or mucous membranes
- nasal discharge (snuffles)
- hepatosplenomealy
- anemia
- osteochondritis
what can happen if infants with congenital syphilis arent tx?
- interstitial keratitis
- hutchinson teeth
- saddle nose
- deafness
- CNS abnormality
how doe you screen for syphilis?
- verneral dz research lab
- rapid plasma reagent test (RPR)
how can T. pallidum be identified?
on dark-field microscopy, but the technique is difficule
can T. pallidum be cultured?
no
what is the ecommended test for syphilis diagnosis?
serologic testing
how do VDRL and RPR tests work?
- nontreponemal antigen tests that detect nonspecific antibodies to lipoidal antigens
when do VDRL and RPR tests become positive?
4-6 weeks after infxn
-may be negative in late forms of syphilis
who is more likely to get a false-positive ion a VDRL or RPR test?
pt with an autoimmune dz
what ese can the VDrL ad RPR tests be used for?
assess the effectiveness of tx
what test is used to confirm positive screening tests?
Fluorescent treponemal antibody absorption test (FTA-ABS) and Treponema pallidum particle agglutination assay (TPPA)
how does FTA-ABS work?
treponemal antibody tst that uses live or killed T pallidum as antigen to detect specific antibodies
what may cause a false positive in FTA-ABS test?
lyme dz, SLE, malaria, or leprosy
what testing can be done for tertiary syphilis?
- lumbar punction
- joint fluid analysis
- biopsy
what is the first line tx for syphilis
benzathine PCN G
2.4 million U IM qd X 1
what does tx of late latent and tertiary syphilis requres?
3 injx of PCN
what is neurosyphilis tx with?
aquesou PCN every 4 hours for 10-14 days that may be followed with 3 wkly does of benzathine PcN G
what is a jarisch-herxheimer rxn?
fever, toxic state
-occurs when there is asudden massive destruction of spirochetes
how is a jarisch-herxheimer rxn treated?
-prevented by giving antipyretics during the first 24 hours of tx
what is the likely hood of getting an HIV infx if concomitant infxn w/ syphilis?
2-5 times increased risk
Chancre increases likelihood of HIV transmission in both directions (to infect others if HIV+, to become infected by HIV+ partner)
is syphilis a reportable dz?
absolutely yes
