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Random infectious dz (inpt) > STDs > Flashcards

STDs Flashcards

1
Q

Gonorrhea

A

STI by Neisseria gonorrhea (gram negative cocci)

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2
Q

what pt population is most likely to get gonorrhea?

A

15-19 yo

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3
Q

what is the incubation period of gonorrhea?

A

2-8 days after exposure

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4
Q

what are the symptoms of men? (G)

A

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
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5
Q

what may happen if males aren’t treated? (Gonorrhea)

A

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
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6
Q

what happens to females w/ gonorrhea?

A
  • typically asx

- low-grade sx like dysuria, increased vag discharge or bleeding btw periods

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7
Q

what are some serious complications if gonorrhea is left untx?

A

PID/abscess and increased rik for ectopic preganancy, infertility

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8
Q

what are sx of an anal gonorrhea infection?

A

asx, or have bleeding, burning, discharge

*think purulent urethral discharge

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9
Q

sx of gonorrhea throat infx?

A

asx, sore throat

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10
Q

what is gonoccoccal bactermia (disseminated infxn) associated with?

A

peripheral skin lesions or septic arthritis of the knee, ankle or wrist

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11
Q

what are sx of gonococcal conjunctivites?

A

results from direct inoculation

-copius discharge, usually unilateral, global rupture is a risk if not treated adequately

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12
Q

untreated gonorrhea can increase the risk of what infection?

A

the risk of transmitting HIV if infected or becoming co-infected with HIV

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13
Q

who should be tested for gonorrhea?

A

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

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14
Q

what is the gold standard for testing for gonorrhea?

A

Nucleic acid amplification test (same for chlamydia)

others in clude culture, gram stain, DNA probe w/ amplification

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15
Q

what will gram stain of urethral discharge typically show in gonorrhea?

A

gram-neg intracellular diplocci

  • smears are less often postitive in women
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16
Q

tx of gonorrhea?

A

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

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17
Q

chlamydia?

A

Chlamydia trachomatis

  • obligate intracellular parasite
  • trachoma (inner surface of eyelids), inclusion conjuntivitis, pna, genital infections
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18
Q

what is the most frequeently reported bacterial STI?

A

chlamydia

-often a silent infection, so underreported

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19
Q

what other organisms are in the clhamydia family?

A
  • chlamydia psittaci (bird infect than can be transmitted to humans
  • Chlamydia pneumoniae (respiratory)
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20
Q

how is chlamydia transmitted?

A

oral, anal or vaginal sex or via vaginal childbirth when pregnant woman infected
Increased risk with greater number of partners

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21
Q

who is most at risk for chlamydia?

A

teen girls and young women due to immature (open) cervix

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22
Q

what is the incubation period for chlamydia

A

7-21 days

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23
Q

what are clinical features of chalmydia? (when it affects the lymphnodes)

A

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
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24
Q

what are sx of an anorectal disease (chlamydia)

A

tenesmus, discharge, fistulae

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25
Q

what are female clinical features when infected with chlamydia?

A

: 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

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26
Q

what is a leading cause of infertility?

A

chlamydia infections

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27
Q

what are male clinical features of chlamydia?

A

penile discharge, dysuria, pain or pruritus around meatus

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28
Q

what is the most common cause of nongonococcal urethritis?

A

chlamydia

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29
Q

what helps differentiate a gonococcal vs nongonococcal urethritis?

A

nongonococcal: discharge is more painful and watery

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30
Q

what is the preferred method of testing for chlamydia?

A

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

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31
Q

what is the tx for chlamydia?

A

azithromycin (single dose) or doxycycline

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32
Q

what are complications of untreated chlamydia? in women

A

PID, ectopic pregnancy, infertility

Also increases risk of developing HIV if exposed

33
Q

what are complications of untx chlamydia in men?

A

occasionally epididymitis which can result in pain, fever, rarely, sterility

34
Q

chlamydia complications in prego women?

A

child at risk of chlamydial pneumonia or conjunctivitis

Possible link with premature delivery

35
Q

when should you recommend retesting after STI treatment?

A

3 mnths

36
Q

syphilis?

A

caused by Treponema pallidum

-spirochete that can affect any oran or tissue

37
Q

what is syphilis also known as?

A

the great imitator bc it has many stages where it might look like something else

38
Q

what are the stages of syphilis

A

primary, secondary, late/latent

39
Q

what is congenital syhpilis?

A

trasmitted via the placenta from the mother to the fetus and can result in severe defects

40
Q

how is syphilis transmitted?

A

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

41
Q

what are the symptoms of primary syphilis?

A

-heralded by a chancre

42
Q

what is the incubation period of syphilis

A

10-90 days (median 21)

43
Q

what is a syphilis chancre?

A

a firm, round, painless lesion which may be single or multiple (entry point)

44
Q

what can be an issue when first infected with syphilis?

A

may be infected and not know it, at risk for latent infection if not treated

45
Q

how long does it take a chancre to heal?

A

will typically heal w/o tx in 3-6 weeks, but infection will progress if not treated

46
Q

what are early (primary and secondary) and late (tertiary) syphilis separated by?

A

a sx free latent phase during which the infectious stages may reoccur

47
Q

what other sx may be seen with primary syhpilis?

A

regional lymphandemoaprhy (rubbery, discrete, nontender)

48
Q

what are sx of secondary syphilis?

A
  • 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

49
Q

when does secondary syphilis occur?

A

2-8 wks after primary infection

50
Q

what does a secondary syphilis rash look like?

A

rash varies from faint to reddish brown spots, but unlike many rashes, affects palms of hands and soles of feet

51
Q

what is latent syphilis infection?

A

asx, but seropositive

52
Q

when does late syphilis occur?

A

about 10-20 years after the initial infection aka tertiary syphilis

53
Q

what are tertiary syphilis legions?

A

gummatous lesions that invovle the skin, bonees, and viscera,

54
Q

how else does tertiary syphilis manifest itself?

A

internal organ damage: brain, CNS, eyes, heart & vascular system, liver, bones, and joints

55
Q

what is neurosyphilis?

A

can be asx, meningovascular syphilis (chornic meningitis), generalized paresis, or tabes dorsalis

56
Q

what is tabes dorsalis

A

chronic progressive degenration of parenchyma

  • imparied proprioception
  • loss of vibratory sense
  • argyll robertson pupil
  • tabes orsalis crises
57
Q

what is argyll robertson pupil

A

reacts to light but does no accommodate

58
Q

what is a tabes dorsalis crises?

A

sever pain and neurological decompensation

59
Q

what are sx of congenital syphilis?

A
  • abnormalities in the skin or mucous membranes
  • nasal discharge (snuffles)
  • hepatosplenomealy
  • anemia
  • osteochondritis
60
Q

what can happen if infants with congenital syphilis arent tx?

A
  • interstitial keratitis
  • hutchinson teeth
  • saddle nose
  • deafness
  • CNS abnormality
61
Q

how doe you screen for syphilis?

A
  • verneral dz research lab

- rapid plasma reagent test (RPR)

62
Q

how can T. pallidum be identified?

A

on dark-field microscopy, but the technique is difficule

63
Q

can T. pallidum be cultured?

A

no

64
Q

what is the ecommended test for syphilis diagnosis?

A

serologic testing

65
Q

how do VDRL and RPR tests work?

A
  • nontreponemal antigen tests that detect nonspecific antibodies to lipoidal antigens
66
Q

when do VDRL and RPR tests become positive?

A

4-6 weeks after infxn

-may be negative in late forms of syphilis

67
Q

who is more likely to get a false-positive ion a VDRL or RPR test?

A

pt with an autoimmune dz

68
Q

what ese can the VDrL ad RPR tests be used for?

A

assess the effectiveness of tx

69
Q

what test is used to confirm positive screening tests?

A

Fluorescent treponemal antibody absorption test (FTA-ABS) and Treponema pallidum particle agglutination assay (TPPA)

70
Q

how does FTA-ABS work?

A

treponemal antibody tst that uses live or killed T pallidum as antigen to detect specific antibodies

71
Q

what may cause a false positive in FTA-ABS test?

A

lyme dz, SLE, malaria, or leprosy

72
Q

what testing can be done for tertiary syphilis?

A
  • lumbar punction
  • joint fluid analysis
  • biopsy
73
Q

what is the first line tx for syphilis

A

benzathine PCN G

2.4 million U IM qd X 1

74
Q

what does tx of late latent and tertiary syphilis requres?

A

3 injx of PCN

75
Q

what is neurosyphilis tx with?

A

aquesou PCN every 4 hours for 10-14 days that may be followed with 3 wkly does of benzathine PcN G

76
Q

what is a jarisch-herxheimer rxn?

A

fever, toxic state

-occurs when there is asudden massive destruction of spirochetes

77
Q

how is a jarisch-herxheimer rxn treated?

A

-prevented by giving antipyretics during the first 24 hours of tx

78
Q

what is the likely hood of getting an HIV infx if concomitant infxn w/ syphilis?

A

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)

79
Q

is syphilis a reportable dz?

A

absolutely yes

Random infectious dz (inpt) (8 decks)

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