STDs Flashcards
1
Q
STD + HIV Transmission
A
- Disruption of epithelial/mucosal barriers
- Increased numbers of HIV target cells in genital tract
- Increased expression of HIV co-receptors
- Induce secretions of cytokines (increase HIV shedding)
- HIV alters natural history of some STDs
2
Q
“Sores” STDs
A
- Syphilis
- Genital Herpes
3
Q
“Drips” STDs
A
- Gonorrhea
- Chlamydia
- Nongonococcal urethritis/mucopurulent cervcitis
- Trichomonas vaginitis/urethritis
- Bacterial vaginosis
4
Q
Other STDs of Concern
A
- Genital HPV
- Cervical/Anal/Oral Cancers
5
Q
Gonorrhea
A
- 2nd most common bacterial STD
- Caused by Neisseria gonorrhea
- Gram “-“ diplococcus
- Intracellular parasite
- Humans are only natural host
- Grows in warm/moist areas of reproductive tract
- Also grows in mouth, throat, anus, and eyes
6
Q
Men + Gonorrhea
A
- Onset: 1-14 days after infection
- Some have no symptoms but more likely to have them than women
- Site of infection: urethra, rectum, oropharynx, eye
7
Q
Men + Gonorrhea Signs/Symptoms
A
- Purulent urethral or rectal discharge
- Burning sensation when urinating
- Painful and swollen testicles
8
Q
Women + Gonorrhea
A
- Most have no or only mild symptoms
- Site of infection: Endocervical canal, rectum, oropharynx, eye
9
Q
Women + Gonorrhea Signs/Symptoms
A
- Painful, burning sensation when urinating
- Abnormal vaginal discharge
- Uterine bleeding
10
Q
Male + Gonorrhea Complications
A
- Rare b/c most of the time sx will lead to treatment
- Epididymitis
- Prostatitis
- Urethral stricture
- Inguinal lymphadenopathy
- Disseminated gonorrhea
11
Q
Female + Gonorrhea Complications
A
- Most don’t have recognizable symptoms until complications arise
- Pelvic inflammatory disease: infertility, ecotopic pregnancy
- Fitz-Hugh-Curtis Syndrome: perihepatitis
- Disseminated gonorrhea (more likely in women than men)
12
Q
DGI
A
- Disseminated gonoccocal infection
- Presentation: joint, tendon pain, low grade fever (<39C)
- Tenosynovitis, dermatitis, migratory polyathralgia
- Second stage: septic arthritis, most common in knee
- Skin lesions disappear and blood cultures are negative
- Rarely progress to meningitis and endocarditis
13
Q
Gonorrhea Diagnosis
A
- Gram stain smear: positive when gram negative diplococci are identified within PMNs, most sensitive/specific for symptomatic urethritis in men
- Culture: most reliable in non-symptomatic patients
- Other: NAAT, rapid with increased sensitivity/specificity
14
Q
Gonorrhea + Treatment
A
- Uncomplicated gonococcal infections of the cervix, urethra, pharynx, and rectum
- Ceftriaxone + Azithromycin as a single dose
15
Q
Chlamydia
A
- Caused by C. trachomatis (intracellular parasite)
- Most common cause of bacterial STD
- Co-infection with gonorrhea is typical
- 5x increased risk of acquiring HIV
- Causes genital, ocular, pharyngeal, and rectal infections
16
Q
Women + Chlamydia Signs/Symptoms
A
- Onset: 7-21 days
- 66% are asymptomatic
- Cervix: abnormal discharge, bleeding
- Rectum: bleeding, pain, discharge
- Complications: PID and Reiter’s syndrome
17
Q
Men + Chlamydia Signs/Symptoms
A
- Onset: 7-21 days
- 50% are asymptomatic
- Urethra: mild dysuria, discharge
- Rectum: bleeding, pain, discharge
- Complications: epidydmitis, Reiter’s syndrome
18
Q
Chlamydia + Neonates
A
- Can be transmitted by cervicovaginal secretions
- 50% develop neonatal conjunctivitis: can cause scarring
- 16% develop pneumonia
19
Q
Chlamydia + Diagnosis
A
- DNA amplification: NAAT, to detect DNA from vaginal, cervical, or urethral swabs or first void urine
- All sexually active females from 13-25 and females with multiple partners should be screened
20
Q
Chlamydia + Treatment
A
-Azithromycin once
OR
-Doxycycline x 7 days
-Difference of 87% and 98% cure
21
Q
Syphilis
A
- Caused by spirochete bacteria, Treponema pallidum
- Highly contagious
- Associated with increased risk for HIV
- Route of transmission: typically sexual contact, can also be congenital or rarely nonsexual
22
Q
Primary Syphilis
A
- Manifests after 10-90 days with an average of 21 days
- Highly contagious, but individuals are asymptomatic
- Sore appears on penis, vagina, or rectum
- Sore can be single or multiple, usually painless
- Persists 4-6 weeks then heals spontaneously
23
Q
Secondary Syphilis
A
Results from hematogenous and lymphatic spread
- Skin rash that appears 1-6 months after primary infection
- Symmetrical, reddish-pink non-itchy rash on trunk and extremities involving palms/soles
- Nonspecific symptoms: malaise, fever, pharyngitis, headache, weight loss, arthralgia
- Disappears in 4-10 weeks
- Most contagious
24
Q
Latent Syphilis
A
- Patients with positive serologies, other asymptomatic
- Divided into early and late stages
- Requires therapy because we can’t predict who will or won’t progress
25
Q
Early Latent Syphilis
A
- Less than 1 year from secondary syphilis
- Infectious: 25% mucocutaneous relapse
26
Q
Late Latent Syphilis
A
- > 1 year after secondary syphilis
- Generally considered non-infectious except in pregnancy
- 25% will progress
27
Q
Tertiary Syphilis
A
- Occur 3-15 years after initial infection
- Develops in 1/3 of those not treated and isn’t infectious
- 3 Different forms: cardiovascular, gummatous, neurosyphilis (rarest)
28
Q
Cardiovascular Syphilis
A
- 10%
- Aortic insufficiency
- Aneurysm formation
29
Q
Gummatous syphilis
A
- Non specific granulomatous lesion
- Develop in 50% of patients with disease progression
- Chronic, destructive lesions (skin, bone, soft tissue, liver, brain, heart)
30
Q
Syphilis Treatment
A
- Preferred: Parenteral Penicillin G, single-dosed prolonged exposure
- If >1 year duration: 3 consecutive weekly doses given
- Give doxycycline if allergic to PCN
31
Q
Patients + PCN Allergy
A
- No alternatives identified for neurosyphilis, congenital syphilis, and syphilis in pregnant women
- Recommend skin testing
- Negative: administer PCN appropriate for stage
- Positive: desensitize
32
Q
Jarisch-Herxheimer Rxn
A
- Idiosyncratic response to therapy
- Not PCN allergy
- Self limiting: headache, fever, chills malaise, arthralgia/myalgia
- Usually occurs within first 24 hours of syphilis allergy and resolves in 12-24 hours
- Occur most in early syphilis patients
- Antipyretics may be used but not proven to prevent reaction
33
Q
Genital Herpes
A
- 1/6 of Americans have it and is associated with increased HIV risk
- DNA virus with humans as only known hosts
- HSV-1: acquired in childhood and causes orolabial ulcers
- HSV-2: transmitted sexually and causes anogenital ulcers
34
Q
Herpes Pathophysiology
A
- Transmission via virus from secretions onto mucosal surface or abraded skin
- 5 stage life cycle: primary infection, infection of ganglia, establishing latency, reactivation, recurrent infection
- When outbreak passes, virus only present in ganglia
- Dormancy of virus contributes to its difficulty in treating
35
Q
Herpes First-Episode Infections
A
- Multiple painful or ulcerative lesions on external genitalia
- Appears ~6 days after sexual contact and lasts 2-6 weeks
- Contains numerous HSV particles
- Viral shedding lasts longest in first episode (15-16 days)
- Women have more severe disease: cervical ulcerative lesions, intermittent bleeding and vaginal discharge, dysuria and urinary retention syndromes
36
Q
Herpes + Recurrent Infections
A
- 50% will have prodrome: mild burning, itching, or tingling
- Fewer and more localized lesions, shorter duration, and milder symptoms than initial infection
- Viral shedding is [lower] and shorter (~3 days)
- HSV-2 is more severe and has higher recurrence rates
37
Q
Herpes Complications
A
- From genital spread or autoinoculation to eye, rectum, pharynx, fingers
- CNS infections occasionally occur
38
Q
Neonatal Herpes
A
- Exposure to HSV in birth canal
- Risk greater for first-episode infections
- Mortality rate ~50%
- Significant morbidity including permanent neurologic damage
39
Q
Herpes Diagnosis
A
- Tissue culture
- Serological tests: differentiates between HSV-1 and HSV-2
- PCR: more sensitive than tissue and choice for CNS infection
40
Q
Herpes Treatment
A
- Initial episode: w/in 24 hours of first lesion appearance
- Episodic: administered within 24 hours of lesion appearance but patients with severe or prolonged symptoms may also benefit
- Suppressive: benefit of reducing shedding and transmission risk
- Suppression Drug: Valacyclovir 500 mg once a day, not as effective if patient has very frequent recurrences
41
Q
HPV
A
- Human Papillomavirus
- Most common viral infection in US
- Can range from genital warts to cancer depending on strand
- Many sexually active teens will get HPV but spontaneously clear the infection
42
Q
HPV Symptos
A
- Most are subclinical
- <1% have visible warts
- Warts can occur anywhere that experienced sexual contact
43
Q
HPV Treatment
A
WARTS
- Goal: removal
- Can spontaneously resolve
- Patient applied: podofilox, imiquimod, sinecatechins
- Provider administrated: cryotherapy, trichloracetic acid or bichloracetic acid, surgical removal
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