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Repro II: Test 2 > STDs and GUI's > Flashcards

STDs and GUI's Flashcards

1
Q

RPR

A

rapid plasma regain and “VDRL” are initial Ab test screenings for suspected syphilis

have false positive results assoc. w/ many other illnesses (SLE, mono, malaria, leprosy, hep A, HIV)

FTA (fluorescent treponemal antibody): confirmatory test performed after screening for syphilis

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2
Q

generalized macular rash, patchy hair loss, generalized lymphadenopathy and flat grey white lesions in the perianal area

A

secondary syphilis – can also have a widespread rash

shows up 4-8 weeks after primary infection (primary infection occurs after three weeks)

can have rash on palms and soles of feet!

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3
Q

rash on palms and soles of feet

A

secondary syphilis

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4
Q

PAINLESS white vesicle/painless chancre

A

primary syphilis - has smooth base and smooth round border

treponema pallidum

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5
Q

tx for syphilis

A

IM penicillin - (Bicillin)

1 dose if had for less than 1 year

3 doses if had for more than 1 year

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6
Q

white exudate on cervix w/ RLQ pain

A

chlamydia trachomatis - can have severe abdominal pain along with the exudate

RLQ pain is indicative of PID, which is commonly caused by chlamydia (however the majority of PID are asymptomatic)

sx of urethritis: can also include urinary frequency and dysuria

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7
Q

tx for chlamydia?

A
  1. macrolides (azithromycin) - works at 50S
  2. tetracyline - works at 30S

Chlamydia is an intracellular obligate, thus Abs that work to disrupt cell wall synth will not be effective - must use macrolides or tetracycline

NOTE: Must always treat as if the patient has a Neisseria gonorrhoeae co-infection.

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8
Q

tx for gonorrhea?

A

ceftriaxone

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9
Q

thin gray vaginal discharge, vulvovaginal discomfort, pelvic exam shows non tender cervix, no odor

A

thrichomonas vaginalis - see wet mount with large numbers of leukocytes and motile organisms

both sexually transmitted and nonsexually transmitted - male partners can be completely asymptomatic

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10
Q

foul fishy odor

A

gardnerella vaginalis

do KOH

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11
Q

tx for trichomonas vaginalis?

A

metranidazole (or tinidazole)

DONT DRINK

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12
Q

male w/ multiple painful vesicles on glans of penis, sex one week ago. No discharge, b/l swollen nodes in groin

A

herpes simplex-2

- crop of painful vesicles

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13
Q

tx of haemophilus ducreyi

A

ceftriaxone, azithromycin

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14
Q

confirm ddx of klebsiella granulomatis

A

tissue biopsy

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15
Q

tx of klebsiella granulomatis

A

erythromycin or tetracycline for 3 weeks

ampicillin for 12 weeks

  • deep seated nature of the infection
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16
Q

confirm ddx of herpes simplex 2?

A
  • viral cultures (vesicles) and serology
  • though now its often done by PCR
  • Tzanck smear (older technique)
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17
Q

tx for herpes simplex 2?

A

acyclovir, famciclovir, valacyclovir

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18
Q

sore throat, generalized aches, fever, anorexia, abdominal rash, uses condoms variably, has many sexual parterns

A

Human Immunodeficiency VIrus

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19
Q

20 y/o female, rash, fever, joint pain - began in right knee –> hip. rash is scattered painful lesion on hands and feet.

A

neisseria gonorrhoeae - disseminated gonorrhea shows migratory polyarthritis

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20
Q

migratory polyarthritis

A

disseminated neisseria gonorrhoeae

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21
Q

painless papule on lip and cervical lymphadenopathy

A

Treponema pallidum - one of few painless lesions

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22
Q

Dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tenderness on physical examination

A

think GU infection

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23
Q

secondary syphilis incubation time

A

incubation time:

  • 3 weeks for primary syphilis
  • 4-8 weeks after the appearance of the chancre for secondary syphilis
  • 1-30 years for latent/tertiary syphilis
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24
Q

neisseria gonorhoeae incubation time

A
  • 2-6 days acutely

- a few days-two weeks for disseminated infection

25
Q

chlamydia incubation time?

A

7-21 days

26
Q

HPV incubation time

A

** this one is longer!

2-20 months: highly variable!

27
Q

Culture in a high CO2 environment

A

– this is an older method of identifying Neisseria gonorrhoeae used in conjunction with special culture media.

28
Q

urethral DNA probe

A

– these technique are used to identify Neisseria gonorrhoeae and Chlamydia trachomatis

29
Q

gram stain

A

would be used to indentify Neisseria gonorrhoeae and would identify gram negative intracellular “coffee-bean shaped” diplococci organisms.

NOTE: Syphilis requires dark field microscopy.

30
Q

when treating chlamydia trachomatis what other disease must be considered?

A

neiserria gonorrhoeae

and other STD’s

31
Q

candida albicans

A

a yeast infection and not associated with sexual transmission. It presents as a chalky white discharge and is associated with vulvovaginal discomfort. It is often associated with antibiotic use, oral contraceptive use, and the removal of protective vaginal flora. Usually diagnosed clinically.

32
Q

gardnerella vaginalis

A
  • not sexually transmitted illness
  • has few leukocytes on wet mount
  • assoc. w/ “fishy odor”, “clue cells” and “stawberry cervix”
  • gram negative
33
Q

trichomonas vaginalis

A
  • sexually transmitted
  • protozoa
  • assoc. w/ LARGE number of luekocytes and “motile organisms” on wet mount
  • abnormal vaginal discharge in women
  • men are often asymptomatic
34
Q

chlamydia trachomatis

A
  • presents as mucopurulent cervicitis
  • no foul odor
  • pt. usually doesn’t c/o vaginal irritation (though may cause PID)
  • causes lymphogranuloma venereum (but no lymphadenopathy)
  • gram negative
35
Q

Neisseria gonorrhoeae

A
  • presentation similar to chlamydia
  • exception: cervix easily bleeds and pt. may have abnormal bleeding in hx that is assoc. with intercourse
  • can cause septic arthritis and multiple joint problems (“migratory polyarthritis)
  • it is common for women to present w/ arthritis
  • gram negative
36
Q

herpes simplex 2`

A
  • this is the usual cause of painful genital ulcers

- incubation is 4-7 days

37
Q

treponema pallidum

A

spirochete (gram negative)

primary syphilis

  • starts as a papule but rapidly deteriorates to a painless ulcer with a clean base
  • has raised firm and indurated borders and has variable lymphadenopathy

secondary syphilis:
- presents as rash - on hands and feet

38
Q

haemophilus ducreyi

A
  • causes “chancroid disease”
  • presents initially as vesicular pustule but progresses to painful genital ulcer that may be multiple
  • irregular border and has gray necrotic exudate at its base
  • ** often see unilateral lymphadenopathy!
  • often assoc. with underdeveloped countries/sex workers
  • incubation is 1-2 weeks
  • gram negative

presents as a vesicular pustule but progresses to painful genital ulcer, unilateral lymphadenopathy is common

more often seen in underdeveloped countries

confirm ddx through chocolate agar plate

39
Q

klebsiella granulomatis

A

painless elevated granulomatous lesions that can lead to autoamputation

  • causes granuloma inguinale (“donovanosis”)
  • elevated painless granulomatous lesions that are progressively destructive –> autoamputation
  • lesions themselves are painless
  • uncommon in US: more seen in India/ southern africa
40
Q

how do you confirm the ddx of H. ducreyi?

A

chocolate agar plate

41
Q

Hepatitis B

A
  • transmitted sexually/through blood

- pt. has signs: icterus, jaundice, RUQ tenderness, dark urine, light stools

42
Q

Human papillomavirus

A
  • cause of condyloma acuminata and cervical cancer
43
Q

human immunodeficiency virus

A

often presents as a nonspecific viral syndrome with a fever, sore throat, swollen lymph nodes and a transient maculopapular rash. The incubation period is consistent for the presentation of these symptoms.

44
Q

ddx when see genital ulcers?

A
  • syphilis (treponema pallidum): painless
  • herpes: painful
  • chancroid: painful w/ u/l lymphadenopathy
  • lymphogranuloma venereum: chlamydia
45
Q

ddx when see urethritis and cervicitis?

A
  • neisseria gonorrhoeae
  • chlamydia trachomatis
  • complications of PID
46
Q

Reiter’s syndrome

A

caused by chlamydia trachomatis

= conjunctivitis, urethritis, arthritis

47
Q

presentation of UTI?

A

Dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tenderness on physical examination

48
Q

simple cystitis

A

can be treated with just the presenting sx, even w/out a dip stick in young females

culture is indicated:

  • pregnancy
  • Ab resistance suspected
  • pt. has multiple drug sensitivities
  • pt has medical conditions

NOTE: in males, UTIs are ALWAYS complicated!

49
Q

complicated cystitis

A
  • Males
  • recurrent in females
  • urethral malformations
  • neurogenic bladder
  • nephrolithiasis
  • IC people
  • renal disease
  • pregnancy
  • DM
  • catheterization
  • upper tract disease
50
Q

presentation of pyelonephritis?

A

fever, toxic appearance, + Lloyd’s sign, elevated WBC w/ left shift

51
Q

asymptomatic bacteriuria

A

Dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tenderness on physical examination

  • seen in females, DM, elderly
  • usually not treated, unless:
  • pregnancy
  • outlfow obstruction
  • instrumentation
  • risk of upper tract infection
52
Q

sterile pyuria?

A

think organisms that won’t grow on culture

Culture negative
Mycobacterium tuberculosis
Adenovirus
Polyomavirus
Cytomegalovirus
Anaerobes
Fungal
Interstitial cystitis
53
Q

urine dip stick

A

Positive for nitrites and leukocyte esterase is 68-88% sensitive for a urinary tract infection

Negative for nitrites and leukocyte esterase has a high negative predictive value

nitrites = evidence of bacteria

leukocyte esterase = evidence of host response

54
Q

antibiotic prophylaxis?

A

recommended for pregnancy and recurrent UTIs

Non-antibiotic prophylaxis:
Topical estriol replacement (vaginally)
Cranberry
Methenamine

55
Q

staph aureus

A

seen in IV drug users

  • aortic valve murmur
  • elevated WBC count, fever and left flank pain
56
Q

staph saprophyticus

A

seen commonly for UTI in young sexually active females

57
Q

most common causitive agent for UTI?

A

E. Coli

if immune compromised then think candida

58
Q

nitrofurantoin

A

used for tx of simple cystitis - look at tx slides

Repro II: Test 2 (9 decks)

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