STDs and GUI's Flashcards
RPR
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
generalized macular rash, patchy hair loss, generalized lymphadenopathy and flat grey white lesions in the perianal area
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!
rash on palms and soles of feet
secondary syphilis
PAINLESS white vesicle/painless chancre
primary syphilis - has smooth base and smooth round border
treponema pallidum
tx for syphilis
IM penicillin - (Bicillin)
1 dose if had for less than 1 year
3 doses if had for more than 1 year
white exudate on cervix w/ RLQ pain
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
tx for chlamydia?
- macrolides (azithromycin) - works at 50S
- 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.
tx for gonorrhea?
ceftriaxone
thin gray vaginal discharge, vulvovaginal discomfort, pelvic exam shows non tender cervix, no odor
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
foul fishy odor
gardnerella vaginalis
do KOH
tx for trichomonas vaginalis?
metranidazole (or tinidazole)
DONT DRINK
male w/ multiple painful vesicles on glans of penis, sex one week ago. No discharge, b/l swollen nodes in groin
herpes simplex-2
- crop of painful vesicles
tx of haemophilus ducreyi
ceftriaxone, azithromycin
confirm ddx of klebsiella granulomatis
tissue biopsy
tx of klebsiella granulomatis
erythromycin or tetracycline for 3 weeks
ampicillin for 12 weeks
- deep seated nature of the infection
confirm ddx of herpes simplex 2?
- viral cultures (vesicles) and serology
- though now its often done by PCR
- Tzanck smear (older technique)
tx for herpes simplex 2?
acyclovir, famciclovir, valacyclovir
sore throat, generalized aches, fever, anorexia, abdominal rash, uses condoms variably, has many sexual parterns
Human Immunodeficiency VIrus
20 y/o female, rash, fever, joint pain - began in right knee –> hip. rash is scattered painful lesion on hands and feet.
neisseria gonorrhoeae - disseminated gonorrhea shows migratory polyarthritis
migratory polyarthritis
disseminated neisseria gonorrhoeae
painless papule on lip and cervical lymphadenopathy
Treponema pallidum - one of few painless lesions
Dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tenderness on physical examination
think GU infection
secondary syphilis incubation time
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
neisseria gonorhoeae incubation time
- 2-6 days acutely
- a few days-two weeks for disseminated infection
chlamydia incubation time?
7-21 days
HPV incubation time
** this one is longer!
2-20 months: highly variable!
Culture in a high CO2 environment
– this is an older method of identifying Neisseria gonorrhoeae used in conjunction with special culture media.
urethral DNA probe
– these technique are used to identify Neisseria gonorrhoeae and Chlamydia trachomatis
gram stain
would be used to indentify Neisseria gonorrhoeae and would identify gram negative intracellular “coffee-bean shaped” diplococci organisms.
NOTE: Syphilis requires dark field microscopy.
when treating chlamydia trachomatis what other disease must be considered?
neiserria gonorrhoeae
and other STD’s
candida albicans
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.
gardnerella vaginalis
- not sexually transmitted illness
- has few leukocytes on wet mount
- assoc. w/ “fishy odor”, “clue cells” and “stawberry cervix”
- gram negative
trichomonas vaginalis
- sexually transmitted
- protozoa
- assoc. w/ LARGE number of luekocytes and “motile organisms” on wet mount
- abnormal vaginal discharge in women
- men are often asymptomatic
chlamydia trachomatis
- 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
Neisseria gonorrhoeae
- 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
herpes simplex 2`
- this is the usual cause of painful genital ulcers
- incubation is 4-7 days
treponema pallidum
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
haemophilus ducreyi
- 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
klebsiella granulomatis
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
how do you confirm the ddx of H. ducreyi?
chocolate agar plate
Hepatitis B
- transmitted sexually/through blood
- pt. has signs: icterus, jaundice, RUQ tenderness, dark urine, light stools
Human papillomavirus
- cause of condyloma acuminata and cervical cancer
human immunodeficiency virus
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.
ddx when see genital ulcers?
- syphilis (treponema pallidum): painless
- herpes: painful
- chancroid: painful w/ u/l lymphadenopathy
- lymphogranuloma venereum: chlamydia
ddx when see urethritis and cervicitis?
- neisseria gonorrhoeae
- chlamydia trachomatis
- complications of PID
Reiter’s syndrome
caused by chlamydia trachomatis
= conjunctivitis, urethritis, arthritis
presentation of UTI?
Dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tenderness on physical examination
simple cystitis
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!
complicated cystitis
- Males
- recurrent in females
- urethral malformations
- neurogenic bladder
- nephrolithiasis
- IC people
- renal disease
- pregnancy
- DM
- catheterization
- upper tract disease
presentation of pyelonephritis?
fever, toxic appearance, + Lloyd’s sign, elevated WBC w/ left shift
asymptomatic bacteriuria
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
sterile pyuria?
think organisms that won’t grow on culture
Culture negative Mycobacterium tuberculosis Adenovirus Polyomavirus Cytomegalovirus Anaerobes Fungal Interstitial cystitis
urine dip stick
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
antibiotic prophylaxis?
recommended for pregnancy and recurrent UTIs
Non-antibiotic prophylaxis:
Topical estriol replacement (vaginally)
Cranberry
Methenamine
staph aureus
seen in IV drug users
- aortic valve murmur
- elevated WBC count, fever and left flank pain
staph saprophyticus
seen commonly for UTI in young sexually active females
most common causitive agent for UTI?
E. Coli
if immune compromised then think candida
nitrofurantoin
used for tx of simple cystitis - look at tx slides
