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Endocrine II > STI’s > Flashcards

STI’s Flashcards

1
Q

A woman is brought to the clinic complaining of vaginal discharge and RUQ abdominal pain. On history, the patient reports having many sexual partners. Pelvic exam reveals cervical motion tenderness and labs of vaginal discharge detect numerous polymorphonuclear leukocytes but no organisms on gram stain. The doctor makes a diagnosis based on these findings and administers doxycycline and ceftriaxone. Later, surgeons, concerned about the patient’s abdominal pain, perform alaparoscopy and find adhesions around the patient’s liver
capsule.

A

Chlamydia trachomatis

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2
Q

Urethritis Cervicitis
Pelvic Inflammatory Disease
Whose the culprit of theses STI’s

A

Neisseria gonorrhea
Chlamydia trachomatis
Mycoplasma
Ureaplasma

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3
Q

Pain with urination (dysuria) Feeling urge to urinate frequently Pain during sex (dyspareunia) Discharge from the urethral opening or vagina. In men, blood in the semen or urine

A

Urethritis

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4
Q

Urethritis Causal organisms

A

Gonococcal Neisseria gonorrhea
Non-gonococcal Chlamydia and Mycoplasma Trichomonas vaginalis Herpes simplex virus Escherichia coli

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5
Q

What are the symptoms for Cervicitis?

A

unusual vaginal discharge Frequent, painful urination
Pain during sex
Bleeding between menstrual periods Vaginal bleeding after sex, not associated with a menstrual period

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6
Q

Cervicitis Causal organisms

A

Gonococcal Neisseria gonorrhea
Non-gonococcal Chlamydia, Trichomonas

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7
Q

Pelvic inflammatory disease PID symptoms

A

Pain in the lower abdomen; Fever
unusual, foul smelling vaginal discharge
Pain and/or bleeding during sex Burning micturition Bleeding between periods.

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8
Q

Pelvic inflammatory disease PID Causal organisms

A

Gonococcal Neisseria gonorrhea
Non-gonococcal Chlamydia

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9
Q

Which three STI’s has casual agent gonorrhea

A

Cervicitis
Urethritis
PID

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10
Q

How is gonorrhea transmitted

A

almost exclusively by sexual contact with an infected person including vaginal, oral, and anal intercourse

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11
Q

Can gonorrhea spread from mother to child during brith and if so what is most affects the ______ called

A

Yes,
Eyes called ophthalmia neonatorum

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12
Q

What are the complication of gonorrhea

A

PID(salpingitis, endometritis)
Disseminated gonococcal infection

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13
Q

Risks for getting gonorrhea which there are many give the one that was highlighted in the PPT

A

Terminal complement deficiency

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14
Q

What is the morphology of gonorrhea

A

Gram -ve diplococci
Coffee bean shaped
No capsule
Oxidase +
Ferment glucose
NG=glucose +
Grow on Thayer martin , chocolate agar
Selective medium with antibiotics (vancomycin, Colsitin, Nystatin)

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15
Q

What is the VF for gonorrhea

A

Pilus
Pro protein
Opa proteins
LOS
Rpm proteins
IgA protease
Iron binding proteins(siderophores)

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16
Q

Why do some patients present with repeated gonococci infection and no immunity?

A

Surface structures like pili, Opa proteins and LOS indigo Antigenic variation
Genes coding for pili switched off or on

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17
Q

Neisseria gonorrhea
Primarily infects

A

mucus membranes of the urethra and cervix
may infect mucus membranes of rectum, oropharynx and conjunctivae
Does not infect post pubertal vaginal epithelium

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18
Q

Pre puberty STIs

A

Non keratinized vaginal epithelium (Not keratinized in the absence of estrogen) is susceptible Vulvovaginitis in a child maybe indicative of (sexual abuse)

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19
Q

Post Puberty STI’s

A

Gonococcal infection limited to
columnar epithelium of urethra, cervix, rectum, pharynx and conjunctiva
Keratinized Squamous epithelium (under the influence of estrogen) is not susceptible in post pubertal women (vagina not infected)

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20
Q

What is the incubation period for symptoms of gonorrhea

A

2-5 days after exposure

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21
Q

What are the symptoms of men with gonorrhea

A

• painful urination (dysuria)
• yellow or greenish pus discharge
from the tip of the penis
• swelling or pain in the testicles or
scrotum (epididymitis)
• swelling or redness at the
opening of the penis

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22
Q

What are the symptoms for women with gonorrhea

A

• Increased vaginal discharge watery, creamy or greenish yellow
• painful sexual intercourse (dyspareunia)
• painful or frequent urination
• abdominal or pelvic pain
• vaginal bleeding between periods
• Bleeding after intercourse

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23
Q

Gonorrhea symptoms in extragenital sites

A

• Anal itching
• straining during a bowel movement
• pus like discharge from the rectum
• tissue stained with blood
• eye pain
• pus like discharge from one or both eyes
• sensitivity to light
• sore throat this is usually acquired from
performing an oral sex on an infected partner
• Swollen inflamed lymph nodes in the neck

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24
Q

Infections caused by N. gonorrheae

A
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25
Q

Complication caused by N. gonorrhea

A
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26
Q

Infections that ascends from the cervix or vagina to involve fallopian tubes and endometrium

A

Pelvic inflammatory disease

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27
Q

DGI result of gonococcal bacteremia presents with a triad of

A

Fever bacteremia
Tenosynovitis arthritis
Pustular necrotic skin lesions(dermatitis)

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28
Q

What are lab diagnosis tests

A

NAAT(nucleic acid amplification test
PCR-polymerase chain reaction
Urine sample
Bacterial culture on selective medium NYC medium
Gram stain

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29
Q

What is the treatment of gonorrhea

A

Single dose of Ceftriaxone injection

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30
Q

What is the treatment for urethritis/ cervicitis

A

Ceftriaxone injection +doxycycline

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31
Q

Prevention/ reducing the risk of gonorrhea

A

Barrier protection

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32
Q

non gonococcal urethritis
Most prevalent bacterial STI in the USA

A

Chlamydia trachomatis

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33
Q

silent disease

A

Chlamydia trachomatis

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34
Q

untreated chlamydia can lead to significant complications such as –

A

• pelvic inflammatory disease in women 40% ( salpingitis, endometritis)
• infertility women (scarring of reproductive structures)
• Ectopic pregnancy
• Reitters syndrome

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35
Q

Risks for getting Chlamydia infection

A

• having oral, anal or vaginal sex with a person who is infected
• multiple sex partners
• younger age (teenage or young adult)
• previous chlamydia diagnosis
• having other sexually transmitted infections
• new sex partners
• Men who have sex with men
• Use of alcohol or illicit drug use

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36
Q

Obligate intracellular bacteria (antimicrobial and immune response) ?

A

Chlamydia trachomatis- bacteria

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37
Q

Chlamydia trachomatis- bacteria morphology

A

Obligate intracellular bacteria (antimicrobial and immune response) ?
• Depend on host cell for ATP, NAD. Energy parasite
• No peptidoglycan (antimicrobial and immune response)
• Cannot be stained by Gram stain, so demonstrated by Iodine, Giemsa and
Fluorescent stain
• Cytoplasmic membrane, double layered outer membrane
• Outer membrane has weak LPS/ endotoxin like activity
• MOMP major outer membrane protein
• Undergo unique development in the host cytoplasm as inclusions

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38
Q

Obligate intracellular bacteria Undergo unique development in the host cytoplasm as inclusions

A

Chlamydia trachomatis

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39
Q

Larger intracellular form, metabolically active and replicates within target cell.
No ATP; depend on target cell

A

RB- reticulate body ( seen as cytoplasmic inclusions) (4)

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40
Q

Smaller extracellular infectious form metabolically inert and resistant

A

EB- elementary body

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41
Q

Obligate intracellular bacteria
• No peptidoglycan
• Cannot be stained by Gram stain
• Cytoplasmic Inclusions
(reticulate bodies) are demonstrated by Iodine, Giemsa and Fluorescent stain
Giemsa stain

A

Chlamydia trachomatis- demonstration

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42
Q

Chlamydia trachomatis- pathogenesis

A

Tropism for epithelial cells of the
endo-cervix and upper genital tract of women
urethra, rectum and conjunctiva
Infect non ciliated columnar epithelial cells of mucous membrane which have receptors for EB (elementary body)

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43
Q

Infect non ciliated columnar epithelial cells of mucous membrane
Release of proinflammatory cytokines (IL-1, IL-6,IL-8,IL-12, TNF-a attract
neutrophils, macrophages, lymphocytes, plasma cells and eosinophils persistent infections leads to
aggregates of lymphocytes and macrophages (lymphoid follicles in the sub mucosa)
chronic sequelae of progressive inflammation with scarring and fibrosis seen in the genital tract and conjunctiva
Blocked fallopian tubes-infertility

A

Chlamydia trachomatis- pathogenesis

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44
Q

Cervicitis, urethritis, proctitis, conjunctivitis, pneumonia (in neonates) which serotype of chlamydia trachomatis

A

D-K

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45
Q

Lymphogranuloma venereum what is the serotype

A

L1, L2, L3

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46
Q

Chlamydia urethritis- cervicitis symptoms men

A

• painful urination (dysuria)
• Clear or purulent discharge from
the tip of the penis
• swelling or pain in the testicles or
scrotum (epididymitis)
• swelling or redness at the
opening of the penis

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47
Q

Chlamydia urethritis- cervicitis symptoms women

A

• Increased vaginal discharge watery, creamy or greenish yellow
• painful sexual intercourse (dyspareunia)
• painful or frequent urination (dysuria)
• abdominal or pelvic pain
• vaginal bleeding between periods
• Bleeding after intercourse

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48
Q

symptoms in extragenital sites Chlamydia trachomatis

A

• Anal itching
• straining during a bowel movement
• pus like discharge from the rectum
• tissue stained with blood
• eye pain
• pus like discharge from one or both eyes
• sensitivity to light
• sore throat this is usually acquired from
performing an oral sex on an infected partner
• Swollen inflamed lymph nodes in the neck

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49
Q

Infections caused by Chlamydia trachomatis D-K

A
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50
Q

Chlamydia trachomatis D-K infections in females

A
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51
Q

Chlamydia trachomatis D-K infections in males

A
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52
Q

Chlamydia trachomatis D-K infections complications

A
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53
Q

Autoimmune condition
Urethritis- conjunctivitis- asymmetric arthritis
May occur during or shortly after a genital chlamydial infection Clinical findings: mainly urethritis, conjunctivitis, asymmetric polyarthritis may include oral ulcers, uveitis, rashes, inflammation of the sacroiliac joints, cardiac and neurologic complications. Reactive arthritis occurs more commonly in men linked to the HLA-B27 genotype; persons with HLA-B27 may have a more aggressive clinical course.

A

Reiter’s syndrome SARA- Sexually Acquired Reactive Arthritis

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54
Q

Laboratory diagnosis- tests Chlamydia

A

NAAT nucleic acid amplification test
PCR- polymerase chain reaction
Urine sample
swab
Fluorescent antibody
Giemsa stain
Iodine stain
Chlamydia antigen test
Gram stain ( only inflammatory cells no organisms seen) important clue

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55
Q

Treatment for Chlamydia trachomatis D-K

A

Doxycycline 100mg or Azithromycin 500mg

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56
Q

Treatment for urethritis/ cervicitis Treatment for Chlamydia trachomatis D-K

A

Ceftriaxone injection 500 mg + doxycycline 100mg

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57
Q

Non gonococcal urethritis (NGU) Mycoplasma

A
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58
Q

VF for Chlamydia

A

Virulence: obligate intracellular, use host ATP EB (infective) and RB (inclusions)
No peptidoglycan-not gram stained

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59
Q

Sexually transmitted genital ulcers

A
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60
Q

Caused by bacteria called Treponema pallidum
A Spirochete Spiral bacteria

A

Syphilis

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61
Q

_________ is a chronic, systemic infectious disease that is sexually transmitted or by other intimate contact
The ________ bacteria can remain dormant in the body for decades if not treated. It can then become active again.
If left untreated, ________ can severely damage the heart, brain and other organs and even be life threatening.
Who am I?

A

Mr. Syphilis

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62
Q

Syphilis- transmission

A

most common mode of transmission is through sexual contact with the infected person. intimate contact of skin-skin or mucus membrane to mucus membrane bacteria can enter the body through compromised skin, such as through minor cuts or abrasions in the skin. Thus, transmissible through direct contact with an active lesion during kissing
also be transmitted from a mother to her fetus, resulting in congenital syphilis

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63
Q

Syphilis- increased risk transmission

A

• having oral, anal or vaginal sex with a person who is infected
• multiple sex partners
• younger age (teenage or young adult)
• having other sexually transmitted infections
• Having HIV infection
• new sex partners
• Men who have sex with men
• Use of alcohol or illicit drug use

64
Q

Treponema pallidum characteristics

A

Morphology - thin, spiral shaped
Motility - corkscrew motility, internal endo-flagella(axial filament)
Cell wall- cannot be stained seen in Gram stain
Cannot be cultured on artifical media

65
Q

the great imitator Clinical manifestation changes frequently and easily Protean manifestation
If left untreated, syphilis is a chronic disease that spreads through out the body hematogenously and can produce manifestations in virtually every organs system

A

Syphilis- the great imitator

66
Q

Syphilis- symptoms

A

characterized by 4 stages- 1. Primary
2. Secondary 30-90 days after exposure
3. Latent 4-10 weeks after initial infection
4. Tertiary - 3-15 years after initial infection
with varied symptoms associated with each stage

67
Q

presents with a firm, painless, small, and highly infectious sore called chancre
chancre appears at the spot where the bacteria enters the body ( vagina, penis, mouth, rectum, anus)
usually develops 3 weeks after exposure
Primary chancre on tongue with clean base and rolled up edges

A

Syphilis- primary stage symptoms

68
Q

Syphilis- secondary stage symptoms

A

presents with a non-itchy, coppery rash that begins on the trunk and eventually spreads to the entire body, including the palms and soles
Flat, moist, lesions on mucus membranes (condylomata latum) highly infectious
may also be accompanied by hair loss (alopecia), muscle aches, a fever, sore
throat (pharyngitis), and swollen lymph nodes (lymphadenopathy)
symptoms can resolve a few weeks after they appear, or repeatedly come and go for as long as a year

69
Q

Syphilis- latent stage symptoms

A

W/o symptoms

70
Q

Damage due to chronic inflammation of multiple organs including the brain, nerves, eyes, liver, bones, heart, and joints.
blindness, deafness, mental illness (general paresis of the insane), memory loss, destruction of soft tissue and bone (gumma- granuloma), neurological disorders such as stroke, heart disease (aortitis, endarteritis) meningitis, neurosyphilis (tabes dorsalis)

A

Syphilis- tertiary stage symptoms

71
Q

Syphilis- tertiary stage symptoms

A
72
Q

Syphilis- pathogenesis

A

Adhere to mucosal membrane (fibronectin, laminin)
Organism coated with fibronectin,
Resist phagocytosis and immune recognition
Multiply at the initial site to large numbers
Produce hyaluronidase facilitates tissue invasion
Spread to other organs through blood stream; skin, endothelium, cartilage, bones, joints, mucosa

73
Q

Syphilis-pathogenesis
Granulomatous infections who are the immnune cells

A

Chancres and rash have intense inflammatory infiltrate of lymphocytes (TH1 CD4 & CD8), macrophages and plasma cells surrounding the bacteria in all stages of syphilis

74
Q

Syphilis Laboratory diagnosis-tests

A

Serology
PCR
Direct microscopy

75
Q

What two types of antibodies are produced Syphilis

A

Non treponemal antibodies -produced in response to tissue damage from inflammation; useful in prognosis of tx; become negative after tx
Treponemal antibodies -produced against bacteria, useful in confirming dx, remain positive after tx

76
Q

Which test use cardiolipin as antigen

A

Non treponemal test
VDRL, RPR test

77
Q

Which test use FTA-ABS

A

Treponemal test for specific test and confirmatory test

78
Q

Dark field microscopy is use from which casual antigen

A

Primary Syphilis due to they do not stain by gram stain
Secondary syphilis use DFA-TP

79
Q

What are the laboratory diagnosis-sensitivity of various test for Syphilis

A
80
Q

Treatment for syphilis

A

Penicillin injections
If allergic to penicillin Doxycycline
or Azithromycin

81
Q

Soft, tender ulcers
Deep punched out ulcers, irregular edge, red margin, not indurated
Painful inguinal lymphadenopathy

A

Chancroid – soft chancre- Hemophilus ducreyi

82
Q

Chancroid – soft chancre- Hemophilus ducreyi is seen where and in which population the most common

A

Seen in Africa, Asia, Caribbean, South America, southern states of N. America
Mostly seen among men who have sex with men (MSM)
Increased risk of getting HIV infection

83
Q

Gram-negative coccobacilli in railroad track or school of fish pattern

A

Chancroid – soft chancre- Hemophilus ducreyi

84
Q

Morphology: gram negative rods Grows on chocolate agar

A

Chancroid – soft chancre- Hemophilus ducreyi

85
Q

Virus characteristics DNA virus
Enveloped Herpesviridae family Alphaherpes subfamily

A

Genital herpes herpes simplex virus-2

86
Q

Genital herpes-transmission

A

Easily pass from person to person through contact with the moist skin of the mouth and genitals (vesicle/ulcer fluid).
• spread through contact with other areas of the skin and the
eyes.
• The virus is most contagious between the time when
symptoms first appear and when they heal.
• Less commonly, a person can transmit the virus when
symptoms are not present (asymptomatic).
• If a woman with genital herpes has sores while giving birth,
the virus can pass on to the baby (congenital transmission).
• The tissue in a woman’s vagina is more prone to small tears,enabling the virus to enter easily

87
Q

Herpes simplex virus-2 pathogenesis

A

Enters through break in skin or mucus membrane
• Multiplies locally in the tissue
• Lytic infection of host cells
• Retrograde transport along nerve
axons
• Remains latent/ dormant in the
dorsal ganglion ( not whole virus
only DNA)
• Later, certain triggers, such as
stress, illness, exposure to sunlight, and menstruation can make the virus active again (reactivation)
• virus return down (anterograde) the
axons to skin causing another

88
Q

Giant cells syncytium in Tzank smear

A

Herpes simplex virus-2

89
Q

Presents as painful vesicular lesions, and ulcers on mucus
membrane and skin of the penis, around or inside the vagina, on the thighs, buttocks or the anus
Pain, tingling, and itching, burning micturition, vaginal discharge swollen lymph nodes, fever, malaise and fatigue

A

Genital herpes symptoms

90
Q

Genital herpes symptoms incubation period

A

Incubation period- 2-12 days

91
Q

Genital herpes laboratory diagnosis

A

PCR- polymerase chain reaction (gold standard)
Vesicle/ ulcer fluid collected with a swab
Blood sample
Look for virus antigen by immunofluorescence
Tzank smear for HSV infected multinucleated giant cells

92
Q

Genital herpes treatment

A

Acyclovir (nucleoside analog) 400mg Inhibits DNA polymerase can prevent the virus from multiplying and thus reducing the severity of symptoms.
Valacyclovir 500 mg

93
Q

Genital ulcer- lymphogranuloma venereum (LGV) cause? Symptoms

A

C. trachomatis L1, L2, L3
• Africa, SEAsia, South America, India and
Caribbean
• Painless primary lesion on genitals
• Fever, headache, myalgia
• Inflammation, swelling of inguinal lymph nodes (suppurative inguinal adenitis; buboe)

94
Q

Genital ulcer- lymphogranuloma venereum (LGV)
Complications

A

• Ulcers, multiple draining fistula, genital elephantiasis,
• Proctitis, proctocolitis, perirectal abscess (MSM)
• Doxycycline

95
Q

Donovanosis- granuloma inguinale caused by

A

Caused by
Klebsiella granulomatis formerly Calymmatobacterium granulomatosis

96
Q

Donovanosis- granuloma inguinale

Clinical manifestation
Morphology
Epidemiology

A
97
Q

Gram negative cocco bacilli seen within cytoplasmic vacuole of monocyte from granulation tissue of genital lesion

A

Klebsiella granulomatis

98
Q

• Most common sexually transmitted disease
• Cervical dysplasia and neoplasia
• Benign ________
• Anogenital ___________ (condylomata _________)
• Laryngeal papilloma

A

Genital warts Human papilloma virus (HPV)

99
Q

Human papilloma virus characteristics

A

• Double stranded DNA virus
• Circular DNA
• Non enveloped
• Encode proteins that promote cells growth (E6 to p53), (E7 to p105RB)
• Lytic infection and Oncogenic transformation

100
Q

Serotypes Human papilloma virus

A

• Cervical neoplasia and cancer (16,18)
• Condyloma acuminatum (6, 11)
• Laryngeal papilloma (6,11)
• Benign skin warts (1,2,3,4,5, 8,10)

101
Q

Transmission Genital warts Human papilloma virus (HPV)

A

Direct contact
• Through abrasions on skin and mucus membrane
• Sexual contact
• Passage through genital tract (laryngeal papilloma)
Who is at risk Pathogenesis

102
Q

Who is at risk HPV

A

• Sexually active
• Early age sexually active
• Multiple sexual partners/number
• Co-factors: smoking, oral contraceptives, folate deficiency

103
Q

Pathogenesis HPV

A

• Cervical neoplasia and cancer (16,18)
• Condyloma acuminatum (6, 11)
• Laryngeal papilloma (6,11)
• Benign skin warts (1,2,3,4,5, 8,10)

104
Q

Virus replicates in stratum granulosum and stratum corneum

A

HPV

105
Q

Virus reach stratum basale (basal keratinocytes )

A

HPV

106
Q

HPV assembly and release in the

A

Stratum corneum

107
Q

HPV Vision genome amplification initiation of late gene expression initiation of virion assembly

A

Stratum granulosum

108
Q

HPV induced hyperplasia where

A

Stratum spinosum

109
Q

Where does HPV infection uncoating early transcription establish and maintence of viral genome take place

A

Stratum basale

110
Q

Benign papillomatous, pedunculated, sessile growth throughout the anogenital area
Appear weeks to months after contact
Flesh to gray colored, hyper- pigmented, erythematous and in groups
Large perianal warts in HIV/AIDS patients
Laryngeal papilloma
Benign epithelial tumor of larynx
Infection occurs during birth
Life threatening if it obstructs airways

A

Condylomata acuminata

111
Q

Flesh to gray colored, hyper- pigmented, erythematous and in groups
Large perianal warts in HIV/AIDS patients

A

HPV

112
Q

Cervical dysplasia micro

A

Cytological changes indicating HPV infection
Koilocyte and superficial desquamated epithelial cells on a Papanicolau smear
Koilocyte: Cell with perinuclear halo (vacuolated cytoplas

113
Q

Histo HPV

A

Histology: hyperplasia of prickle cells
Hyperkeratosis
PAP smear: Koilocyte
Molecular: DNA probe
PCR of cervical swabs, tissue

114
Q

HPV Tx

A

Podophyllin
Imiquimod (immunology)
Interferon Cidofovir Cryotherapy

115
Q

HPV Prevention

A

Human recombinant vaccine:
Gardasil-9v (HPV- 6,11,16,18, 31,33,45,52, 58)
Cervarix (HPV-16,18)
For girls, boys before sexual activity

116
Q

Molluscum contagiosum is a________

A

• Pox viridae
• Double stranded DNA
• Enveloped
• Replicates in the cytoplasm
• Carries its own DNA polymerase enzyme

117
Q

Molluscum contagiosum Poxvirus transmission

A

• Infection occurs after breakage of skin
• Sexual contact
• Wrestling
• Sharing of fomites, towels

118
Q

Pathogenesis Molluscum contagiosum

A

• Virus replicates in lower layers of epidermis, extends upwards
• Epidermis hypertrophies
• Characteristic inclusions
(Henderson-Paterson bodies, or molluscum bodies) are formed in the cytoplasm of the prickle cell layer and gradually enlarge as cells age and migrate to the surface

119
Q

Pearl like, umblicated nodules 2-10mm diameter with a central caseous plug which can be squeezed out
Trunk, genitalia, thighs, extremities
AIDS disseminated lesions

A

Molluscum contagiosum Poxvirus

120
Q

• Intracytoplasmic inclusions
• Replicates in the cytoplasm
Histo _____________?

A

Molluscum contagiosum Poxvirus

121
Q

Lesions: Pearl like, umbilicate nodules 2-10mm diameter with a central caseous plug which can be squeezed out
Seen on trunk, genitalia, thighs, extremities

A

MOLLUSCUM CONTAGIOSUM

122
Q

Double stranded DNA
Enveloped
Replicates in the cytoplasm
Carries its own DNA polymerase enzyme

A

MOLLUSCUM CONTAGIOSUM

123
Q

Transmission: through breakage of skin Sexual contact
Wrestling
Sharing of fomites, towels

A

MOLLUSCUM CONTAGIOSUM

124
Q

Histopathology: hypertrophied epidermal cells, cytoplasm occupied by a large acidophilic granular inclusion mass (the molluscum body), project above the skin to appear as a wart like lesion

A

MOLLUSCUM CONTAGIOSUM

125
Q

Serotypes: Cervical neoplasia and cancer (16,18) Condyloma acuminatum (6, 11)
Laryngeal papilloma (6,11)
Benign skin warts (1,2,3,4,5, 8,10)
Lytic infection and Oncogenic transformation

A

GENITAL WARTS Human papilloma virus

126
Q

DNA Virus
Non enveloped Squamous cell Carcinoma

A

Human papilloma virus
DNA Virus

127
Q

Transmission: Direct contact through abrasions on skin and mucus membrane
Sexual contact
Passage through genital tract (laryngeal papilloma)

A

Human papilloma virus

128
Q

At risk: Early age sexually active
Multiple sexual partners/number
Co-factors: smoking, oral contraceptives, folate deficiency

A

Human papilloma virus

129
Q

PAP smear: Koilocyte cell with perinuclear halo (vacuolated cytoplasm)

A

Human papilloma virus

130
Q

Who keeps the vagina acidic

A

Lactobacilli

131
Q

A decline in lactobacilli causes

A

Vaginosis

132
Q

Gram positive anaerobic rods

A

Gardnerella vaginalis

Bacterial vaginosis- cause

133
Q

Bacterial vaginosis- symptoms

A

Presents as excessive malodorous, thin white, grey white discharge with fishy odor
Milky clings to vaginal walls
Odor worsens after sexual intercourse
Vaginal itching, burning during urination
Vaginal pH> 4.5
Vaginal epithelium appear normal

134
Q

Bacterial vaginosis- risk factors

A

Reduced lactobacilli ( antibiotics) Multiple sex partners
Unprotected sex
Vaginal douching
Intrauterine device
Higher incidence among women who
have sex with women (increased risk by 60%)

135
Q

Bacterial vaginosis- diagnostic criteria

A
  1. Presence of Clue cells ( at least 1in 5 vaginal epithelial cells with edges
    obscured by bacteria )
  2. Vaginal pH > 4.5
  3. Whiff test positive: Amine odor spontaneously or after addition of 10% KOH to vaginal fluid
  4. Thin homogenous discharge
136
Q

Gram stain of clue cell (vaginal epithelial cell whose margins are obliterated with numerous

A

Gardnerella bacteria causing vaginosis

137
Q

Bacterial vaginosis- treatment

A

Clindamycin 150 mg
Metronidazole 250 mg

138
Q

Vulvovaginits whose the culprit

A

Trichomoniasis
Trichomonas vaginalis

139
Q

Vulvo vaginitis- Trichomonas vaginalis symptoms

A

Malodorous, frothy, purulent, greenish yellow vaginal discharge
Vaginal itching, burning Dysuria
Pain during intercourse
Asymptomatic infection common
Infection often seen mixed with gonorrhea and chlamydia

140
Q

Vulvo vaginitis- Trichomonas vaginalis symptoms

A

Erythematous vaginal epithelium Fiery red cervix
Strawberry cervix
Marked dilation of cervical mucosal vessels

141
Q

Trichomonas vaginalis risk factors

A

Multiple sexual partners
A history of other sexually
transmitted infections (STIs)
A previous episode of trichomoniasis Sex without a condom

142
Q

Trichomonas vaginalis complications

A

Increased risk of getting and spreading HIV and other STI
Pregnant women deliver too early (prematurely)
Have a baby with a low birth weight
Give the infection to the baby as the baby passes through the birth canal
Increased risk of cervical or prostate cancer.
Untreated, trichomoniasis infection can last for months to years.

143
Q

Morphology: Protozoan, Flagellate
Trophozoites: Ovoid, leaf like, anterior tuft of 4 flagella Undulating membrane
No cyst stage
Who am I?

A

Vulvo vaginitis Trichomonas vaginalis characteristics

144
Q

Trichomonas vaginalis laboratory diagnosis tests

A

Vaginal discharge swab

NAAT- (Nucleic acid amplification technique PCR- polymerase chain reaction
Urine sample

145
Q

Wet mount of vaginal fluid mixed with saline
Move with a jerky motion

A

Trichomonas vaginalis laboratory diagnosis

146
Q

Trichomonas vaginalis Treatment

A

Metronidazole 250 mg
Tinidazole Treat both partners

147
Q

Vaginal thrush Candidiasis predisposing factors

A

Candida albicans

148
Q

Candidiasis symptoms

A

Intense pruritis: vaginal itching Thick, curdy, cottage cheese like or white- creamy, odorless discharge
Erythematous vaginal mucosa Excoriated mucosa
Pain during urination or sex

149
Q

Candida albicans Morphology

A

Oval yeast like budding cells Buds called blastospores
Elongated buds with constriction called pseudohyphae
Elongated buds without constrictions- true hyphae- germ tubes at 37C in serum

150
Q

Candida albicans laboratory diagnosis

A

Gram stain
Vaginal discharge
Culture on Sabourauds agar

151
Q

Candida albicans treatment

A

Oral ketoconazole Oral itraconazole
Oral fluconazole Topical- Miconazole Clotrimazole Nystatin

152
Q

Females: malodorous thin yellowish green frothy discharge
Numerous pus cells
pH >4.4
Vaginal erythema
Straw berry cervix
Microscopy of discharge: Motile flagellates seen Lab: NAAT
Treatment: Metronidazole

A

TRICHOMONAS VAGINALIS

153
Q

Females: Malodorous fishy odor vaginal discharge
Milky- greyish and clings to the vaginal wall Homogenous adherent
Vaginal pH alkaline pH >4.4
Microscopy: Clue cells with numerous bacteria Test: Positive whiff test: Fishy amine odor add 10% KOH to the vaginal fluid; release volatile amines; fishy odor)

A

GARDNERELLA VAGINALIS

154
Q

Pruritic, cheesy, curdy discharge Erythema and burning
Normal pH 4.3 or less
Predisposing factors Antibiotics use Immunosuppression Diabetes
Elderly
Morphology: Budding yeast cells and pseudohyphae seen
Treatment: Azoles

A

CANDIDA ALBICANS VAGINAL THRUSH

155
Q

Pruritic dermatitis caused by Itch mite (Sarcoptes scabei) that live on within skin
Female Mite burrows, tunnels through the stratum corneum and lays eggs
Transmitted through skin to skin contact, clothing

A

Scabies - itch mite - ectoparasite infection
Sarcoptes scabei

156
Q

Scabies - itch mite - ectoparasite infection
Manifestation

A

Pruritic tracks or papules seen on web of palms, wrists, axillary folds and genitals.
Rash and itching due to delayed type hypersensitivity to mite, eggs and excreta

157
Q

Scabies - itch mite - ectoparasite infection
Treatment

A

Permethrin Crotamiton Ivermectin (oral)

Endocrine II (16 decks)

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