STI/STD Flashcards
Chain of Infection
Causative organism –> reservoir–>
portal of exit–>mode of transmission –> susceptible host–>mode of entry
colonization
state when microorganisms are present without host interference or interaction
Infection
Host interaction with an organism
Infectious disease
State in which the infected host displays a decline in wellness due to the infection
When C & S swab of a healthy person’s skin is + for a microorganism, the patient is infected? T or F
False
How are STIs acquired
sexual contact
Syphilis incubation period
10 days to 3 months
Syphilis mode of transmission
Direct contact with infectious exudate (fluid)
Is Syphilis for forever?
Yes. You can supress it but once you get it, you always have it.
Is Syphilis an STD or STI?
Since you have it for forever it is an STD
Syphillis is caused by what organism?
Spirochete Treponema pallidum
Shyphillis medication of choice
Penicillin G Benzathine IM
Primary syphilis occurs how long after initial inoculation?
2-3 weeks
What happens during primary syphilis?
A lesion (chancre)appears at the site of infection & disapear within about 2 months if left untreated
When does Secondary Syphilis occur?
when the hematogenous spread of organisms from the original chancre leads to generalized infection
When does the rash appear during secondary syphilis & where is the rash loacted?
about 2-8 weeks after the chancre. Rash can be on palms of hands, soles of feet & extrmities
What happens after the secondary stage of syphilis?
there is a period of latency (no s/s)
Generalized signs of infection of syphilis?
lymphadenopathy, arthritis, meningitis, hair loss, fever, malaise & weight loss
lymphadenopathy
abnormal enlargement of lymph nodes
How can the latency period of syphilis be interrupted
by a recurrence of secondary syphilis
Tertiary syphilis is what stage
the last stage in the natural progression of the disease. Some people do not exhibit s/s in this stage. dementia, stroke are most common
Can the tertiary syphilis affect other organs?
Yes. this stage presents as a slow progressive inflammatory disease
What is done to test for syphilis during the primary stage?
direct identification of the spirochete from the chancre lesions
What is done to test for syphilis during the Secondary & Tertiary stage
Serologic tests. Venereal Disease Research Laboratory (VDRL) & Rapid plasma reagin circle card test (RPR-CT)
When does the spirochete cross the placenta in congenital syphilis
After 18 weeks the spirochete cross the placenta barrier
How is mom tested for syphilis when shes pregnant?
Venereal Disease Research Laboratory (VDRL) & Rapid plasma reagin circle card test (RPR-CT), or Automated reagin test (ART)
What is the Fluorescent treponemal antibody-absorption test (FTA-ABS) used for
Used to verify that the syphillis screening did not represent a false-positive
Symptoms of congenital syphilis
stillborn (if its a severe infection), lesions on umbilical cord, nasal passages, copper colored rash after one week of age, possible severe rhinitis, growth plate changes @ 1-3 months of age, pegged or notched teeth, eye scarring or blindness, severe neurological symptoms
Where will a cooper rash develop on a child born with syphilis? & what else might appear?
Rash will be prominent over face, soles of feet & palms of hands. Bullous lesions can appear on palms & soles
What is rhinitis?
inflammation or irritation of the nasal passages, resulting in runny nose, nasal congestion, & postnasal drainage
If mom is tested + for syhilis by a VDRL, the newborn gets what at birth?
Penicillin
If a patient who has syphilis is allergic to Penicillin G Benzathine, what do they get instead?
Doxycyline PO BID for 14 days
Gonorrhea incubation period
2-7 days
Gonorrhea mode of transmission
Contact with mucous membrance of infected people
Gonorrhea symptoms in females
Purulent cervical discharge, asymptomatic, UTIs, vaginitis
Gonorrhea symptoms in males
Purulent discharge from urethra, burning during urination, painful swollen testicles
Gonorrhea symptoms in rectal infection
asymptomatic, pruritis (itching), tenesmus (involuntary straining), discharge
Tenesmus
involuntary straining
pruritis
itching
Gonorrhea & Chlamydia are both bacterial or viral infections?
Bacterial
Gonorrhea discharge color?
white
Chlamydia discharge color?
clear
Can Chlamydia & Gonorrhea be transmitted from mother to child at birth?
yes
Chlamydia s/s in females
Purulent cervical discharge, asymptomatic
Chlamydia s/s in males
Purulent discharge from urethra, burning during urination ,
Complications with Chlamydia & Gonorrhea
PID, ectopic pregnancy, endometritis & infertility
Causative agent of chlamydia
Chlamydia trachomatis
Causative agent of gonorrhea
Neisseria gonorrhoeae
Target group for preventive patient teaching about gonorrhea & chlamydia?
adolescent & young adult population. Usually occurs with first sexaul experience
NAAT (Nucleic Acid Amplification test) is for what?
A used for chlamydia. They are for chlamydia-specific antibodies
Antibiotics for Chlamydia
Azithromycin or doxycycline
Antibiotic for Gonorrhea
Rocephin or Suprax Pellico pg 974
When can a patient have sex again with chlamydia/gonorrhea?
No sex until treated & cured
When are women tested again for Chlamydia?
3-4 months afterward
Vaginits
Inflammation of vaginal epithelium
S/S of vaginits
itching, reddish irritation, white, cheese-like discharge clinging to epithelium,
Lactobacillus
healthy bacteria that live in vagina. They maintain normal vaginal ph
What decrease lactonacilus?
Antibiotics, oral contraceptives, menopause, spermicides, diabetes
Is vaginits an STD or STI?
neither. It can coexist with STI’s but not considered an STI by itself
Vaginits is caused by
Candida albicans, Trichomonas, Bacterial Vaginosis (BV)
Candidiasis incubation period
variable
Candidiasis s/s
cottage-cheese like discharge, odorless, burning inflammation, pruritis, increased symptoms before or during menstrual cycle
Candidiasis treatment
Diflucan (Fluconazole) 150mg x1, Clotrimazole or miconazole vaginal cream 3-7 day treatment
Diflucan (Fluconazole) 150mg x1, Clotrimazole or miconazole vaginal cream 3-7 day treatment is used for?
Candidiasis
Trichomoniasis incubation period
4-20 days
Trichomoniasis s/s
may be asymptomatic, itching, inflammation, bubbly gray or yellow discharge,strawberry spot on vaginal wall
Trichomoniasis treatment
Metrodiazole (Flagyl) 2 Gm PO single dose or Metrodiazole (Flagyl) 500 mg BID for 7 days
Trichomonas vaginalis is a
flagellated protozoan
What kind of membrance does a trichimonasis have & what shape is the organism?
undulating membrance with a pyriform shape
How is a patient tested for trichimonasis
microscopic detection
trichimonasis causative organism
Trichomonas vaginalis
Trichimonasis transmission
almost exclusively sexually transmitted
Where is Trichomoniasis found in women?
Vagina, urethra & paraurethral glands
Where is Trichomoniasis found in men?
urethra
Bacterial Vaginosis (BV) mode of transmission
controversial whether sexually transmitted
BV s/s
fishy odor (positive whiff test), grayish or milky discharge
How is BV diagnosed
by positive clue cells on wet mount
BV causative agent
overgrowth of anaerobic bacteria & Garnerella vaginalis with an absence of lactobacilli
BV risk factors
douching after menses, smoking, multiple sex partners, other STIs
BV treatment
Flagly 500mg BID for 7 days or Clindamycin (Cleocin) cream or 300mg TID for 7 days, Augmentin 500mg TID for 7 days. If pregnant: Flagly 250mg TID for 7 days
Flagly, Clindamycin (Cleocin) & Augmentin are used to treat?
BV
Is BV and STI or STD?
BV is not considered an STI exclusively but is associated with sexual activity
Special instructions when taking flagly
avoid alcohol during and for 24 hrs after treatment to prevent significant GI upset
BV complications
premature labor, endometritis, PID, recurrant UTIs
Herpes causative agent
Herpes simplex virus (HSV) type 1 & 2
Herpes mode of transmission
baginal, oral or anal sex. Transmitted by open sores or skin surface covered with HSV
Herpes incubation period
2-12 days
Herpes patient profile
age 14-49 yrs old. 1 out of 6 people in the US
Testing for Herpes
Culture sores or if there are no symptoms, a blood test is taken for IgG antibodies
Herpes treatment
Acyclovir. taken daily to supress infection or Famciclovir, Valacycovir
THINK: meds ending in “vir” =viral infection
Acyclovir
antiviral medication
Herpes teaching
no sex during outbreak, use a condom everytime
untreated herpes in babies leads to
permanent CNS damage, mental retardation, or death
HSV-1 transmission
transmitted to the genitalia by oral sex or self-inoculation (touching a cold sore then touching the genital area
Sexually transmitted infections in the US per year. (highest to lowest)
Chlamydia, Herpes, HIV
HIV transmission
blood-borne, sexually , thru breast milk
what precautions do you use with an HIV patient?
Standard precautions
Does HIV carry its own RNA or DNA?
RNA
retrovirus
viruses that carry their genetic material in the form of RNA rather than DNA. HIV is a retrovirus
HIV pathophysiology
HIV binds to T-cell (CD4+ cell), RNA is released into cell, reverse transcription converts RNA to DNA, Viral DNA enters T-cell’s nucleus & inserts itself into T-cell DNA, T-cell makes copies of HIV components and are released from the cell
HIV tests
Antibody test: emzyme immunoassay (EIA) test, Western blot test, Viral load tests
Stage 1) Primary HIV infection
intense viral replication, window period occurs (HIV infected patients can test negative on the HIV antibody blood test. (Thats why you have to get tested more than once if you think you might have HIV)
Stage 2) HIV asymptomatic
by about 6 months, the rate of viral infection reaches a lower but relatively steady state
Stage 3) HIV symptomatic
of t-cells gradually falls
Stage 4)AIDS
T-cell level drops below 200 cells/mm3
A persons stage of HIV infection is based on what?
Based on symptoms AND T-cell levels
Viral load tests measure
HIV RNA levels
IF you have HIV antibodies are you immune?
No. HIV antibodies do not indicate immunity
Kaposi’s sarcoma
HIV-related malignancy. Leasions on skin
Wasting syndrome
wasting of whole body. Manifestation of HIV
Manifestations of HIV (Common infections with HIV)
TB, PCP, loss of appetite, oral & esophageal candidiasis, chronic diarrhea, t-cell lymphomas, HIV encephalopathy, CMV, Immune reconstitution inflammatory syndrome (IRIS)
HIV encephalopathy
progressive decline in cognative, behavioral & motor functions
HIV Gynecologic manifestations occur how often?
often. recurrent vaginal candidiasis or BV may be first sign of HIV
HIV Treatment is based on what?
s/s, viral load test, T-cell counts, & willingness of participation
Effective antiretroviral regimens contain at least ____ virologically active meds from at least ____ classes
three, two. That way Dr. can figure out effects
What is most important when on treatment for HIV
Strict adherence to the regimen is vital
What is considered when doing HIV treatment?
side effects & drug resistance
Pneumocystic Pneumonia (PCP) in HIV patients is treated with
TMP-SMZ (Bactrim, Septra)
Cytomegalovirus (CMV)
fluffy-yellow-white retinal leasions. Manifestation of HIV
Cytomegalovirus (CMV) is treated with
various antiviral agents
Kaposi’s sarcoma treatment successful?
No one treatment has been shown to increase survival
Mycrobacterium avium complex (MAC) treated with
clarithromycin(biaxin) or azithromycin (Zithromax)
condylomata
genital warts
what stains of HPV cause genital warts?
HPV 6 & 11
Which strains affect the cerfix
HPV 16, 18, 31,33 &45
How do we detect HPV?
pap smear
What does HPV effect?
cervix
When is the HPV vaccine recommend for males & females
before onset of sexual activity Ages 9-26 yrs old
Treatment of HPV
Topical agents:Trichloroacetic acid, podophyllin, chemotherapeutic agents; Injections: interferons; electrocautery (used with large areas)
HPV transmission
sexual intercourse, can be transmited by skin to skin
HPV vaccine for girls protects against how many strains?
4
Males are vaccinated with quadrivalent HPV to prevent what
genital warts
