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Week 85 > STIs > Flashcards

STIs Flashcards

1
Q

What STIs are caused by Bacteria?

A

Chlamydia

N. Gonorrhea

T. Pallidum (syphilis_

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2
Q

What STIs are caused by viruses?

A
  • HSV
  • HIV
  • HPV
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3
Q

Gonorrhea is caused by?

A
  • N. Gonorrhea
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4
Q

N. Gonorrhea

A
  • Gram (-) diplococcus
  • aerobic
    • requires moisture and pH
    • killed by drying
  • Transmission:
    • sexual contact
    • no fomites
  • Replicates in transitional epithelium better than squamous epithelium
    • oral cavity=rare
      • oropharyngeal transition region
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5
Q

Where is oral gonorrhea most commonly found?

A
  • Oropharyngeal transition region
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6
Q

Gonorrhea: Men vs Women

A
  • Men:
    • mostly symptomatic
      • 40% asymptomatic
    • urethral infection
      • purulent urethral discharge
      • pain w/urination
      • urgency of urination
      • frequency of urination
  • Women
    • Mostly asymptomatic (80%)
    • intra-menstrual bleeding
    • results in pelvic inflammatory disease: 1 milll/yr
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7
Q

Oral Gonorrhea

A
  • Spread by oral sex
  • Exudates
    • yellowish fluid discharge
    • spreads across mucous membranes→spreads infection
  • Symptoms: (mostly asymptomatic)
    • slight discomfort when eating
    • sore throat
  • Gonococcal pharyngitis
    • uncommon
    • 1-22% have oral infections
    • most common in gay men
    • asymptomatic
    • infrequent transmission
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8
Q

Gonorrhea Treatment options:

A
  • Recommended: (& Gonococcal Pharyngitis)
    • Ceftriaxone + Azithromycin
  • Alternative:
    • If ceftriaxone is not available
      • Cefixinae + Azithromycin
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9
Q

Gonorrhea: Dental Considerations

A
  • pt w/history of gonorrhea +. no signs of infection= Little threat
  • clinical exam should include assessment for active infection
    • referral if signs are present
    • tx all sex partners
  • Avoid elective tx w/active oral infection
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10
Q

What is Syphilis is caused by?

A
  • T. pallidum
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11
Q

T. Pallidum

A
  • Fragile spirochete
  • anaerobe
    • Killed by heat, drying, oxygen, soap & water
  • Transmission:
    • sexual contact (Vaginal, anal, oral)
      • person to person by direct contact w/a Chancre (Syphilitic spore)
        • occur on or around external genitals
          • vagina, anus, rectum, mouth
    • fomites-Rare
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12
Q

What are some groups at risk for syphilis?

A
  • 15-25 y.o.
  • multiple sex partners
  • urban dweller
  • Males 3:1 F
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13
Q

What are the different stages of infection in Syphilis?

A
  1. Primary
  2. Secondary
  3. Latent
  4. Tertiary
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14
Q

When do symptoms first appear when you have syphilis?

A
  • on avg 21 days after infection
    • range: 10-90 days
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15
Q

Primary Stage of Syphilis

A
  • Appearance of a single sore=Chancre
    • can have multiple
  • No tx→Secondary stage after 6 weeks
  • Chancre:
    • firm, round, small, painless
    • appears at the spot where syphilis entered the body
    • lasts 3-6wks→heals w/o tx
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16
Q

Secondary Stage of Syphilis

A
  • Skin Rash & Mucous Membrane lesions
  • Rash:
    • appears as the chancre is healing or wks after its healed
    • rough, red or reddish brown spots on the palm of hands and bottom of feet
    • DOES NOT ITCH
  • Symptoms:
    • Fever
    • swollen lymph glands
    • patchy hair loss
    • weight loss
  • Signs & Symptoms resolve with or w/o tx
    • w/o tx→ Latent & Late stages
17
Q

Latent Syphilis

A
  • untreated infection
  • Seroreactive
    • RPR, VDRL, FTA
    • no other evidence of disease
  • early latent syphilis < 1 yr
  • Late latent syphilis > 1 yr
18
Q

Tertiary Syphilis

A
  • Aka Late syphilis
  • The destructive Phase
  • non-infectious
    • years after initial infection
  • Obliterative endarteritis of:
    • epithelium
    • bone
    • nervous system
    • vascular system (aortic aneurysm)
  • Signs & Symptoms: 80% vascular
    • difficulty coordinating muscle movements
    • paralysis
    • numbness
    • gradual blindess
    • dementia
19
Q

Congenital Syphilis:

A
  • concern in the US
    • 500 cases in 2015 vs 125 perinatal HIV
    • declining rate
  • passed from mother to fetus after week 16
  • Late Congenital Syphilis
    • Hutchisons Triad
      • Hutchinson’s Teeth
      • Interstitial Keratosis
      • CN8→Deaf
    • Other manifestations:
      • Saddle Nose
      • Frontal Bossing
      • Clutter joints
        • painless swelling of joint
    • within 3 months:
      • anemia
      • skin rash
      • hepatosplenomegaly
      • nasal discharge
      • multi-organ infection
      • neurological manifestations
      • musculoskeletal handicap
        • rhagades
        • saddle nose
      • Death
19
Q

Congenital Syphilis:

A
  • concern in the US
    • 500 cases in 2015 vs 125 perinatal HIV
    • declining rate
  • passed from mother to fetus after week 16
  • Late Congenital Syphilis
    • Hutchisons Triad
      • Hutchinson’s Teeth
      • Interstitial Keratosis
      • CN8→Deaf
    • Other manifestations:
      • Saddle Nose
      • Frontal Bossing
      • Clutter joints
        • painless swelling of joint
    • within 3 months:
      • anemia
      • skin rash
      • hepatosplenomegaly
      • nasal discharge
      • multi-organ infection
      • neurological manifestations
      • musculoskeletal handicap
        • rhagades
        • saddle nose
      • Death
20
Q

Syphilis: Treatment

A
  • Penicillin G:
    • kills the syphilis bacterium
    • prevents further damage
      • does not repair damage
    • prevents maternal transmission & treats fetal infection
    • No sexual contact w/new partners until syphilis sores are completely healed
    • Must notify sex partners
      • test & tx if positive
  • Benzathine penicillin G
    • 1 IM Injection
      • cures Primary, Secondary, or early latent syphilis
    • 3 doses at weekly intervals recommended for
      • late latent syphilis
      • late syphilis of unknown duration
  • Aqueous crystalline penicillin G or Procaine Penicillin G
    • Congenital Syphillis
21
Q

HIV Infection

A
  • Retrovirus that causes AIDs
  • Transmission:
    • sexual contact
    • exposure to contaminated blood
    • perinatal transmission
    • any bodily fluid
22
Q

What tells you that the patient has progressed from HIV+ to AIDs?

A
  • CD4+ Count< 200 + 1 opportunistic infection
  • disease related to AIDs
  • Untreated pts: 10+ years
23
Q

HIV Infections: Characteristics

A
  • Severe immunodeficiency w/opportunistic infections:
    • Viral Infections:
      • Herpes Simplex
      • Varicella
      • Epstein-Barr
      • Cytomegalovirus (CMV)
    • Fungal Infections:
    • Protozoal Infections:
      • Toxoplasmosis
      • Cryptococcus
    • Mycobacterium infection→ Tuberculosis
  • Viral & Parasitic Diarrhea
  • Kaposi’s Sarcoma
  • Lymphoid malignancies
  • encephalopathy (brain fxn by virus)
24
Q

HIV Infections: What tests are available?

A
  • NAT: (Nucleic Acid Tests)
    • look for actual virus in blood
    • result: +/- or amount of virus present (HIV viral load test)
    • very expensive, not routine
      • except high risk exposure or possible exposure w/early symptoms
  • Antigen/Antibody Test
    • looks for HIV antibodies and antigens in blood
    • HIV+: antigen p24 produced before antibodies
  • Antibody Tests
    • look for HIV antibodies in blood or oral fluid
    • rapid test & home tests
    • use blood from vein=detects faster
      • vs blood from finger prick or oral fluid
25
Q

HIV Infection: Oral Manifestations

A
  • Hairy Leukoplakia
  • HPV
  • Kaposi’s Sarcoma
  • Flucanazole resistant Candida albicans
    • recurrent fungal infection
26
Q

Can a HIV patient with an undetectable viral load infect others?

27
Q

HIV: Treatment

A
  • HAART
    • Highly Affective Antiretroviral Therapy
  • Medicine options:
    • Nucleosid/nucleotid reverse transcriptase inhibitors
      • abacavir
      • tenofovir
    • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
      • nevirapine
    • Protease Inhibitors (PIs)
      • (-navir)
    • Entry Inhibitors:
      • maraviroc
    • Integrase inhibitors:
      • (-gravir)
28
Q

HIV: Dental Considerations

A
  • Aggressive Management of HIV associated perio disease
    • debridement w/antiseptic rinses
    • metronidazole and/or amoxicillin
      • 5-7 days
  • Check CD4+ count→ Disease Progression
    • Neutrophil count
      • better indicator for risk of infection from invasive procedure
      • Normal NAC: 1.5-8.0 (1500-8,000 mm3)
  • Antibiotics:
    • no evidence
    • but give if neutrophil count <500
    • at risk of fungal infection
      • Long term anti fungal meds not needed if on HAART
  • Oropharyngeal Candidiasis
    • common when CD4<200
  • HSV Lesions
    • Treat with (-clovir)
      • acyclovir
  • HIV affected children
    • psychosocial issues
29
Q

HPV

A
  • Genital Human Papillomavirus
  • most common STI in US

Week 85 (8 decks)

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