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446- ID and transplant > STIs > Flashcards

STIs Flashcards

1
Q

STi jmeans

A

an infection spread mainly via sexual contact

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2
Q

STBBI means

A

an infection transmitted via blood or sexual

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3
Q

which of the following is false
1. rates of STIs have increased dramatically
2. goals to reduce incidence include improving access to testing, treatment, and ongoing care + reducing stigma and discrimination
3. there was less STIs reported during covid than expected- likely due to lower actual prevalence and social distancing
4. STIs may be asymptomatic for a long time
5. YMSM are at increased risk for STIs

A

3- likely underreporting

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4
Q

why are YMSM at increased risk fro STIs

A

of partners
freq of sex without a condom
overlapping sexual networks
frequency of anal sex

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5
Q

STIs have 4 major effects on sexual and repro health, which include

A

fertility issues
increased risk of HIV acquisition
vertical transmission of STIs
increased risk of cancer

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6
Q

vertical transmission of STIs causes the following in children

A

stillbirth, neonatal death, low birth weight, prematurity, sepsis

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7
Q

what are the 5 Ps for taking a sexual hx

A

partners, practices, protection, past hx STIs, prevention of pregnancy

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8
Q

what are 3 painful ulcers that are STIs

A

genital herpes
chanceroid
LGV

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9
Q

what are 3 painless ulcers that are STIs

A

syphilis
granuloma
inguinale

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10
Q

what are 2 genital warts/ ectoparasites

A

HPV, pubic lice

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11
Q

what are 5 causes of urethritis/ cervicitis

A

gonorrhea, chlamydia, trichomoniasis, mycoplasma and ureaplasma

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12
Q

a woman has a discharge sample that shows gram - intracellular diplococci. this is most likely
1. gonorrhea
2. syphilis
3. pubic lice
4. trichomoniasis

A

1

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13
Q

what is the second most frequently reported notifiable STI in Alberta and Canada

A

gonorrhea

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14
Q

why is there national concern about gonorrhea

A

emergence of drug resistant strains

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15
Q

RFs for gonorrhea include

A

multiple/ new partners, unprotected sex, alcohol/ SU, sex workers and street involved youth

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16
Q

____% pts with gonorrhea are also coinfected with chlamydia

A

25-30%

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17
Q

what is the causative pathogen of gonorrhea

A

neisseria gonorrheae

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18
Q

how is gonorrhea transmitted

A

via sexual activity
perinatal possible

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19
Q

how long is the incubation period for gonorrhea

A

2-7 days

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20
Q

there is an increased rate of gonorrhea in _______ > ________

A

males > females

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21
Q

gonorrhea increases HIV acquisition due to ___________ increasing ________ of HIV

A

urethritis increases viral shedding of HIV

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22
Q

men with gonorrhea are typically _____ (more/ less) sx than females

A

more- females more likely to be detected via exam/ testing

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23
Q

nongonococcal urethritis is likely

A

chlamydia- less commonly mycoplasma/ ureaplasma

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24
Q

urethritis sx nclude

A

inflam of urethra, discharge, dysuria, possibly itchiness or irritation

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25
Q

gonorrhea may be refered to as

A

the drip or the clap

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26
Q

hyperacute gonococcal conjunctivitis can lead to

A

corneal ulceration and blindness

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27
Q

neonatal gonorrheal infection predominantly occurs from

A

preinatal exposure to mother’s infected cervix during birth- can be prevented with routine prenatal screening

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28
Q

what are the 2 most common manifestations of neonatal gonorrhea

A

ophthalmia neonatorum - causes blindness
neonatal sepsis/ meningitis

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29
Q

why is erythromycin 0.5% ung OU given to all newborns

A

to prevent ophthalmia neonatorum- reduce preventable blindness

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30
Q

disseminated gonococcal infection can occur through _____________ and occurs predominantly in ___________

A

hematogenous spread
women

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31
Q

list 2 organ systems that DGI can affect

A

skin
tendon sheaths/ joints
pericardium
endocardium (infective endocarditis)
meningitis
bacterial hepatitis

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32
Q

T or F: samples of arthritis in gonorrhea may be sterile

A

T

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33
Q

gonorrhea may cause ___ in females and _____ in males

A

PID
epididymo-orchitis

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34
Q

gonorrhea is often asymptomatic ____% in women

A

50%

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35
Q

PID refers to the infection of the ___, ____, and/or ____ typically as a result of ________ in females

A

infection of the uterus, fallopian tubes, ovaries
ascending spread

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36
Q

what are the 2 most common pathogens for PID

A

gonorrhea, chlamydia

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37
Q

tx for PID include

A

often hospital admit + antibitotics targeting pathogens for 7-14d

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38
Q

what are some complications of PID

A

tubo-ovarian abscess, damage to uterine wall, reduced fertility

fertility issues = most common comp of PID

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39
Q

how is gonorrhea dx

A

often highly sus by hx and physical along
can confirm dep on sit affected

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40
Q

how is urethritis/ cervicitis caused by gonorrhea dx

A

urine NAT testing - detects dead organisms too
- can also do swab

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41
Q

how is eye/pharynx/ rectal involvement caused by gonorrhea dx

A

gram stain, culture and sensitivity

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42
Q

gonorrhea is generally sus to

A

cephalosporns
meropenem/imipenem, ertapenem, aztreonam

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43
Q

what is the pref and alt tx for uncomplicated urethral and cervical gonorrheal infxn in heterosexual/ preg

A

pref: cefixime + azithro
alt: ceftriaxone + azithro

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44
Q

T or F: azithromycin can be used as monotx in gonorrhea

A

F- resistance reported- must use with cefixime or ceftriaxone

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45
Q

in the tx of gonorrhea, abstinence from unprotected sex for ___ is rec to protect others

A

7 days

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46
Q

how long after tx are you noncontagious anymore for gonorrhea? how long should you wait to have unprotected sex?

A

24hrs after start
7 days wait

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47
Q

what is the pref and alt tx for MSM + pharyngeal gonorrheal infections

A

pref: ceftriaxone + azithro (risk of drug resistant gonorrhea may be higher in MSM pop)
alt: cefixime + azithro

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48
Q

what are the recs for TOC for GC

A

rec for all cases with urine NAT 3-4wks after completion of tx + rescreen after 6mths

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49
Q

a pt presents with dysurea and discharge, no visible organisms are seen on microscopy- what is the dx likely?

A

chlamydia- atypically = can’t be stained

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50
Q

what is the most common reported notifiable STI in alberta

A

chlamydia

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51
Q

what is the most common cause of urethritis and cervicitis

A

chlamydia

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52
Q

chlamydia can infect (4)

A

urogenital, rectal, pharyngeal, conjunctival

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53
Q

females are ____ likely to be affected than males by chlamydia

A

more (gonorrhea = less)

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54
Q

chlamydial serovars A-C causes

A

conjunctivitis aka trachoma

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55
Q

chlamydia serovars D-K causes

A

urogenital tract infection

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56
Q

chlamydia serovars L1-L3 causes

A

invasive disease, another STI called lymphogranuloma venereum (LGV)

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57
Q

how is chlamydia transmitted

A

mostly sexual contact
some vertical

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58
Q

how long is chlamydia’s incubation period

A

7-21 days

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59
Q

why are chlamydia species atypical

A

no peptidoglycan cell wall

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60
Q

which has the longer incubation period- gonorrhea or chlamydia

A

chlamydia- 7-21 days = longer than gonorrhea 2-7 days

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61
Q

______ is an autoimmune inflam response that can happen in response to chlamydia trachomatis infections and gonorrhea

A

reactive arthritis

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62
Q

what is the classic triad of reactive arthritis from chlamydia

A

can’t see- anterior uveitis
can’t pee- urethritis/ cervicitis
can’t climb a tree- inflam monoarthritis

63
Q

reactive arthritis typically happens ____ after chlamydia infection

A

1-6wks

64
Q

what is the tx of RA from chlamydia

A

antibiotics for infection, NSAIDs for acute phase of reactive arthritis

65
Q

T or F: most cases of reactive arthritis are short lived + resolve sponatneously

A

T

66
Q

chlamydia can threaten male fertility through ______ and ______

A

epididymitis and epididymo-orchitis

67
Q

what is epididymo-orchitis

A

infection involving both the epididymis and testis

68
Q

describe epididymo-orchitis in males sx from chlamydia

A

scrotal pain, unilateral swelling/ redness + tenderness

69
Q

tx for chlamydial epididymo-orchitis in males

A

antibiotics (ex- ceftriaxone + azithro) F2-3wks

70
Q

epididmyal abscess can form in the ______ which then requires ____________

A

vas deferens
surgical incision and drainage

71
Q

how is chlamydia dx

A

often highly sus via hx and physical

urethritis = urine or swab NAT

difficult to culture- requires special media

72
Q

chlamydia is generally sus to

A

amoxicillin/ ampicillin
amoxi/clav
fluoroquinolones
erythro/clarithro/azithromycin
doxy/mino/tigecycline

73
Q

what is the rec tx for cervical, urethral, and pharnygeal chlamydia if gonorrhea test is negative (pref + alt)? what about P/BF?

A

pref: azithro
alt: doxycycline

perg/BF
- pref: azithro
alt: amoxi

74
Q

what is the pref and alt tx for rectal chlamydia

A

pref: doxy
alt: azithro

75
Q

T or F: a TOC is not necessary for rectal chlamydia

A

F- still rec

76
Q

T or F: a TOC for chlamydia is not routinely indicated

A

T

77
Q

when is a TOC rec for chlamydia

A

when adherence is suboptimal
tx is not provided in line with alberta guidelines
client is perpubertal
a nongenital site is involved
client is pregnant

78
Q

what is the pref test for TOC for chlamydia + when

A

NAAT 3-4wks after tx + rescreening after 6mths

79
Q

trichomonas vaginalis is a ____ STI

A

parasitic/ protozoan

80
Q

how is trichomoniasis trasmitted

A

sexual contact with direct contact or fluids

81
Q

trichomoniasis more often affects

A

females

82
Q

trichomoniasis is typically ________ (asymptomatic/ symptomatic) in males

A

asymptomatic

83
Q

what is the presentation of trichomoniasis

A

forthy/ yellow green vaginal discharge +/- fishy odor, sorenses, dysuria, dyspareunia

84
Q

how is trichomoniasis diagnosed?

A

NAT+ for urine, microscopic testing

85
Q

in those infected with trichomoniasis, coinfection with _______ is common

A

G/C

86
Q

_____________ is one of the only STIs that can be prevented by an effective vaccine

A

genital warts

87
Q

what is the pathogen that causes HPV?

A

HPV

88
Q

what is the most common VIRAL STI

A

HPV

89
Q

HPV increases the risk of _______ in women and _________ in men

A

cervical cancer in women
oropharangeal/ rectal cancer in men

90
Q

________ HPV vaccines are highly effective at preventing urogenital cancers + anogenital warts

A

9-valent

91
Q

what HPV types are oncogenic

A

16, 18

92
Q

T or F: routine testing for HPV is not available

A

T

93
Q

how is HPV dx

A

direct examination with hands or lens
colposcopy for visible warts of cervix and anus + urethroscopy if extensive meatal warts
pap smears

94
Q

dx of HPV is confirmed by

A

response to liquid nitrogen tx

95
Q

T or F: no tx garantees cure of clinical lesions, none are superior to other

A

T

96
Q

what are 3 options for genital wart tx

A

cryotx
surgical tx
home initiated therapies

97
Q

what are 3 home approved tx for genital warts

A

podofilox
imiquimod
sinecatechins

98
Q

during pregnancy, ___ or —- is pref as tx for genital warts

A

liquid nitrogen
trichloroacetic acid

99
Q

HPV should be given at age ____ for ____, as early as ____ if question of sexual abuse/ assult

A

11-12yrs for all girls and boys
9yrs of SA

100
Q

in alberta, pts are able to receive the HPV vaccine for free to age

A

26

101
Q

what pathogen causes syphilis

A

trepnema pallidum

102
Q

syphilis is a gram ___, ___ (shape_

A

gram - spirochete

103
Q

what is known as the “great imitator” in STIs

A

syphilis

104
Q

how is syphilis transmitted

A

sexual contact
vertical transmission

105
Q

T or F: syphilis increases susceptibiltiy to HIV

A

T

106
Q

in congenital syphilis, pts are often _____ at birth, then _______

A

asymptomatic
then develop problems later in life

107
Q

most pts with congenital syphilis are infected during

A

pregnancy

108
Q

what is the screening rec for syphilis for pregnant women

A

screen in 1st trim + rescreen at delivery

109
Q

early congenital syphilis is in months ___

A

0-3

110
Q

describe the sx of late congenital syphilis

A

gummatous ulcers of nose/ palate
saber shins/ frontal bossing
corneal scarring from interstitial keratitis
sensorineural hearing loss

111
Q

T or F: tx of newborns with penicillin may prevent manifestations of congenital syphilis

A

F- may or may not

112
Q

when does primary syphilis happen after exposure? how long does it take to resolve?

A

21 days
resolves spontaneously in 4-6wks

113
Q

secondary syphilis often develops _____wks after primary syphilis

A

2-12

114
Q

when is a syphilis patient contagious
1. primary phase
2. secondary phase
3. early latent phase
4. late latent phase
5. 1-3
6. all of the above

A

5

115
Q

when does tertiary syphilis tend to occur

A

years- decades after initial infection

116
Q

in secondary syphilis, pts will have _______ and can be reactive to ——-

A

high grade bacteremia
reactive to penicillin

117
Q

what are the 3 steps in screening syphilis

A
  1. syphilis EIA- if + then proceed to 2
  2. TPPA: a confirmatory test, if + proceed to 3
  3. RPR: most important- tells if previously treated + current status
118
Q

what is defined as tx failure in syphilis

A

decrease of less than 4x RPR in 6-12mths or 12-24mths if later

119
Q

why is syphilis not resistant to penicillin

A

mutation to PBP results in a fatal error incompatible with life
also incapable of doing horizontal gene transfer

120
Q

what drugs are used to tx primary, secondary, or early latent syphilis

A

pen G F 1 dose or doxy F 14 d

121
Q

what drug is used to tx late latent syphilis

A

pen G F3 doses or doxy F 4wks

122
Q

what is used for tx of syphilis in preg women who are allergic to penicillin

A

must undergo desensitization prior to tx

123
Q

what is the potential mech of desensitization for syphilis

A

IgE internalization or counter regulation
getting limited mast cell degranulation until it is depleted

124
Q

desensitization to penicillin lasts up to ——–

A

4 half lives (48hrs for penicillin_

125
Q

where is penicillin desensitization usually done

A

ICU

126
Q

should you pretreat pts undergoing desensitization with CS or antihistamines

A

no

127
Q

when can you stop serological syphilis FU

A

once RPR nonreactive (unless HIV +)

128
Q

when to FU for infectious syphilis/ HIV negative

A

serology at 1, 3, 6, 12 mths or until RPR nonreactive

129
Q

when to FU for noninfectious syphilis/ HIV negative

A

serology at 12 and 24mths (unless RPR nonreactive)

130
Q

T or F: pts may be reinfected with syphilis

A

T- no immunity

131
Q

what is the structure and group of HHVs

A

group 2, dsDNA virus
icosahedral, enveloped

132
Q

seropositivity (IgG+) to HHVs is equal to

A

age

133
Q

HHV is transmitted ______(2), an affects M ___F

A

sexual, vertical
M>F

134
Q

what host cells typically control HHV infection

A

CD8 T lymphocytes

135
Q

how long is inculation for HHV

A

~7d

136
Q

T or F: HHV pts can still be contagious in recovery period after primary infection

A

T

137
Q

severe disseminated herpes virus disease may occur in those who are _____ or _________

A

sus + exposed to high inoculum
immunodeficient

138
Q

whatre the sx of severe disseminated herpes virus disease

A

viral meningoencephalitis (seizures, altered LOC, HA), ANS dysfxn, herpesvirus pneumonia, viral hepatitis

139
Q

reactivation of HHV typically leads to _____ (more/less) severe sx at the original site of disease

A

less

140
Q

genital herpes typically last _____ and resolves _______

A

2wks
spontaneously

141
Q

describe the herpesvirus lief cycle and pharmacologic targets

A

attach/ fusion - uncoating - transcription/ translation - assembly/ packaging - egress

142
Q

HHV uses ___ ribosomes to translate viral protein

A

host

143
Q

what is the primary pharm target for HHV

A

DNA dependent DNA polymerase
most HHV antivirals mimic free floating DNA pairs = chain termination = stops replication

144
Q

Ig _____ spikes in primary infection then fluctuates periodically even if asymptomatic

A

IgM

145
Q

IgM+/IgG- is confirmatory for ________ of HHV

A

primary disease

146
Q

how is HSV diagnosed

A

clinically with corresponding serology +/- PCR testing if active disease (swab blood/ CSF if active lesions)

147
Q

MOA of acyclovir, valacyclovir, ganciclovir, valganciclovir, and cidofovir

A

interferes with DNA polymerase by mimicking nucleosides = chain termination

148
Q

foscarnet acts as a ___________ and disrupts DNApolymerase

A

pyrophosphate analog

149
Q

T or F: valacyclovir is often preferred to acyclovir due to better bioavailability and frequency of dosing

A

T

150
Q

tx of HSV with valacyclovir decreases time to resolution by ______, time to healing by ______, and duration of viral shedding by _____ if started within 72hrs of onset

A

resolution by 2 days
time to healing by 4 days
duration of viral shedding by 7 days

151
Q

chronic suppression for HSV is used if

A

> 6 outbreaks/yr

152
Q

suppressive tx for HSV in pregnant women is required to start at _______ until ________

A

36wks until delivery

153
Q

what antivirals are safe to use in pregnancy

A

acyclovir, valacyclovir

446- ID and transplant (18 decks)

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