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ID Exam 4 > STIs > Flashcards

STIs Flashcards

1
Q

Groups more often affected by STIs

A

Young people aged 15-24
Gay and Bisexual men
Pregnant people
Racial and ethnic minority groups

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2
Q

Gonorrhea pathogenesis

A

Neisseria gonorrhoeae
● Caused by the gram- negative diplococcus
● Less common is dissemination to skin and
joints (sores, fever, arthritis)
● A purulent infection of mucous membranes
● Typically infects the urethra, cervix, rectum,
pharynx, or conjunctivae

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3
Q

Gonorrhea is a purulent infection of ____

A

mucous membranes

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4
Q

Less common for Gonorrhea is dissemination to _____

A

skin and joints (sores, fever, arthritis)

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5
Q

Epidemiology of Gonorrhea

A

Gonorrhea is the 2nd most commonly reported communicable
disease, and the 2nd most prevalent STI in the US

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6
Q

T/F Gonorrhea can present asymptomatically

A

T

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7
Q

Who is gonorrhea more common in?

A

More common among ages 20-24, men, ethnic minorities, and those in the US SE region

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8
Q

Symptoms of gonorrhea (Men and Women)

A

● Purulent and profuse discharge
● Can be asymptomatic
Men- burning on urination; serous penile discharge → yellow, creamy, profuse, sometimes blood-tinged discharge

Women- Vaginal discharge (thin, purulent, and mildly odorous), dysuria, vaginal bleeding, dyspareunia, lower abdominal tenderness

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9
Q

Gonorrhea can cause this in men vs. women

A

● Male urethritis
● Female endocervicitis

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10
Q

Complications of gonorrhea

A

● Epididymitis
● Pelvic inflammatory disease
● Fitz-Hugh-Curtis syndrome
● Rectal gonorrhea
● Pharyngitis
● Infertility
● Gonococcal septic arthritis
● Disseminated gonococcal
infection (DGI)

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11
Q

Diagnosis Gonorrhea, what is gold standard?

A

● Gram stain
● Bacterial culture - Gold Standard!
● NAAT (nucleic acid amplification test)
Men - first catch AM urine or swab of urethral discharge
Women - endocervical or vaginal swabs

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12
Q

Treatment for gonorrhea

A

Treatment for uncomplicated infection:
Ceftriaxone 500 mg IM

Treatment for G&C:
(500 mg IM ceftriaxone + 100 mg
PO doxycycline BID x 7 days)

Make sure you are getting a pregnancy test in females, may change treatment!

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13
Q

Chlamydia (Chlamydia trachomatis)

A

Small, gram-negative obligate
microorganisms, Chlamydia trachomatis, affects the cervix, urethra, salpinges, uterus, nasopharynx, and epididymis

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14
Q

Can cause infections in many organ
systems (including conjunctivitis and
pneumonia, F-H-C, etc.)

A

Chlamydia

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15
Q

The most commonly reported bacterial
STI in the US

A

Chlamydia

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16
Q

Chlamydia Elementary bodies and Reticulate bodies

A

● Elementary bodies (EB) are the
infectious form, adapted for extracellular survival
● Reticulate body (RB) are not
infectious, adapted for intracellular environment

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17
Q

Epidemiology of chlamydia

A

● A leading cause of infertility of US females
● Incidence is 2-3x that of gonorrhea
● Four million cases of chlamydia in the US in 2018
● Coinfection with gonorrhea is common

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18
Q

T/F chlamydia can be asymptomatic

A

T

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19
Q

Signs and symptoms of Chlamydia

A

● Frequently asymptomatic
● Vaginal bleeding, vaginal discharge, urethral discharge, cervical friability, dysuria, lower abd tenderness

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20
Q

_____ Most commonly affects the cervix

A

Chlamydia

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21
Q

What is CMT (Cervical Motion Tenderness) and what is it seen with?

A

Severe pain seen with chlamydia when you are doing a pelvic exam

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22
Q

Chlamydia signs and symptoms in men

A

● Urethritis: Mucopurulent urethral discharge, urinary frequency/urgency,
dysuria
● May progress to epididymitis with testicular pain and tenderness

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23
Q

Chlamydia diagnosing

A

Diagnosing: NAAT
Women - vaginal swabs
Men - first catch urine

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24
Q

Treatment of chlamydia

A

100 mg PO doxycycline BID for 7 days OR
1g PO azithromycin in a single dose
*Counsel on abstinence for one week after treatment

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25
Q

With _____ you should Retest for recurrent infection in 3 months

A

Chlamydia

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26
Q

Complications of chlamydia

A

● PID (could lead to F-H-C)
● Infertility
● Ectopic pregnancy
● Urethral scarring

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27
Q

Chlamydia can cause _____ (formerly Reiter syndrome):

A

Reactive arthritis
1. Conjunctivitis
2. Urethritis
3. Arthritis
“Can’t see, pee, or climb a tree”

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28
Q

Syphilis

A

Caused by the spirochete, Treponema pallidum, which cannot last long outside the human body

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29
Q

Pathogenesis of syphyllis

A

● Enters through mucous
membranes or skin, reaches the
lymph nodes, spreads throughout
body
● Transmitted sexually, also by skin
contact or transplacentally

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30
Q

Stages of syphyllis

A
  • primary, secondary, latent, and late/tertiary.
  • There can be long latent periods
    between stages.
  • Infected people are contagious during
    the first 2 stages
  • Can cause long term complications
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31
Q

Epidemiology of syphyllis

A

● The overall rate has been increasing since 2000
● In the US, most commonly occurs in Men who have sex with Men (83.7% of
reported cases)
● Most new cases occur in people aged 20-29 years
● The rate of HIV and syphilis co-infection is high

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32
Q

Primary Symptoms of syphilis

A

Chancre: a solitary, red, firm papules → painless ulcer with
clean base and firm indurated borders.
● Usually heals within 4-8 weeks, with or without therapy
Also, regional lymphadenopathy

33
Q

Secondary symptoms of syphilis

A

Skin rash - often on palms and soles,
rough, red/brown spots
● Condylomata lata - flat papules
● Generalized lymphadenopathy - more widespread
● Constitutional symptoms - fever, nausea, fatigue
● Headaches; bone pain

34
Q

Latent symptoms of syphilis

A

Symptoms resolve (antibodies are still present)
Early latent = occurs within the 1st year of infection
Late latent = after 1st year of infection

35
Q

Late/Tertiary symptoms of syphilis

A

● Develops years to decades after initial
infection
● Is slowly progressive
- Benign tertiary syphilis (may involve skin, bones, organs), Gummas = soft, destructive, inflammatory masses
- Cardiovascular syphilis
- Neurosyphilis

36
Q

Syphilis diagnosis

A
  1. Nontreponemal (reaginic) test
    i. If positive, will need a confirmatory test
  2. Treponemal test - detects antibodies specific to T pallidum
    a. Fluorescent treponemal antibody absorption (FTA-ABS) or
    enzyme immunosorbent assay (EIA to confirm RPR
37
Q

Syphilis Treatment, early stage

A

Early stages: 1 dose of Benzathine
penicillin G 2.4 million units IM
● Will cure a person with primary,
secondary, or early latent syphilis

38
Q

Syphilis treatment, late stage

A

1 dose of Benzathine penicillin G 2.4 million units IM weekly
for 3 wks

39
Q

Syphilis (Treponema pallidum) Complications

A

● Damage to internal organs, brain, nerves, eyes, heart, blood
vessels, liver, bones, and joints
● Can lead to difficulty with muscle coordination, paralysis,
numbness, blindness, and dementia

40
Q

Neurosyphilis (Syphilis, CNS)

A

● Can occur at any stage of the disease
● Can be a progressive, disabling, and life-threatening complication

41
Q

Workup of Neurosyphilis

A

Sxs: Nonspecific - HA, confusion, stiff neck, general paresis, loss
of coordination of movement
Dx: see previous slides + lumbar puncture/CSF examination
Tx: Aqueous PCN G 18-24 million units IV qd

42
Q

____ produces epithelial tumors or the skin and mucous
membranes. It causes warts

A

HPV

43
Q

Is the most common STI

A

HPV

44
Q

Epidemiology of HPV

A

So common that nearly all sexually active men and women get
it at some point in their lives

45
Q

Pathogenesis of HPV

A

● Many different types of HPV, some can cause genital warts and cancers. Types 6, 11, 16, and 18 associated with genital
warts and cancers.
● Spread by vaginal, anal, or oral sex with someone with the virus

46
Q

Symptoms of Human Papillomavirus (HPV)

A

Anogenital warts (condyloma
acuminata)
○ Usually soft, moist, minute pink
or gray polyps
○ Often asymptomatic

47
Q

Diagnosis of HPV

A

● Clinical evaluation
● Acetic acid test (vinegar)
○ Turns wart areas white (helps identify flat lesions)
○ Can be used in conjunction with colposcopy
● Pap smears - cervical cytologic testing
○ Screen for cervical neoplasia
● DNA test
○ Identify specific strains that are linked to genital cancers

48
Q

HPV Treatment

A

● Treat the lesions as they appear
● No treatment of anogenital warts is completely satisfactory
● No treatment is clearly more efficacious than others
Mechanical removal
-Cryotherapy, laser,
electrocauterization,
surgical excision

49
Q

Topical treatments of HPV

A

-Salicylic acid (OTC) – removes layers of the
wart a little at a time; can cause skin irritation
-Imiquimod (Aldara, Zyclara)
○ May enhance immune system’s ability to fight HPV
-Podofilox (Condylox)
○ Destroys genital wart tissue; can cause pain and itching
-Trichloroacetic acid (cytotoxic agent)
○ Chemically burns off genital warts

50
Q

Complications of HPV

A

● 99% of cervical cancers had HPV present
● 70% of cervical cancers directly correlated with types
16 and 18
● Can cause anogenital and oropharyngeal cancers
Prevention: HPV vaccine (more to come)

51
Q

_____ commonly cause recurring infections of ulcerative
lesions affecting the skin, mouth, lips, eyes, and genitals.

A

HSV 1 and 2

52
Q

Epidemiology of HSV

A

● Prevalence of HSV-2 in the US in 2016 was approx. 11.9%
● Most cases of genital herpes are caused by HSV 2,
although HSV 1 prevalence rates are increasing
● More common in women and non-Hispanic blacks

53
Q

Symptoms of HSV

A

● Painful genital lesions
● May also have dysuria, fever, tender
local inguinal lymphadenopathy,
itching, and headache
May have prodromal symptoms: Mild tingling, shooting pains
in legs, hips, or buttocks

54
Q

Diagnosing HSV

A

● Clinical evaluation
● Viral culture- may swab if active lesions are present
● PCR - can differentiate between HSV 1 and 2
○ More sensitive than culture
○ Useful for detecting asymptomatic HSV shedding

55
Q

Treatment of genital herpes

A

Acyclovir (Zovirax)
Valacyclovir (Valtrex)

56
Q

Complications of Genital Herpes

A

● Superinfections
● Eczema herpeticum
● Esophagitis
● Keratitis/conjunctivitis
● Encephalitis

57
Q

Trichomoniasis

A

A GU infection from a parasitic
protozoan Trichomonas vaginalis

58
Q

Most common non viral STD worldwide

A

Trichomoniasis

59
Q

Epidemiology of Trichomoniasis

A

More common among women

60
Q

Male symptoms of Trichomoniasis

A

● Asymptomatic 75% of the time; often spontaneously resolves
● May have mild urethritis with discharge and/or dysuria

61
Q

Female symptoms of Trichomoniasis

A

● Can range from asymptomatic carrier state to severe PID
● A purulent, frothy, thin vaginal discharge associated with burning, pruritus, dysuria, lower abdominal pain, or dyspareunia
Discharge: green-yellow, frothy, malodorous
● Can range from asymptomatic carrier state to severe PID
● Vaginal walls and cervix may have punctate, red spots; “strawberry” cervix

62
Q

Diagnosing Trichomoniasis (men and women)

A

Women
○ Microscopy wet mount (motile trichomonads)
○ NAATs (Gold Standard)
○ Rapid antigen or nucleic acid probe test

Men
○ Most reliable: NAAT (ie, PCR) of urine or urethral swab

63
Q

Treatment of Trichomoniasis

A

Metronidazole or tinidazole (PO 2g in single dose or 500mg PO bid for 7 days)
● Avoid alcohol to avoid a potential disulfiram-like reaction
● Treat both symptomatic and asymptomatic patients
● Treat partners
● Patients should avoid intercourse until one week after completing treatment

64
Q

Trichomoniasis Complications in non-pregnant, pregnant and newborns

A
  • Nonpregnant women- cervicitis, PID, cervical neoplasms, tubo-ovarian abscesses and infertility
  • Pregnant women- associated with adverse outcomes (PROM, preterm delivery, and low birth weight)
  • Newborns- may contract infection during delivery from infected mothers. S/sxs may include fever, respiratory problems, urinary tract infection, nasal discharge, and vaginal discharge
65
Q

Viral Hepatitis

A

Diffuse liver inflammation caused by various hepatitis viruses

66
Q

Hepatitis A transmission

A

fecal-oral transmission, also sexual activity

67
Q

Hepatitis B transmission

A

more common in US to be transmitted sexually

68
Q

A painful, soft ulcer with a necrotic base, surrounding erythema,
and undermined edges is a _____

A

Chancroid

69
Q

_____ Also presents is unilateral adenitis- they may become fluctuant and rupture (suppurative bubo)

A

Chancroid

70
Q

Diagnosis of Chancroid

A

● Clinical evaluation
● No lab testing is able to immediately confirm diagnosis
● Culture a swab of the lesion in a special medium; PCR

71
Q

Chancroid Treatment

A

● A single dose of azithromycin (1g PO) or ceftriaxone
(250mg IM)
● Multiple doses of erythromycin (500mg PO qid for 7 days)
or ciprofloxacin (500mg PO bid for 3 days)
Aspiration

72
Q

Pubic lice “crabs”

A

Pediculosis pubis
Wingless, blood-sucking insects that infest the pubis

73
Q

Pubic lice “crabs” Transmission

A

● Transmitted sexually
● Transmission via fomites is also a
possibility

74
Q

Pubic lice Epidemiology

A

-Occurs worldwide
-Most often affects teenagers and young adults

75
Q

Pubic lice Symptoms

A

● Significant pruritus
● May be able to visualize nits at the
base of hair shafts and crawling lice
● May affect the eyelashes

76
Q

Diagnosis of Pubic lice

A

● Visual examination of the lice
● Microscopic examination of the hair shaft to visualize the nits

77
Q

Pubic lice treatment

A

Primary: topical pediculicides (ie. permethrin) and topical
pyrethrins with piperonyl butoxide
(has neurotoxin effects on the lice)
Secondary: remove nits

78
Q

Risk factors for STIs

A

●New sex partner in past 60 days
●Multiple sex partners or sex partner with multiple concurrent sex partners
●No or inconsistent condom use when not in a mutually monogamous sexual partnership
●Trading sex for money or drugs
●Sexual contact with sex workers
●Meeting anonymous partners on the internet

79
Q

Risk Groups for STIs

A

●Young age (15 to 24 years old)
●Men who have sex with men (MSM)
●History of a prior STI
●Unmarried status
●Lower socioeconomic status, or high school education or less
●Admission to correctional facility or juvenile detention center
●Illicit drug use

ID Exam 4 (3 decks)

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