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FM3_ EB > STIs > Flashcards

STIs Flashcards

1
Q

List the ABCDEs of preventing the spread of STIs

A 
Abstinence
Barrier protection
Contacts
Drug therapy 
Education and counseling
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2
Q

List infections that can facilitate the transmission of HIV

A 
Chlamydia trachomatis
Neisseria gonorrhoeae
Bacterial vaginosis
Genital HSV-1 and HSV-2
Treponema pallidum
Haemophilus ducreyi
Klebsiella granulomatis
Chlamydia trachomatis L1, L2, L3- lymphogranuloma venereum or LGV
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3
Q

Chancroid is caused by

A

Haemophilus ducreyi

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4
Q

Granuloma inguinale or Donovanosis is caused by

A

Klebsiella granulomatosis

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5
Q

List causes of non-gonococcal urethritis in men

A 
Chlamydia trachomatis
Mycoplasma genitalium 
Ureaplasma urealyticum
Trichomonas vaginalis (uncommon)
Enteric GNRs (uncommon, consider if hx of insertive anal intercourse)
HSV
Unknown- 30% of urethritis
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6
Q

Compare and contrast urethritis caused by Neisseria gonorrhoeae vs non-gonococcal urethritis

A

Gonococcus:

  • incubation less than 4 days
  • discharge will be profuse and yellow
  • dysuria is severe

NGU:

  • incubation 7-14 days
  • slight grey or clear discharge
  • moderate, intermittent dysuria
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7
Q

Describe the diagnostic work up for urethritis in men

A
  • physical exam
  • gram stain of urethral discharge (high sensitivity and specificity if symptomatic)
  • urinalysis
  • nucleic acid amplification test
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8
Q

Describe the gram stain seen in gonococcal urethritis

A

WBCs

Gram negative intraceullular diplococci

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9
Q

Describe what is seen on urinalysis in gonococcal urethritis

A

WBCs and positive for leukocyte esterase

Must be first a.m. voided urine

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10
Q

All patients empirically treated for gonococcus should also be treated for _______

A

chlamydia

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11
Q

How can non-gonococcal urethritis be treated?

A

Azithromycin 1x po

Doxycycline bid 7 days

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12
Q

Other than medication, what measures must be taken to treat urethritis?

A
  • Abstain from sex for 7 days
  • partner notification and testing (partners within last 60 days)
  • test for STDs including HIV, syphilis
  • test of cure not recommended
  • follow up testing in 3-6 months
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13
Q

What is a complication of Chlamydia trachomatis in men?

A

epididymitis

reactive arthritis

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14
Q

List causes of mucopurulent cervicitis in women

A

gonococcal: Neisseria gonorrhoaea

non-gonococcal: 
Chlamydia trachomatus
Mycoplasma genitalium 
Trichomonas vaginalis
bacterial vaginosis
HSV1 and HSV2
frequent douching
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15
Q

What are common presentations of mucopurulent cervicitis in women?

A

often asymptomatic
abnormal vaginal discharge
intermenstrual bleeding
bleeding after intercourse

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16
Q

What are the two main diagnostic features of mucopurulent cervicitis in women?

A
  1. Purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab
  2. sustained endocervical bleeding induced by gentle passage of a cotton swab through the cervical os
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17
Q

In general, in mucopurulent cervicitis, endocervical bleeding is (painful/ painless)

A

painless

pain suggests diagnosis of PID

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18
Q

All women who seek medical attention for cervicitis must also be evaluated for _____

A

PID

Cervicitis can be a sign of upper genital tract disease

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19
Q

In a women with cervicitis, what other conditions should be tested for?

A

PID
Chlamydia trachomatis and Neisseria gonorrhoeae with sensitive and specific testing- NAAT of cervical specimins
Trichomonas vaginalis by microscopy and culture
Bacterial vaginosis
Other STIs- HIV, syphilis

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20
Q

What is a complication of cervicitis in women?

A

PID

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21
Q

Pregnant women can pass Chlamydia trachomatis to their infant during delivery, causing _________ or _______

A

neonatal inclusion conjunctivitis/ opthalmia neonatorium
or
neonatal C. trachomatis pneumonia

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22
Q

__________ is the most common bacterial STI in the US

A

Chlamydia trachomatis

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23
Q

Who should be screened annually for chlamydia?

A

Sexually active women < 25 years old

Highest rates of infection in men and women 14-24 years old

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24
Q

Why are teens and younger women at increased risk of contracting chlamydia?

A

The cervix is not fully mature

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25
Q

What cells can be infected by chlamydia?

A
  • squamocolumnar cells of the endocervix and upper genital tract
  • epithelial cells in the urethra and rectum
  • epididymal cells
  • conjunctival cells and pulmonary columnar cells of neonates
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26
Q

Up to 70% of women have asymptomatic ______ infection

A

chlamydia

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27
Q

List complications of chlamydia infection in men

A

epididymitis
prostatitis
reactive arthritis

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28
Q

List complications of chlamydia infection in women

A

PID
tubal infertility
ectopic pregnancy
chronic pelvic pain

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29
Q

Contrast how proctitis occurs from chlamydia in MSM vs in women

A

MSM- direct inoculation

women- secondary spread from cervical secretions

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30
Q

True or false: infection with chlamydia can cause impaired fertility in men

A

false, only in women

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31
Q

List complications of chlamydia infection in pregnancy

A
  • neonatal inclusion conjunctivitis/ opthalmia neonatorium (develops within 12 days of birth)
  • neonatal trachomatis pneumonia (develops within 8 weeks)
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32
Q

How are neonatal inclusion conjunctivitis and C. trachomatis pneumonia due to chlamydia treated?

A

Systemic antibiotics

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33
Q

How can neonatal chlamydia infection be prevented?

A

Perinatal screening

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34
Q

List specimens that can be used to diagnose chlamydia infection by NAAT

A

men: urethral swab
women: endocervical swab, vaginal swab
both: urine, rectal swab

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35
Q

What groups should be routinely screened for chlamydia?

A

sexually active women < 25
women with high risk factors
all pregnant women
** high risk men presenting to STI clinics, correctional facilities, etc

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36
Q

How is chlamydia treated?

A

azithromycin 1 dose

doxycycline bid for 7 days

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37
Q

_________ is the second most common bacterial STI in the US

A

Neisseria gonorrhoeae

38
Q

Describe symptoms of gonococcal urethritis in men

A

onset 4 days after exposure

most men are symptomatic- purulent discharge, dysuria

39
Q

Describe symptoms of gonococcal cervicitis in women

A

very often asymptomatic, possible bleeding with intercourse

40
Q

List complications of gonococcus in men

A

epididymitis

disseminated gonococcal infection

41
Q

List complications of gonococcus in women

A 
PID
disseminated gonococcal infection 
tubal infertility
ectopic pregnancy
chronic pelvic pain
42
Q

List the two syndromes that comprise disseminated gonococcal infection

A
  1. arthritis/ dermatitis syndrome- migratory, additive arthritis and cutaneous papules and pustules on the extremities
  2. gonococcal septic arthritis
43
Q

List complications of gonococcal infection in pregnancy

A

opthalmia neonatorum, conjunctivitis within 2 days of delivery- can be prevented at birth with erythromycin ointment- contrast to chlamydia

other complications: scalp abscess, meningitis, bacterial sepsis

44
Q

List samples that can be used for diagnosis of gonococcal infection

A

NAAT: urine, vaginal swab, endocervical swab, urethral swab

Culture: rectal swab, pharyngeal swab

45
Q

What groups should be targeted for gonococcal screening?

A

high risk

46
Q

How is gonococcus treated?

A

First Line

  • Ceftriaxone IM 1 dose PLUS azithromycin 1 dose
  • Ceftriaxone IM 1 dose PLUS doxycycline bid for 7 days

Alternatives:

  • cefixime 1 dose plus azithromycin 1 dose
  • cefixime 1 dose plus doxycycline bid for 7 days
  • *increasing resistance against cefixime so must test for cure with those regimens within 1 week of therapy
47
Q

List risk factors for PID

A 
teens
multiple sexual partners
new sexual partner
prior PID
IUD insertion
douching
48
Q

Describe the pathogenesis of PID

A

Polymicrobial infection, direct extension of microorganisms from the vagina or endocervix to upper reproductive
structure leads to scar tissue formation
Scar tissue blocks normal movement of egg from falopian tube to uterus, leading to infertility or ectopic pregnancy

49
Q

List symptoms of PID

A 
lower abdominal pain
fever
vaginal discharge with foul odor
painful intercourse
dysuria
intermenstrual bleeding 
Fitz-Hugh-Curtis syndrome of upper quadrant peri-hepatitis
50
Q

How is PID diagnosed?

A

Clinical suspicion is key
- cervical motion tenderness, uterine tenderness, adnexal tenderness
AND
- presence of WBCs in vaginal secretions or mucopurulent cervicitis

Supportive findings: bacterial vaginosis, fever, elevated ESR or CRP

51
Q

How is PID treated?

A

broad spectrum antibiotics including activity against Chlamydia trachomatis and Neisseria gonorrhoeae as well as strep, GNRs, anaerobes
testing for HIV, syphilis

52
Q

What are sequelae of PID?

A

ectopic pregnancy

chronic pelvic pain

53
Q

How can PID be prevented?

A

screening for chlamydia

54
Q

_________ is the most common cause of vaginal discharge in the US

A

bacterial vaginosis

55
Q

Describe the pathogenesis of bacterial vaginosis

A

Replacement of lactobacillus (produce H2O2) with anaerobic bacteria

Can be a risk factor for acquisition of other STIs and post-operative infections

56
Q

List risk factors for bacterial vaginosis

A 
Multiple male or female sexual partners
New sex partner
Lack of condom use
Douching
Lack of vaginal Lactobacillus sp.

**BV increases the risk for acquisition of HIV, C. trachomatis, N. gonorrhoeae, HSV 2

57
Q

Describe clinical exam findings in bacterial vaginosis

A

white or grey discharge with fishy odor
wall contains grey homogenous discharge
no inflammation of vaginal wall or cervix and no tenderness (BV does not cause PID, cervicitis, or cervical/ uterine/ adnexal tenderness, if inflammation is present there are two diagnoses)

58
Q

How is bacterial vaginosis diagnosed?

A

Must meet 3 of 4

  • homogenous thin white discharge with fishy odor
  • positive whiff test with 10% KOH
  • vaginal pH > 4.5
  • wet mount of vaginal fluid shows clue cells (epithelial cells coated with coccobacilli)
59
Q

How is bacterial vaginosis treated?

A

Metronidazole or clindamycin

avoid intercourse

60
Q

What are complications of bacterial vaginosis?

A

Increased risk of other STIs
Increased risk of post-op complications
Can cause PROM, early labor, preterm birth, postpartum endometritis

61
Q

List 5 infectious causes of genital ulcers

A 
Haemophilus ducreyi (chancroid)
Klebsiella granulomatis (donovanosis)
Chlamydia trachomatis L1, L2, L3 (LGV)
Treponema palladum (syphilis)
HSV
62
Q

Describe the epidemiology of HSV

A

50 million people with genital infection, 1/5 adolescents and adults
more common in women

63
Q

HSV-1 replicates in the _____ ganglia; HSV-2 replicates in the _____ ganglia

A

HSV1 in trigeminal

HSV2 in sacral

64
Q

Describe the pathophysiology of genital HSV infection

A

HSV penetrates mucosal surfaces to replicate in the epidermis and dermis. The virus enters nerve cells, is transported within the neuron to bodies of ganglia
After initial infection, the virus
remains latent in the ganglia (episomal, not integrated into the host DNA).
During reactivation, the virus spreads to skin and mucosal surfaces by peripheral sensory nerves, which can result in asymptomatic shedding or formation of new blisters.

65
Q

Describe primary HSV infection, non-primary first episodes, and recurrence

A

Primary: symptomatic or asymptomatic infection with no antibodies developed

Non-primary first episode: fever, headache, malaise, myalgia with local ulcers and adenopathy

Recurrence: subsequent episodes tend to be milder, resolve faster, and decline over 5+ years

66
Q

How are HSV1 and HSV2 diagnosed?

A

PCR
Serologic assays
cell culture- cytopathic effect, lower sensitivity than PCR
Tzanck prep- giant cells with inclusions, not specific

67
Q

How is genital herpes treated?

A

Acyclovir, Valacyclovir, Famciclovir.

All people get therapy for first episode
Then can chose episodic or suppressive therapy

68
Q

What are complications of HSV in pregnancy?

A

Greatest risk if HSV is acquired during pregnancy
Neonatal transmission via infected vaginal secretions during birth

Prevention: acyclovir starting at 36 weeks, avoid intercourse with positive partners during 3rd trimester; delivery by Cesarean if lesions are present at delivery

69
Q

Syphilis is caused by ______

A

treponema pallidum, a spirochete

70
Q

Describe the pathogenesis of syphilis

A

T. pallidum penetrates mucous membranes then enters the bloodstream and lymphatics to widely disseminate throughout the body. Disseminated disease lasts until a sufficient immune response develops to control T. pallidum replication.
The incubation period is directly proportional to the size of the inoculum and clinical lesions appear when 10^7 organisms/ mg tissue

71
Q

The pathologic lesion characteristic for all stages of syphilis is _____

A

obliterative endarteritis

72
Q

Describe the stages of syphilis

A
  1. Primary syphilis: development of chancre at sit of inoculation with painless lymphadenopathy
  2. Secondary syphilis: constitutional symptoms plus rash (palms and soles), condyloma lata, mucous patches, alopecia, syphilitic rash
    Latent syphilis: symptoms disappear. In early syphilis, there can be relapses of mucocutaneous symptoms but no relapses in late latent syphilis
  3. Tertiary syphilis: involvement of neural and vascular tissue, gummatous local tissue damage
73
Q

List complications of congenital syphilis

A

Greatest risk early in infection when there is spirochetemia

late abortion, still birth, neonatal death, neonatla disease

74
Q

How is syphilis diagnosed?

A

Serology, PCR
Two different serologic methods must be used for diagnosis
- nontreponemal: VDRL, RPR, used to monitor response to therapy; will decline with therapeutic success
- treponemal: TPA-ABS, TPPA, TPHA, MHA-TP; used as confirmation of diagnosis and will remain positive for life

75
Q

How is syphilis treated?

A

penicillin

  • 1 IM dose if Primary, secondary, early latent
  • 1x weekly doses for late latent, tertiary
  • IV for neurosyphilis
76
Q

The etiologic agent of granuloma inguinale (also known as Donovanosis) is _______, which is an encapsulated gram-negative rod that infects mononuclear cells

A

Klebsiella granulomatis

77
Q

Describe the presentation of granuloma inguinale

A

The initial lesion is a small, painless papule or nodule that begins within 1-3 months after sexual exposure and develops into a beefy red, granulomatous ulcer with rolled edges and bleeds easily on contact

Lesions are NOT painful and there is no lyphadenopathy or bubo formation

78
Q

How is granuloma inguinale diagnosed and treated?

A

Diagnosis based on clinical presentation, biopsy shows Donovan bodies in mononuclear cells

Tx= doxycyclin bid for ~3 weeks until lesions heal

79
Q

________ are the etiologic agents of lymphogranuloma venerum

A

Chlamydia trachomatis serovars L1, L2, L3

80
Q

Describe the stages of lymphogranuloma venereum

A

Primary stage: painless papule or pustule that develops into an ulcer that is often unnoticed
and resolves on its own (painless, self-limited ulcer).

Secondary stage: Painful inguinal of femoral lymphadenopathy (bubo) that is usually
unilateral, can be above and below the inguinal ligament (groove sign)

Tertiary stage: chronic inflammation of untreated infection leads to fibrosis of tissues and obstruction of lymphatics (elephantiasis) and widespread destruction of external genitalia

81
Q

How is lymphogranuloma venereum diagnosed and treated?

A

Diagnosis: presentation and serology, aspiration of bubo

Tx= doxycyclin bid for 21 days

82
Q

Which serotypes of HPV are high risk for cancer? Which cause genital warts?

A

16 and 18 are oncogneic

6 and 11 cause cancer

83
Q

Describe the pathogenesis of genital warts

A

HPV DNA does NOT integrate into the host genome and replicates as extrachromosomal DNA in the nucleus of infected keratinocytes. HPV
infection begins with entry into the basal keratinocytes of the stratum basale. As the basal
cells divide, differentiate and progress to the surface, HPV replicates and induces
excessive proliferation of non-basal epithelial layers (e.g. stratum spinosum, stratum
granulosum, stratum corneum) to result in warts.

84
Q

Describe the pathogenesis of HPV malignancy

A

HPV DNA is generally integrated into the host genome and induces basal cells to undergo excessive replication, which results in accumulation of deleterious mutations that result in dysplasia and progression to
malignancy

85
Q

What is a complication of infection with HPV during childbirth?

A

Recurrent respiratory papillomatosis (RRP): occurs following inhalation of HPV-infected secretions during childbirth

result in altered cry, hoarseness, stridor and respiratory distress.

Most common HPV
genotypes to cause RRP= 6 and 11.

86
Q

List treatments for genital warts

A

Patient applied: imiquimod, podofilox, sinectachin
Provider administrated: liquid nitrogen, podophyllin, trichloroacetic acid, bichloroacetic acid, surgical

Prevention: 2 vaccine options (quadrivalent and bivalent)

87
Q

What is appropriate treatment for pediculosis pubis?

A

Pubic lice
permethrin cream + decontamination of bedding and clothing
evaluate for other STIs

88
Q

_______ is usually sexually transmitted in adults but not in children

A

Sarcoptes scabiei- scabies

89
Q

What is appropriate treatment of scabies?

A

Permethrin cream + decontamination of bedding and clothing

90
Q

List the 5 P’s of taking a sexual history

A 
Partners
Practices
Protection from STDs 
Past history of STDs
Prevention of pregnancy
91
Q

In chlamydia infection, the _____ body is the infectious particle that infects the cell. The ______ body replicates within the cell. The ____ body assembles and exits the cell

A

Elementary body- enters and exits

Reticulate body- replicates within the cell

FM3_ EB (25 decks)

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