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STIs Flashcards

1
Q

What is the most common bacterial STI in the US?

A

Chlamydia trachomatis

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2
Q

What is the most common cause of genital ulcers?

A

HSV (herpes simplex virus)

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3
Q

What accounts for the majority of new STI diagnoses?

A

HPV

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4
Q

Overall what is the most common new diagnosis STI?

A

HPV (viral)

  • then chlamydia second
  • 3rd: trichomoniasis
  • 4th: gonorrhea
  • 5th: HSV-2
  • 6th: syphilis
  • 7th: HIV
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5
Q

What age group comprises the majority of new STI diagnoses per yr in the US?

A

1/2 of the new STI/year are in men and women 15-24 yoa (young adults)

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6
Q

Why is chlamydia dangerous in women?

A

Increases risk for PID (pelvic inflammatory disease) which can => infertility

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7
Q

Why is it thought that chlamydia is on the rise?

A

Increased rate likely due to screening

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8
Q

Why is gonorrhea incidence rate increasing?

A

B/c of increasing drug resistance

  • running out of drugs to treat it with!
  • incidence has basically plateaued but we’re bad at treating it
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9
Q

Syphilis

(a) increasing in which population
(b) decrease in which population

A

Syphilis

(a) increasing in MSM and bisexual men
(b) decreasing in women

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10
Q

What population has the greatest number of genial herpes cases?

A

African American women make up 48% of new diagnoses

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11
Q

If a pt is diagnosed w/ HSV, what is the automatic next step?

A

HIV testing

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12
Q

Can HSV be transmitted while asymptomatic?

A

YES!!! 70% of transmission occurs when the person is asymptomatic

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13
Q

How can you prevent HSV transmission?

A

Transmission can occur when pt is asymptomatic => only way to actually prevent transmission is by condoms or abstinence

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14
Q

Describe the clinical course of primary herpes simplex

(a) how many days after sexual encounter does viral shedding start?
(b) how long does viral shedding persist?
(c) how long does the illness fully last?

A

Primary herpes simplex

(a) 4 days after sexual encounter the viral shedding begins
(b) viral shedding continues from day 0-12 (about 12 days) while have vesicular pustule and wet ulcer
(c) Illness lasts about 3 weeks- about 3 weeks after sexual contact the lesion will form and heal

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15
Q

What are some complications aside from genital warts that can arise from genital herpes?

A

67% of ppl have systemic symptoms

  • 98% have local pain
  • 8% have aseptic meningitis
  • 20% have distant lesions
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16
Q

Differentiate the course of primary and secondary herpes simplex based on

(a) duration
(b) symptoms

A

Primary vs. Secondary herpes

(a) lasts 12 days, while primary lasts 21 days (3 weeks)
(b) symptoms are more severe in primary- secondary shows much less of an immune response
- secondary => much more conspicuous warts, less red

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17
Q

Why can HSV recur?

A

B/c it is incurable and remains dormant in the sensory ganglion

-recurrence rate especially high in immuncompromised (duh)

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18
Q

How is HSV diagnosed (gold standard)?

A

PCR for viral genetic material

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19
Q

What is the treatment for a primary HSV infection?

A

HSV is NOT CURABLE (huge bummer)

  • treatment for primary = 7-10 days of nucleoside analogues (ex: acyclovir, Valacyclovir etc)
  • only have a shot of decreasing duration and severity if treated w/in the first 72 hours
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20
Q

What is the treatment for secondary HSV infection?

A

Nucleoside analog for 5 days

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21
Q

When would you give suppressive therapy to a pt w/ HSV?

A

Suppressive therapy (= daily nucleoside analogue) to HSV pt who has 6 or more recurrences in one year

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22
Q

What is the difference btwn treating an immunocompetent vs. HIV (+) pt for HSV?

A

HIV pt may require increased doses of nucleoside analogues to treat an HSV infection

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23
Q

What is treponema pallidum?

A

Spirochaete bacterium (corkscrew-shaped cells) w/ subtypes that can cause treponemal diseases such as syphilis

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24
Q

Treponema pallidum

(a) hosts
(b) what percent of ppl exposed are infected?
(c) describe it’s growth in culture

A

Treponema pallidum (bacteria that causes syphilis)

(a) only host is humans!
(b) 1/3 of ppl exposed are infected
(c) it doesn’t grow in culture => not detectable by culture (has to be dx w/ serology). has a very slow doubling time (30 hours)

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25
Q

What is a chancre?

A

Painless ulceration formed during the primary stage of syphilis

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26
Q

What stage of syphilis is accompanied by a rash? Describe the rash

A

Rash occurs in secondary syphilis

  • textbook rash: salmon colored dots including the palms and bottom of feet
  • secondary syphilis occurs 3-8 weeks after the chancre
27
Q

What CNS complication can syphilis cause? How is this be diagnosed?

A

Secondary syphilis can => meningitis

-diagnose w/ spinal tap to measure serology in CSF

28
Q

Condyloma lata

A

Wart lesions on the genitals due to secondary syphilis

29
Q

Differentiate the two serologic tests for syphilis

(a) Non-treponemal
(b) Treponemal

A

Diagnostic tests for syphilis

(a) Non-treponemal (ex: RPR) are not as specific => have higher false positive rate. However, titers fall w/ Rx => this can be used to follow the pt
(b) Treponeal: very specific using antigen of spirochete => confirmatory for diagnosis. However once (+) you remain (+) forever => can’t be used as a marker of successful treatment or of recurrence

30
Q

What is the treatment for primary/secondary syphilis?

A

1 dose of long acting PCN (penacillin) = Benzathine

31
Q

When do you give a pt doxycycline to treat syphilis?

A

When they are allergic to penicillin?

32
Q

What do you have to warn pts about when you give them PCN to treat syphilis?

A

Jarisch-Herxheimer reaction = acute febrile syndrome w/in first 24 hours after therapy

-right after you lyse tons of spirochetes this can cause a febrile, shaky reaction in the pt. But this will resolve on its own (want to tell the pt so they don’t get scared and come back!)

33
Q

How do you treat a pt w/ syphilis who has neurologic symptoms?

A

Admit these pts and give IV PCN (penicillin) for 10-14 days

-diagnose CNS involvement via spinal tap to measure sypholitic serology in the CSF

34
Q

What is a cardiac outcome of tertiary syphilis?

A

Aortic aneurysm

35
Q

What bacterial infection increases the spread of HIV transmission by 3-5 fold?

A

Treponema pallidum (syphilis)

36
Q

What is chancroid? Most common symptom?

A

Chancroid = bacterial STI characterized by painful genital ulcers

37
Q

Why is chancroid important if it’s so rare?

A

B/c 10% coinfection w/ HSV or T. pallidum (syphilis)

38
Q

Which bacteria species can cause lymphogranuloma venereum (and what is LGV?)

A

LGV = infection of lymphatics and lymph nodes

-caused by specific serovars (subtypes) of chlamydia trachomatis

39
Q

How is LGV treated?

A

First drain the abscesses formed at the lymph nodes

-then treat (like all other chlamydial infections) w/ doxycycline

40
Q

What is the NAAT test?

(a) sample required
(b) tests for what?

A

NAAT = nucleic acid amplification test

(a) urine sample
(b) tests for both gonorrhea and chlamydia

41
Q

What STI are we starting to lose susceptibility to?

A

Gonorrhea

  • susceptibility to fluoroquinolones lost in 2007
  • strains w/ reduced cephalosporin susceptibility first shown in 2013

-No effective backup drug for cephalosporin-resistance gonorrhea!! (UHOH)

42
Q

What is the first line treatment for gonorrhea?

A

Ceftriaxone IM (3rd generation cephalosporin)

43
Q

What are some signs and symptoms typical of gonorrhea?

A

Purulent discharge, pelvic pain

44
Q

Which gender has a higher risk of disseminated gonococcal infection?

A

Women are at 3x higher risk

  • gonorrhea settles in a joint => fever and arthralgia (joint pain)
  • need to aspirate the infected joint then treat w/ abx (Ceftriaxone)
45
Q

Are chlamydia rates higher in men or women?

A

MUCH higher in women

46
Q

If a pt comes in w/ genital white discharge, what two things do you treat for?

A

Usually can’t immediately distinguish gonorrhea and chlamydia => treat for both

  • For gonorrhea give Ceftriaxone (3rd gen cephalosporin)
  • For chlamydia give azithromycin

-if a pt has gonorrhea, 30-50% of the time they will also have chlamydia

47
Q

Differentiate gonorrhea and chlamydia by

(a) gram-stain appearance
(b) type of discharge

A

Gonorrhea vs. chlamydia

(a) gram-stain appearance: both you see PMNs, in gonorrhea you can see the bacteria (Gram neg diplococci) while the chlamydia bacteria don’t stain => see just PMNs in chlamydia
(b) Purulent (gonorrhea) vs. mucousy (chlamydia)

48
Q

Why is screening high risk populations for chlmaydia so important?

A

B/c many cases are asymptomatic and in females can cause PID => infertility
-screening can decrease the incidence of PID by 60%

49
Q

What can mycoplasma genitalium cause?

A

Acute or persistent NGU = non-gonococcal urethritis (inflammation of the urethra)

50
Q

What other STI besides chlamydia has a strong association w/ PID?

A

MG = mycoplasma genitalium

can also cause NGU

51
Q

What is the most common result of an HPV infection?

A

The immune system will clear 90% of HPV infections w/in 2 years

52
Q

Why is HPV so important and therefore screened for?

A

B/c of its association w/ cervical dysplasia (=> carcinoma)

53
Q

How will the unlucky ppl infected w/ HPV present to medical attn?

A

Initial PV infection will develop into CIN 1 –> CIN 2/3 –> then pt will present w/ cervical cancer up to decades later

54
Q

Condyloma Accuminatum is a clinical manifestation of which STI?

A

HPV

55
Q

How effective is the HPV vaccine?

(a) What serotypes are protected against?
(b) when is the best time to give vaccination
(c) can you not get pap smears if you get the vaccine?

A

HPV vaccine is 90% effective- contains proteins from the serotype that assemble into immunogenic, non-infections units

(a) 6, 11, 16, 18
(b) Before sexually active,

56
Q

What is bacterial vaginosis?

A

A change in the vaginal flora w/ a decrease in lactobacilli (good bacteria) and an increase in anaerobes and G. vaginalis

57
Q

What are clue cells diagnostic for on histology?

A

Bacterial vaginosis

58
Q

Why is bacterial vaginosis dangerous?

A

B/c it massively increases the risk of HIV, HSV-2, GC (gonorrhea), and chlamydia

59
Q

Why is bacterial vaginosis especially dangerous in pregnant women?

A

Bacterial vaginosis (change in the vaginal flora) can lead to pre-term delivery

60
Q

What abx is given to treat bacterial vaginosis?

A

Metronidazole = Flagyl

-abx used against anaerobes and protozoa

61
Q

Strawberry cervix

A

Classic finding in trichomonas vaginalis (anaerobic flagellated protozoan)

62
Q

What is the most common non-viral STI worldwide?

A

Trichomonas Vaginalis = anaerobic flagellated protozoan

63
Q

What is the main cause and symptom of pubic lice?

A 
Phthirus pubis (crab lous) transmitted thru sexual contact
-main symptom = itching
64
Q

IN the 2015 guidelines what disease is a main emerging issue as an STD?

A

Hepatitis C

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