STIs and congenitally acquired infection Flashcards
1
Q
what are the routes of transmission for STIs
A
- oral-genital
- vaginal intercourse
- anal intercourse
- anilingus
2
Q
4 ways we can diagnose STIs
A
- microscopy
- culture
- serology
- nucleic acid aggregation (PCR)
3
Q
typical presentation of neisseria gonorrhoeae when symptomatic
A
- urethral discharge (thick and creamy)
- throat (pharyngitis with lymphadenopathy)
4
Q
what kind of bacteria of Gonorrhoea
A
gram negative diplococci
5
Q
where does gonorrhoea adhere to and what is the incubation period
A
columnar epithelial cells
2-7 days
6
Q
explain who and what proportion of people with gonorrhoea are asymptomatic
A
females - 80%
males - 10%
7
Q
what do you see under microscopy for gonorrhoea
A
neutrophils showing phagocytosed diplococci
8
Q
what symptoms do you get with disseminated gonorrhoea
A
- arthritis
- maculopapular rash
- meningitis
- endocarditis
- epididymitis
- peri-hepatitis (Fitz-Hugh-Curtis Syndrome)
9
Q
what are the symptoms of pelvic inflammatory disease
A
fever, pelvic tenderness, discharge, manual palpation of cervix can induce pain
10
Q
when can gonorrhoea pass to the foetus/baby
A
during delivery as the baby touches the cervix/vagina
11
Q
what is the presentation of neonatal gonorrhoea and what can it lead to
A
gross purulent conjunctivitis –> can lead to perforation and blindness
12
Q
what is the treatment of neonatal gonococcal opthalmia
A
- cefotaxime 50mg/kg IV, 8 hourly, for 7 days
- irrigation regularly
- treat mother and sexual contacts
13
Q
what kind of diagnostic specimens do you need to take for gonorrhoea
A
- cervical swab
- male urethral swabs
- first pass void
- from other body fluids
14
Q
what technique do you use to diagnose gonorrhea
A
- culture
- Nucleic acid amplification tests
15
Q
treatment of gonorrhoea
A
cefriaxone 550mg IM/IV and azithromycin Ig oral
16
Q
what kind of organisms are gonorrhoea and chlamydia
A
gonorrhoea - bacteria
chlamydia - obligate intracellular parasite
17
Q
which serovars of chlamydia are associated with genital infection
A
D-K
18
Q
which serovars of chlamydia are associated with LGV
A
L1-3
19
Q
which serovars of chlamydia are associated with ocular infection (trachoma)
A
A-C
20
Q
what are the two Life stages of chlamydia and what are their properties
A
- elementary bodies - infectious, non-replicating, hardy
- reticulate bodies - metabolically active, replicate
21
Q
which sex is usually asymptomatic for chlamydia
A
females
22
Q
what are the clinical findings of chlamydia in men
A
- dysuria
- meatal erythema
- clear urethral discharge
- testicular pain
- prostatis
23
Q
what are the clinical findings of chlamydia in women
A
- cervicitis, endometritis, vaginal discharge
- urethritis/dysuria
- irregular bleeding
- pelvic pain and dyspareunia
- PID
24
Q
what is lymphogranuloma venereum
A
invasive lymphatic infection by a chlamydia sp
25
what are the signs of chlamydia - LGV
- ulcerative genital lesion
| - procto-colitis with strictures
26
what is the transmission rate from mum to bub with chlamydia
50%
27
what are the signs of neonatal chlamydia
- conjunctivitis (more haemorrhage) - (25%)
| - pneumonia (10%)
28
what lab investigations do you do for chlamydia
- cervical/urethral/anal swab
- first pass void
- PCR
29
which STIs require test of cure
chlamydia
30
treatment of chlamydia
azithromycin or doxycycline
31
what kind of organism is trichomonas vaginalis
flagellated protozoon
32
what kind of vaginal discharge is associated with trichomonas vaginalis
frothy, green-yellow, smelly, discharge
33
what signs and symptoms do you have with trichomonas vaginalis if the patient is symptomatic
- vaginal discharge
- cervical erythema and friability
- pruritis, dysuria, abdominal pain
34
what lab investigations do you do for trichomonas vaginalis
- high vaginal swab --> wet prep microscopy or culture
| - urine --> PCR
35
treatment of trichomonas vaginalis
metronidazole or tinidazole
36
what is the proper organism name for syphilis
treponema pallidum
37
what is the primary infection of syphilis
chancres on the genitals (1-2cm, painless) occurs 2-3 weeks after exposure --> heals
38
what is the secondary infection of syphilis
rash (particularly on the palms and soles), lymphadenopathy, alopecia --> goes away to a phase of latency
39
explain the early and late phases of latency of syphilis
```
early = asymptomatic but lots of organisms and very infectious
late = less infectious but more difficult to treat
```
40
explain the tertiary infection of syphilis
gummers
41
what is the laboratory detection of syphilis
- microscopy
| - serology (more common) - non treponemal and treponemal tests
42
what does the non-treponemal tests for syphilis test for
antibodies to cellular lipids and lecithin
43
what is the sensitivity of non-treponemal serology testing
70% within 2 weeks of chancre
| 100% for secondary and latent syphilis
44
when does the non-treponemal serology testing become positive
between 4-8 weeks post infection
45
what are the non-treponemal tests for syphilis also useful for
screening and monitoring therapy
| titrate to detect response to treatment
46
what are the benefits of treponemal tests for syphilis
positive slightly earlier
| positive for life
47
how do we diagnose mycoplasma genitalium
PCR
48
symptoms of mycoplasma genitalium
- urethritis in men
- cervicitis in women
- acute endometritis
49
treatment of mycoplasma genitalium
azithromycin or moxifloxacin (if azithromycin fails)
50
what are the differences between prenatal, perinatal and postnatal
prenatal - during foetal development
perinatal - around the time of delivery
postnatal - after delivery
51
what is vertical and horizontal disease transmission to baby
```
vertical = mum to foetus/baby
horizontal = one person to another
```
52
what is ascending infection
vaginal organisms producing foetal infection
53
describe the structure of VZV
icosahedral, dsDNA, eveloped
54
VZV is part of which family of viruses
herpes viridae
55
what is the incubation period of chickenpox
10-21 days
56
route of transmission of VZV
respiratory and direct contact with vesicles
57
signs and symptoms of chickenpox
fever, lethargy, pruritic vesicular rash (starts face and trunk and then spreads outwards)
58
explain the time course of the vesicles of chicken pox
clear vesicle --> cloudy --> ruptures --> ulceration
59
what are the 3 major complications of chickenpox
- secondary bacterial infection (commonly by Strep pyogenes or Staph aureus) --> purpura fulminans
- pneumonitis
- acute cerebellar ataxia
60
death from maternal varicella is most common in which trimester
3rd (when your IS is the most compromised)
61
what things can happen to foetus with a first trimester primary infection of varicella
- limb hypoplasia
- cicatricial scarring (dermatomal)
- microcephay
- cataracts
- mental retardation
- GI and GI abnormalities
62
when does mum have to get varicella for the baby to get perinatal varicella
-7 to +2 days from delivery
63
what is the transmission rate of perinatal varicella
17-30%
64
what is the outcome of perinatal varicella
disseminated infection --> mortality in 25-30%
65
who can you give prophylactic VCIG to
- susceptible pregnant women
- infants whose mothers develop varicella <7 days prior to delivery and in first month of life
- IC people
- premature babies
66
treatment of acute varicella
acyclovir
- oral if no systemic symptoms
- IV is systemic symptoms
67
when is the varicella vaccine given
18 months
| 2 doses when >14
68
which viral family does cytomegalovirus below to
herpesviridae
69
explain the structure of cytomegalovirus
icosahedral capsid, dsDNA, spherical lipid envelope
70
where does cytomegalovirus live when latent
within WBCs
71
what is the transmission of CMV
body fluids
72
what are the routes of infection of CMV for foetus/babies
- transplacental (haematogenous)
- perinatal (genital secretions, breast milk, saliva)
- toddlers in day care
73
what are the symptoms of congenital cytomegalovirus
sepsis like syndrome
- hepatomegaly
- respiratory distress
- atypical lymphocytosis
74
what percentage of congenital CMV show symptoms at birth
10%
75
what is the difference in getting congenital CMV during a primary maternal CMV infection and a reactivation of CMV
primary - 20-50% foetal infection
| reactivation - 1-3% foetal infection
76
what is the most common long term sequelae of CMV
unilateral sensoryneural deafness
77
can asymptomatic congenital CMV babies have long term sequelae?
yes - about 10-15% of them
78
how can you test for CMV infection
IgG (seroconversion)
IgM - acute phase antibody tell
IgG avidity (stronger avidity = longer time after infection)
PCR
79
in practice, how do you test for maternal CMV
IgG seroconversion (from the past)
IgG avidity
look for the virus in the amniotic fluid
80
how do you confirm foetal CMV infection
amniotic fluid PCR
| foetal cord blood IgM sensitivity or PCR
81
action taken if baby with congenital CMV is asymptomatic at birth
serial audiometry
serial visual assessment
psychomotor assessment
watch for pneumonitis
82
which virus family is rubella
togavirus
83
explain the structure of rubella virus
eveloed, ssRNA
84
incubation period of rubella
14-21 days
85
transmission of rubella
nasopharyngeal secretions
86
what proportion of rubella patients are symptomatic
25-50%
87
what are the signs and symptoms of rubella if the patient is symptomatic
- low grade fever
- lymphadenopathy (particularly occipital nodes)
- exanthem (maculopapular - face-->trunk-->limbs)
- polyathralgia/arthritis
88
during what time of gestation is the greatest risk of passing rubella to foetus
<4 weeks
89
if baby gets congenital rubella syndrome >12 weeks gestation, what will the symptoms be
retinopathy and deafness only
90
what is the classical triad for congenital rubella syndrome (gained it <12 weeks gestatino)
Opthalmological - cataracts, glaucoma, retinopathy
Cardiac - PDA, PA stenosis
Auditory - sensorineural deafness
91
how do you diagnose rubella
IgG seroconversion or rising titre
IgM
amniotic fluid/cord blood PCR
92
why can you give rubella vaccine during pregnancy
live vaccine
93
explain the structure of parvovirus
ssDNA
94
what does parvovirus cause
shortens the lifespan of RBC progenitors --> erythema infectiosum (fever, rash and generalised maculopapular rash)
- can also cause arthralgia in adults
- can also cause acute aplastic crisis through chronic haemolytic anaemia if patient has abnormal RBC already
95
outcome of congenital parvovirus infection
```
hydrops foetalis (anaemia)
foetal loss in small percentage
```
96
parvovirus diagnosis
- IgG past infection (immunity)
- IgM present at time of rash
- PCR
97
HSV infection during pregnancy can lead to
abortion
IUGR
preterm labour
98
3 patterns of disease seen with HSV infection near delivery
- skin-eye-mouth
- encephalitis
- disseminated
99
treatment of primary HSV infection during pregnancy
- acyclovir treatment and suppression until deliver
| - C section
100
treatment of recurrent HSV disease during pregnancy
- acyclovir suppression
- avoid instrumentation
- careful clinical examination for lesions
- investigations of baby for 'colonization'
101
explain the differences in the transmission of syphilis to a foetus at different times of gestation
```
primary - 90%
secondary - 60-90%
early latent - 40%
late latent - <10%
tertiary rare
```
102
outcomes of congenital syphilis
```
stillbirth
premature delivery
early and late onset disease
hepatosplenomegaly
snuffles
osteochondritis syphilitica
Hutchinson's teeth
hereditary gumma
```
103
what is the rate of transmission of congenital chlamydia
50%
104
symptoms of congenital chlamydia
haemorrhagic conjunctivitis
| pneumonitis
105
what proportion of babies with congenital toxoplasma gondii are asymptomatic
70-90%
106
explain structure of Hep B virus
dsDNA, glycolipid envelope
107
incubation period of Hep B
45-180 days
108
what proportion of people are chronic carriers
0.2% of women
12% of adults following infection
90% of congenitally infected babies
109
outcome of chronic Hep B
cirrhosis
| can develop hepatocellular carcinoma
110
explain the Hep B vaccination schedule
birth, 2 4, 6 and 12 months
111
explain the treatment of baby born with congenital Hep B
give hepatitis B immunoglobulin within 12 hours of delivery
112
explain infection of baby with group B strep
infection by ascending infection or colonized at birth
113
what proportion of babies with mothers who have strep B in bowel/vagina are colonised
40-70%
114
symptoms/signs of group B strep in babies
pneumonia and sepsis - common for early onset infection
| meningitis - common for late onset infection
115
what are the maternal risk factors for passing strep B strep to baby
- preterm delivery
- prolonged ruptured membranes
- intrapartum fever
- chorioaminonitis
- previous baby with group B strep
116
treatment of group B strep
penicillin + gentamicin
117
what is the recommended screening of pregnant mothers
```
rubella
syphilis
HBV
HCV
HIV
```
118
what are the extra tests that may be considered for screening of pregnant mothers
VZV
CMV
toxoplasma gondii
