STIs by Unrein Flashcards
generalized macular rash, patchy hair loss, generalized lymphadenopathy and flat grey white lesions in the perianal area. In order to diagnose his disease, you should order which test first? He relates having unprotected sex two months ago.
A) Culture in a high CO2 environment B) PCR for HPV types 6 and 11 C) Urethral DNA probe D) RPR E) Gram stain
RPR is a test for syphilis (secondary). Incubation time for 2ndary is 3-8 weeks after; tertiary is years later. Primary- 3 weeks
Neisseria gonorrhoeae- 2-6 days accute, up to 2 weeks for disseminated
7-21 days for Chlamydia trachomatis
2-20 months highly variable incubation period for HPV
what do we culture in high CO2 environment?
neisseria gonorrhoeae
testing for herpes
PCR for HPV types 6 and 11- these types are for condylomata acuminata.
HPV 16 and 18 –> 70% of cervical cancers. Vaccines var from 2-4 strains, but all contain subtypes 16 and 18. The 9 valent strains vaccine is near 100% effective in prevention of disease transmission.
Urethral DNA probe
used to ID neisseria gonorrhoeae and chlamydia trachomatis
testing for syphilis
RPR or the VDRL are initial antibody test screenings for 2dary syphilis but have fals positive results associated with SLE, mono, malaria, leprosy, hep A, HIV and even pregnancy.
FTA- is confirmatory test after screening test for syphilis.
Primary syphilis can also be dxed by dark field microscopy, but not widely available.
gram stain could ID
gram negative intracellular “coffee-bean shaped” diplococci organisms (neisseria gonorrhoeae)
syphilis signs
condylomata lata
and painless chancre
as opposed to chancroid- hurt, moth-eaten border, raised
treatment for syphilis
penicillin
IM- Bicillin
one dose for having it less than a year
multiple doses over time (usually 3) if the pt has had the condition more than one year
A 26 y/o female presents with right lower quadrant tenderness equivocal for rebound tenderness, a low grade fever, normal bowel sounds, and exudative and tender cervical examination. Her white blood cell count is 15,000 (4,000-10,000/L). You suspect which organisms?
A) GI tract coliforms B) Treponema pallidum C) Human papillomavirus D) Human Immunodeficiency Virus E) Chlamydia trachomatis
Chlamydia trachomatis
this is PID
acute appendicitis
can be caused by GI tract coliforms
HIV
often presents as a nonspcific viral syndrome with a fever, sore throat, swollen lymph nodes and a transient maculopapular rash
chlamydia trachoomatis
symptom of salpingitis adn/or endometritis often referred to as pelvic inflammatory disease
Fitz-Hugh-Curtis syndrome- inflammation of the liver capsule adn adjacent peritoneal surfaces and an advanced presentation of PID. C. trachomatis is a common cause of PID– most are asymptomatic.
Cervicitis may present with vaginal discharge and lower abdoinal pain. Symptoms of urethritis can include urinary frequency and dysuria.
causes lymphogranuloma venereum, genital ulceration and lymphadenopathy. Fleeting, often missed, common in sub-saharan africa.
when evaluating chlamydia trachomatis, what other diseases must be considered?
gonorrhea syphilis HIV HBV HCV CMV trichomonas vaginalis others (zika)
treatment for chlamydia
azithromycin
if allergic to macrolides- tetracycline
chlamydia is an obligate intracellular pathogen (thus antibiotics that work to disrupt cell wall synthesis will not be effective- enicillins, cephalosporins.
treathment for gonorrhea?
ceftriaxone
A 35 y/o female presents with a thin gray vaginal discharge and vulvovaginal discomfort. She relates four current male sexual partners. None of her partners have any symptoms and have all been checked recently for sexually transmitted illness: all partners are negative. Pelvic exam notes normal appearing cervix that is non-tender. There is no unusual odor. Wet mount notes large numbers of leukocytes and motile organisms. You suspect the etiology to be:
A) Candida albicans B) Gardnerella vaginalis C) Trichomonas vaginalis D) Chlamydia trachomatis E) Neisseria gonorrhoeae
trichomonas
trichomonas vaginalis
large numbers of leukocytes
motile organisms on wet mount
abnormal vaginal discharge
men often asymptomatic
candida
yeast infection not associated with sexual transmission chalky white discharge vulvovaginal discomfort often with abx use, oral contraceptives, and removal of protective vaginal flora
garnderella
not STI
usually few leukocytes
abnormal odor
neisseria vs chlamydia
gonorrhea - cervix easily bleeds and pt may have abnormal bleeding history, esp. w/ intercourse
treatment for trichomonas?
metronidazole
no booze!
A 22y/o male presents with multiple painful vesicles on the glans of his penis. He relates a new unprotected sexual encounter after a concert one week ago. He has no discharge, but has bilateral swollen lymph nodes in the groin. You suspect the following most likely etiology:
A) Chlamydia trachomatis B) Treponema pallidum C) Haemophilus ducreyi D) Herpes Simplex-2 E) Klebsiella granulomatis
Herpes simplex-2
painful vesicles
how to confirm dx of haemophilus ducreyi?
chocolate agar (fastidious)
treatment of haemophilus ducreyi?
ceftriaxone
azithromycin
either one as a single dose
klebsiella granulomatis
causes granuloma inguinale (= donovanosis), painless elevated granulomatous lesions that are progressively destructive and can lead to autoamputation of the affected area. Lesions- painless. Usualy STI but also direct contact. Mostly in India, southern Africa, Australia and Papua New Guinea.
how to confirm dx of klebsiella granulomatis?
tissue biopsy (look for donovanosis)
treatment for klebsiella granulomatis?
erythromycin or tetracycline for 3 weeks
ampicillin for 12 weeks
(prolonged treatment because deep tissue issue)
how to confirm the dx of HSV-2?
Viral cultures (vesicles) and serology- PCR
Tzanck smear
treatment of HSV-2?
acyclovir, famciclovir, valacyclovir
A 24 y/o male presents to the community health center with an eight-day history of sore throat, generalized aches, fever and anorexia. Today he developed a trunk and abdominal rash. He has had multiple male and female sexual contacts and uses condoms variably. His last sexual encounter was four weeks ago. You are most suspicious of which infection:
A) Hepatitis B B) Human papillomavirus C) Herpes Simplex-1 D) Human Immunodeficiency Virus E) Primary Treponema pallidum
HIV
Hep B
transmitted by blood, bodily fluids and tissue.
icterus, jaundice, RUQ tenderness, dark urine, light stools, etc.
A 20 y/o female presents to the emergency department with a new onset of a rash, fever, and joint pain. Initially the pain began in her right knee but has progressed to her right ankle and hip. Her rash is represented by scattered painful lesion on the hands and feet.
A) Chlamydia trachomatis B) Treponema pallidum C) Neisseria gonorrhoeae D) Herpes Simplex-2 E) Human Immunodeficiency Virus
rash and joint pain
neisseria gonorrhoeae, when it has become a disseminated disease in the body
(= migratory polyarthritis)
19 y/o female presents to you with a painless papule on her lip and cervical lymphadenopathy. You suspect which disorder? She relates a new unprotected sexual encounter 1 month ago. A) Haemophilus ducreyi B) Neisseria gonorrhoeae C) Treponema pallidum D) Herpes Simplex-2 E) Human Immunodeficiency Virus
painless chancre- still treponema pallidum
Ulcers?
think syphilis HSV chancroid lymphogranuloma venereum
Urethritis and Cervicitis?
Think :
neisseria gonorrhoeae
chlamydia trachomatis
complications like PID and epididymitis
genital warts?
Think HPV
confusion with secondary syphilis