T2 Flashcards
Differential Diagnosis - Ulcerative lesions
Herpes simplex virus, syphilis and tuberculosis
General causes - genital tract infections
Syphilis caused by (Treponema pallidum),
Granuloma,
Chancroid (caused by hemophyllus ducreyi),
Trachomonas vaginalis,
scabies ( using same towel/clothes),
Herpes,
HPV,
Chlamydia trachomatis (caused by klebseilla granuloma)
Syphilis - lab tests
VDRL test and CSF VDRL test NAAT (viruses) Immunofluorescence test Staining (rapid) not specific Culture in tissue (viruses)
Immunofluorescence test
Clonal antibodies (commercially produced) reacts with antibodies in patients producing complex which is then stained with immunofluorescent material (rapid)
Symptoms: 4 day history of -fever, chills, myalgia, painful genital lesions 2 days prior (this didn’t concern her enough to go to ER), (headache, photophobia & stiff neck on day of admission) -
- flu, dengue, ecephalitis, west nile virus, malaria, leptospirosis, meningitis
Gold standard for STD test
Culture
Screening test CSF VDRL doesn’t confirm diagnosis for Syphilis (T or F)
True; test can be +ve in absence of syphilis
Purpose of lumbar puncture
Obtain CSF
Indications to not take CSF
Abnormal opening pressure - liquid flow rate fast
Cause of abnormal pressure
Scoliosis, fracture of skull,
Subarachnoid hemorrhage (SAH) ( bleeding into the subarachnoid space),
Unconscious with high pressure
Bacterial causes of STDs
-Neisseria gonorrhea, treponema pallidum,
Chlamydia trachonapis,
Chancroid (caused by hemophyllus ducreyi,
Klebsiella grandomatis -> donovan disease
Complication - HSV
Aseptic meningitis (from external genitalia it -> nerve and cause inflamed meninges) Symptoms - neck pain, photophobia
STORCH
Infections passed from mother to child Syphillis Toxoplasma gondii Rubella Cytomegalovirus Herpes, HIV, Hepatitis B, C
Neonatal effect of Syphilis
Stillbirth, miscarriage, congenital syphilis (Deformed bones, severe anemia, meningitis)
Neonatal effect of HSV
Neonatal herpes.
< 0.1% of babies in US develop neonatal herpes
20-25% pregnant women have genital herpes.
Risk is low
Stages of Syphilis
Primary stage
- Painless sore ( chancre) at bacteria entrance site.
- Commonly occurs within 3 weeks of exposure
- Highly infectious
Secondary stage
-Rash 2 - 8 weeks after chancre develops; sometimes before it heals
Latent (hidden) stage
-If untreated, progress to the latent stage
-No symptoms
(Immune system fights off pathogen and it goes into hiding. Any lapse in immune system due to illness can cause reemergence of the bacteria)
Tertiary (late) stage
- Gummata (large sores inside the body/on skin)
- Cardiovascular syphilis (heart, BVs)
- Neurosyphilis (nervous system)
Serotype
Distinct variation within a species of bacteria or virus or among immune cells of different individuals
Serotypes of Herpes
Type 1 - affects oral originally (HSV-1)
Type 2 - affects genital area originally (HSV-2)
Now affects both areas.
Trichomonas vaginalis
Parasite (virulence factor - heavily flagellated)
Specimen - urine, vaginal + urethral swab
Swab samples - immediate processing
Cotton material at tip of swab - can destroy organisms (not proper environment to be viable); must process quickly
Vaginitis
Vaginal inflammation; may be due to vaginosis
Wet mount procedure for vaginal infections (vaginosis)
Sample of vaginal discharge is placed on a glass slide and mixed with a salt solution.
Slide is looked at under a microscope for bacteria, yeast cells, trichomoniasis (trichomonads), white blood cells that show an infection, or clue cells that show bacterial vaginosis.
Vaginosis etiology
Gardnerella vaginalis and Mycoplasma hominis - bacteria
Candida albicans (candidiasis) - yeast
Trichomonas vaginalis infection (trichomoniasis) - parasite (sexually transmitted)
Gold standard for vaginosis diagnosis
Direct examination via wet mount/gram stain
Wet mount procedure
Sample of vaginal discharge is placed on a glass slide and mixed with a salt solution.
Slide is looked at under a microscope for bacteria, yeast cells, trichomoniasis (trichomonads), white blood cells that show an infection, or clue cells that show bacterial vaginosis.
Wet mount results
Bacterial vaginosis
- “clue cells,” cells from vaginal lining coated by bacteria.
- few to no white blood cells (WBCs)
Candida
-budding yeast and/or tube or branch-like structures (pseudohyphae)
Trichomonas
-oval bodies with flagella that move.
> WBCs may also be seen
Gram stain - vaginosis procedure
Vaginal fluid is placed on a glass slide and stained with a special dye (Gram stain)
Evaluation is based on the quantity of each type of bacteria.
Gram stain - vaginosis results
If 20% or more of the cells from the vagina lining are covered by bacteria (“clue cells”), -bacterial vaginosis
Yeast cells detected with a Gram stain
Trichomonas is not detected by this method.
Syphilis tests - Diagnosis
Rapid plasma reagin (RPR), a syphilis blood test that looks for antibodies to the syphilis bacteria.
(VDRL) test, which also checks for syphilis antibodies. A VDRL test can be done on blood or spinal fluid.
Syphilis - Treatment
Penicillin
Tetracycline
Erythromycine - if patient sensitive to penicillin
Gonorrhea - etiology
Neisseria gonorrhoeae
Neisseria gonorrhoeae - lab ID
Gram neg cocci
chocolate agar
Glucose test +ve
Motile
Gonorrhea - Treatment
Azithromycin
Ceftriaxone - if resistant
CPE
Cytopathogenic effect (CPE) - structural changes in host cells caused by viral invasion.
CPE is used to culture Herpes (T/F)
True
