TBL 2 Flashcards
What are the most important components of the sexual history?
The 5 P’s: practices (condom use, anal sex, etc), past history of STDs, partners (STD risk factors), prevention (reporting laws, screen for asymptomatic infection, pregnancy), protection (condoms, counseling on safe behaviors)
What is urethritis and what are the common etiologies?
Urethral inflammation; gonorrhea (20%), chlamydia, mycoplasma
What is Neisseria gonorrhoeae?
Gram neg diplococci (kidney bean shaped), aerobic, non-motile, nonsupport-forming, ferments glucose only (N. Meningitis is ferments glucose and maltose)
What is the major reservoir of gonorrhea?
Asymptomatic carriers - 50% of infected women are asymptomatic
What are the virulence factors for gonorrhea?
Pili (inhibit PMN phagocytosis, attaches and penetrates into the cell), Opa proteins (adhesions that bind to epithelial cells), LOS (stimulates inflammatory response and release of TNFa), Ng-OMPA (host adhesion and invasion), PorB (forms pores), RMP proteins (stimulate antibodies which inhibit host bacteriocidal antibodies
How do you diagnose gonococcal infections?
Gram stain (gram neg diplococci - most relevant in symptomatic men), culture, nucleic acid amplification assays (preferred testing method, although not cleared for pharynx, rectum and conjunctiva)
What are the clinical manifestations of gonorrhea?
Incubation period of 2-5 days (can be up to 14); men have pruritic urethral discharge and dysuria; women have vaginal discharge, urinary frequency and dysuria, abdominal pain, and vaginal bleeding
How is gonorrhea linked to other diseases?
30% of patients w/ gonorrhea will also be infected w/ chlaymdia
What are less common manifestations of gonorrhea?
Epididymitis, prostatitis, pelvic inflammatory disease, infertility, rectal infection, ophthalmia neonatorum, disseminated infection
What is disseminated gonococcal infection?
Occurs in 1-3% of infected patients; associated w/ being female and menstration; deficiency in C5-C8 may increase susceptibility; symptoms include fever, skin legions, asymmetrical arthralgia, hepatic, endocarditis
How do you treat gonorrhea?
Third generation cephalosporins (ceftriaxone shot or gentamicin+azithromycin); used to use quinolones (now can’t b/c of resistance); can use azithromycin to presumptively treat for chlamydia
What is expedited partner therapy?
Routine for gonorrhea and chlamydia - medications and counseling given to index and dispensed to partner; not routin for MSM
What is chlamydia trachomatis?
Obligate intracellular parasite w/ inner and outer membrane similar to gram negative bacteria (but lack rigid peptidoglycan layer)
What is the epidemiology of chlamydia?
Most common in
What are the clinical manifestations of chlamydia?
Incubation period 7-21 days; urethritis, epididymitis, prostatitis, proctitis, PID in women, cervicitis (often asymptomatic, but leads to PID, infertility, and ectopic pregnancy), Reiter’s Syndrome, newborn inclusion conjunctivitis
How is chlamydia diagnosed?
Nucleic acid amplification tests (test of choice), cell culture is not commonly used, serology for LGV
How do you treat chlamydia?
Azithromycin or doxycycline (longer course, so not used as often)
What is LGV?
Lymphogranuloma venereum: Associated w/ chlamydia - first painless genital lesion, then tender inguinal or femoral lymphadenopathy, late (months to years) draining of sinus tracts, lymphatic obstruction, chronic hard inguinal masses
What is Herpes Simplex?
Icosahedral dsDNA virus; recurrent, life-long viral infection (primary and recurrent infections); HSV-1 more frequently causes orolabial legions and keratitis, but can cause genital lesions which tend NOT to be recurrent; HSV-2 is the primary cause of recurrent genital lesions
What is the pathogenesis of reactivated genital HSV infection?
HSV in ganglion if nerve cells produces recurrent disease via peripheral migration along axons to skin and mucous membranes (causing lesions and potential for transmission)
What is the epidemiology of HSV?
1 in 4 people over 18 has HSV-2 antibodies (most unaware b/c mild or unrecognized infection); associated w/ increased transmission of HIV
What are symptoms of HSV?
Women: vulvovaginitis, cervicitis, urethritis; men: balance is, urethritis; many have systemic symptoms (Fever, HA, malaise); lymphadenopathy may develop; painful fluid-filled vesicles evolve and then crust over; duration of primary stage is 21 days; can cause neonatal HSV infection
How do you diagnose HSV?
Viral culture (best if early in course), immunofluorescence, serology (glycoprotein G test can differentiate b/w HSV-1 and HSV-2), detection of DNA (in situ hybridization or PCR)
How do you treat HSV?
Acyclovir, famciclovir, or valacyclovir can decrease duration/severity but will not prevent recurrence; can use suppressive therapy to reduce recurrences and transmission; condoms can reduce risk
What is haemophilus ducreyi?
Chancroid; gram negative coccobacilli; common in Africa, uncommon in USA, major risk for acquisition of HIV; painful ulcer (ragged undetermined edges and grain or yellow exudate); most cases are in males; can cause lymphadenitis; treat w/ cephalosporin, quinolone, or macro life
What is granuloma inguinale?
Gram negative bacillus, uncommon in US; painless subcutaneous nodule w/out regional lymphadenopathy; dark stain Donovan bodies in a smear of the legion to dx; treat w/ doxycycline for 21 days or until improved
What is the spirochaetaceae family?
Borrelia (Lyme disease, tick-borne Fever), leptospirosia, treponema (yaws, pinta, treponema pallium pallidum); they have a shared corkscrew shape
How was syphilis historically treated?
Mercury, arsenic, bismuth (like Pepto-Bismol), malaria (Fever therapy)
What are the disease stages of syphilis?
Early (1 year since infection or unknown duration): less infectious but harder to treat
How is syphilis transmitted?
Horizontally (sexually) or vertically; having primary syphilis increases the transmission of HIV 2-5x
What is treponema pallidum pallidum?
Syphillis: corkscrew-shaped, motile w/ undulating movement around its center; can’t be cultured in vitro (remember the rabbit testicles!), has to be viewed using darkfield microscopy; IS sensitive to penicillin!
Does syphilis affect the CNS?
Yes, it can invite the CNS at any stage of syphilis
What are the symptoms of primary syphilis?
Primary lesion or “chancre” develops at site of inoculation - chancre is painless, has a clean base, and is highly infectious; this heals in 3-6 weeks; regional lymphadenopathy (rubbery, painless, bilateral); serologic tests may not be positive during early primary syphilis
What are the symptoms of secondary syphilis?
Secondary lesions may persist for weeks or months (mucocutaneous lesions most common); rash, lymphadenopathy, malaise, mucous patches, condylomata late, alopecia in 5%
What are the symptoms me of latent syphilis
None! Only evidence is positive serologic test (host suppresses infection); may occur b/w P and S stages, between secondary relapses, and after secondary stage
What is neurosyphilis?
Occurs when T. Pallidum invades the CNS - may occur at any stage and can be asymptomatic; can be decades after infection; can include ocular involvement, general paresis, tabes dorsalis
What are the symptoms of tertiary (late) syphilis?
Gummatous lesions (syphilitic tumors), cardiovascular syphilis
What does congenital syphilis cause?
Stillbirth, neonatal death, deafness, neurological impairment, bone deformities; fetal infection can occur during any trimester of pregnancy
What are the two kinds of serologic test for syphilis?
NOTE: need to use both; treponemal (qualitative), no treponemal (qualitative and quantitative)
What is the difference in treatment of early or late syphilis?
Early is 1 shot, late is 3
How should syphilis be treated?
Benzathine penicillin G - can use doxycycline or tetracycline if penicillin allergy and patient is not pregnant
How should a patient with syphilis be followed?
Reexamine at 6 and 12 months, follow up tigers should be compared; add a 24 month visit for latent syphilis, more often for HIV-infected patients
Which age group composes the largest % of STD cases?
15-24 (50%)
