Week 11 Flashcards
1
Q
bacterial vaginosis
A
overgrowth of gardinerella vaginalis
2
Q
bacterial vaginosis - which microbe
A
gardinerella vaginalis
3
Q
causes of Bacterial vaginosis (4)
A
changes in vaginal environment
- douching (rinsing vagina)
- new/multiple sex partners
- use of antibiotics
4
Q
gardinerella vaginalis - how it infects
A
naturally exists in vagina
5
Q
Pathophysiology of bacterial vaginosis
A
- decrease in population of other natural bacteria
- increase in populatiojn of gardinerella vaginalis
6
Q
Bacterial vaginosis - symptoms
A
- copious vaginal discharge
- fishy odour
- pregnant women (preterm labour)
7
Q
Bacterial vaginosis - diagnosis`
A
1) wet mount (sample from vagina)
2) put under microscope
3) examine vaginal epithelial cells for signs of clue (bacteria) cells
8
Q
Treatment for bacterial vaginosis
A
- antibiotics to remove gardinerella vaginalis
9
Q
Prevention of bacterial vaginosis
A
- condoms (new/multiple sex partners)
- otherwise No true prevention
10
Q
UTI
A
- urinary tract infection
- infection of kidneys, ureters, bladder, etc
11
Q
Upper UTI - where (2)
A
- kidney
- ureter
12
Q
Lower UTI - where
A
- urinary bladder
- prostate
- urethra
13
Q
medical term for bladder infection
A
cystitis
14
Q
Pyelonephritis
A
infection of renal pelvis (the region where urine drains into ureters)
15
Q
populations most prone to UTI
A
- children
- elderly
- women (pregnancy, sex, menopause)
16
Q
Most common Bacteria causing UTI
A
E. Coli
17
Q
Clinical setting: bacteria causing UTI (3)
A
- E. Coli
- Klebsiella pneumoniae
- Proteus mirabilis
(all gram negative)
18
Q
Bacteria causing UTI - gram status
A
gram negative (all)
19
Q
Symptoms of uncomplicated UTI (7)
A
- burning sensation with urination
- increased frequency of urination
- poor control over urge
- pinkish or whitish urine
- pain while passing urine
- fever
- occasional abdominal pain
20
Q
Pyelonephritis symptoms (5)
A
- high-grade fever
- shivering/chills/rigors
- vomiting
- pain in the back and sides of abdomen
- reduced urinary output (advanced)
21
Q
Host conditions + UTI (4)
A
- conditions that disrupt washout of the agent from urinary tract
- change the protective properties of mucin lining of urinary tract
- disrupting the protective function of normal bacterial flora
- impair the function of the immune system
22
Q
Virulence of agents causing UTIs (4)
A
- ability to gain access to and thrive in the urinary tract
- ability to adhere to the tissues of the lower or upper urinary tract
- ability to evade the destructive effects of the host’s immune system
- develop resistance to antimicrobial agents
23
Q
Pathogenesis of a UTI
A
- bacteria enters through urethra (with aid of pilli)
- bacteria colonizes in the bladder
- pyelonephritis = when infection ascends from Lower urinary tract
24
Q
Mid stream Urine collection instructions (7)
A
1) wash hands with soap
2) remove and open towettes
3)
- female = seperate folds of urinary opening and clean
with towlette (back to front)
- Males = clean head of penis
4) remove container from package (do not touch inside of container)
5) begin urination into toilet. As urination continues, bring container into stream, fill specimen half way
6) remove cap from package (do not touch inside of cap)
7) screw cap on container
25
How to test for UTI
- urine dipstick
- Urinary culture and sensitivity
26
What does urine dipstick test for (UTI)
- leukocytes
- blood
- protein
- nitrates (if infected with E. Coli)
27
Yeast infections - fungus
Candida albicans
28
Candica albicans
normal part of flora, oropharynx, bowels, skin, vagina
29
Candidiasis - can it be transmitted sexually
can be passed back and forth between partners if a favourable environments
30
Diagnosis of bacterial vaginosis
culture
31
diagnosis of candidasis
- vaginal culture showing budding yeast filaments (hyphae) or spores
32
Epididymitis
- inflammation of epididymis (cordlike structure around border of testes which matures and transports sperm)
33
2 types of Epididymitis
- sexually transmitted infections (urethritis)
- non-sexually transmitted infections (UTI)
34
types of pathogens causing Epididymitis
typically bacterial
35
Primary nonsexual Epididymitis - pathogenesis
pressure associated with voiding/physical strain forces pathogen-containing urine from urethra/prostate up the ejaculatory duct, through vas deferens, into epididymys
36
Pre-pubertal children with Epididymitis - pathogeneiss
- congenital urinary tract abnormalities
- typically gram negative bacteria (E.Coli)
37
Sexually transmitted Epididymitis - which population
- young adult males
38
Epididymitis - initial symptoms (24-48 hours)
- unilateral pain and swelling
- erethema and edema of overlying scrotal skin
39
Epididymitis - later symptoms
- fever (1/2 cases)
- dysuria (1/2 of cases)
- urethral discharge (depending on organism)
40
Epididymitis - diagnosis
- urinalisis and urine culture (bacteruria, pyruria)
- may be absent on these --> urethral swabs
41
pyuria
pus in urine
42
Orchitis - what
infection of the testes
43
Orchitis - how it happens
- primary infection in GU tract
- OR systemic infection spread by blood or lymphatic tissue
44
Orchitis - common pathogen for systemic spreacd
mumps!!! - orchitis in 20-30%
45
Orchitis - symptoms (3)`
- acute!!!
- fever
- painful enlargement of the testes
- absence of urinary symptoms
46
Prostatitis - what
variety of inflammatory disorders of the prostate (bacterial or other)
47
Prostatitis - cause
- spontaneously due to catheterization
- secondary to other diseases of male GU system
48
Acute bacterial prostatitis - classification
considered a subtype of UTI
49
Acute bacterial prostatitis - etiology
ascending urethral infection OR reflux of infected urine into prostatic ducts
- E. Coli
50
Acute bacterial prostatitis - symptoms (7)
- fever
- chills
- malaise
- myalgia
-frequent and urgent urination
- dysuria and urethral discharge
- dull aching in perenium, rectum, sacrococcygeal region
51
Acute bacterial prostatitis - urine appearance
cloudy and malodorous
52
Acute bacterial prostatitis - rectal examination (4)
- a firm, swollen, very tender, and warm prostate
53
Balanitis - what
infection of the glans penis (head)
54
Balanitis - pathogen
fungal origin
55
Balanitis - common population
more common in uncircumcised males
56
Herpes Simplex Virus - symptoms
- typically asymptomatic
- Skin and mucous membrane lesions
57
Types of Herpes infections
- mouth and tongue infections
- genitals
58
Herpes Simplex Virus - types
- HSV 2
- HSV2
59
Herpes Simplex Virus - family
Herpesviridae family
60
Herpes Simplex Virus - genetic material
DNA
61
Herpes Simplex Virus - which virus affects where on the body
- HSV-1 = above the waist (mouth and tongue)
- HSV-2 = below the waist (genitals)
but BOTH viruses can cause both infections
62
Herpes Simplex Virus - transmission (2)
- most contagious = transmission by virus-filled lesions
- CAN be spread by asymptomatic shedding (saliva and genital secretions)
63
Herpes Simplex Virus - pathogenesis
- binds onto skin of new host
- binds to epithelial cell receptors
- skin internalizes virus
- lytic cycle (viral DNA transcribed and translated by cell to form viral proteins = new herpes viruses to infect cells
- latent cycle (virus infects sensory neurons, travel up axon to cell body and settles into sensory ganglia of face or sacrum FOR LIFE)
64
Herpes Simplex Virus - lytic cycles
viral DNA transcribed and translated by cell to form viral proteins = new herpes viruses to infect cells
65
Herpes Simplex Virus - latent cycle
(virus infects sensory neurons, travel up axon to cell body and settles into sensory ganglia of face or sacrum FOR LIFE)
- herpes from sensory neurons re-infect epithelial cells
66
Triggers for herpes episode
- stress
- skin damage
- viral illness
67
Herpes Prodrome symptoms
- tingling or burning one day before blisters
68
Herpes - symptoms of primary infection
usually asymptomatic
symptoms worse in primary infection than subsequent ones
69
Oral Herpes - where lesions occur (5)
- gums
- palate
- tongue
- lip
- facial area
70
Oral Herpes - primary age of onset
children
71
Oral Herpes - symptoms
- lesions in oral area
- fever
- enlarged lymph nodes
72
Herpes lesion
clusters of small, painful, fluid filled blisters that ooze, ulcerate and health in a few weeks
73
common complication of oral herpes in children and adults
Pharyngitis
74
Reactivation of oral herpes - lesions are where
- asymptomatic
- often at vermillion border (edge of lips)
- smaller and heal faster
75
Genital herpes - Female - Primary infection Lesions are where
- labia majora and minora
- mous pubis
- vaginal mucosa
- cervix
76
Genital herpes - Male - Primary infection Lesions are where
shaft of penis
77
Reactivation of genital herpes
- often no symptoms
- fewer blisters
- resolves in about a week
78
Hepatic Whitlow
- infected finger or nailbed
- when finger rubs against active lesion
- note: easy to transfer to other body parts (autoinocculation)
79
Herpes Gladiatorum
- infection of trunk, extremities and head
- common in wrestlers
80
Eczema Herpeticum
- Herpes infection with Burns or Atopic dermatities
- serious infection in these areas
81
Keratoconjunctivitis
- Herpes infection in the eye
- inflammation of Cornea (blurry vision, branching dendritic lesion)
- Inflammation of conjuctiva (pain, redness, tearing, sensitivity
82
Inflammation of cornea symptoms (2)
- blurry vision
- branching dendritic lesion
83
Inflammation of conjunctiva (4)
- pain
- redness
- tearing
- sensitivity
84
Herpes in the CNS
- can cause meningitis or encephalitis
- typically in temporal lobe
- commonly happens during reactivation (virus in blood)
- lumbar puncture = increased RBC, WBC, protein levels
85
Herpes - from mother to baby
- happens at birth (baby passes through maternal vaginal secretions)
- 3 patterns of illness
86
Herpes - from mother to baby - Skin, eye, mucous membrane involvement
- lesions 1-2 weeks after delivery
- at sites of damaged skin (ex fetal electrode sites)S
87
Herpes - from mother to baby - 3 types
- skin, eye, mucous membrane involvfement
- CNS infection
- disseminated infection
88
Herpes - from mother to baby - CNS
- lethargy, irritability
- Seizures
- 2-3 weeks after delivery
- Lumbar puncture, CT, MRI, EEG
89
Herpes - from mother to baby - disseminated infection (2)
- sepsis, organ failure
- from lack of treating other types
90
HSV in immunocompromised people
- more frequent reactivation
- more severe symptoms
- wider range of symptoms (lesions in esophagus, lungs)
91
HSV diagnosis
- how skin or mucous membrane lesions look
- PCR = viral DNA
- antibody response to virus
- growing virus in culture
92
HSV treatment
- often resolves without treatment
- antiviral drugs (reduce pain, speed healing OR take at start of prodrome)
- high-dose IV antivirals for severe cases
93
Syphillis - bacterium
treponema pallidum
94
Syphillis - shape
spirochete shape
95
Syphillis - transmission
- SEX ( oral, vaginal, anal)
- childbirth
96
Syphilis - stages of infection
1) infected
2) primary syphilis (show symptoms)
3) Secondary syphilis (spirochete spreads to blood)
4) Early latent syphilis (no symptoms)
5) Late latent syphilis (no symptoms)
6) Tertiary syphilils (death)
97
Primary Syphillis
- chancre (lesion on shaft or tip of penis, OR cervix)
- deep indurated lesion
- painless
- Lymphadenopathy - inguinal lymph nodes are elarged/painful
98
Chancre in syphyllis
lesion on shaft or tip of penis, OR cervix)
- deep indurated lesion
- painless
99
When does primary Syphillis happen
3 weeks after infection
100
When does secondary Syphillis happen
9 weeks after infection (3-6 weeks after primary)
101
Secondary Syphillis - symptoms
- Fever (immune response from WBC, cytokines, etc.)
- condyloma lata = large white wart on mucous membranes (tip of penis, vaginal wall)
- lymphadenopathy (local or systemic)
- Maculopapular rash = all over body (palms/soles of feet)
102
condyloma lata (2)
- large white wart on mucous membranes (tip of penis, vaginal wall)
- characteristic of syphyllis
103
Early latent syphyllis vs Late Latent syphyllis
- early = more likely to relapse
-early = more contagious
104
Late latent syphyllis - how long after infection
2 years after initial infection
105
Sexually transmitted diseases - discharge transmission (3)
- chlamydia
- gonnorhea
- Trichomoniasis
106
Sexually transmitted diseases - Ulcer transmission (2)
- Herpes simplex virus (HSV)
- Syphyllis
107
Sexually transmitted diseases - Wart transmission (2)
- Human papillomavirus (HPV)
- Molluscum contagiosum
108
Sexually transmitted diseases - Bloodborne transmission
- Human immunodeficiency virus
- Hepatitis B
109
Chlamydia - transmission
discharge
110
Gonnorhea - transmission
discharge
111
Trichomoniasis - transmission
Discharge
112
Herpes - transmission
- ulcer
113
syphylis - transmission
Ulcer
114
HPV - transmission
wart
115
Molluscum contagiosum - transmission
wart
116
HIV - transmission
blood
117
hepatitis B - transmission
Blood
118
Longterm effects of untreated STI (8)
- STI persistance
- STI recurrance
- Pelvic inflammatory disease (scarring of vagina, uterus, ovaries, fallopian tubes)
- pelvic pain (incl. painful periods)
- challenges getting pregnant
- ectopic pregnancy (pregnancy outside uterus)
- increase in fluid discharge
- infectious conditions = lesions on genitals
119
Chlamydia - bacteria
Chlamydia Trachomatis
120
Chlamydia Trachomatis - gram status
gram negative
121
Chlamydia - symptoms
- mostly asymptomatic-
- milder disease
122
Chlamydia - complications
- infertility
- pelvic inflammatory disease
- chronic pelvic pain
- increase risk of ectopic pregnancy
123
Chlamydia - how it enters the body
- intercourse --> bacteria enters through perigenital skin or mucous membranes
124
Chlamydia in infants
- can cause blindness in infants
125
Chlamydia - global status
leading cause of blindness in developing countries
126
Gonorrhea - shape
diplococci
127
Gonorrhea - gram status
gram negative
128
Gonorrhea - pathogen class
bacterial
129
Gonorrhea - virrulence
- pilli = attachment
- outer membrane = escape phagocytosis
- produces endotoxin
130
Gonorrhea - common other infections
often occurs at the same time as Chlamy- can be asymptomatic
- change or increase in vaginal discharge
- bleeding between periods
- pain or bleeding during/after vaginal sex
- pain in lower abdomen
- burning upon urination
131
Gonorrhea - transmission
- oral, vaginal, anal sex
132
Gonorrhea - symptoms - vagina (6)
- can be asymptomatic
- change or increase in vaginal discharge
- bleeding between periods
- pain or bleeding during/after vaginal sex
- pain in lower abdomen
- burning upon urination
133
Gonorrhea - symptoms - penis
- burning upon urination
- discharge from penis
- burning/itching around opening of penis
- pain in testicles
134
Gonorrhea - complications (5)
- infertility
- pelvic inflammatory disease (PID)
- chronic pelvic pain
- increased risk for ectopic pregnancy
- pain in the testicles
135
Trichomonas Vaginalis - pathogen class
protozoa
136
Trichomonas Vaginalis - virulence factor
flagella (motion)
137
Trichomonas - men symptoms
- mostly asymptomatic
- maybe mild urethritis
138
Trichomonas Vaginalis - symptoms (vagina) (4)
- off-white/yellow frothy vaginal discharge
- ocassional itching
- dysuria
- asymptomatic
139
Trichomonas Vaginalis - pregnancy (3)
complications
- premature rupture of the membranes
- preterm birth
- low birth weight
140
Syphillis - gram status
gram negative
141
Syphillis - transmission
- sexual contact
- mother-child
142
Syphillis - common population
- men who have sex with men
143
Syphillis - trend
increasing with time
144
Neurosyphillis
- CNS, ocular, optic involvement
- Neurologic, psychiatric, visual, ocular, auditory, vestibular s/s
- symptoms vary depending on when it occurs in course of infection
- few months to few years after initial infection
145
Meningo-vascular syphilis sypmtoms
- stroke like syndrome
- progresses to CVA (stroke)
146
Ocular neurosyphilis symptoms (4)
- blurred vision
- vison loss
- eye pain
- eye redness
147
Tertiary syphyllis - when
decade or more after initial infection if left untreated
148
Tertiary syphllis - symptoms (3)
- Cardiovascular disease (aortic aneurysm, aortic valve insufficiency, etc,)
- Late neurologic complication (general paresis, tabes dorsalis (neuro degen) gummatous disease of CNS
- Late benign syphillis (gumma of skin, bone, vicera, soft tissue)
149
Untreated syphilis - pregnancy
- child with congenital syphillis
- consequences for developing fetus
150
Syphilis - immunity
- a person treated for syphilis can become reinfected multiple times (no long-term immunity)
151
Human papilomavirus - causes which disease (2)
Condylomata acuminate, genital warts
152
HPV infection - symptoms (4)
- mostly asymptomatic
- genital warts (sometimes)
- PAP test abnormalities
- Cervical cancer
153
HPV - enveloped?
non-enveloped
154
HPV - cervical cancer (why)
- HPV proliferates and causes lesions in squamous epithelium of cervix
- certain subtypes (16, 18) associated with cervical dypolasia and angogenital cancers
155
HPV progression
- viral inoculation into squamous epithelium
- HPV lesions produced
- Incubation over 6 weeks to 8 months
- most individuals with healthy immune system clear virus after 3 months (30%) or 2 years (90%)
156
Genital warts presentation
- soft, raised, fleshy lesions on external genetalia
- flat, rough, penduculated
157
Molluscum Contagiousum - pathogen
- viral
158
Molluscum Contagiousum - presentation
- ubilicated papules (dome-like, dimpled)
159
Molluscum Contagiousum - transmission
- mildly contagious
- skin-to-skin contact, fomites, autoinoculation
160
Molluscum Contagiousum - progression
- benign and self-limiting
- spontaneously regresses over 6 months - 1 year
161
Molluscum Contagiousum - treatment
typically no treatment (treatments are skaring)
162
Monkeypox - global
- first identified in 1970 in republic of the Congo
- 2022 = outbreak (2000 cases in 37 countries)
163
Monkeypox - transmission
- not typically an STI, but current 2022 outbreak identified sex as a role in transmission
164
Monkeypox - pathogen class
- viral zoonosis (virus from humans to animals)
165
Monkeypox - symptoms
- similar to smallpox (clinically less severe)
166
Monkeypox - classification
orthopoxvirus
167
Monkeypox - communities found in
typically rural communities in central and west africa near tropical rainforests
- increasing spread urban
168
Monkeypox - transmission (human-human)
- close contact with respiratory secretions, skin lesions, recently contaminated objects
- droplet respiratory particles (prolonged face-to-face contact) putting health workers at risk
169
Monkeypox - common populations
- Men who have sex with men
- patients with pre-existing HIV
170
Monkeypox - incubation period
6-13 days (range to 5-21)
171
Monkeypox - invasive period symptoms (4)
- fever
- intense headache
- lymphadenopathy
- skin eruption to face and extremities (palms/soles, oral mucous membranes, genitalia, conjunctivae)
- self-limiting disease (2-4 weeks)
172
Monkeypox - rash progression
1) macules (lesions with flat base)
2) papules (slightly raised firm lesions)
3) vesicles (lesions with clear fluid)
4) pustules (lesions with yellow fluid)
5) crusts (dry up and fall off)
173
Monkeypox - at risk population
- children
- people with extensive virus exposure
- patient health status
- nature of complications
174
Monkeypox - complications
- cornea impacts
- lesions coalescing to large sections of skin sloughing off
175
Nursing role in GU complaints (6)
- know what you can and cannot test for
- know when you should and should not test
- know which test to use when
- know specimen collection techniques and storage guidlines
- counselling pre/post testing
- education for pt
176
STI risk factors (who to screen) (16)
- sexual contact with person with known STI
- sexually active youth under 25
- new sexual partner
- more than 2 sexual partners in one year
- serial monogamous indicifuals who have had a series of one-partner relationships over time
- no contraception or sole use of non-barrier methods
- IV drug use
- other substance use (cocaine, meth) esp if associated with sex
- pregnancy (vehicle transmission)
- individual with unsafe sexual practices (unprotected, oral/genital/anal sex, sex with blood exchange, sharing toys)
- sex workers/clients
- survival sex
- street involvement/homelessness
- anonymous sexual partnering (bar, rave)
- victims of sexual assault
- previous STI
177
How to screen for STI
Depends on organism you are looking for
- culture
- microscopy
- antigen detection
- nucleic acid detection (nucleic acid hybridization, NAAT)
- visual inspection
178
"I have been tested" syndrome: (2)
1) Individual who tested negative after multiple STI screenings = false sense of security
2) indiidual who recieved medical attention (pap smear, given blood) who THINKS they were tested for STIs
EDUCATION
179
History - STI testing
- asking is not enough:
- be STI specific
- clarifty routine blood work/urine test =/ testing
180
Which STI testing is most sensitive
NAAT (nucleic acid screening)
181
Which STI testing is most specific
culture testing
182
When to send samples (STI)
within 24 hours
183
how to take a Chlamydia trachomatis/Gonnorhea NAAT test
urethral, cervical (NOT vaginal), throat, rectal swabs
- can also send urine for NAAT (culture for pregnancy)
184
How to diagnose HIV, Hepatitis, Syphilis
- serology (regardless of suspected stage of infection
185
HPV - diagnosis (2)
- Warts = no specific further testing required
- Pap smear - DNA/RNA test to find at risk genotypes (16/18/45)
186
HSV diagnosis
- fluid for culture or NAAT (swab de-roofed lesion)
- ulcers = gently scrape the base of the lesion for culture or NAAT
187
STI reporting requirements and confidentiality
- Child Protection Act (release personal info without consent for STI where child abuse is suspected)
- Patients informed info will only be reported as per law (young people for STI care)
- Partner notification = identify sexual partners and other contacts + assess them. Done by patient, HCP or public health
188
Chamydia - treatment
- antibiotics
- curable
189
Gonorrhea - treatment
- antibiotics (resistance developing)
- curable
190
Sphyllis - treatment
- antibiotics
- curable
191
Hepatitis C - treatment
- antiviral
- curable
192
HPV - treatmemt
- often clear on own
- treat warts with LN
- curable
193
Trich/BV - treatment
- treat with antibiotics (not STI)
- curable
194
Yeast infection - treatment
- antifungal supps, cream, oral meds
- curable
195
HSV - treatment
- antivirals to reduce pain
- not curable
196
HIV/AIDS - treatment
- antiretrovirals
- not cureable
197
Hep B - treatmement
- not cureable
