Week 11 Flashcards
bacterial vaginosis
overgrowth of gardinerella vaginalis
bacterial vaginosis - which microbe
gardinerella vaginalis
causes of Bacterial vaginosis (4)
changes in vaginal environment
- douching (rinsing vagina)
- new/multiple sex partners
- use of antibiotics
gardinerella vaginalis - how it infects
naturally exists in vagina
Pathophysiology of bacterial vaginosis
- decrease in population of other natural bacteria
- increase in populatiojn of gardinerella vaginalis
Bacterial vaginosis - symptoms
- copious vaginal discharge
- fishy odour
- pregnant women (preterm labour)
Bacterial vaginosis - diagnosis`
1) wet mount (sample from vagina)
2) put under microscope
3) examine vaginal epithelial cells for signs of clue (bacteria) cells
Treatment for bacterial vaginosis
- antibiotics to remove gardinerella vaginalis
Prevention of bacterial vaginosis
- condoms (new/multiple sex partners)
- otherwise No true prevention
UTI
- urinary tract infection
- infection of kidneys, ureters, bladder, etc
Upper UTI - where (2)
- kidney
- ureter
Lower UTI - where
- urinary bladder
- prostate
- urethra
medical term for bladder infection
cystitis
Pyelonephritis
infection of renal pelvis (the region where urine drains into ureters)
populations most prone to UTI
- children
- elderly
- women (pregnancy, sex, menopause)
Most common Bacteria causing UTI
E. Coli
Clinical setting: bacteria causing UTI (3)
- E. Coli
- Klebsiella pneumoniae
- Proteus mirabilis
(all gram negative)
Bacteria causing UTI - gram status
gram negative (all)
Symptoms of uncomplicated UTI (7)
- burning sensation with urination
- increased frequency of urination
- poor control over urge
- pinkish or whitish urine
- pain while passing urine
- fever
- occasional abdominal pain
Pyelonephritis symptoms (5)
- high-grade fever
- shivering/chills/rigors
- vomiting
- pain in the back and sides of abdomen
- reduced urinary output (advanced)
Host conditions + UTI (4)
- 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
Virulence of agents causing UTIs (4)
- 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
Pathogenesis of a UTI
- bacteria enters through urethra (with aid of pilli)
- bacteria colonizes in the bladder
- pyelonephritis = when infection ascends from Lower urinary tract
Mid stream Urine collection instructions (7)
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
How to test for UTI
- urine dipstick
- Urinary culture and sensitivity
What does urine dipstick test for (UTI)
- leukocytes
- blood
- protein
- nitrates (if infected with E. Coli)
Yeast infections - fungus
Candida albicans
Candica albicans
normal part of flora, oropharynx, bowels, skin, vagina
Candidiasis - can it be transmitted sexually
can be passed back and forth between partners if a favourable environments
Diagnosis of bacterial vaginosis
culture
diagnosis of candidasis
- vaginal culture showing budding yeast filaments (hyphae) or spores
Epididymitis
- inflammation of epididymis (cordlike structure around border of testes which matures and transports sperm)
2 types of Epididymitis
- sexually transmitted infections (urethritis)
- non-sexually transmitted infections (UTI)
types of pathogens causing Epididymitis
typically bacterial
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
Pre-pubertal children with Epididymitis - pathogeneiss
- congenital urinary tract abnormalities
- typically gram negative bacteria (E.Coli)
Sexually transmitted Epididymitis - which population
- young adult males
Epididymitis - initial symptoms (24-48 hours)
- unilateral pain and swelling
- erethema and edema of overlying scrotal skin
Epididymitis - later symptoms
- fever (1/2 cases)
- dysuria (1/2 of cases)
- urethral discharge (depending on organism)
Epididymitis - diagnosis
- urinalisis and urine culture (bacteruria, pyruria)
- may be absent on these –> urethral swabs
pyuria
pus in urine
Orchitis - what
infection of the testes
Orchitis - how it happens
- primary infection in GU tract
- OR systemic infection spread by blood or lymphatic tissue
Orchitis - common pathogen for systemic spreacd
mumps!!! - orchitis in 20-30%
Orchitis - symptoms (3)`
- acute!!!
- fever
- painful enlargement of the testes
- absence of urinary symptoms
Prostatitis - what
variety of inflammatory disorders of the prostate (bacterial or other)
Prostatitis - cause
- spontaneously due to catheterization
- secondary to other diseases of male GU system
Acute bacterial prostatitis - classification
considered a subtype of UTI
Acute bacterial prostatitis - etiology
ascending urethral infection OR reflux of infected urine into prostatic ducts
- E. Coli
Acute bacterial prostatitis - symptoms (7)
- fever
- chills
- malaise
- myalgia
-frequent and urgent urination - dysuria and urethral discharge
- dull aching in perenium, rectum, sacrococcygeal region
Acute bacterial prostatitis - urine appearance
cloudy and malodorous
Acute bacterial prostatitis - rectal examination (4)
- a firm, swollen, very tender, and warm prostate
Balanitis - what
infection of the glans penis (head)
Balanitis - pathogen
fungal origin
Balanitis - common population
more common in uncircumcised males
Herpes Simplex Virus - symptoms
- typically asymptomatic
- Skin and mucous membrane lesions
Types of Herpes infections
- mouth and tongue infections
- genitals
Herpes Simplex Virus - types
- HSV 2
- HSV2
Herpes Simplex Virus - family
Herpesviridae family
Herpes Simplex Virus - genetic material
DNA
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
Herpes Simplex Virus - transmission (2)
- most contagious = transmission by virus-filled lesions
- CAN be spread by asymptomatic shedding (saliva and genital secretions)
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)
Herpes Simplex Virus - lytic cycles
viral DNA transcribed and translated by cell to form viral proteins = new herpes viruses to infect cells
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
Triggers for herpes episode
- stress
- skin damage
- viral illness
Herpes Prodrome symptoms
- tingling or burning one day before blisters
Herpes - symptoms of primary infection
usually asymptomatic
symptoms worse in primary infection than subsequent ones
Oral Herpes - where lesions occur (5)
- gums
- palate
- tongue
- lip
- facial area
Oral Herpes - primary age of onset
children
Oral Herpes - symptoms
- lesions in oral area
- fever
- enlarged lymph nodes
Herpes lesion
clusters of small, painful, fluid filled blisters that ooze, ulcerate and health in a few weeks
common complication of oral herpes in children and adults
Pharyngitis
Reactivation of oral herpes - lesions are where
- asymptomatic
- often at vermillion border (edge of lips)
- smaller and heal faster
Genital herpes - Female - Primary infection Lesions are where
- labia majora and minora
- mous pubis
- vaginal mucosa
- cervix
Genital herpes - Male - Primary infection Lesions are where
shaft of penis
Reactivation of genital herpes
- often no symptoms
- fewer blisters
- resolves in about a week
Hepatic Whitlow
- infected finger or nailbed
- when finger rubs against active lesion
- note: easy to transfer to other body parts (autoinocculation)
Herpes Gladiatorum
- infection of trunk, extremities and head
- common in wrestlers
Eczema Herpeticum
- Herpes infection with Burns or Atopic dermatities
- serious infection in these areas
Keratoconjunctivitis
- Herpes infection in the eye
- inflammation of Cornea (blurry vision, branching dendritic lesion)
- Inflammation of conjuctiva (pain, redness, tearing, sensitivity
Inflammation of cornea symptoms (2)
- blurry vision
- branching dendritic lesion
Inflammation of conjunctiva (4)
- pain
- redness
- tearing
- sensitivity
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
Herpes - from mother to baby
- happens at birth (baby passes through maternal vaginal secretions)
- 3 patterns of illness
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
Herpes - from mother to baby - 3 types
- skin, eye, mucous membrane involvfement
- CNS infection
- disseminated infection
Herpes - from mother to baby - CNS
- lethargy, irritability
- Seizures
- 2-3 weeks after delivery
- Lumbar puncture, CT, MRI, EEG
Herpes - from mother to baby - disseminated infection (2)
- sepsis, organ failure
- from lack of treating other types
HSV in immunocompromised people
- more frequent reactivation
- more severe symptoms
- wider range of symptoms (lesions in esophagus, lungs)
HSV diagnosis
- how skin or mucous membrane lesions look
- PCR = viral DNA
- antibody response to virus
- growing virus in culture
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
Syphillis - bacterium
treponema pallidum
Syphillis - shape
spirochete shape
Syphillis - transmission
- SEX ( oral, vaginal, anal)
- childbirth
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)
Primary Syphillis
- chancre (lesion on shaft or tip of penis, OR cervix)
- deep indurated lesion
- painless
- Lymphadenopathy - inguinal lymph nodes are elarged/painful
Chancre in syphyllis
lesion on shaft or tip of penis, OR cervix)
- deep indurated lesion
- painless
When does primary Syphillis happen
3 weeks after infection
When does secondary Syphillis happen
9 weeks after infection (3-6 weeks after primary)
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)
condyloma lata (2)
- large white wart on mucous membranes (tip of penis, vaginal wall)
- characteristic of syphyllis
Early latent syphyllis vs Late Latent syphyllis
- early = more likely to relapse
-early = more contagious
Late latent syphyllis - how long after infection
2 years after initial infection
Sexually transmitted diseases - discharge transmission (3)
- chlamydia
- gonnorhea
- Trichomoniasis
Sexually transmitted diseases - Ulcer transmission (2)
- Herpes simplex virus (HSV)
- Syphyllis
Sexually transmitted diseases - Wart transmission (2)
- Human papillomavirus (HPV)
- Molluscum contagiosum
Sexually transmitted diseases - Bloodborne transmission
- Human immunodeficiency virus
- Hepatitis B
Chlamydia - transmission
discharge
Gonnorhea - transmission
discharge
Trichomoniasis - transmission
Discharge
Herpes - transmission
- ulcer
syphylis - transmission
Ulcer
HPV - transmission
wart
Molluscum contagiosum - transmission
wart
HIV - transmission
blood
hepatitis B - transmission
Blood
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
Chlamydia - bacteria
Chlamydia Trachomatis
Chlamydia Trachomatis - gram status
gram negative
Chlamydia - symptoms
- mostly asymptomatic-
- milder disease
Chlamydia - complications
- infertility
- pelvic inflammatory disease
- chronic pelvic pain
- increase risk of ectopic pregnancy
Chlamydia - how it enters the body
- intercourse –> bacteria enters through perigenital skin or mucous membranes
Chlamydia in infants
- can cause blindness in infants
Chlamydia - global status
leading cause of blindness in developing countries
Gonorrhea - shape
diplococci
Gonorrhea - gram status
gram negative
Gonorrhea - pathogen class
bacterial
Gonorrhea - virrulence
- pilli = attachment
- outer membrane = escape phagocytosis
- produces endotoxin
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
Gonorrhea - transmission
- oral, vaginal, anal sex
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
Gonorrhea - symptoms - penis
- burning upon urination
- discharge from penis
- burning/itching around opening of penis
- pain in testicles
Gonorrhea - complications (5)
- infertility
- pelvic inflammatory disease (PID)
- chronic pelvic pain
- increased risk for ectopic pregnancy
- pain in the testicles
Trichomonas Vaginalis - pathogen class
protozoa
Trichomonas Vaginalis - virulence factor
flagella (motion)
Trichomonas - men symptoms
- mostly asymptomatic
- maybe mild urethritis
Trichomonas Vaginalis - symptoms (vagina) (4)
- off-white/yellow frothy vaginal discharge
- ocassional itching
- dysuria
- asymptomatic
Trichomonas Vaginalis - pregnancy (3)
complications
- premature rupture of the membranes
- preterm birth
- low birth weight
Syphillis - gram status
gram negative
Syphillis - transmission
- sexual contact
- mother-child
Syphillis - common population
- men who have sex with men
Syphillis - trend
increasing with time
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
Meningo-vascular syphilis sypmtoms
- stroke like syndrome
- progresses to CVA (stroke)
Ocular neurosyphilis symptoms (4)
- blurred vision
- vison loss
- eye pain
- eye redness
Tertiary syphyllis - when
decade or more after initial infection if left untreated
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)
Untreated syphilis - pregnancy
- child with congenital syphillis
- consequences for developing fetus
Syphilis - immunity
- a person treated for syphilis can become reinfected multiple times (no long-term immunity)
Human papilomavirus - causes which disease (2)
Condylomata acuminate, genital warts
HPV infection - symptoms (4)
- mostly asymptomatic
- genital warts (sometimes)
- PAP test abnormalities
- Cervical cancer
HPV - enveloped?
non-enveloped
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
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%)
Genital warts presentation
- soft, raised, fleshy lesions on external genetalia
- flat, rough, penduculated
Molluscum Contagiousum - pathogen
- viral
Molluscum Contagiousum - presentation
- ubilicated papules (dome-like, dimpled)
Molluscum Contagiousum - transmission
- mildly contagious
- skin-to-skin contact, fomites, autoinoculation
Molluscum Contagiousum - progression
- benign and self-limiting
- spontaneously regresses over 6 months - 1 year
Molluscum Contagiousum - treatment
typically no treatment (treatments are skaring)
Monkeypox - global
- first identified in 1970 in republic of the Congo
- 2022 = outbreak (2000 cases in 37 countries)
Monkeypox - transmission
- not typically an STI, but current 2022 outbreak identified sex as a role in transmission
Monkeypox - pathogen class
- viral zoonosis (virus from humans to animals)
Monkeypox - symptoms
- similar to smallpox (clinically less severe)
Monkeypox - classification
orthopoxvirus
Monkeypox - communities found in
typically rural communities in central and west africa near tropical rainforests
- increasing spread urban
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
Monkeypox - common populations
- Men who have sex with men
- patients with pre-existing HIV
Monkeypox - incubation period
6-13 days (range to 5-21)
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)
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)
Monkeypox - at risk population
- children
- people with extensive virus exposure
- patient health status
- nature of complications
Monkeypox - complications
- cornea impacts
- lesions coalescing to large sections of skin sloughing off
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
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
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
“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
History - STI testing
- asking is not enough:
- be STI specific
- clarifty routine blood work/urine test =/ testing
Which STI testing is most sensitive
NAAT (nucleic acid screening)
Which STI testing is most specific
culture testing
When to send samples (STI)
within 24 hours
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)
How to diagnose HIV, Hepatitis, Syphilis
- serology (regardless of suspected stage of infection
HPV - diagnosis (2)
- Warts = no specific further testing required
- Pap smear - DNA/RNA test to find at risk genotypes (16/18/45)
HSV diagnosis
- fluid for culture or NAAT (swab de-roofed lesion)
- ulcers = gently scrape the base of the lesion for culture or NAAT
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
Chamydia - treatment
- antibiotics
- curable
Gonorrhea - treatment
- antibiotics (resistance developing)
- curable
Sphyllis - treatment
- antibiotics
- curable
Hepatitis C - treatment
- antiviral
- curable
HPV - treatmemt
- often clear on own
- treat warts with LN
- curable
Trich/BV - treatment
- treat with antibiotics (not STI)
- curable
Yeast infection - treatment
- antifungal supps, cream, oral meds
- curable
HSV - treatment
- antivirals to reduce pain
- not curable
HIV/AIDS - treatment
- antiretrovirals
- not cureable
Hep B - treatmement
- not cureable