Week 3: Urethritis and ulcerative lesions Flashcards
1
Q
Definition and diagnosis of urethritis
A
- urethral inflammation usually caused by infection
- symptoms: urethral discharge, dysuria, meatal pruritis, pain in testicles, worsening symptoms during menses for women
- confirmed by presence of mucoprulent or purulent discharge. Labs of >5 wbc per oil immersion field on urethral smear
- first void urine sediment has >10 WBC per high power field
2
Q
Neisseria gonorrhea
A
- aerobic, gram negative diplococci
- grows in chocolate agar (non selective) and thayer martin (selective). oxidase positive, ferments glucose
- higher transmission from male to female than from female to male
- women: cervicitis. Incubation 1-10days. Vaginal discharge, dysuria, bleeding. Mostly asymptomatic. Can cause PID, extension into pelvis (peritonitis).
- men: acute urethritis. incubation 2-5days. Discharge, burning, some asymptomatic.
- can also cause proctitis (rectal) and pharyngitis
3
Q
Nesseria gonorrhea in newborns
A
- opthalmia neonatorum
- In Ca must put antibiotics in newborns eyes
- can lead to blindness
4
Q
Diagnosis of neisseria gonorrhea
A
- gram stain/culture from infected site
- first void urine optimal. gram stain has high sensitivity and high specificity in males. Not recommended for endocervical specimens
- Currently preferred test: Nucleic acid amplification tests (NAATs) using urine. Will diagnose most patients without disseminated sites.
5
Q
Therapy for GC urethritis
A
- there’s rising antibiotic resistance to penicillin
- use Ceftriaxone IM x1
- must be tested for other diseases, e.g. HIV
6
Q
Disseminated gonorrhea
A
- 0.5%-3% of patients with untreated mucosal GC
- risk factors: complement deficiency, menstruation, pregnancy
- dermatitis-arrhritis-tenosynovitis
- monoarticular septic arthritis
- endocarditis
- Rx: ceftriaxone IV or IM q24hr for 1 week +screen sex partners
7
Q
Chlamydia Trachomatis: general
A
- intracellular bacteria. Elementary body (EB) form is like spores, can’t replicate and infectious. Reticulate body (RB) are intracellular, metabolically active.
- infection depends on serovars: eye infection, urogenital infection, lymphgranuloma venereum
8
Q
Chlamydia: genital disease
A
- women: mostly asymptomatic. Can cause cervicitis, endometritis, urethritis, salpingitis
- risk untreated: PID, infertility,
- men: mostly symptomatic. may cause reactive arthritis.
- diagnosis: NAATs for urine is preferred test.
- Rx: Azithromycin 1000mg x 1 dose
- should screen sexually active teens annually
9
Q
Understand the communicability and treatment for genital herpes
A
- HSV1 mostly oral herpes, HSV2 is primary agent of genital herpes
- infection through skin, virus enters cutaneous neurons
- mostly asymptomatic but can be still shedding virus
- Dx: serology
- Rx: Acyclovir (or other -clovir drug for 7-10 days) for first clinical episode. Episodic therapy-acyclovir or equiv. 2 or 3 x daily for 3-5 days
- Rx daily suppression for patients with more than 6 episodes/yr.
10
Q
3 stages of syphilis
A
- Treponema pallidum. more common in men.
1. Primary: 21 day incubation. - chancre: painless ulcer with well defined rounded border
- regional LAD
- heals in 3-6 weeks
2. Secondary syphilis - 2-8 weeks after chancre. Fever, malaise, generalized LAD,rash, CNS involvement.
- condylomata lata: wart like lesion on genitals, painless. highly infectious.
3. Tertiary: - cardiovascular: aortitis, aneurysm
- gumma: form of granuloma
- neurosyphilis: meningitis, latent neurosyphilis, cerebrovascular syphilis (5-12 yrs), general paresis (15-20 yrs), tabes dorsalis (20-25 yrs)
11
Q
Differentiate the non-treponemal and the treponemal tests, and explain how each is used
A
Start with treponemal screening test (EIA,e.g.). If negative-no evidence of syphilis. If positive, do Non treponemal test. If positive, have syphilis. If negative, its either false+, early/late/latent, or past infection.
- non-treponemal antibody
- directed against cardiolipin. Titer correlates with dz activity. - Specific treponemal Ab test
- assay presence of several Ab to specific treponemal antigens
- persist for life, titers don’t correlate with disease activity
12
Q
Discuss the treatment of each of the stages of syphilis
A
- Early syphilis
- primary, secondary, or early latent
- benzathine (penicillin)-1 shot - Late syphilis
- late latent, gummata, CV
- benzathine IM weekly for 3 weeks - Neurosyphilis
- aq. crastalline penicillin IV, procaine penicillin IM + probenecid PO 10-14 days
13
Q
List the less common causes of genital ulcers and their risk factors
A
- chancroid (Haemophilus ducreyi)
- requires factor X to grow
- uncommon in US
- painful, ragged ulcer, tender regional LAD - lymphogranuloma venereum
- caused by chlamydia trachoma’s L1,2,3,4
- uncommon in US
- primary: papule or ulcer, small and painless.
- second stage: inflammation and swelling of inguinal lymph nodes (Buboes) - granuloma inguinale-calymmatobacterium granulomatis
- encapsulated, gram - bacillus
- frequent in tropical places.
- painless ulcer with rolled edges. Bleeds easily on contact.
- histology shows donavan bodies
14
Q
Neurosyphilis
A
- general paresis: meningoencephalitis with invasion of cerebellum. Early-Irritability, memory loss, personality changes. Late-emotional lability, defective judgement, delusions of grandeur, paranoia.
- tabes dorsalis: lancinating pains, ataxia, bladder disturbances, paresthesias. Signs: pupil abnl., absent ankle/knee reflex, romberg sign, impaired vibration/position, argyl-robertson
15
Q
Diagnosis of syphilis by stage
A
- primary: darkfield exam
- secondary: clinical and serology
- latent: serology
- tertiary: clinical, serology, pathology
- CNS: CSF exam
- -Serology: tests measure 2 different types of Ab made in response to infection-non treponemal and treponemal
