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Infectious Disease > Week 4: Sexually Transmitted Infections > Flashcards

Week 4: Sexually Transmitted Infections Flashcards

1
Q

Question

A

C. They don’t survive long without warmth and moisture

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2
Q

Features of sexually transmitted diseases

A
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3
Q

Epidemiology of STDs

A
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4
Q

Most common STD

A

Chlamydia

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5
Q

Why are STDs prevalence increasing

A

?

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6
Q

Chlamydia clinical manifestations

8 listed

A
  • Urethritis
  • Cervicitis
  • PID
  • Epididymitis
  • Proctitis
  • Conjunctivitis, Trachoma
  • Neonatal pneumonia and conjunctivitis
  • Reactive arthritis
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7
Q

Gonorrhea clinical manifestations

8 listed

A
  • Urethritis
  • Cervicitis
  • PID
  • Epididymitis
  • Proctitis
  • Conjunctivitis
  • Neonatal conjunctivitis
  • Disseminated infection
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8
Q

Why are the clinical manifestations of Chlamydia and Gonorrhea similar?

A

They both adhere to columnar epithelium

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9
Q

What is Urethritis?

A
  • infection of urethra (not urinary tract infection)
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10
Q

Gonococcal urethritis or cervicitis incubation period

A

3 - 7 days

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11
Q

Urethritis signs & symptoms

A
  • dysuria
  • purulent discharge
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12
Q

Cervicitis signs and symptoms

A
  • Dysuria (pain with urination)
  • Purulent discharge
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13
Q

Gonococcal urethritis and cervicitis

A
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14
Q

Gonorrhea pathogen

A

Neisseria gonorrheae

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15
Q

Neisseria gonorrheae classification

A

Gram-negative diplococci (not truly intracellular)

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16
Q

Neisseria gonorrheae tropism

A

Adhere to columnar epithelium

  • Cervix
  • Urethra
  • Rectum
  • Eye
  • Throat
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17
Q

Neisseria gonorrheae discharge

A

Vigorously purulent response

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18
Q

Neisseria gonorrheae immune response

A
  • Vigorous purulent discharge
  • Phagocytosed by WBCs
  • Pili are antigenically variable
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19
Q

Examples of diplococci

A
  • Neisseria gonorrheae
  • Neisseria meningitidis
  • Moraxella sp
  • etc.
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20
Q

Gram-stain of Neisseria gonorrheae

A

gram-negative diplococci (pink)

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21
Q

How is gonorrhea diagnosed?

A
  • Gram stain - gram-negative diplococci
  • Culture media chocolate agar in high-CO2 atmosphere
  • Nucleic acid amplification
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22
Q

Gonorrhea culture details

A

Chocolate agar in high CO2 atmosphere

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23
Q

Gonorrhea nucleic acid amplification from where?

A
  • Urethra
  • Cervix
  • Throat
  • Rectal
  • Urine
  • Vaginal
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24
Q

Gonorrhea evolution of resistance

A
  • has acquired multiple plasmid and chromosomal resistance mutations
  • Becoming resistant to a lot of conventional antibiotics
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25
Resistance tracking of Neisseria gonorrheae
26
First-line treatment for gonorrhea
Ceftriaxone or Cefixime
27
Neisseria gonorrheae susceptibility patterns
28
Recommended treatment for Gonorrhea
Ceftriaxone and Azithromycin
29
Ceftriaxone method of use
IM
30
Ceftriaxone drug class
3rd generation cefalosporin
31
Considerations of gonorrhea treatment 6 listed
* Be sure the patient is treated correctly * Be sure the partner is treated * All abstain from sex for 7 days * Report case to DOH * Educate patient * Promote development of new drugs
32
Question
D. the surface antigens mutate frequently (surface pili proteins are antigenically variable)
33
Chlamydia pathogen
Chlamydia trachomatis
34
Chlamydia trachomatis classification
Obligate intracellular bacterium
35
Chlamydia trachomatis tropism
Adhere to columnar epithelium cells
36
Chlamydia trachomatis gram stain
Outr membrane is like gram-negative bacteria but does NOT gram stain
37
Chlamydia trachomatis features of intracellular infection
* Doesn't make its own ATP so it uses host cell ATP * Cytopathic effect: cytoplasmic inclusion bodies
38
Chlamydia trachomatis culture
Culture requires Eukaryotic cell line so they are rarely done
39
Memory immune response and Chlamydia trachomatis
Immunity does not protect against reinfection
40
Describe the life cycle of Chlamydia trachomatis
Slower life-cycle so it requires a longer duration of anti-biotic Have 2 different forms Start out as Elementary bodies (more hardy survive in the environment) where they stick on columnar epithelial cell and enter the cell and form Reticulate bodies and replicate and form inclusion bodies and continue replicating until cell lysis and release of more chlamydia in the Elementary body form to infect more cells
41
Chlamydia and gonorrhea are most common in what age group?
* young people * more common in women
42
Chlamydial urethritis incubation
7 - 21 days
43
Chlamydial urethritis signs & symptoms
* Dysuria (pain while urinating) * A discharge which is often clear or scant
44
Chlamydial urethritis gram stain
white cells, no organisms seen
45
Chlamydial urethritis vs Gonorrhea urethritis
Gonorrhea is often more inflammatory and produces a purulent discharge while Chlamydia is less inflammatory and produces a clear or scant discharge
46
Chlamydial Cervicitis incubation
7-21 days
47
Chlamydial Cervicitis signs & symptoms
* Dysuria (pain while urinating) * A discharge which is often clear or scant
48
Chlamydial Cervicitis gram stain
white cells, no organisms
49
Chlamydial Cervicitis vs gonorrhea cervicitis
Gonorrhea is often more inflammatory and produces a purulent discharge while Chlamydia is often less inflammatory and produces a clear or scant discharge
50
Pictures of Chlamydial urethritis or Cervicitis
51
PID AKA
Pelvic inflammatory disease
52
PID caused by Chlamydia or Gonorrhea
Chlamydia and gonorrhea start in the cervix and can progress if not treated up to the uterus and fallopian tubes where there is also columnar epithelium and cause a lot of inflammation and adhesions which can cause infertility, chronic pelvic pain, ectopic pregnancies (fallopian tube damage)
53
Complications of Chlamydia in women AND Gonorrhea
54
What is the most common presentation of chlamydia?
Absolutely no symptoms
55
How is Chlamydia diagnosed
Antigen detection methods DNA probe Nucleic acid amplification (NAAT)
56
Tissue culture of Chlamydia
* Expensive * insensitive
57
Chlamydia Antigen Detection Methods
Insensitive
58
Chlamydia DNA probe
more sensitive
59
Test of choice for Chlamydia
NAAT (Nucleic Acid Amplification)
60
Chlamydia NAAT
* most sensitive can do on * urine * anal swab * cervix * throat * self-collected
61
Chlamydia screening parameters
62
Chlamydia and pregnancy
Conjunctivitis and pneumonia in neonates
63
Gonorrhea and pregnancy
Conjunctivitis
64
When is Chlamydia and Gonorrhea transmitted during pregnancy?
Transmitted at the time of delivery
65
Pregnant women and STD screening
SCREEN ALL PREGNANT WOMEN!
66
Chlamydia treatment
want something that gets into cells and has a long half-life (Tetracycline, newer Doxycyline) Azithromycin
67
Unique syndromes associated with Gonorrhea
* Disseminated gonococcal infection * Bacteremia * Skin Pustules * Septic Arthritis * Tenosynovitis
68
Unique syndromes associated with Chlamydia
Reactive arthritis * arthritis * Skin lesions * Dysuria * Eye problems
69
Differential Diagnoses of Genital ulcers
**STIs** * Herpes Simplex * Syphilis (Treponema pallidum) * Chancroid (Hemophilus ducreyi) **Autoimmune** * Behcet's * Reactive arthritis (circinate balanitis) **Drug toxicity** * Fixed drug eruption **Other infectious and non-infectious conditions**
70
Herpes Simplex Virus classification
Enveloped, double-stranded DNA virus (susceptible to soap and water (lipid envelope))
71
Type 1 Herpes Simplex virus
Usually oral
72
Type 2 Herpes Simplex virus
usually genital
73
Prevalence of HSV-2
* 17% of US adults * Most who have it don't know they have it
74
Herpes simplex virus duration of infection
Latent in neurons, reactivates periodically with or without symptoms Herpes is forever
75
How can herpes simplex virus be transmitted?
can be transmitted from symptomatic sores or can even be transmitted by asymptomatic shedding
76
Herpes simplex virus severity
* Nuisance for most people giving them a couple of sores every couple of months * Can be serious in immunosuppressed or neonates - transmitted at time of delivery can be very bad or lethal (however neonatal herpes infections are very rare)
77
Vaccine for Herpes
No vaccine yet
78
Treatment of Herpes Simplex Virus
* Acyclovir * Valacyclovir * Famciclovir episodically for outbreaks or daily for suppression
79
Pictures of Genital HSV
80
Syphilis pathogen
Treponema pallidum
81
Treponema pallidum causes
Syphilis
82
Treponema pallidum family
Spirochete family (others in family: Borrelia, Leptospira)
83
Treponema pallidum classification
* too small for light microscopy
84
Treponema pallidum culture
* Cannot grow in vitro * Can inoculate into mammals for research
85
Diagnosis of Treponema pallidum
Direct visualization by special staining Serology: Can be challenging to interpret
86
Treponema pallidum treatment
curable with penicillin
87
Syphilis prevalence
Was very common around 1900s but it is increasing again
88
Syphilis serology
89
Once you have had syphilis what antibody do you have
Always have Treponemal antibody if you've had syphilis
90
Categories of syphilis serology tests
* Nontreponemal (antibodies against self as a result of syphilis infection) * Treponemal
91
Characteristics of nontreponemal syphilis serology
* RPR, VDRL * Quantitative * Titers go down with treatment * False positives and negatives
92
Characteristics of treponemal syphilis serology
* TPPA, MHA-TP, FTA * Qualitative * Stays positive for life after an infection * More specific than nontreponemal
93
False positives of nontreponemal Ab tests can be related to
other autoimmune antibodies causing a false positive for syphilis
94
Rates of primary and secondary syphilis
95
Describe the distribution of syphilis
96
How does syphilis get into the body
The delicate spirochetes can enter the body if there is cracked skin or microabrasions, or if they get through columnar epithelium
97
Events of syphilis infection
* immediately after syphilis enters the body you will get an immune response causing a local ulceration (Chancre) * After that they can enter lymph nodes which can cause local lymphadenopathy but from the lymphatic system can distribute throughout the body
98
Syphilis staging
* Primary * Secondary * Latent * Tertiary * Neurosyphilis * Congenital syphilis
99
When would a syphilis infection be staged as primary
2-3 weeks after infection
100
When would a syphilis infection be staged as secondary
6-12 weeks
101
When would a syphilis infection be staged as latent
where there is a positive blood test so the patient is infected but there are no current signs or symptoms
102
When would a syphilis infection be staged as tertiary
sometime after 12 weeks
103
Describe the signs and symptoms of primary syphilis
* Chancre at entry site * regional lymphadenopathy
104
what is this?
Chancre (syphilis)
105
Serology of primary syphilis
serology may not yet be positive
106
Signs & symptoms of secondary syphilis
* Rash * joint pain * hepatitis * general lymphadenopathy * etc
107
Signs & symptoms of latent syphilis
Positive blood test so patient is infected but there are no signs & symptoms
108
Signs & symptoms of tertiary syphilis
* CNS damage * Aorititis * gumma * other late sequelae
109
When does neurosyphilis occur?
CNS infection can happen at ANY stage of syphilis
110
How is congenital syphilis transmitted from mother to baby
Passed through the placenta
111
Primary chancre
usually painless
112
Rash of secondary syphilis
can be anywhere and can be highly variable but this rash can also go on the "palms and soles"
113
Condyloma lata
secondary syphilis
114
Patchy alopecia
secondary syphilis
115
Mucous patches
Secondary syphilis
116
Signs & symptoms of congenital syphilis
* Miscarriage * Stillbirth **Early or Late** * Hepatomegaly * Meningitis * Rash * CBC changes * Bone changes * Blindness * Deafness * CNS damage
117
Most important thing to prevent congenital syphilis
Screen ALL pregnant women
118
What is Vaginitis?
* Vaginal discharge/discomfort * Not necessarily an "-itis" (inflammation)
119
Common causes of Vaginitis
* Bacterial vaginosis * Candida * Trichomonas * Many other infectious and non-infectious causes
120
Normal vaginal flora
Lactobacillus and other good bacteria
121
Epidemiology of HPV and genital worts
Prevalent (mostly asymptomatic)
122
Signs & symptoms of HPV and genital worts
* Mostly asymptomatic * Some strains more likely to cause warts (6, 11) * Some strains more likely to cause dysplasia (16 & 18 \> 31, 33, 35, 52, 58) * Infection and warts may spontaneously resolve * Worse in immunocompromised
123
HPV strains more likely to cause warts
6 & 11
124
HPV strains more likely to cause dysplasia
16 & 18 \> 45, 31, 33, 35, 52, and 58
125
HPV tropism
Only infects squamous epithelial cells
126
Pathology of HPV
Viral E6 and E7 proteins immortalize squamous cells -\> cervical, anal, head/neck squamous cancer
127
Treatment of HPV
* No antiviral medication * Vaccine greatly reduces warts and dysplasia * The vaccine effective against multiple strains
128
Prevalence of cervical dysplasia
129
Principles of STI management
* Evaluate patient for other STIs, including HIV * Evaluate and treat all recent partners * Educate patient: treatment failure, reinfection, prevention * Condoms reduce risk * Notify public health department (reportable diseases) * Follow CDC treatment guidelines

Infectious Disease (82 decks)

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