Class 6 chapter 41

Question 1

STIs

Answer 1

Reporting not accurate
Person-to-person transfer (Oral, genitalia, urinary meatus, rectum, skin, mother to fetus)
Increasing frequency in teenage population: often more than 1 type
Resistance is developing
Viral forms are not curable as yet
Organisms don’t survive long outside host!

Question 2

STI treatment

Answer 2

Sexual partners must be identified and treated

Abstinence during therapy

Question 3

Genital Warts (condylomata acuminata)

Answer 3

Human papillomavirus (HPV)
Increased incidence
Transmission
- Fomites (ex contaminated clothing)
- Mother to newborn
- Mucosal/skin to mucosal/skin

Question 4

Genital Warts risk factors

Answer 4

<25 years old
Early first intercourse (<16 years old)
Increased number of partners

Question 5

Genital Warts progression

Answer 5

Transient or persistent
Incubation is 1-8 months
May be asymptomatic
Associated with genital cancers (Cervical is rare)

Question 6

Genital Warts appearance

Answer 6

1. External
   Soft raised fleshy lesions, or small bumps or flat rough surfaced areas on external genitalia (male and female)
2. Internal
   Cauliflower-shaped lesions causing discomfort, bleeding, painful intercourse

Question 7

Genital Warts treatment

Answer 7

Vaccine recently developed
Antimitotic agent necrosing wart tissue
Cryotherapy (cold - treatment of choice)
Surgical excision
Laser vaporization
Electrocautery

Question 8

Genital Herpes

Answer 8

Herpes Simplex Virus (HSV) 2
Incubation is 2 – 12 days
Neurotropic virus 
- Grows in neurons
- Latent form moves up via peripheral nerves; dormant in dorsal root ganglia (Reactivates and spreads down neurons, Alters when replicating from dormant state)
Highly contagious!
Spread by people unaware they have it

Question 9

Genital Herpes risk factors

Answer 9

Women
Increased sexual partners
Compromised immune system

Question 10

Genital Herpes symptoms

Answer 10

Dysuria, dysparenuia (painful intercourse)
Itching, tingling, painful to touch
“Wet” vesicle eventually crusts over

Question 11

Genital Herpes primary infection

Answer 11

Headache, malaise, muscle aches, lymphadenopathy

Question 12

Genital Herpes recurring episodes

Answer 12

Less severe

Question 13

Genital Herpes triggers

Answer 13

Stress, sleep loss, overexertion, other infections, prolonged coitus, menstrual distress

Question 14

Genital Herpes

Answer 14

Acyclovir family

Question 15

Candidiasis

Answer 15

Candida albicans
Yeast infection/Thrush/Moniliasis
- Present in healthy women
- Activated when vaginal environment altered
Usually not transmitted sexually (not an “official” SDI)
75% of women

Question 16

Candidiasis risk factors

Answer 16

Decreased normal bacterial flora 
Altered hormonal levels (Birth control pills, pregnancy)
Decreased immune system
- Diabetes Mellitus
- HIV infection

Question 17

Candidiasis manifestations

Answer 17

Thick, white, odourless discharge

Irritation, erythema, swelling, dysuria

Question 18

Trichomoniasis

Answer 18

Trichomonas vaginalis
Sexual contact
Fomites (hot tubs, swimming pools)
Currently very prevalent
Men harbor organism but are asymptomatic

Question 19

Trichomoniasis risk factors

Answer 19

Diagnosed with other STIs

Question 20

Trichomoniasis risk factors

Answer 20

Diagnosed with other STIs

Question 21

Trichomoniasis manifestations

Answer 21

Women

• Sometimes asymptomatic
• Frothy, malodorous green/yellow discharge
• Erythema/edema of mucosa
• Itching, irritation
• Hemorrhagic cervical “strawberry spots”

Men
- Harbour organisms in urethra and prostate but are almost always asymptomatic

Question 22

Trichomoniasis complications

Answer 22

Human Immunodeficiency Virus (HIV)
Women - Infertility, PID and premature births
Men - Infertility, chronic prostatitis and urethritis

Question 23

Chlamydia Trachomatis

Answer 23

Bacterial infection but can behave like a virus
Has two distinct morphologies
- Elementary body (survives outside the cell) attaches and is ingested and activates the reticulate body (can’t survive outside the cell) which divides and forms new “elementary bodies” released when cell bursts
Difficult to treat!
Most common STI in North America

Question 24

Chlamydia manifestations

Answer 24

Women

• Can be asymptomatic
• Frequency, dysuria, vaginal discharge)(Mucopurulent cervical discharge)
• Cervix becomes hypertrophied, edematous, friable (on touch it falls apart)

Men

• Urethritis, meatal erythema/tenderness, itchiness, discharge
• Dysuria, prostatitis, epididymitis

Question 25

Chlamydia complications

Answer 25

Women - PID (40%) - Infertility (20%) - Chronic pain (18%) - Conjunctivitis (infection in eye) - Damaged fallopian tubes - tubal pregnancy 9%) Men - Infertility - Reiter’s syndrome (reactive arthritis, conjunctivisits, urethritis)

Question 26

Gonorrhea

Answer 26

Neisseria gonorrhoeae Transmission - Entry via genitals, urinary tract, eyes, oropharynx, rectum, skin - Neonates born to infected mothers (Gonorrhea conjunctivitis/blindness, Amniotic infection syndrome) - Likes warm mucus membranes - Highest rate in adolescents and young adults

Question 27

Gonorrhea symptoms

Answer 27

May be asymptomatic Men have more symptoms than women Men: urethra pain, creamy yellow/blood discharge, rectal infections from male-to-male contact Women: genital or urinary discharge, dysuria, dyspareunia, pelvic pain, bleeding, fever, proctitis, uterine infection

Question 28

Gonorrhea complications

Answer 28

Males: spread to prostate, epididymis Females: uterine infection, salpingitis (fallopian tubes), scarring/infertility Pharyngitis if oral-genital contact Conjunctivitis Bloodstream (bacteria): joint, heart valves, meninges

Question 29

Syphilis

Answer 29

Treponema pallidum Increasing incidence as of 2001 Transmission Direct contact with infectious moist lesion during sexual intimacy, kissing Mother to fetus invitro/transplacental - Prematurity, stillbirth, congenital defects, active infection

Question 30

Syphilis stages

Answer 30

Primary stage Secondary stage Latent phase Tertiary stage

Question 31

Syphilis primary stage

Answer 31

Chancre at site of exposure (within 3 wks, but can incubate longer) Buttonlike papule erodes skin Male: usually obvious, penis or scrotum Women: cervix, vagina, sometimes external Often painless Mild symptoms of infection Heals within 3-12 weeks

Question 32

Syphilis secondary stage

Answer 32

2-6 wks after initial chancre, lasts 1 wk to 6 months Rash on palms/soles Fever, sore throat, malaise, stomatitis, nausea, eye inflammation, arthralgias Alopecia (hair loss) Elevated lesions on genitals: highly infectious

Question 33

Syphilis latent phase

Answer 33

1-20 years Symptoms resolve but still seroreactive (still in blood and can still be passed on) 1 in 3 progress Others have minimal symptoms or spontaneous cure

Question 34

Syphilis tertiary stage

Answer 34

Gumma lesions CV: aortic valve, aortic aneurysm CNS (neurosyphilis): dementia, blindness Skin/Liver/Bone

Question 35

Syphilis treatment

Answer 35

Penicillin