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Block 4 - OBGYN > Clin Lab: STIs > Flashcards

Clin Lab: STIs Flashcards

1
Q

Note

A

Many STIs can be asymp & are often underdx

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2
Q

Undx infx can lead to what significant complications in females?

A

PID & infertility

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3
Q

List common STIs

A

Chancroid
Chlamydia
Gonorrhea
Genital warts / HPV
Hepatitis A/B/C
Herpes simplex
HIV
Syphilis
Mycoplasma genitalium
Scabies and crab louse
Syphilis
Trichomonas

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4
Q

What is commonly tested/route for STIs

A

serum & wet prep/urine

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5
Q

We test serum for which STIs?

A
  • HIV
  • Syphilis
  • Hep A/B/C
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6
Q

We test wet prep/urine for which STIs?

A
  • Gonorrhea
  • Chlamydia
  • Trichomonas
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7
Q

Who do we test for HIV?

A

Everyone!!!
- Suspected acute infx
- Those at incr risk – yearly, maybe even quarterly
- All adults at least once
- All pregnant women, each pregnancy

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8
Q

What are some S/Sx of a suspected HIV acute infx pt?

A

Flu-like symptoms, sore throat in the right person

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9
Q

When do we test pregnant women for HIV?

A

at their first prenatal visit

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10
Q

What is the best test to detect HIV and how long is the window?

A
  • RNA
  • 5-7 days
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11
Q

What can diagnostics tests for HIV detect?

A
  • antibodies against HIV 1 or 2
  • HIV p24 antigen
  • HIV-1 RNA*
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12
Q

NOTE

A

Different HIV tests are used depending on acute infection vs chronic infection vs screening

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13
Q

Screening test for HIV

A
  • 3rd gen immunoassay
  • 4th gen immunoassay
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14
Q

What does the 3rd gen immunoassay for HIV measure?

A

Abs only
- IgG and IgM Abs

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15
Q

What does the 4th gen immunoassay for HIV measure?

A

Ab & PRO Ag
- IgG/IgM and P24 Ag

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16
Q

What are the FU tests/confirmatory test if HIV screening test is (+)?

A
  • HIV-1/HIV-2 Ab differentiation assay
  • HIV-1 RNA
  • Older -> Western blot (PRO electrophoresis)(HIV-1)
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17
Q

Further diagnostic testing in pts w/ HIV

A
  • CD4 T-Lymphocyte Count
  • HIV-RNA quantification (viral load)
  • Phenotypic & Genotypic Assays for Antiretroviral Drug Resistance
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18
Q

Diagnostic tests for acute HIV infx

A
  • 4th gen assay
    AND
  • HIV-1 RNA test

Often have (-) assay & (+) RNA test in acute infx

If both are (-)& there is high suspicion of infx, repeat in 1-2 wks

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19
Q

Laboratory Testing for HIV flow chart

A

DONE

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20
Q

Recommended Initial Tests: Dx of chronic HIV infx or screening in asymp ppl

A

4th gen assay

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21
Q

Recommended Initial Tests: Dx of acute HIV infx

A

4th generation assay & HIV-RNA detection

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22
Q

Recommended Initial Tests: Dx of HIV in infants born to HIV-infected mother

A

DNA PCR or HIV-RNA detection

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23
Q

Recommended Initial Tests: Prognosis

A

HIV-RNA quant & CD4 T-cell count

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24
Q

Recommended Initial Tests: Response to antiretroviral therapy

A

HIV-RNA quant & CD4 T-cell count

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25
Recommended Initial Test: Antiretroviral drug resistance testing
Phenotypic and/or genotypic resistance assays
26
Recommended Initial Tests: blood donor screening
3rd gen assay & HIV-RNA detection
27
How is Hep B tested?
measure Hep B surface antigen, surface antibody &core antibody
28
Hep B Testing Results Chart (Phase (5), HBsAg, Anti-HBc, IgM Anti-HBc, Anti-HBs)
DONE
29
Describe testing interpretation for Hep C
- If (-), chronic infx is unlikely - If (+), measure Hep C RNA (PCR) --> If (+), chronic infx confirmed--> tx
30
Who do we screen for Hep B/C?
higher risk patients
31
What do we measure for Hep C testing
Hep C Antibodies (anti-Hep C)
32
Describe Hep C test interpretation
- If (-), chronic infx is unlikely - If (+), measure Hepatitis C RNA (PCR) -->If (-), chronic infx unlikely --> If (+), chronic infx confirmed--> tx
33
What 2 tests can be done to detect syphilis?
1. Direct visualization 2. Antibody testing
34
Describe the protocol/results of the two antibody tests for syphilis?
- If initial test is (-), no further testing is needed unless high suspicion for infx - If initial test is (+), need to do the other type of antibody test for confirmation --> Do test of opposite type: (+)/(+) tx for syphillis
35
Syphilis antibodies are usually detected by...
serum
36
Which STI requires testing of the CSF?
neurosyphilis
37
Name the 2 types of syphilis antibody test
Non-treponemal tests & Treponemal tests
38
Non-treponemal test detects...
serum reagin antibodies
39
What antigens are associated w/ non-treponemal testing?
cardiolipin/cholesterol
40
What happens to the non-treponemal titer as infx is resolved over time?
it decreases
41
What are the types of non-treponemal tests?
- Rapid plasma reagin (RPR) - Venereal Dz Research Lab (VDRL)
42
Treponemal test detects...
antibodies against treponemal antigens
43
What happens to the treponemal titer?
remains (+) after infx resolved
44
What are the types of treponemal tests?
- FTA-ABS (Fluorescent Treponemal Antibody – absorbed) - TP- EIA (T palladium ELISA)
45
If (-) non-treponemal (RPR or VDRL) test, what happens next?
no further testing necessary, unless strong suspicion for either very early primary infx or latent infx
46
If (-) treponemal (FTA-APS or TP-EIA), what happens next?
no further testing considered necessary
47
If either the non-treponemal/treponemal test is (+), what happens next?
perform confirmatory test of opposite type
48
(+) non-treponemal + high titer / positive treponemal means...
syphilis infx
49
(+) initial non-treponemal + low titer / negative FU treponemal means...
likely initial false (+)
50
(+) initial treponemal + (-) FU non-treponemal means...
either - prior tx infx - very early primary infx - late infx
51
Syphilis screening flow chart
DONE
52
What organism causes Chlamydia?
Chlamydia trachomatis
53
Describe chlamydia trachomatis
Intracellular (GNID) pathogen of columnar epithelial cells
54
Is chlamydia a urogenital infx?
YES usually, but can cause non-urogenital infx... - conjunctivitis, pharyngitis, reactive arthritis, proctitis, lymphogranuloma venerum
55
S/Sx of chlamydia
usually asymp --> can have burning during urination &/or discharge
56
Testing for chlamydia & describe how it is obtained
- NAAT --> First-catch urine in men - vag/endocervical swab in women
57
Describe Neisseria gonorrhea.
intracellular pathogen --> gram (-) intracellular diplococci
58
2 diagnostic tests for N. gonorrhea
1. NAAT 2. Gram stain & culture
59
Describe N. gonorrhea gram stain & culture for males
- gram stain of urethral exudate -->If Gram stain(+) for GNID = def dx First catch urine
60
Describe N. gonorrhea gram stain & culture for females
DON'T use gram stain of vaginal discharge - use endocervical swab - (+) GNID = presumptive diagnosis in female **Confirm w/ culture results**
61
What type of infx is gonorrhea?
non-urogenital
62
Gonorrhea can cause which type of conditions(5)?
- conjunctivitis - proctitis - pharyngitis - disseminated gonorrhea - septic arthritis
63
Testing for gonorrhea
- NAAT testing - Gram stain / culture (in some instances)
64
What specimens can be used for gram stain/culture?
- Synovial fluid - Blood cultures - Eye
65
Site of disseminated gonorrhea.
- joints (purulent septic arthritis) - heart (endocarditis) - bone (osteomyelitis) - brain (meningitis)
66
Describe ailments of disseminated syndrome of gonorrhea.
- arthritis-dermatitis - tenosynovitis, - migratory polyarthritis - painless skin pustules - often with fever/malaise as well
67
List the prevalence of gonorrhea/chlamydia/mycoplasma genitalium (highest - lowest)
68
Mycoplasma genitalium is a major cause of...
non-gonococcal urethritis
69
How will a patient present w/ mycoplasma genitalium?
The same as a person w/ gonorrhea-chlamydia, but their testing will be (-) for those conditions
70
Who do we test for mycoplasma genitalium?
anyone who you are testing for Gonorrhea/Chlamydia
71
Testing for Mycoplasma genitalium (men vs women)
NAAT - first-catch urine for men - vaginal swab for women
72
Which herpes virus can cause genital herpes?
HSV 1 & 2
73
Which HSV virus is more likely to cause oral herpes?
HSV-1
74
Which HSV virus is more likely to cause genital herpes?
HSV-2
75
How is HSV usually diagnosed?
clinical dx
76
How does a HSV rash look?
Painful, grouped vesicles, on erythematous base
77
Describe testing methods for HSV
- Tzanck prep--> unroof young vesicle--> multi nucleated cells - Cell culture from early vesicular lesion **gold standard** - Viral PCR from lesion swab* - Direct fluorescent testing - Serum Ab testing
78
Which HSV test can detect asymptomatic shedding of the virus?
viral PCR from lesion swab
79
What is the most common STD in the US & the world
Human Papilloma Virus (HPV)
80
What % of sexually active adults have been infected w/ HPV?
>75%
81
HPV is associated w/ what conditions?
ano/genital dysplasia & epithelial (squamous cell) CAs
82
What conditions can HPV cause?
- Condylomata accuminata (genital warts)--> non-CA - Cervical CA - Oropharyngeal CA
83
HPV diagnostics
limited to cervical specimens
84
What other testing can be done for HPV?
testing CA samples for HPV DNA
85
What vaccine can be used to protect against strains of HPV & most likely ones to causes cervical cancer?
Gardasil
86
What is the most common non-viral, non-bacterial STI in the US?
trichomoniasis
87
What organism causes trichomoniasis?
Trichomonas vaginalis
88
What are the testing options for Trichomoniasis?
- direct visualization on wet prep - culture - Rapid antigen tests - NAAT
89
NOTE
You have to see the trichomonas vaginalis & you have to see it moving to say its (+)
90
How long does a trichomoniasis culture take?
about 48 hours
91
What is the GS testing for trichomoniasis?
NAAT
92
What is Leptothrix?
long bacteria often present with trichomonas --> if seen you should also check for trichomonas vaginalis
93
Is chancroid rare or common?
RARE
94
Describe a chancroid.
Genital ulcers, often necrotic or erosive and painful
95
What differentiates a chancroid ulcer from syphilis ulcer?
- chancroid is painful - syphilis is painless
96
Testing for chancroid
- Culture - PCR (only available through regional labs)
97
Organism that causes crab louse
Pthirus pubis
98
Crab louse dz is called...
Pediculosis pubis
99
How does crab louse (pthirus pubis) survive?
feeds on human blood
100
How will a pt present w/ crab louse?
itching
101
Does crabs louse embed in the skin or stay on the surface?
stays on surface - eggs are on the pubic hairs
102
Crab Louse Dx
visualization of louse or eggs
103
What organism causes scabies?
Sarcoptes scabiei
104
Describe a scabies rash
Pruritic papular rash
105
Does scabies embed in the skin or stay on the surface?
embedded into skin
106
Scabies Dx
skin scraping
107
Indications for a vaginal wet prep
- Vaginal discharge/odor - Vulvar or vaginal itching - Vaginal or lower abdo pain
108
Describe the vaginal wet prep procedure
- Cotton swab used to get sample of vaginal discharge/cervix - Swab placed in test tube in several drops of saline - One drop is placed on slide w/ coverslip & examined w/ light microscope - KOH test
109
Which part of the vagina should you exam for wet prep and why?
Look at posterior fornix for any pooling of discharge or clumps
110
Vaginal wet prep will give you the following results...
- epithelial cells/types - WBCs - Evidence of infx
111
What are the layers of vaginal epithelium? (outer to inner)
- superficial cells - Intermediate cells - Parabasal cells - Basal cells
112
Describe what seen w/ Superficial Squamous Epithelium
- Normal Squamous Epithelium - Normal Flora (lactobacilli) - a few WBCs
113
Describe to look of Superficial Squamous Epithelium
- “fried eggs” - irregular borders - Mostly cytoplasm, nucleus appears small
114
Parabasal squamous epithelium is seen in...
- estrogen deficiency - traumatic exfoliation of vaginal lining -vaginal wall atrophy
115
Parabasal Squamous Epithelium are similar to what cells in the kidney system?
transitional cells
116
Seeing basal squamous epithelium indicates...
extremely atrophic or deeply ulcerated vaginal mucosa
117
Describe basal squamous epithelium
Simple cuboidal cells --> when free they look more rounded
118
Basal Squamous Epithelium are similar to what cells in the kidney system?
renal tubular epithelial cells
119
Which organisms elicit an immune response?
- Trichomonas - Candida - Herpes - Gonorrhea - Chlamydia
120
Which bacteria does NOT cause an immune response?
Gardnerella vaginalis
121
What is the most common cause of a yeast infx?
candida albicans
122
Describe what is seen when a person has a yeast infx?
- budding yeast &/or hyphae - Small amount normally found; overgrowth is infx
123
Is a yeast infx an STI?
NO
124
Testing used for a yeast vaginal infx?
KOH test
125
What bacteria causes bacterial vaginosis?
Gardnerella vaginalis
126
Describe bacterial vaginosis.
NOT an STI - an overgrowth of normal flora
127
Does bacterial vaginosis have a WBC response?
NO
128
Testing proof of bacterial vaginosis
"Clue cells"
129
Bacterial vaginosis can result in...
urethritis
130
Describe clue cells
bacteria attaches itself to the squamous cells & obscures the edges; looks sandy in appearance
131
What can be the cause of whitish clumps & vaginal itching not due to yeast infx?
- azithromycin - douching
132
What is actually causing the white clumps not caused by yeast infx?
sheets of squamous epithelial cells

Block 4 - OBGYN (5 decks)

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