GU: STIs - I Flashcards
(46 cards)
1
Q
STIs in general
- are most common / severe in what populations?
- usually present how?
- can lead to what complications?
A
adolescents/adults
- demographics
- m/c in adolescents / young adults
- complications typically more severe in women
- can lead to
- inc risk of acquiring HIV
- in women
- PID (which can cause → infertility/ectopic pregnancies)
- fetal STI
2
Q
what STIs can cause genital ulcer? which is the m/c in the US?
A
- genital herpes, syphilis, chancroid, granuloma inguinale, lymphogranuloma venerum
- genital herpes = m/c in US
3
Q
genital herpes is
- caused by what agents?
- transmitted how?
A
-
HSV-2 (m/c).
- transmitted either
- sexually
- from mother to newborn
- transmitted either
-
HSV-1
- transmitted by genital contact with infected saliva / oral lesions
4
Q
genital herpes - presentation
A
- usually is asymptomatic
- if symptomatic, typically most severe in initial infection:
-
painful genital lesions progressing from red base → vesicles → ulcers
- in women: these lesions can cause “external dysuria” painful urination right at external urethra
- lymphadenopathy in inguinal / pelvic / femoral nodes
-
systemic affects
- headache/malaise myalgia
-
painful genital lesions progressing from red base → vesicles → ulcers
5
Q
genital herpes - complications
A
HSV can be passed from a mother to her fetus during delivery
6
Q
during delivery, newborns can develop disseminated infections from what etiological agents?
A
TORCH:
T- Toxoplasma gondii
O- other: HIV, VZV, Parvovirus, Syphilis, Borrelia
R- Rubella
C- CMV
H- HSV
7
Q
transmission of HSV to neonate in HSV + pregnant women
- what makes transmission risk high/low?
- what measures are taken to prevent transmission?
A
- high vs low risk
- high risk:
- acquired HSV (primary infection) near delivery
- low risk: if mother has
- recurrent herpes
- acquired HSV (primary infection) in 1st half of pregnancy
- high risk:
- preventative measures
-
asymptomatic pt: cervicovaginal swab during delivery just to check
- if + for virus: treat neonate with antiviral
-
pt with genital herpes dx:
- if not currently active: treat neonate with antiviral
- if prodrome/active lesions: delivery by C-SECTION
-
asymptomatic pt: cervicovaginal swab during delivery just to check
8
Q
what role does therapy have in the management of HSV?
A
- anti-virals
- do
- make recurrences less frequent/less severe
- reduce risk of sexual transmission of HSV-2 to another person
- do not
- have any affect on latency
- do
9
Q
syphilis - etiological agent
A
treponema pallidum
10
Q
syphilis - presentation
A
syphilis has 3 phases of presentations
- primary (right after infection)
-
chancre + regional lymphadenopathy
- chancre = PAINLESS, indurated (hard)
-
chancre + regional lymphadenopathy
- secondary (6-8 weeks after chance)
- non-systemic
- patchy alopecia
- mucous patches on tongue
- condyloma lata - wart like lesions
- systemic - malaise /arthralgia / fever
- non-systemic
- tertiary (if secondary not cured) - gummas, CV affects
11
Q
syphilis - primary presentation
A
-
painless chancre + regional lymphadenopathy
- chancre = painless, hard, indurated
12
Q
syphilis - secondary presentation
A
- non-systemic
- patchy alopecia
- mucous patches on tongue
- skin presentations
- maculopapular rashes on palms, soles
- condylomata lata (wart like lesions)
- systemic - malaise /arthralgia / fever
13
Q
what can happen is syphilis is untreated and becomes latent?
A
- relapse of secondary
- tertiary syphilis
14
Q
congenital syphilis - presentation
A
- stillborn, or
- is a “secondary” syphilis presentation that occurs in 2 phases
- early presentation
- skin manifestations: maculopapular rash / condyloma lata, tongue mucous patch
-
organ defects - liver/kidney/spleen/bone
- hepatosplenomegaly
- glomerulonepphritis
- osteochondritis
- late presentation = developmental defects
-
bone
- clutton’s joints
- saber shins
- saddle nose
-
teeth
- Hutchinson teeth
- mulberry molars
-
bone
- early presentation
15
Q
congenital syphilis - early presentation
A
skin manifestations + organ defects
-
skin manifestations (same as adults)
- maculopapular rash
- condyloma lata
- tongue mucous patch
-
organ defects
-
liver / kidney / spleen/ bone
- hepatosplenomegaly
- glomerulonephritis
- osteochondritis
-
liver / kidney / spleen/ bone
16
Q
congenital syphyllis - late presentation
A
= developmental defects
-
bone
- clutton’s joints
- saber shins
- saddle nose
-
teeth
- Hutchinson teeth
- mulberry molars
- rhagades
17
Q
what is this image showing?
when is this seen?
A
chancre
primary syphilis in adult (painless)
18
Q
what is this image showing?
when is it seen?
A
condyloma lata - wart like lesions
secondary syphilis / early presentation congenital syphilis
19
Q
what is this?
when is it seen?
A
tongue lesion
secondary syphilis
20
Q
what is this?
when is it seen?
A
Clutton’s joint
late presentation congenital syphilis
21
Q
what is this?
when is it seen?
A
Hutchinson teeth
late presentation congenital syphilis
22
Q
what is this?
when is it seen?
A
saber shins
late presentation congenital syphilis
23
Q
what is this?
when is it seen?
A
saddle nose
late presentation congenital syphilis
24
Q
what is this?
when is it seen?
A
mulberry molar
late stage congenital syphilis
25
what is this?
when is it seen?
rhagades
late presentation congenital syphilis
26
dx of syphilis
* first - do a reagin test: VDRL, RPR
* issue is these give a lot of false positives
* second - do confirmatory **(treponemal)** tests: FTA-AB
* much more accurate
27
chancre
* caused by what agent?
* is transmitted how?
* demographics?
* presentation?
* ***haemophilus ducreyi***
* almost exclusively by **sexual contact**
* seen often in _prostitution_
* presentation
* **PAINFUL chancre +** **lymphadenopathy**
* chancer is
* _painful_
* _soft - NOT indurated/ hard_
* ulcerated
* +/- present in multiples
* lymphadenopathy
* _painful_
* often significant
28
granuloma inguinale
* cause?
* transmitted how?
* demographics?
* presentation?
* ***klebsiella granulomatous***
* transmitted - sexually
* demographics
* seen mostly in the **tropics: _think of foreign travelers_**
* presentation
* **painless ulcers + subcutaneous granulomas**
* ulcers
* are PAINLESS
* have **rolled border** on a **beefy, cobblestone base**
* _bleed following contact_
* subcutaneous granulomas
* are in inguinal region, but not in lymph nodes
29
*klebsiella granulomatous* has what
* characteristics?
* virulence factors?
* intracellular **gram negative rod**
* have a _safety pin like appearance d/t bipolar staining:_ when they collect in vacuoles in WBCs, = **donovan bodies**
* virulence factors - prevent phagocytosis
* capsule
* polysaccharide
30
lymphogranuloma veneruem
* cause
* transmitted how?
* demographics?
* presentation?
* manifestations?
* ***chlamydia trachomatis***
* transmitted - sexually
* demographics - _tropic/subtropical Africa/Asia_
* presentation - **painless herpetiform lesions**
* complications
* **primary inguinal syndrome: lymphadenitis + systemic sx**
* **genito-anorectal syndrome: rectal strictures + genital elephantitis**
* late manifestations
* draining fistulas
* abscess formation
* urethral destruction
31
what is primary inguinal syndrome
* cause
* presentation
* cause - LGV (*clamydia trachomatis*)
* = lymphadenitis that develops after LGV lesions heals
* presentation
* **painful**
* **systemic sx**
* fever / chills + headache + anorexia
* **hypergammaglobulemia**
* **splenomegaly**
32
genito - anorectal syndrome
* cause
* presentation
* cause - LGV (*chlamydia trachomatis*)
* presentation
* **rectal stricture**
* **genital elephantitis**
33
chance
**soft, painless chance**
d/t *h. ducreyi*
34
**donovan bodies** - WBCS containing vacuoles filled with *klebsiella granulomatous* - have a safety pin appearance d/t _bipolar staining_
seen in granuloma inguinale
35
**subcutunaeous granulomas**
granuloma inguinale
36
**painless, herpetiform ulcers**
lymphogranuloma venerum (LGV)
37
draining fistula
manifestation of LGV
38
**genital elephantiasis**
seen in genito-anorectal syndrome, a complication of LGV
39
**rectal stricture**
seen in genito-anorectal syndrome, a complication of LGV
40
tzanck cell
seen in HSV (genital herpes)
41
**spirochetes (treponema pallidum)**
seen in syphilis
42
granuloma inguinale
ulcer:
* painless
* beefy red on a rolled base
* bleed following contact
43
HSV
ulcers - (red → vesicular → ulcers); VERY painul & can cause **_externa_**l dysuria
44
granuloma inguinale
subcutnaeous granuloma not associated with lymph nodes
45
klebsiella granuloma
donovan bodies
46
ulcers:
* _painless_
* beefy red with rolled borders
* bleed following contact
granuloma inguinale
