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Repro Week 4 > ICL 8.4: STIs > Flashcards

ICL 8.4: STIs Flashcards

1
Q

what are the common STDs in the US?

A
  1. syphilis
  2. gonorrhea
  3. HSV
  4. chalmydia
  5. trichomonad
  6. HIV
  7. HPV
  8. Hepatitis A,B,C
  9. public lice
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2
Q

what type of treatment regimens do we want for STDs?

A

simple, one dose curative treatment!!!

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3
Q

what are the 5P’s of sexual history?

A

partners

practices

prevention of pregnancy

protection from STDs

past history of STDs

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4
Q

what are the characteristics of gonorrhea?

A

nonmotile non spore forming gram negative intracellular diplococci

may have pili which increase virulence by allowing better attachment to mucosal surfaces

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5
Q

what are the mechanisms of drug resistance of gonorrhea?

A
  1. chromosomal mediated
  2. plasmids
  3. transfer of naked DNA
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6
Q

what is the pathology of gonorrhea infections?

A

primarily infects columnar or cuboidal epithelium via attachment of bacteria to epithelium

bacteria then penetrate through and between epithelial cells

neutrophil response results in purulent discharge

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7
Q

how common is gonorrhea?

A

1 million cases/year in the US

sexual itnercourse and perinatal transmission are the 2 most common routes of transmission

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8
Q

what is gonorrhea in men?

A

most commonly recovered organism in acute urethritis in men under 35

90% of men with urethras gonorrhea infection are symptomatic however the majority of rectal and pharyngeal infections are asymptomatic

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9
Q

what are the symptoms of gonorrhea in men?

A
  1. abrupt onset of copious discharge and dysuria
  2. anorectal FC can be associated with proctitis
  3. pharyngeal GC is usually asymptomatic; harder to eradicate than the other types
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10
Q

what are the symptoms of gonorrhea in women?

A

most are asymptomatic…..

if symptomatic, vaginal discharge and prururitis are most common complains

can sometimes have pain

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11
Q

what are the severe presentations of gonorrha?

A
  1. PID = abdominal pain, adnexal.cervical tenderness, fever
  2. Fitz-Hugh Curtis syndrome

perihepatitis associated with PID resulting in RUQ

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12
Q

what is disseminated gonorrhea?

A

usually more common in women

two classic forms:
1. tenosynovitis, dermatitis, polyarthalgia syndrome = fever, ashiness, inflamed tendons, scattered pustules

derma

  1. septic arthritis
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13
Q

how do you diagnose gonorrhea?

A

gram stain of urethral discharge in symptomatic men –> 99% specific and 95% sensitive when PMNs and gram negative intracellular diploccoi are seem

DNA probes, NAAT, PCR are all types of non-culture methods for diagnosis of GC which are good for urine, endocervical specimens, and urethral swabs

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14
Q

how do you treat gonorrhea?

A

500 mg ceftriaxone IM single dose + 1 g orally azithromycin for chlamidya

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15
Q

how do you treat gonococcal conjunctivitis?

A

500 mg ceftriaxone IM single dose + 1 g orally azithromycin for chlamidya

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16
Q

how do you treat disseminated gonorrhea?

A

ceftriazone 1 gram IB or IM + azithromycin

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17
Q

how do you treat gonorrhea in pregnant women?

A

250 mg IM ceftriazone plus 1 gm PO azithromycin

doxycycline is not an alternative during pregnancy

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18
Q

which 3 chalmydia species cause disease?

A
  1. C. psittaci (pneumonia)
  2. C. pneumonia (pneumonia)
  3. C. trachomatis

different servars: LGV, etc.

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19
Q

what is the pathophysiology of chlamydia?

A

attaches to epithelial cells and enters to the cell by pinocytosis or endocytosis

it then resides intracellular membrane bound inclusions and growth and replication begins

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20
Q

what is LGV?

A

strain of chalmydia aka lymphogranuloma venereum

endemic in africa, SE asia, india and south america

predominantly a disease of the lymphatic system so associated with lymphangitis, inflammation and fibrosis of regional lymph nodes

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21
Q

what are the stages of LGV?

A
  1. painless ulcer or papule on genitals
  2. lymphadenopathy and systemic complaints 2-6 weeks later – unilateral femoral or inguinal lymphadenopathy with red, swollen tender lymph nodes which can form big abscessed inflammatory masses
  3. in about 20% of untreated cases, strictures of the anogenital tract can occur
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22
Q

how do you diagnose LGV?

A

clinical symptoms usually

can use NAAT with PCR if needed

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23
Q

what is LGV associated with?

A

75% of patients with LGV also have HIV!

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24
Q

how do you treat LGV?

A

doxycycline

25
Q

what is chlamydia trachomatis serovars D-K?

A

urogenital infection resulting in urethritis

dysuria, urethral discharge sometimes but asymptomatic infections are common

26
Q

what are the complications common in untreated chlamydia trachomatis serovars D-K?

A
  1. proctitis
  2. urethritis/epididymitis
  3. endometritis, cervicitis, salpingitis
  4. PID, ectopic pregnancy, infertility
  5. reactive arthritis (Reiter’s syndrome)
27
Q

how do you diagnose chlamydia trachomatis serovars D-K?

A

NAATs

serology, cytology are rarely used

28
Q

how do you screen for chlamydia trachomatis serovars D-K?

A

different recommendations from different groups….

CDC recommends routine annual screening of sexually active women under 25 and older women with new partners/multiple partners/other risk factors – prescreen all women who are treated 3 months later due to high reinfections

29
Q

how do you treat chlamydia trachomatis serovars D-K?

A

azithromycin or doxycycline

azithromycin is preferred because it’s one dose while doxy is twice a day for 7 days

30
Q

what is the big problem with chlamydia trachomatis serovars D-K treatment?

A

abstinence from sexual intercourse is recommended for 7 days after completion of therapy in patients AND sexual partners

this obviously is a problem and reinfection is very high

31
Q

how do you treat chlamydia trachomatis serovars D-K in pregnancy?

A

azithromycin 1 gram by mouth one time – amoxicillin or erythromycin are fine but not doxy

test of use needed 3 weeks after therapy

retesting 3 months after treatment

32
Q

do we screen for chalmydia in pregnancy? why?

A

recommended to prevent neonatal chlamydia infections:

  1. ophthalmia neonatorum whiten 5-12 days of birth
  2. pneumonia
33
Q

what are the characteristics of trichomonas vaginalis?

A

flagellated, motile protozoan

34
Q

how do women vs men present with trichomonas vaginalis?

A

women: asymptomatic to yellow vaginal discharge, dysuria, vulvar itching, dyspareunia, lower abdominal pain –> most common is purulent, copious frothy discharge with foul odor

men are usually asymptomatic

35
Q

how do you diagnose trichomonas vaginalis?

A
  1. wet prep – take vaginal swab and mount on microscope to look for organism but only 60% sensitive
  2. culture is 95% sensitive
  3. NAATs are most commonly sued
36
Q

how do you treat trichomonas vaginalis?

A

metronidazole or tinidazole 2 g orally in single dose

both fine in pregnancy

follow up because reinfection is common so prescreen 3 months after treatment

37
Q

how does trichomonas vaginalis effect pregnancy?

A

adverse outcome in pregnancy like premature ROM, preterm delivery or low birthweight

however, standard treatment doesn’t seem to help these outcomes….

38
Q

what is bacterial vaginosis?

A

not an STD but often confused with trichomonas vaginalis

partners don’t need to be treated

mild to moderate vaginal discharge, thing gray adherent, itching with odor

39
Q

how do you diagnose bacterial vaginosis?

A
  1. homogenous thin white discharge that smoothly coats vaginal walls
  2. clue cells (epithelial cells coated with bacteria)
  3. pH over 4.5
  4. fishy odor og vaginal discharge before or after additional of KOH aka whiff test
40
Q

how do you treat bacterial vaginosis?

A

metronidazole 500 mg orally twice a day for 7 days

41
Q

how does bacterial vaginosis effect pregnancy?

A

adverse outcomes like preterm labor, PROM, intramaniotic infection, endometritis

treatment may improve these but clinical trials have mixed results….treat symptomatic pregnancy women with BV either way though

42
Q

how does HSV present?

A

60% are asymptomatic with primary infection so usually when people walk in it’s actually a reactivation

vesicular lesions that are clustered is the most common – can also form painful ulcers and can affect urethra which can be mistaken for UTI

primary disease lasts up to 3 weeks with regional lymphadenopathy, fever, malaise, anorexia, assertive meningitis –> recurrence occurs in 90% of patients with symptomatic HSV2 genital infections with itching, tingling, burning prior to an eruption but systemic complains are rare

43
Q

how is HSV transmitted?

A

usually it’s transmitted by persons unaware that they have the infection or who are asymptomatic when transmission occurs because they are intermittently shedding the virus in the genital tract

asymptomatic viral shedding is more frequent with HSV2 than HSV1

44
Q

how do you diagnose HSV?

A
  1. Tzanck smear
  2. cutlure
  3. PCR
45
Q

how do you treat HSV?

A

acyclovir

46
Q

how does hSV effect pregnancy?

A

can cause neonatal herpes….

it’s 30-50% for women who acquire genital HSV near term but only 1% in women with a history of genital HSVHSV in the first 1/2 of pregnancy

treat with acyclovir 400 mg 3x daily

47
Q

what causes syphilis?

A

treponema pallidum

48
Q

what is the pathology of syphilis?

A

spirochetes penetrate skin or mucous membranes then enter lymphatics and hematogenously idsseminate

49
Q

what is the presentation of primary syphilis?

A
  1. ulcerated non-tender ulcers = chancres; with hard, smooth clean base
  2. contender inguinal lymphadenopathy often bilateral

serologic tests are positive only 50% of the time at this stage…

50
Q

what is the presentation of secondary syphilis?

A

3-6 weeks after chancre

generalized rash involving the palms, soles oral mucosa and genitals but it isn’t that itchy

can also see sore throat, myalgia, constitutional complaints, patchy alopecia, generalized lymphadenopathy, condylomata lata, oral ulcers

51
Q

what is the presentation of tertiary syphilis?

A
  1. meningitis
  2. dementia
  3. hearing loss
    tabes dorsalis
  4. disease of aorta with potential incompetence/aneurysm
  5. arthralgia
  6. argyll robertson pupil = = accomodates to near vision but doesn’t react to light
  7. gummas
52
Q

when do you screen for syphilis?

A

screen at first prenatal visit and consider prescreen in third trimester

53
Q

how does syphilis effect the fetus?

A
  1. saber shins
  2. saddle nose
  3. Hutchinson/mullbery teeth
54
Q

how do you diagnose syphilis?

A

treponema test for antibodies against T palladium

nontreponemal tests are nonspecific so there’s lots of false positive!

VDRL and RPR are both nontreponemal tests which test for IgG antibodies

titers drop with treatment and eventually become negative

55
Q

how do you treat syphilis?

A

penecillin

no other recommendation!! even if they’re allergic

56
Q

what is a chancroid?

A

infection with gram negative rod H. ducreyi

presents with painful ulcer, ragged edges, painful inguinal lymphadenopathy

often associated with HIV

57
Q

how do you treat a chancroid?

A

azithromycin, ceftriaxone, ciprofloxacin, or erythromycin base

58
Q

what is donovanosis?

A

klebsiella granulomatis that results in painless destructive ulcers without regional lymphadenopathy

omg so horrible looking

59
Q

how do you treat donovanosis?

A

doxycycline, azithromycin, or cipro

Repro Week 4 (16 decks)

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