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MBBS II ERS > L36 - Sexually transmitted diseases > Flashcards

L36 - Sexually transmitted diseases Flashcards

(47 cards)

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1
Q

Define the reservoir, site of entry and transmission of STDs?

A

Reservoir = asymptomatic human carriers, do not survive in environment

Entry:

  • Mucous membrane +/- trauma
  • Minute abrasion in skin surface
  • Local sites: vagina, cervix, urethra, rectum, pharynx, eye)
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2
Q

Define the public health centers for STD?

A

Department of health Social hygiene clinics

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3
Q

Most common STI in HK?

A

Non-gonococcal urethritis/ nonspecific genital infection by Chlamydia trachomatis

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4
Q

3 typical clinical presentation features of STDs?

A
  1. Urethral discharge (urethritis/male).
  2. Genital ulcer (male and female)
  3. Genital lumps (male/female)
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5
Q

List 2 main pathogens that cause urethral discharge/ urethritis?

A
  • Neisseria gonorrhoeae
  • Chlamydia trachomatis

(Asymptomatic: Ureaplasma urealyticum, Mycoplasma genitalium)

(Rare: Herpes Simplex virus, Trichomonas vaginalis, yeasts)

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6
Q

Compare gonococcal and Non-gonococcal urethritis: onset, incubation period, relapse?

A

Gonococcal:

  • 2-5 days
  • Abrupt onset
  • Rare relapse

Non-gonococcal:

  • 7-14 days
  • Gradual onset
  • Common relapse
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7
Q

Compare gonococcal and Non-gonococcal urethritis: dysuria, discharge?

A

Gonococcal:

  • Prominent dysuria
  • Copious discharge

Non-gonococcal:

  • Mild dysuria
  • Scanty, non-purulent discharge
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8
Q

List infections caused by Chlamydia trachomatis serotype A,B,C?

A

Trachoma

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9
Q

List infections caused by Chlamydia trachomatis serotype D to K?

A

Cervicitis, urethritis, pelvic inflammatory disease, neonatal pneumonia

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10
Q

List infections caused by Chlamydia trachomatis serotype L?

A

Lymphogranuloma venereum (LGV)

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11
Q

List infections caused by Chlamydophila/ Chlamydia pneumoniae?

A

Respiratory tract infection (not genital)

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12
Q

How to clinically establish presence of urethritis?

A
  1. P/E
  2. Microscopy: swab for anterior surface of urethra, anal mucosa, endocervix:
    - 1st swab for Gonococcal culture
    - 2nd swab for Chlamydia culture
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13
Q

Which serotypes of chlamydia cause STDs?

A

D to L

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14
Q

Define the medium and culture for gonococcal urethritis?

A

Modified Thayer-Martin medium (nutritive culture media with antibiotics): small, grayish-white mucoid colonies

Incubation: 35 oC, CO2 enriched, humid atmosphere

Never refrigerate, immediate culture

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15
Q

Define the medium and culture for Chlamydial urethritis?

A
  • Need special transport medium and cell culture: McCoy Cell Line shows Chlamydia inclusion bodies
  • Can refrigerate for 24h
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16
Q

Name one test for rapid chlamydia urethritis Dx and give 2 limitations?

A

Antigen detection e.g. Chlamydiazyme

–Less sensitive than culture

–False-positive results from cross reacting bacterial species

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17
Q

Describe the morphology of gonococci and gram stain?

A

Gram-negative diplococci

small mucoid colonies

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18
Q

Pharyngeal gonorrhoea is often asymptomatic in normal adults. T or F?

A

True

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19
Q

Name one test for pharyngeal gonorrhea?

Study These Flashcards
A

Direct fluorescent antibody (DFA) for gonococcal pharyngitis

20
Q

Name one test for detecting both gonococcal and chlamydial urethritis simultaneously? Give 2 advantages?

Study These Flashcards
A

nucleic acid amplification tests (NAAT): e.g. PCR

Higher sensitivity than culture
Performed on non-invasive specimens (e.g. first-void urine)

21
Q

Treatment for urethritis?

Study These Flashcards
A
  • Single dose oral azithromycin/ 7 days oral doxycycline for chlamydial
  • Single dose intramuscular ceftriaxone for gonococcal
22
Q

List 5 common genital ulceration diseases?

Study These Flashcards
A
  • Herpes simplex
  • Syphilis (Treponema pallidum)

Chancroid
Lymphogranuloma venereum (LGV)
Donovanosis

23
Q

Which serotype of HSV causes most genital ulceration?

Study These Flashcards
A

HSV Type I (10%)

HSV Type II (90%)

24
Q

Morphology of Treponema pallidum?

Study These Flashcards
A

Spirochete:

 Helical, slender, long cells

 Flagella within periplasm

25
List the STDs causing multiple genital ulcers vs those causing single?
Single: Syphilis, LGV Multiple: Genital herpes, Chancroid, Donovanosis
26
Ddx STDs causing genital ulcers based on lymph tenderness/ adenopathy?
Tender - Genital herpes, Chancroid, LGV Non-tender - Syphilis, Donovanosis
27
Describe the edge, base and lymphadenopathy of genital ulcers by Herpes?
Edge: Soft (rim of inflammation) Base: Clean Lymphadenopathy: tender
28
Describe the edge, base and lymphadenopathy of genital ulcers by Syhilis?
Edge: Indurated (elevated) Base: Clean Lymphadenopathy: Indolent
29
Describe the edge, base and lymphadenopathy of genital ulcers by Chancroid?
Edge: Soft Base: Dirty, Gray Lymphadenopahty: tender
30
Describe the edge, base and lymphadenopathy of genital ulcers by Donovanosis?
Edge: Serpinginous (wavy), white Base: BEEFY RED** granulation tissue Lymphadenopahty: Erosive lesion over nodes
31
Describe the edge, base and lymphadenopathy of genital ulcers by LGV
Edge: soft Base: eroded papule Lymphadenopahty: PROMINENT* tender
32
Lab Dx tests of Herpes?
TZANCK SMEAR: identify multinucleated giant cells via Wright or Giemsa stain Viral culture
33
Describe how herpes can cause recurrent infection?
Mucocutaneous infection >> spread to local sensory nerve endings >> Maintain neuronal latency >> Reactivation and distal spread again
34
Lab dx test for Syphilis?
Serology- detect specific antibodies: 1) Non-trepenamal specific test: Time-specific: VDRL, RPR tests 2) Treponemal specific tests: syphilis specific: TPPA, FTA-abs, EIA-syphilis test Need both for Dx**
35
Antibody detection can Dx syphilis as soon as genitla ulcerations appear. T or F? *exam*
False Ulceration/ primary syphilis may appear before development of detectable antibodies
36
Describe the time course of syphilis infection? *exam*
[Early syphilis (<2 years)] Infection >> primary syphilis (9-90 days) >> secondary s. (6 weeks to 6m) >> Early latent up to 2 years [Late syphilis (>2 years)] >> Late latent (3 to 30 years)**
37
Disease outcome of syphilis?
 1/3: spontaneous cure  1/3: persistent latent  1/3: tertiary syphilis Infectivity decrease rapidly with time
38
Describe the pathological damage caused by primary and secondary syphilis?
Primary = Local multiplication > ulceration > healing Secondary = Bloodstream dissemination > Localized at BV > lesion in skin, mucosa, LN, CNS
39
Which organs are involved in latent syphilis?
spleen, lymph nodes
40
How to clinically Dx Chancroid? Treatment?
- P/E: tenderness, ulceration, base, edge...etc - Due to unreliable culture: Dx if no evidence of syphilis and HSV –single dose of azithromycin or single dose Ceftriaxone
41
Treatment options for genital ulceration?
Single dose azithromycin + single dose Ceftriaxone covers Gonorrhoea, Chlamydia trachomatis, Chancroid *Must always consider asymptomatic syphilis or HIV*
42
How to Dx Genital lumps?
- No culture - No routine serology tests: only test if high-risk HPV suspected - Dx based on exam and clinical presentation **
43
Causative pathogen of genital lumps?
Human papilloma virus (HPV): > 100 types causing genital warts
44
Which serotypes of HPV mainly cause mucotaneous diseases at genitals?
* Genital warts = 6, 11 *** | * Laryngeal papillomata = 6, 11 •Oral papillomata = 6, 11, 16, 18,
45
Incubation period of HPV and disease course?
Incubation period 1 to 6 month Most HPV infections are selflimited and are asymptomatic
46
Clinical presentation of genital lumps caused by HPV?
Superficial, clusters of warts with grey appearance on the penis, vulva & perianal regions.
47
Which HPV serotypes should be screened by serology?
HPV types associated with cervical cancer (esp. 16 & 18)

MBBS II ERS (37 decks)

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