Sec 32 Sexually Transmitted Diseases Flashcards Preview

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Flashcards in Sec 32 Sexually Transmitted Diseases Deck (126):
1

Etiologic agent: Syphilis

Treponema pallidum pallidum

2

Etiologic agent: Chancroid

Haemophilus ducreyi

3

Etiologic agent: Lymphogranuloma venereum

Chlamydia trachomatis

4

Etiologic agent: Granuloma inguinale

Klebsiella granulomatis

5

Etiologic agent: Gonorrhea

Neisseria gonorrheae

6

Etiologic agent: Chlamydia

Chlamydia trachomatis

7

Etiologic agent: Genital mycoplasma

Mycoplasma sp.
Ureaplasma sp.

8

Etiologic agent: Trichomoniasis

Trichomonas vaginalis

9

Etiologic agent: Bacterial vaginosis

Polymicrobial

10

Characterized by one or more chancres in presence of laboratory evidence

Primary syphilis

11

Starts as a dusky red macule that evolves into a papule then to a round-to-oval ulcer with sharply demarcated regular, raised borders that are indurated giving a cartilaginous feel

Chancre

12

Retraction of the foreskin when a chancre is present on the underside causes foreskin to flip suddenly

Dory flap

13

Unilateral labial swelling with rubbery consistency and intact surface indicative of deep-seated chancre

Edema induratum

14

Characterized by localized or diffuse mucocutaneous lesions, often with generalized lymphadenopathy in the presence of laboratory evidence from tissues or sera

Secondary syphilis

15

Lesions of secondary syphilis that erupts 3-12 weeks after the chancre erupts

Syphilids

16

Erythematous macules in secondary syphilis

Roseola syphilitica

17

A white scaly ring on the surface of papulosquamous lesions in secondary syphilis

Biette's collarette

18

Seborrheic dermatitis-like lesions around the hairline in secondary syphilis

Crown of Venus
corona veneris

19

Plantar lesions mistaken for calluses in secondary syphilis

Clavi syphilitici

20

Confluence of mucous patches on the tongue in secondary syphilis

Plaques fauches en prairie

21

Rare manifestation that presents as crusted or scaly papules and plaques that can ulcerate or become necrotic with lesions described as rupioid

Malignant lues

22

Without treatment, the secondary stage recedes in

4-12 weeks

23

Hallmark of late benign syphilis

Gumma

24

Nontender pink to dusky red granulomatous nodular lesion with variable central necrosis which commonly affect skin or mucous membranes common in scalp, forehead, buttocks, presternal, supraclavicular or pretibial areas

Gumma

25

Two syndromes commonly associated with late neurosyphilis

1. Dementia paralytica
2. Tabes dorsalis

26

Presents with sensory ataxia and bowel & bladder dysfunction resulting from damage to the posterior columns of the spinal cord which can be accompanied by an Argyll-Robertson pupil (accommodates but does not react to light)

Tabes dorsalis

27

Presents as a rapidly progressive dementia accompanied by personality changes in late tertiary syphilis

Dementia paralytica

28

Treatment: Primary or Secondary or Early latent syphilis

Benzathine penicillin G 2.4 M units IM single dose (both HIV-uninfected and -infected)
Alt - Doxycycline 100mg orally BID for 14 days

29

Etiologic agent: Pinta

Treponema carateum

30

Etiologic agent: Yaws

Treponema pallidum pertenue

31

Etiologic agent: Bejel or Endemic syphilis

Treponema pallidum endemicum

32

Treatment: Nonvenereal treponematoses

Benzathine penicillin G 1.2 M units IM single dose (>10 years old
Benzathine penicillin G 0.6 M units IM single dose(<10 years old)

33

Treatment: Chancroid

Azithromycin 1g orally single dose
Ceftriaxone 250mg IM single dose
Ciprofloxacin 500mg orally BID for 3 days
Erythromycin 500mg orally QID for 7 days

34

Treatment: Lymphogranuloma venereum

Doxycycline 100mg orally BID for 3 weeks (1st line)
Erythromycin 500mg orally QID for 3 weeks (2nd line)
Azithromycin 1g orally once weekly for 3 weeks (3rd line)

35

Treatment: Granuloma inguinale

Doxycycline 100 BID orally for 3 weeks or until lesions heal (CDC)
Azithromycin 1g on Day 1 then 500mg OD for 3 weeks or until lesions heal (WHO)

36

Treatment: Uncomplicated Gonococcal infection

Ceftriaxone 125mg IM single dose or
Cefixime 400mg PO single dose

37

Treatment: Disseminated Gonococcal infection

Ceftriaxone 1g IM or IV every 24 hours until improvement noted

38

Treatment: Gonococcal infection in Neonates

Ceftriaxone 25-50 mkday IV or IM OD for 7 days (10-14 days if with meningitis)

39

Treatment: Chlamydia

Azithromycin 1g PO single dose or
Doxycycline 100mg PO BID for 7 days

40

Treatment: Trichomoniasis

Metronidazole 2g PO single dose or
Tinidazole 2g PO single dose

41

Treatment: Bacterial vaginosis

Metronidazole 500mg PO BID for 7 days
or
Metronidazole gel 0.75% 5g intravaginal OD for 5 days
or
Clindamycin cream 5% 5g intravaginal OD for 7 days

42

Ranges in diameter from a few millimeters to 2 cm and is sharply demarcated with regular, raised borders that are indurated, giving the lesion a cartilaginous feel; base is usually clean, and is classically not painful

Hunterian chancre or “ulcus durum” (hard
ulcer)

43

Relapses of primary syphilis

Monorecidive syphilis or chancre redux

44

Present as moist, flat, well-demarcated papules or plaques with macerated or eroded surfaces in intertriginous areas, commonly in the labial folds in females or in the perianal region in all patients

Condyloma lata

45

Pigmentary changes in Syphilis from inhibition of melanogenesis

Leukoderma colli syphiliticum or, if on the neck, “necklace of Venus”

46

A type of mucous patch of secondary syphilis that can be present at the angle of the mouth, with a characteristic slit traversing its center

Split papule

47

An asymptomatic stage with no clinical findings, with seroreactivity by definition the only evidence of infection; which is a diagnosis of exclusion

Latent syphilis

48

Refers to a solitary gumma of the penis

Pseudochancre redux

49

Responsible for most deaths caused by syphilis

Cardiovascular manifestations:
Syphilitic aortitis leading to aortic regurgitation
Coronaryostial stenosis
Saccular aneurysm

50

Any stage of infection and a reactive CSF-VDRL

Confirmed Neurosyphilis

51

Any stage of infection, a nonreactive CSF-VDRL, elevated protein or white blood count without other known causes of those abnormalities, and clinical symptoms or signs of neurosyphilis without other known causes for those symptoms or signs

Probable Neurosyphilis

52

Most common ophthalmic manifestation of early neurosyphilis, presenting as eye pain, redness, and photophobia

Uveitis

53

Most common manifestation of otologic syphilis

Sensorineural hearing loss

54

Refers to syphilis caused by infection in utero with T. pallidum

Congenital syphilis

55

Signs of disease in an infant or child with specific laboratory evidence of infection with T. pallidum

Confirmed Congenital syphilis

56

Condition affecting an infant whose mother had
untreated or inadequately treated syphilis at delivery,
regardless of signs in the infant, or an infant or child
who has a reactive treponemal test for syphilis and evidence of congenital syphilis on physical examination
or radiographs of long bones, a reactive CSF-VDRL,
an elevated CSF cell count or protein (without other
known cause), or a reactive FTA-ABS IgM antibody
test or IgM enzyme-linked immunosorbent assay

Probable Congenital syphilis

57

Probability of transmission of Syphilis infection

70-100% in primary syphilis
40% for early latent syphilis
10% for late latent syphilis

58

Syphilis in a child aged <2 years

Early congenital syphilis

59

Early congenital syphilis

Persistent rhinitis (“snuffles”)
Hydrops fetalis (edema)
Lymphadenopathy
Neurosyphilis,
Leukocytosis, thrombocytopenia
Periostitis and osteochondritis, with the pain
associated with osteochondritic lesions causing the infantto refuse to move the affected anatomic area (“pseudoparalysis of Parrot”)
Bullous rash (“syphilitic pemphigus”)

60

Child with Syphilis at least 2 years old that typically
manifests over the first two decades of life

Late congenital syphilis

61

Late congenital syphilis

Scars (“rhagades”) resulting from cutaneous fissures
Saddle-nose deformity, resulting from destruction of nasal cartilage from snuffles
Frontal bossing (Olympian brow)
Thickening of the sternoclavicular portion of the clavicle (Higoumenakis sign)
Anterior bowing of the midtibia (saber shins),
Scaphoid scapula
Peg-shaped notched central incisors (Hutchinson teeth) Mulberry molars

62

Hutchinson triad

Hutchinson teeth
Interstitial keratitis
Eighth nerve deafness

63

Diagnostic test of choice in chancres, moist lesions of secondary syphilis (condylomata lata and mucous patches), and the discharge from rhinitis in congenital syphilis

Darkfield microscopy

64

Histopathology: granulomas with central zones of acellular necrosis; endarteritis obliterans
and angiocentric plasma cell infiltrates of dermal
blood vessels can also be present

Tertiary syphilis

65

Nontreponemal tests

Venereal Disease Research Laboratory (VDRL)
Rapid plasma reagin (RPR)

66

In a small percent of secondary syphilis cases, very high antibody titers inhibit test reactivity, producing a false-negative result called

Prozone phenomenon

67

Treponemal tests

T. pallidum particle agglutination (TPPA) test
Microhemagglutination assay for T. pallidum (MHA-TP)
Fluorescent treponemal antibody absorption assay
(FTA-ABS)
T. pallidum haemagglutination test (TPHA)
Treponemal enzyme immunoassays (EIAs)
Immunochemiluminescence assays

68

Treatment: Penicillin-allergic persons with syphilis who are not pregnant and do not have neurosyphilis

Doxycyline

69

Treatment success in Syphilis is generally defined as

A fourfold decline in serologic nontreponemal titer (or reversion to nonreactive result) following appropriate treatment

70

A fourfold titer increase following appropriate treatment
indicates

Reinfection or treatment failure

71

Self-limited clinical syndrome consisting of fever, headache, flare of mucocutaneous lesions, tender lymphadenopathy, pharyngitis, malaise, myalgias, and leukocytosis which occurs within 12 hours of initiating therapy and resolves within 24–36 hours

Jarisch–Herxheimer reaction

72

Most benign of the endemic treponematoses with the skin being the only organ of involvement

Pinta

73

Most prevalent nonvenereal treponematosis and the most destructive and disfiguring skeletal involvement

Yaws

74

Second line treatment for Nonvenereal treponematoses

Erythromycin
Doxycyline
Tetracycline

75

Incubation period of chancroid

3-7 days no more than 10 days

76

Usually tender and or painful not indurated (soft chancre) with diameter varying from 1 mm to 2 cm
and most are found on the external or internal
surface of the prepuce, on the frenulum, or on the glans

Chancroid

77

Painful inguinal adenitis occurs in up to 50% of patients within a few days to 2 weeks after onset of the primary lesion usually unilateral with erythema
of the overlying skin

Buboes

78

The three classic etiologic agents for genital ulceratio

1. H. ducreyi
2. Treponema pallidum
3. Herpes simplex

79

Single lesion extends peripherically and shows extensive ulceration

Giant chancroid

80

Lesion that becomes confluent, spreading
by extension and autoinoculation. The groin or thigh may be involved.

Large Serpiginous Ulcer
(Ulcus molle serpiginosum)

81

Variant caused by superinfection with
fusospirochetes. Rapid and profound
destruction of tissue can occur.

Phagedaenic Chancroid
(Ulcus molle gangraenosum)

82

Small ulcer that resolves spontaneously in a few days may be followed 2–3 weeks later by acute regional lymphadenitis.

Transient Chancroid
(Chancre mou volant)

83

Multiple small ulcers in a follicular distribution.

Follicular Chancroid

84

Granulomatous ulcerated papule may
resemble donovanosis or condylomata lata.

Papular Chancroid
(Ulcus molle elevatum)

85

Most frequent complaint in Chancroid

Local pain

86

Complications of Chancroid

Painful inguinal adenitis (up to 50%)
Spontaneous ruptures of inguinal buboes with occurrence of large abscesses and fistula formation
Spreading of Haemophilus ducreyi to distant sites
(kissing ulcers and/or extragenital lesions due to autoinoculation)
Esophageal lesions in HIV patients
Acute conjunctivitis
Bacterial superinfection (including anaerobs) leading
to extensive destruction
Scarring leading to phimosis
Erythema nudism
Enhanced HIV transmission

87

DOC for pregnant patients with Chancroid

Ceftriaxone

88

A sexually transmitted disease due to specific Chlamydia variants contracted by direct contact with infectious secretions

Lymphogranuloma venereum (LGV)

89

Two distinct morphologic forms of Chlamydiae

1. the small metabolically inactive and infectious elementary body
2. the larger metabolically active and noninfectious
reticulate body

90

5-to-8-mm painless erythematous papule(s) or small
herpetiform ulcers appear at the site of inoculation; heals within a few days, and may go unnoticed

Primary stage of LGV

91

Marked LN involvement and hematogenous dissemination

Secondary stage of LGV

92

Characterized by inguinal and/or femoral LN involvement and is the major presentation in
men

Acute genital syndrome (GS) or inguinal syndrome

93

Pathognomonic of LGV

Nodal enlargement on either side of the inguinal ligament, the “groove sign,”

94

Characterized by perirectal nodal involvement, acute hemorrhagic proctitis, and pronounced systemic symptoms

Acute anorectal syndrome

95

In women with untreated ArS, and includes rectal
strictures (most common) and abscesses, perineal
sinuses, rectovaginal fistulae (leading to “watering
can perineum”), and “lymphorrhoids” (perianal
outgrowths of lymphatic tissue)

Tertiary stage of LGV

96

Diagnostic of LGV

Positive on lymph node aspirate

97

Most commonly used test with titers greater than 1:256 are highly suggestive of LGV and titers below 1:32 exclude the diagnosis

Complement fixation test

98

The earliest diagnostic modality to identify LGV which consists of an intradermal skin test assessing delayed hypersensitivity to chlamydial antigens but no longer used because of its low sensitivity and limited specificity due to cross reaction with C. trachomatis D-K

Frei test

99

In Donovanosis, single or multiple papules or
nodules later develop and grow into a painless ulcer that may extend to the adjacent tissues and moist folds, forming

Kissing lesions

100

Commonly presents as beefy red, easily bleeding, foul-smelling ulcer, which may have hypertrophic or verrucous borders, with granulation tissue; may also present as soft, red nodules that eventually ulcerate

Granuoma inguinale

101

The infectious form in Chlamydiawhich enters host cells through endocytosis

Eelementary body

102

Most common manifestation of Chlamydia which is
characterized by a watery or mucoid discharge
from the urethra that may be accompanied by variably
severe dysuria in both men and women

Urethritis

103

Gonorrhea can also be transmitted vertically from
mother to child during normal vaginal birth, characteristically causing an inflammatory eye infection characterized by profuse, purulent ocular discharge

Ophthalmia neonatorum

104

The most common manifestation of gonococcal infection in men, characterized by a spontaneous, often
profuse, cloudy or purulent discharge from the penile
meatus

Urethritis

105

In some cases, there is so much soft tissue
inflammation that the entire distal penis becomes
swollen, so-called

Bull head clap

106

A manifestation of gonococcal infection
manifesting in those who practice unprotected
anoreceptive intercourse; symptoms may include a rectal mucopurulent discharge, pain on defecation, constipation, and tenesmus

Proctitis

107

Occurs in about 10-40% of uncomplicated
gonorrheal infections in women and is characterized
by fever, lower abdominal pain, back pain, vomiting,
vaginal bleeding, dyspareunia, and adnexal or cervical
tenderness during movement associated with a pelvic
examination

Pevic inflammatory disease

108

This involves inflammation of the liver capsule associated with genitourinary tract infection and may be present in up to one-fourth of women with PID caused by either N. gonorrhoeae or C. trachomatis. Presenting symptoms include right upper quadrant pain and tenderness with abnormal liver function tests.

Fitz-Hugh-Curtis syndrome

109

Spread of infection from the primary site of inoculation to other parts of the body through the bloodstream leads to this which occurs in 0.5-3% of cases and is associated with a classic triad of dermatitis,
migratory polyarthritis, and tenosynovitis.

Disseminated gonococcal infection (DGI), also known as gonococcemia

110

The cutaneous lesions of DGI with concurrence of some degree of hemorrhage and necrosis

Gun metal gray

111

Considered diagnostic for infection with N. gonorrhoeae in symptomatic men

Gram stain of a urethral specimen that demonstrates
polymorphonuclear leukocytes with intracellular
Gram-negative diplococci

112

Gold standard diagnostic test for years for N. gonorrhoeae

Bacterial culture

113

Media for bacterial culture of N. gonorrhoeae

Modified Thayer-Martin medium

114

Permanent sequelae of gonococcal infection in women

Infertility

115

The area most commonly affected in men and women with Chlamydia

Urogenital tract infection

116

Can occur up to 1 month after symptoms of nongonococcal urethritis (NGU) with classic triad associated with this syndrome is NGU, arthritis, and conjunctivitis.

Reactive arthritis

117

Individuals with the haplotype are at increased risk of developing the reactive arthritis syndrome.

HLA-B27

118

Smallest, free-living, self-replicating bacteria, developed
by degenerative evolution from lactobacilli, and lack
a cell wall

Mycoplasma

119

STD caused by parasitic protozoan that infects mucosal epithelium, causing microulceration

Trichomoniasis

120

Specific sign of trichomoniasis with punctate hemorrhages may be seen on the vaginal wall and cervix

Colpitis macularis or “strawberry cervix”

121

Most common diagnostic test in Trichomoniasis

Saline wet mount

122

Drug-drug interaction with Imidazoles

Cimetidine
Warfarin
Phenytoin
Lithium

123

Most common vaginal infection in women of
childbearing age

Bacterial vaginosis

124

Apolymicrobial syndrome that occurs when
there is an imbalance of the bacterial flora normally
present in the vagina. The shift occurs from hydrogen
peroxide-producing lactobacilli to a greater concentration of bacterial organisms.

Bacterial vaginosis

125

Presents with fishy odor and thin, white or gray vaginal discharge; on physical examination, a milky, homogenous vaginal coating may be seen adherent to the vaginal wall

Bacterial vaginosis

126

Amstel criteria for diagnosing Bacterial vaginosis (3 of 4)

1. thin, homogenous vaginal discharge
2. a positive whiff test, which involves the production of a fishy odor when mixing vaginal fluid with 10% potassium hydroxide
3. vaginal fluid pH greater than 4.5
4. the presence of clue cells (epithelial cells covered with bacteria) on microscopic examination