Sexually Transmitted Diseases Flashcards
(105 cards)
1
Q
Ways Sexually transmitted diseases facilitate HIV transmission
A
- Disruption of epithelial/mucosal barriers
- Increase the number of HIV target cells in the genital tract
- Increase the expression of HIV co-receptors
- Induce secretion of cytokines (increase HIV shedding)
- HIV alters the natural history of some STDs
2
Q
STDs of concern can be classified as
A
- Sores
- Drips
- Other
3
Q
Sores (ulcers)
A
- Syphilis
- Genital herpes
4
Q
Drips (discharges)
A
- Gonorrhea
- Chlamydia
- Nongonococcal urethritis/mucopurulent cervicitis
- Trichomonas vaginitis/urethritis
- Bacterial vaginosis
5
Q
Other major concerns
A
Genital HPV and cervical/anal/oral cancer
6
Q
Gonorrhea causative agent
A
Neisseria gonorrhea
7
Q
Neisseria gonorrhea
A
- Gram negative diplococcus
- Intracellular parasite
- Humans are only known host
- Grows in warm, moist areas of the reproductive tract and in mouth, throat, anus and eyes
8
Q
Is gonorrhea curable?
A
It is curable
9
Q
Onset of gonorrhea in men
A
1-14 days after infection, some have no symptoms but men are more likely to have symptoms
10
Q
Site of infection of gonorrhea in men
A
Urethra, rectum, oropharynx, and eyes
11
Q
Signs and symptoms of gonorrhea in men
A
- Purulent urethral or rectal discharge
- Burning sensation when urinating
- Painful and swollen testicles
12
Q
Complications of gonorrhea in men
A
- Rare b/c signs and symptoms will lead men to treatment
- Epididymitis
- Postatitis
- Urethral Stricture
- Inguinal lymphadenopathy
- Disseminated gonorrhea
13
Q
Onset of gonorrhea in women
A
Most women have no symptoms; if symptoms occur they are often mild
14
Q
Site of infection of gonorrhea in women
A
- Endocervical canal
- Rectum, oropharynx, eye
15
Q
Signs and symptoms of gonorrhea in women
A
- Painful, burning sensation when urinating
- Abnormal vaginal discharge, uterine bleeding
16
Q
Complications of gonorrhea in women
A
- 30-60% do not have recognizable symptoms until complications occur
- Pelvic Inflammatory disease
- Fitz-High-Curtis syndrome
- Disseminated gonorrhea
17
Q
Pelvic inflammatory disease
A
- Occurs in 15% of women
- Can lead to infertility and ectopic pregnancy
18
Q
Fitz-High-Curtis syndrome
A
can lead to perihepititis
19
Q
Disseminated Gonococcal Infection (DGI) classic presentation
A
- Joint / Tendon Pain with Low-Grade Fever (< 39°C)
- Migratory Polyarthralgia, especially of the Knees, Elbows, and Distal Joints
- Tenosynovitis
- Dermatitis
20
Q
Disseminated Gonococcal Infection (DGI) second stage
A
- Septic arthritis
- Knee most common affected joint
- Typically, skin lesions disappear, and blood cultures come back negative
- RARELY progresses to Meningitis and Endocarditis
21
Q
How to diagnose gonorrhea?
A
- Gram stain smear
- Culture
- Nucleic acid hybridization test
22
Q
Gram stain smear for gonorrhea diagnosis
A
- Positive when gram negative diplococci are identified within PMNs
- In men with symptomatic urethritis, highly sensitive and specific
- Specific but insensitive for endocervical, pharyngeal or rectal specimens
23
Q
Culture for gonorrhea diagnosis
A
most reliable in non-symptomatic pts and for specimens from rectum or pharynx
24
Q
Treatment for Uncomplicated Gonococcal Infections of the Cervix, Urethra, Pharynx and Rectum
A
Ceftriaxone 500 mg IM in a single dose
25
Is chlamydia curable?
It is curable
26
Chlamydia causative agent
chlamydia trachomatis
27
Background info of chlamydia
- Most common cause of bacterial STDs
- Typically co-infection with gonorrhea
- Associated with a 5-fold increased risk of acquiring HIV
- Causes genital, ocular, pharyngeal, and rectal infections
28
Onset of chlamydia in men
7-21 days
29
Signs and symptoms of chlamydia in men
- Over 50% of infections are asymptomatic
- Urethra:mild dysuria, discharge
- Rectum: bleeding, pain and discharge
30
Complications of chlamydia in men
Epidydmitis and reiter's syndrome
31
Onset of chlamydia in women
7-21 days
32
Signs and symptoms of chlamydia in women
- Over 66% of infections are asymptomatic
- Cervix: abnormal discharge and bleeding
- Rectum: bleeding, pain and discharge
33
Complications of chlamydia in women
- Pelvic inflammatory disease
| - Reiter's syndrome
34
Neonatal chlamydia infections
- Transmitted to infant by infected cervicovaginal secretions
- 50% develop neonatal conjunctivitis
- 16% develop pneumonia
35
How to diagnose chlamydia?
DNA amplification
36
DNA amplification
- Nucleic acid ampplification tests
- Can detect small amounts of DNA
- Highly sensitive 96% and specific >98%
- Vaginal, cervical, or urethral swabs or first void urine
37
Treatment of chlamydia
- Doxycycline 100 mg PO BID x 7 days
| - Azithromycin 1 gm PO x 1 dose
38
Which treatment is preferred for gonorrhea?
Doxycycline had better outcomes in patient with anal chlamydia so it is preferred
39
Is syphilis curable?
It is curable
40
Syphilis causative agent
Treponema pallidum, a spirochete bacterium
41
Syphilis background information
- Highly contagious
| - Associated with an increased risk of HIV
42
Syphilis routes of transmission
- Sexual contact
- Congenital-transmission from mother to child
- Rarely by non-sexual contact
43
4 primary stages of syphilis
1. Primary syphilis
2. Secondary syphilis
3. Latent syphilis
4. Tertiary syphilis
44
Primary syphilis
- Manifests after an incubation period of 10-90 days (avg 21 days)
- Highly contagious, but individuals are asymptomatic
- Sore (chancre) can appear on on penis, vagina, or rectum
45
Primary syphilis sores (chancres)
- Can be single or multiple
- Usually painless
- Chancre may persist 4-6 weeks and heal spontaneously
46
Secondary syphilis
- MOST Contagious period; Non-Specific Symptoms
- Results from Hematogenous (from the Blood) and Lymphatic spread
- Characterized by skin rash; 1 – 6 months after Primary Infection
- Non-Specific Symptoms
- If left untreated, will disappear in 4 – 10 weeks
47
Secondary syphilis skin rash infections
- Symmetrical, reddish-pink, non-itchy on trunk and extremities
- Involves the palms of the hands and soles of the feet
48
Secondary syphilis non-specific symptoms
Malaise, Fever, Pharyngitis, Headache (HA), Weight
| Loss, and Arthralgia (Joint Pain)
49
Latent Syphilis
Positive Syphilis serology; Asymptomatic. Divided into 2 stages
50
Latent syphilis early stage
- Less than 1 year from Secondary Syphilis
| - Infectious – 25% Mucocutaneous Relapse
51
Latent syphilis late stage
- More than 1 year from Secondary Syphilis
- Generally considered non-infectious EXCEPT in Pregnancy
- 25% of patients will Progress to Tertiary Syphilis
52
Tertiary syphilis
- Not infectious
- Occurs 3 – 15 years after initial infection
- Without treatment, 1 in 3 Syphilis patients develop Tertiary Syphilis
53
Tertiary syphilis can be divided into 3 forms:
1. Cardiovascular Syphilis
2. Gummatous Syphilis
3. Neurosyphilis
54
Cardiovascular Syphilis
Aortic Insufficiency, Aneurysm Formation
55
Gummatous Syphilis
- Non-specific Granulomatous lesion
| - Defined by Chronic, Destructive Lesions (Skin, Bone, Soft Tissue, Liver, and fatal if on Heart or Brain)
56
What is the treatment of choice for syphilis?
parenteral penicillin G
57
Syphilis infections that last for more than 1 year should receive?
3 consecutive
| weekly doses if of Parenteral Penicillin G
58
Treatment for Primary, Secondary, or Early Latent (< 1 year) syphilis
Benzanthine Penicillin G, 2.4 mU IM x 1 dose
59
Treatment for Primary, Secondary, or Early Latent (< 1 year) syphilis with PCN allergy
Doxycycline, 100 mg, PO BID x 14 days
60
Treatment for Late Latent (>1 year) or Unknown Duration syphilis
Benzanthine Penicillin G, 2.4 mU IM x 1 dose per week for 3 weeks (7.2 mU total)
61
Treatment for Late Latent (>1 year) or Unknown Duration syphilis with PCN allergy
Doxycycline, 100 mg, PO BID for 28 days
62
Treatment of Neurosyphilis
Aqueous, Crystalline Penicillin G (18 – 24 mU) daily by Continuous infusion (or 3-4 mU IV, q4h for 10 – 14 days
63
Management of syphilis patients with PCN allergy
-Skin testing
-If Negative, administer Penicillin (PCN) regimen appropriate for the stage
of Syphilis
-If Positive, patients should be desensitized to Penicillin
64
Jarisch–Herxheimer Reaction (Rxn) for syphilis
- Idiosyncratic response to therapy; NOT a Penicillin allergy
- Usually occurs with the first 24 hours after any therapy for syphilis
- Resolves within 12–24 hours
- Occurs most frequently among patients who have Early Syphilis
65
Jarisch–Herxheimer Reaction (Rxn) for syphilis self limiting rxn's
Headache, Fever, Chills, Malaise, Arthralgia, Myalgia, Tachypnea, Peripheral Vasodilation, Aggravation of Syphilic lesion
66
Diagnosing syphilis
-Perform a blood test called TPAB – Treponema pallidum Antibody
-If Non-Reactive, a person will test Negative for Syphilis
-If Reactive, a person will progress to Reflex and yield an RPR Titer, with the
results ranging from 1-8 (highly concentrated) to 1-64 (less concentrated)`
67
Is genital herpes curable?
It is incurable
68
Causative agent of genital herpes
herpes simplex virus - DNA viruses whose only known hosts is humans
69
Herpes Simplex Virus Type 1 (HSV-1)
- Acquired in childhood and causes orolabial ulcers
| - Can cause genital herpes
70
Herpes Simplex Virus Type 2 (HSV-2)
Transmitted sexually and causes anogenital ulcers
71
Pathophysiology of genital herpes
transmission via virus from secretions onto mucosal surface or abraded skin
72
HSV life Cycle 5 stages
1. Primary mucocutaneous infection
2. Infection of the ganglia
3. Establishment of latency
4. Reactivation
5. Recurrent infection
73
When an outbreak of herpes has passed, is the virus still present?
It is only present in the nerve body
74
Why is it difficult to treat herpes?
dormancy of virus
75
Are men or women more susceptible to acquiring genital HSV-2?
Women are more susceptible than men
76
Clinical presentation of genital herpes occur as:
- First episode infections
| - Recurrent infections
77
First Episode infections
- Treated the longest
- Multiple painful or ulcerative lesions on external genitalia develop
- Viral shedding lasts longer in first episode (15-16 days)
- Women have more sever disease
78
First episode ulcerative lesions
- Appear 6 days after sexual contact and can last 2-6 weeks
| - Contain numerous HSV particles
79
First episode infections for women
- Cervical ulcerative lesions are common
- Can have intermittent bleeding and vaginal discharge
- Dysuria and urinary retention syndromes may occur
80
Recurrent herpes infections
- 50% of pts will have prodrome: mild burning, itching, or tingling
- Fewer, localized lesions
- Duration of infection is shorter and symptoms are milder
- Viral shedding occurs at lower concentration for 3 days
81
Which typer of genital herpes is more sever and higher rate of occurance
HSV-2
82
Complications with genital herpes
- Result from genital spread or autoinoculation to eye, rectum, pharynx, fingers
- CNS infections can occur
- Neonatal herpes
83
Neonatal herpes
- Exposure to HSV in birth canal
- Risk is greater for first episode infections
- Mortality rate of 50%
- Significant morbidity including permanent neurologic damage
84
How to diagnose herpes?
- Tissue culture
- Serological tests
- PCR
85
Tissue culture for herpes diagnosis
most specific and sensitive for first episode genital herpes
86
Serological tests for herpes diagnosis
require seroconversion before tests can differentiate between HSV-1 and HSV-2
87
PCR for herpes diagnosis
- More sensitive than tissue culture
| - Choice for CNS infections
88
Treatment of initial episode of genital herpes
administered within 24 hours of appearance of first lesion
89
Treatment of episodic genital herpes
- Administered within 24 hours of appearance of first lesion
| - Patients with prolonged episodes or severe symptoms may benefit
90
Treatment of suppressive genital herpes
- Benefit of reducing vial shedding and risk of transmission
| - Reduces frequency of recurrences by 70-80% in patients with >6 occurrences a year
91
First episode therapy
Acyclovir / Valacyclovir / Famciclovir for 7-10 days
92
Episodic Therapy
Acyclovir / Valacyclovir / Famciclovir for 1-5 days
93
Suppressive Therapy
Acyclovir / Valacyclovir / Famciclovir (#30 11 refills)
94
Most common viral STD in the US
Human Papillomavirus (HPV)
95
Symptoms of HPV
- Most pts have subclinical disease
- <1% have visible warts
- Warts occur on penis, scrotum, perianal skin, uterine cervix, vagina, urethra, anus, mouth
96
Goal of treatment of HPV warts
Removal, can spontaneously resolve
97
Patient applied therapies for HPV warts
- Podofilox 0.5% solution or gel
- Imiquimod 3.75% or 5% cream
- Sinecatechins 15% ointment
98
Provider administered therapy for HPV warts
- Cryotherapy
- Trichloracetic acid or bichloroacetic acid 80-90%
- Surgical removal
99
G.M. is a 26-year-old female who presents after a mild febrile illness with painful vesicular lesions on her labia. This is the first time she has had this illness. She states that she has had sex 6 times in the past 2 months with 2 different men and a woman, none of which had any lesions that she knew of. She denies any discharge or itching.
```
This patient’s presentation most likely represents which STD?
A. Herpes
B. Gonorrhea
C. Chlamydia
D. Human Papillomavirus (HPV)
E. Syphilis
```
A. Herpes
100
Mary K presents to the Public Health Clinic with thick, cheesy looking, foul
smelling, vaginal discharge. She had several partners in the last week, and did not practice “safe sex” every time. A vaginal discharge Gram-Stain is performed and reveals Gram-Negative diplococci.
While awaiting further results, what would be the most appropriate empiric treatment for Mary K?
```
A. Acyclovir, 400 mg, PO TID for 10 days
B. Ceftriaxone, 250 mg, IM x 1 + Azithromycin, 1 g, PO x 1
C. Azithromycin, 1 g, PO x 1
D. Ceftriaxone, 2 g, IV q24h
E. Valacyclovir, 1 g, PO BID for 7 days
```
B. Ceftriaxone, 250 mg, IM x 1 + Azithromycin, 1 g, PO x 1
101
CS is a 26-year-old complaining of a non-painful sore on his penis. He
noticed it about 3 weeks ago and though nothing of it. It is not going away and now he’s worried as he recently had sex with a new partner
What’s the most likely diagnosis?
Syphilis
102
CS is a 26-year-old complaining of a non-painful sore on his penis. He
noticed it about 3 weeks ago and though nothing of it. It is not going away and now he’s worried as he recently had sex with a new partner
What’s an appropriate therapy for him?
Benzanthine PCN G 2.5 mU IM x1
103
CS is a 26-year-old complaining of a non-painful sore on his penis. He
noticed it about 3 weeks ago and though nothing of it. It is not going away and now he’s worried as he recently had sex with a new partner
What are the possible etiologic agents that should be considered in the
differential diagnosis?
1. Neisseria gonorrhea / Chlamydia trachomatis
2. Herpes Simplex Virus
3. Treponema pallidum
```
A. I only
B. III only
C. I and II
D. II and III
E. I, II, and III
```
D. – II and III only
104
CS is a 26-year-old complaining of a non-painful sore on his penis. He
noticed it about 3 weeks ago and though nothing of it. It is not going away and now he’s worried as he recently had sex with a new partner
The results of the laboratory tests showed the following:
Treponema pallidum Antibody: Reactive RPP titer: 1:128
What is the appropriate treatment?
A. Acyclovir, 400 mg PO TID x 10 days
B. Benzathine Penicillin 2.4 million units IM once per week for 3 weeks
C. Benzathine Penicillin 2.4 million units IM x 1
D. Ceftriaxone, 2 g IV, q24h
E. Valacyclovir, 1 g PO, BID x 7 – 10 days
B. Benzathine Penicillin 2.4 million units IM once per week for 3 weeks
105
TD, CS’s partner from last month, comes to clinic. You take his history and
learn he hasn’t had any sores for “a long time, like, maybe 2 years.” He was never treated and he did not worry about it as the sore disappear
The results of the laboratory tests showed the following:
1. Treponema pallidum Antibody: Reactive
2. RPR Titer: 1:16
What is appropriate treatment?
A. Acyclovir, 400 mg PO, TID x 10 days
B. Benzathine Penicillin 2.4 million units IM once per week for 3 weeks
C. Benzathine Penicillin 2.4 million units IM x 1
D. Ceftriaxone, 2 g IV, q24h
E. Valacyclovir, 1 g PO, BID x 7 – 10 days
B. Benzathine Penicillin 2.4 million units IM once per week for 3 weeks
