Sexually Transmitted Diseases

Question 1

What are the main types of STDs?

Answer 1

Chlamydia
Gonorrhea
Syphilis
Herpes

Question 2

What is the pathogen of Chlamydia

Answer 2

Chlamydia trachomatis (an obligate intracellular parasite
CAN BE GROWN IN TISSUE CULTURE BUT NOT ON ARTIFICIAL MEDIA

Question 3

What is the mechanism of transmission of chlamydia?

Answer 3

Sexual Contact

Perinatal

Question 4

What is the frequency of chlamydia?

Answer 4

most common STD in western countries
3-5x as common as gonorrhea
Prevalence varies with population

Question 5

What are the usual clinical manifestations of chlamydia in men?

Answer 5

Urethritis- most common in all men
Proctitis- most common in gay men
Epididymitis

Question 6

What are the usual clinical manifestations of chlamydia in women?

Answer 6

Urethritis
Endocervicitis
Proctitis (anal intercourse)
PID
Perihepatitis (inflammation of the capsule of the liver, violent string adhesions; pelvis to the liver)

Question 7

What is the classic clinical diagnosis of chlamydia and gonorrhea?

Answer 7

discharge from the cervix

Question 8

How do you make a diagnosis of chlamydia?

Answer 8

clinical examination (exudate)
culture (tissue culture; BIOHAZARD)
Nucleic acid probe- PCR or NAAT (nucleic acid amplification test)- can be done on urine

Question 9

What is the treatment for chlamydia?

Answer 9

Patient and partner should be treated

1. Doxycycline (100mg 2x daily for 7 days)
2. Erythromycin (250mg (4 tablets)
3. AZITHROMYCIN- 1000MG P.O. in a single dose (Zithromax)

Question 10

What is the pathogen that causes Gonorrhea?

Answer 10

Neisseria gonorrhea
a gram (-) diplococcus
CAN BE CULTURED IN SELECTIVE MEDIA
Thayer-Martin Agar (inexpensive)

Question 11

What is the mechanism of transmission of gonorrhea?

Answer 11

Sexual contact

Perinatal

Question 12

What is the typical presentation of gonorrhea in men?

Answer 12

Urethritis (2nd most common cause)
Epididymitis
Proctitis
Pharyngitis

Question 13

What is the typical presentation of gonorrhea in women?

Answer 13

Urethritis (2nd most common cause)
Endocervicitis
Proctitis
PID
Pharyngitis

Question 14

What types of problems can gonorrhea present with a disseminated infection?

Answer 14

ARTHRITIS
DERMATITIS
Pericarditis and endocarditis
Meningitis
Perihepatitis

Question 15

If you have a single infected joint what disease should come to mind?

Answer 15

Gonorrhea

Question 16

How do you make a diagnosis of gonorrhea?

Answer 16

Clinical examination
Culture
Nucleic acid probe

Question 17

What is the treatment for gonorrhea?

Answer 17

Patient and partner should be treated
Drugs of choice:
Ceftriaxone (250mg IM x 1) PLUS Azithromycin (1000mg PO x 1)

This also cover Chlamydia
Azithromycin aids in the decreased impact of resistance

Question 18

What are consequences of chlamydia and gonorrhea?

Answer 18

Infertility
Ectopic pregnancy
Chronic pelvic pain

Disrupts the fallopian tube cells in PID

Question 19

What is the pathogen that causes syphilis?

Answer 19

Treponema pallidum

CANNOT BE CULTURED IN VITRO

Question 20

What are the classifications of syphilis?

Answer 20

Primary (50 percent perinatal transmission)
Secondary (50 percent perinatal transmission)
Latent- early and late (40 percent perinatal transmission)
Tertiary (10 percent perinatal transmission)

Question 21

How do you diagnose syphilis?

Answer 21

Clinical examination (visible lesions)
Dark Field Microscopy
Serology (VDRL/RPR -screening test; MHA/FTA -confirmatory test)

Question 22

What are you looking for in the screening tests for syphilis?

Answer 22

Non-specific anti-body

Question 23

What is something important to remember when screening someone who may be reinfected?

Answer 23

FTA stays positive after 1st infection for life; NEED TO LOOK AT VDRL

Question 24

What is a principal clinical finding of primary syphilis?

Answer 24

PAINLESS chancre

Question 25

With what STD is the chancre painful?

Answer 25

Herpes

Question 26

What is a principal clinical finding of secondary syphilis?

Answer 26

Condyloma Latum (genital warts), lesions on the feet

Question 27

What are principal clinical manifestations of late stage syphilis?

Answer 27

DESTRUCTIVE GUMMAS Aortic valve injury CNS MANIFESTATIONS (dementia, tabes dorsalis- wobble posture, pupillary abnormalities- ARGOYLE ROBINSON PUPIL- doesn't react but does accommodate)

Question 28

What are manifestations of congenital syphilis?

Answer 28

``` fetal death growth restriction multiple anomalies (immediately apparent at birth or delayed appearance) ```

Question 29

What is the treatment for syphilis?

Answer 29

``` PENICILLIN- preferred, especially during pregnancy - only one proven to protect the fetus, give it even if allergic, dose depends on stage of the disease Doxycycline Tetracycline Ceftriaxone Sexual partner should be treated ```

Question 30

What are the types of herpes simplex virus?

Answer 30

HSV 1- oral herpes | HSV 2- genital herpes

Question 31

What is the classification of HSV?

Answer 31

Primary- no antibodies to either HSV 1 or 2 (bad outbreak, painful) Initial, non-primary- antibodies to HSV 1 (mild 1st breakout) Recurrent- antibodies to HSV 2 (milder outbreak, fewer lesions, less discomfort)

Question 32

How do you make a diagnosis of HSV?

Answer 32

Clinical examination Viral culture (3 days) PCR- more sensitive

Question 33

What is the progression of HSV?

Answer 33

Start as little raised red bumps, then blisters | More advanced lesions, less suitable for culture

Question 34

What is the treatment/management for HSV?

Answer 34

ACYCLOVIR- 400mg PO TID x 7 days | Valacyclovir- 1000 mg PO BID x 7 days

Question 35

What is the risk of pregnancy with HSV?

Answer 35

Patients with active lesions or prodrome at the time of labor require a cesarean delivery

Question 36

In primary care practice what is the most likely stage of syphilis at the time of diagnosis?

Answer 36

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