Sexually Transmitted Diseases And Pelvic infections CH 43

Question 1

Chancroid signs and symptoms

Answer 1

begins as erythematous papule that evolves into pustule and ultimately degenerates into saucer shaped ragged ulcer circumscribed by an inflammatory wheal. very tender and produce heavy foul discharge that is contagious. 50% have painful inguinal adenitis. nodes may undergo liquefaction producing fluctuant babies that may become necrotic and drain spontaneously

Question 2

chancroid lab findings

Answer 2

definitive diagnosis with h ducreyi on culture. most diagnosis is presumptive based on symptoms and ruling out ulcerative diseases like HSV and syphilis

Question 3

chancroid differential diagnosis

Answer 3

syphilis, hsv, granuloma inguinale, lymphohranuloma venerum , behcet disease

Question 4

chancroid complications

Answer 4

inguinal scarring or fistula formation from draining buboes

Question 5

local tx of chancroid

Answer 5

good personal hygiene. cleanse early lesions with mild soap solution. use sitz bath. aspirate or i&d fluctuant lymph nodes to prevent fistula formation or secondary ulcers from spontaneous rupture

Question 6

antibiotic tx for chancroid

Answer 6

azithromycin, ceftriaxone, cipro, or erythromycin. course may need to be repeated

Question 7

chancroid prognosis

Answer 7

usually responds to antibiotics in 3 days and clinical improvement in 7 days. if no improvement in 7 days, reveal and check for misdiagnosis, std coinfection, poor compliance, antibiotic resistance, hiv positive

Question 8

granuloma inguinale (donovanosis) pathogenesis

Answer 8

chronic ulcerative granulomatous disease that develops in vulva, perineum and inguinal areas. rare in US. causative organism is klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). incubation period is 8 to 12 weeks. is reportable disease

Question 9

granuloma inguinale prevention

Answer 9

therapy immediately after exposure may abort infection. sex partners should be treated too (anybody up to 60 days preceding onset of symptoms)

Question 10

granuloma inguinale signs and symptoms

Answer 10

painless, slowly progressive ulcerative lesions on genitals. malodorous discharge. begins as papule which then ulcerates with development of beefy red granular zone with clean sharp edges. lesions are highly vascular and bleed easily and susceptible to secondary bacterial infection. may mimic carcinoma of cervix

Question 11

lab findings of granuloma inguinale

Answer 11

klebsiella granulomatis is difficult to culture. diagnosis requires visualization of dark staining Donovan bodies (bacteria encapsulated in mononuclear leukocytes) on tissue crush preparation or biopsy using Wright’s or Giemsa’s stain. shows up as rod shaped particles that stain purple in hematoxylin and eosin preps. pseudoepitheliomatous hyperplasia

Question 12

granuloma inguinale differential diagnosis

Answer 12

syphilis, HSV, chancroid, lymphgranuloma venereum, behcet dz

Question 13

complications of granuloma inguinale

Answer 13

scarring may cause introital contraction which may make coitus difficult or impossible. walking and sitting may become painful.

Question 14

granuloma inguinale tx

Answer 14

antimicrobials can slow progression of lesions and allow reepithelialization. drug of choice doxycycline. contraindicated in pregnancy. add aminoglycosode for HIV pts

Question 15

lymphogranuloma venereum pathogenesis

Answer 15

causative agent is aggressive L serotype of Chlamydia trachomatis..seen more in tropical regions of Asia and Africa. sexual transmission. incubation is 7 to 21 days. highly associated with HIV . diseases is reportable.

Question 16

lymphogranuloma venereum prevention

Answer 16

avoid infectious contact with carrier by using condom or abstinence. test also for urethral or cervical chlamydial infection

Question 17

lymphogranuloma venereum signs and symptoms

Answer 17

tender, usually unilateral inguinal and/or femoral lymphadenopathy. genital ulcer at site of inoculation (not always). rectal exposure can result in proctocolitis including mucoid and/or hemorrhagic rectal discharge, pain, constipation, fever, tenesmus. late stage they may have fever, headache, arthralgia, chills and abdominal cramps.

Question 18

lab findings lymphogranuloma venereum

Answer 18

diagnosis based on clinical suspicion and ruling out other diseases. can only be proved by isolating chlamydia trachomatis from genital or lymph node specimens and confirming immunotype. these procedures are seldom available

Question 19

lymphogranuloma venereum differential diagnosis

Answer 19

systemic symptoms resemble meningitis, arthritis, pleurisy, or peritonitis. lesions can resemble granuloma inguinale, tb, syphilis, chancroid, carcinoma, schistosomiasis

Question 20

lymphogranuloma venereum complications

Answer 20

chronic colorectal fistulas and structures which can involve the entire sigmoid. vulvar elephantitis can cause marked distortion. vaginal narrowing and distortion may result in severe dyspareunia

Question 21

treatment of choice for lymphogranuloma venereum

Answer 21

doxycycline 100mg bid for 21 days . course can be repeated

Question 22

local and surgical tx for lymphogranuloma venereum

Answer 22

anal strictures should be manually dilated weekly. severe stricture may require diversionary colostomy. aspirate abscesses. complete vulvectomy may be needed.

Question 23

syphilis pathogenesis

Answer 23

chronic systemic disease caused by treponema pallidum. transmitted through direct contact with infectious moist lesion. can be transmitted through sex and from mother to fetus

Question 24

syphilis prevention

Answer 24

treat immediately if exposed even if serology negative and no symptoms . do serology on first prenatal visit and repeat between 28 to 32 weeks in high risk pts. use condom and soap and water after coitus for decontamination

Question 25

primary syphilis signs

Answer 25

chancre that is indurated, firm, painless papule or ulcer with raised borders. groin lymph nodes may be enlarged, firm, and painless. lesions not usually seen in women

Question 26

secondary syphilis signs

Answer 26

diffuse systemic infection. diffuse lymphadenoparhy, dermatitis (diffuse, bilateral, symmetrical, papulosquamous lesions on palms and soles), patchy alopecia, hepatitis, nephritis, condyloma lata. serologic tests are reactive

Question 27

latent syphilis signs

Answer 27

resolution of lesions or reactive serology test without hx of therapy. infectious for first 1 to 2 years.

Question 28

neurosyphilis signs

Answer 28

CNS extra vulnerable to T pallidum during latent syphilis. Neuro involvement of ophthalmic and auditory systems can be detected. cranial nerve palsy and meningeal signs should be evaluated

Question 29

genital herpes simplex virus (HSV) pathogenesis

Answer 29

chronic viral infection caused by HSV 1 and HSV 2. most are recurrent genital herpes caused by HSV 2. usually transmitted by persons unaware that they have infection or who are asymptomatic since virus is shed intermittently in genital tract

Question 30

HSV prevention

Answer 30

when diagnosis is given explain prevention of transmission to partner (condoms). eval those whose sex partners have been diagnosed. symptomatic patients should be given chronic suppressive therapy like valacyclovir

Question 31

HSV signs and symptoms

Answer 31

multiple painful vesicular or ulcerative lesions on genitals. these may be absent though. after initial infection..virus remains dormant but can be reactivated. happens more in HSV 2. . may also have fever, headaches and malaise

Question 32

Lab findings for HSV

Answer 32

tests for symptomatic pts: cell culture and polymerase chain reaction (PCR). PCR is test of choice because it is more sensitive. both test negative does not mean they dont have HSV. need to differentiate which one with serology tests

Question 33

HSV differential diagnosis

Answer 33

syphilis, chancroid, drug eruptions, and behcet's

Question 34

HSV complications

Answer 34

urinary retention caused by severe dysuria. pneumonitis, hepatitis, or CNS complications- meningoencephalitis (should be hospitalized and given IV antivirals and close monitoring)

Question 35

tx for 1st clinical episode of genital herpes

Answer 35

acyclovir, famciclovir, or valacyclovir for 7 to 10 days

Question 36

suppressive therapy for recurrent genital herpes

Answer 36

acyclovir, famciclovir, or valacyclovir once or twice a day.

Question 37

episodic therapy for recurrent genital herpes

Answer 37

acyclovir, famciclovir, or valacyclovir with increased dosage and frequency from suppressive therapy. must start within 1 day of lesion onset.

Question 38

genital herpes and pregnancy

Answer 38

risk of transmission to infant is high if acquired near time of delivery. women without genital herpes should abstain from sex in 3rd trimester if partner has it. May deliver with C section to decrease risk. tx during pregnancy: acyclovir

Question 39

Genital herpes and HIV

Answer 39

can have prolonged or severe episodes. need suppressive and episodic tx with higher and longer doses

Question 40

Chancroid pathogenesis

Answer 40

causitive organism is highly infectious gram negative rod haemophilus ducreyi. exposure usually through coitus, but can also happen through accidental exposure of the hands. incubation is 4-10 days. is reportable disease

Question 41

chancroid prevention

Answer 41

treat sexual partners regardless of symptoms if they've had sexual contact in the last 10 days preceding patient's onset of symptoms.

Question 42

syphilis during pregnancy

Answer 42

misdiagnosis common and signs thought to be herpes. risk for fetal infection since treponemes can cross the placenta at anytime but especially after 18 weeks. the earlier the infant is exposed, the more severe the damage resulting in premature death or stillbirth. The placenta looks hydropic (pale yellow, waxy and enlarged) and there may be polyhydraminos

Question 43

congenital syphilis

Answer 43

infants affected by intrauterine infection resulting in hepatosplenomegaly, osteochondritis, jaundice, anemia, skin lesions, rhinitis, lymphadenopathy, nervous system involvement

Question 44

syphilis lab findings

Answer 44

t pallidum identified by dark field exam of specimens from lesions. PCR for detection in amniotic fluid. Serologic test needed when there is no lesion. use nontreponemal tests and treponemal antibody tests

Question 45

nontreponemal tests

Answer 45

venereal disease research laboratory (VDRL), rapid plasma Reagin test (RPR), and the Toluidine Red Unheated Serum test (TRUST). may have false positives since they are nonspecific. 4 fold change in titer needed. Becomes positive 3-6 weeks after infection or 2-3 weeks after appearance of primary lesion

Question 46

treponemal antibody tests

Answer 46

fluorescent treponemal antibody absorbed test (FTA-ABS) and microhemagglutination assay for Treponema pallidum detect antibodies. These are more sensitive and specific than nontreponemal. Dont do after treatment because it will still show positive

Question 47

syphilis differential diagnosis

Answer 47

called the great imitator because many symptoms indistinguishable from other diseases.

Question 48

primary syphilis differential diagnosis

Answer 48

chancroid, granuloma inguinale, lymphogranuloma venereum, herpes genitalis, carcinoma, scabies, trauma, lichen planus, psoriasis, drug eruption, aphthosis, mucotic infection, reiter syndrome, rowen's dz

Question 49

Secondary syphilis differential diagnosis

Answer 49

pityriasis rosea, psoriasis, lichen planus, tinea versicolor, drug eruption, perleche, parasitic infection, iritis, neuroretinitis, condyloma acuminatum, acute exanthems, infectiosmononucleosis, alopecia, and sarcoidosis

Question 50

syphilis complications

Answer 50

destructive lesions of tertiary syphilis may involve skin or bone, cardiovascular system, and the nervous system. 1/4 of cases are fatal

Question 51

early syphilis (less than 1 year) and contacts treatment

Answer 51

Benzathine Penicillin G 2.4 million units in one dose

Question 52

late syphilis (over 1 year) treatment

Answer 52

Benzathine Penicillin G 2.4 million units weekly for 3 weeks

Question 53

neurosyphilis treatment

Answer 53

Aqueous crystalline penicillin G 18-24 units per day (3-4 million units IV every 4 hours or continuous fusion) for 10 to 14 days.

Question 54

treatment for syphilis with PCN allergy

Answer 54

doxycycline or tetracycline for 14 days

Question 55

syphilis tx in pregnancy

Answer 55

Penicillin G even with allergy

Question 56

congenital syphilis tx

Answer 56

adequate maternal tx before 16-18 weeks gestation can prevent it. but of not would still be treated with pcn

Question 57

Jarisch-Herxheimer reaction

Answer 57

happens in 50-75% of patients in early syphilis treated with PCN. febrile reaction accompanied by myalgia and headaches that occur 4-12 hours after injection and is completed by 24 hours. usually benign but can trigger labor or fetal distress, prophylaxis with antipyretics or corticosteroids

Question 58

coexisting infection with syphilis and HIV

Answer 58

common, no specific change in management but need closer follow up

Question 59

bacterial vaginosis pathogenesis

Answer 59

most prevalent vaginal infection. usually asymptomatic. changes in vaginal flora with loss of lactobacilli, an increase in vaginal pH, and an increase in multiple anaerobic an aerobic bacteria. infection with Gardnerella vaginalis, ureaplasma, mycoplasma, prevotella spp, mobiluncus spp, G vaginalis is most common. associated with multiple sex partners and douching

Question 60

prevention of bacterial vaginosis

Answer 60

condom use, no douching, no need to treat male partners

Question 61

clinical findings of bacterial vaginosis

Answer 61

white noninflammatory vaginal discharge with fishy odor and >4.5 pH, microscopic presence of clue cells. gram stain is gold standard for diagnosis which will show lack of lactobacilli and presence of gram negative and gram variable rods and cocci

Question 62

bacterial vaginosis differential diagnosis

Answer 62

trichomoniasis, atrophic vaginitis, and desquamative inflammatory vaginitis

Question 63

bacterial vaginosis complications

Answer 63

adverse pregnancy outcomes (preterm delivery, premature rupture of membranes, spontaneous abortion, preterm labor)

Question 64

bacterial vaginosis tx

Answer 64

metronidazole and clindamycin, even when pregnant

Question 65

bacterial vaginosis prognosis

Answer 65

usually recurrent, suppressive therapy may be beneficial

Question 66

trichomoniasis pathogenesis

Answer 66

caused by flagellated protozoan trichomonas vaginalis. almost always sexually transmitted. incubation period is 4 to 28 days

Question 67

trichomoniasis prevention

Answer 67

use of condoms, limiting sexual partners good hygiene

Question 68

trichomoniasis signs

Answer 68

purulent, malodorous, thin discharge with associated burning, pruritis, dysuria, frequency and dyspareunia., postcoital bleeeding can occur. urethra is usually also infected. discharge described as green, frothy, and foul smelling but may women are asymptomatic. physical exam often reveals erythema of vulva and vagina, punctate hemorrhage may be visible on cervix (strawberry cervix)

Question 69

trichomoniasis lab findings

Answer 69

diagnosis done by wet prep of vaginal secretions.

Question 70

trichomoniasis differntial diagnosis

Answer 70

bacterial diagnosis, atrophic vaginitis, and desquamative inflammatory vaginitis

Question 71

trichomoniasis complications

Answer 71

risk factor for posthysterectomy cellulitis, tubal infertility and cervical neoplasia. associated with premature rupture of membranes and preterm delivery

Question 72

trichomoniasis treatment

Answer 72

metronidazole and tinidazole in single dose

Question 73

gonorrhea pathogenesis

Answer 73

neisseria gonorrhoeae is gram negative diplococcus that may be recovered from urethra, cervix, anal canal, and pharynx. principal site of invasion is epithelium of GU tract. reportable disease

Question 74

gonorrhea prevention

Answer 74

controlled by detection and tx of asymptomatic carriers and their sexual partners. use condoms. abstain from sex until tx is complete. prevent ophthalmia neonatorum with erythromycin ophthalmic ointment 0.5% in each eye

Question 75

gonorrhea clinical findings

Answer 75

many are asymptomatic, vaginal discharge, urinary frequency or dysuria, rectal discomfort. genitals could be inflamed, if unilateral there is involvement of bartholin duct and gland. acute pharyngitis and tonsilitis can occur. conjunctivitis can occur.systemic infection can occur: triad of polyarthralgia, tenosynovitis, and dermatitis may be present or purulent arthritis

Question 76

gonorrhea lab findings

Answer 76

presumptive diagnosis can be made with stained smear, but confirmation needed. will see gram negative diplococci that are oxidase positive. need to test encdocervical, vaginal, or urine specimens.

Question 77

gonorrhea differential diagnosis

Answer 77

chlamydia, uti, PID

Question 78

complications of gonorrhea

Answer 78

salpingitis which can result in tubal scarring, infertility, and increased risk for ectopic preg

Question 79

gonorrhea tx

Answer 79

abstain for 7 days after therapy is initiated. may need to cotreat chlamydial infection. use doxycyline (for nonpregnant) or azithromycin, no longer use quinolones since its been resistant. Uncomplicated: ceftriaxone, cefixime, azithromycin, doxycycline). disseminated: hospitalized and ceftriaxone IM or IV

Question 80

chlamydia pathogenesis

Answer 80

chlamydia trachomatis is most common infectious dz in US. obligate intracellular organisms that have cell wall similar to that of gram negative bacteria.

Question 81

chlamydia prevention

Answer 81

many are asymptomatic so condom use is needed. have sex partners evaluated if you test positive

Question 82

chlamydia signs

Answer 82

often asymptomatic, women with cervical infection may have mucopurulent discharge with hypertrophic cervical inflammation. salpingitis may cause pelvic pain

Question 83

chlamydia labs

Answer 83

diagnosed either by testing urine or by collecting specimens from endocervix or vagina. NAATs cell culture, direct immunofluorescence, enzyme imunoassay,and nucleic acid hybridization tests available too.

Question 84

chlamydia differential diagnosis

Answer 84

mucopurulent cervicitis

Question 85

chlamydia complications

Answer 85

salpingitis, PID, infertility, ectopic pregnancy, perihepatitis, violin string adhesions near liver. conjunctivitis in infants, chlamydial pneumonitis in infants, otitis media, risk for premature delivery and postpartum infection

Question 86

chlamydia treatment

Answer 86

dual therapy. give azithromycin, doxycycline, ceftriaxone, or cefixime