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AHN 548 Unit 3 > Sexually Transmitted Diseases And Pelvic infections CH 43 > Flashcards

Sexually Transmitted Diseases And Pelvic infections CH 43 Flashcards

1
Q

Chancroid signs and symptoms

A

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

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2
Q

chancroid lab findings

A

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

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3
Q

chancroid differential diagnosis

A

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

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4
Q

chancroid complications

A

inguinal scarring or fistula formation from draining buboes

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5
Q

local tx of chancroid

A

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

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6
Q

antibiotic tx for chancroid

A

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

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7
Q

chancroid prognosis

A

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

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8
Q

granuloma inguinale (donovanosis) pathogenesis

A

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

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9
Q

granuloma inguinale prevention

A

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

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10
Q

granuloma inguinale signs and symptoms

A

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

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11
Q

lab findings of granuloma inguinale

A

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

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12
Q

granuloma inguinale differential diagnosis

A

syphilis, HSV, chancroid, lymphgranuloma venereum, behcet dz

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13
Q

complications of granuloma inguinale

A

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

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14
Q

granuloma inguinale tx

A

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

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15
Q

lymphogranuloma venereum pathogenesis

A

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.

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16
Q

lymphogranuloma venereum prevention

A

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

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17
Q

lymphogranuloma venereum signs and symptoms

A

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.

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18
Q

lab findings lymphogranuloma venereum

A

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

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19
Q

lymphogranuloma venereum differential diagnosis

A

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

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20
Q

lymphogranuloma venereum complications

A

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

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21
Q

treatment of choice for lymphogranuloma venereum

A

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

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22
Q

local and surgical tx for lymphogranuloma venereum

A

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

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23
Q

syphilis pathogenesis

A

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

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24
Q

syphilis prevention

A

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

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25
Q

primary syphilis signs

A

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

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26
Q

secondary syphilis signs

A

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

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27
Q

latent syphilis signs

A

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

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28
Q

neurosyphilis signs

A

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

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29
Q

genital herpes simplex virus (HSV) pathogenesis

A

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

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30
Q

HSV prevention

A

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

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31
Q

HSV signs and symptoms

A

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

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32
Q

Lab findings for HSV

A

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

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33
Q

HSV differential diagnosis

A

syphilis, chancroid, drug eruptions, and behcet’s

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34
Q

HSV complications

A

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

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35
Q

tx for 1st clinical episode of genital herpes

A

acyclovir, famciclovir, or valacyclovir for 7 to 10 days

36
Q

suppressive therapy for recurrent genital herpes

A

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

37
Q

episodic therapy for recurrent genital herpes

A

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

38
Q

genital herpes and pregnancy

A

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

39
Q

Genital herpes and HIV

A

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

40
Q

Chancroid pathogenesis

A

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

41
Q

chancroid prevention

A

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

42
Q

syphilis during pregnancy

A

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

43
Q

congenital syphilis

A

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

44
Q

syphilis lab findings

A

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

45
Q

nontreponemal tests

A

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

46
Q

treponemal antibody tests

A

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

47
Q

syphilis differential diagnosis

A

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

48
Q

primary syphilis differential diagnosis

A

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

49
Q

Secondary syphilis differential diagnosis

A

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

50
Q

syphilis complications

A

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

51
Q

early syphilis (less than 1 year) and contacts treatment

A

Benzathine Penicillin G 2.4 million units in one dose

52
Q

late syphilis (over 1 year) treatment

A

Benzathine Penicillin G 2.4 million units weekly for 3 weeks

53
Q

neurosyphilis treatment

A

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.

54
Q

treatment for syphilis with PCN allergy

A

doxycycline or tetracycline for 14 days

55
Q

syphilis tx in pregnancy

A

Penicillin G even with allergy

56
Q

congenital syphilis tx

A

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

57
Q

Jarisch-Herxheimer reaction

A

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

58
Q

coexisting infection with syphilis and HIV

A

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

59
Q

bacterial vaginosis pathogenesis

A

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

60
Q

prevention of bacterial vaginosis

A

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

61
Q

clinical findings of bacterial vaginosis

A

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

62
Q

bacterial vaginosis differential diagnosis

A

trichomoniasis, atrophic vaginitis, and desquamative inflammatory vaginitis

63
Q

bacterial vaginosis complications

A

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

64
Q

bacterial vaginosis tx

A

metronidazole and clindamycin, even when pregnant

65
Q

bacterial vaginosis prognosis

A

usually recurrent, suppressive therapy may be beneficial

66
Q

trichomoniasis pathogenesis

A

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

67
Q

trichomoniasis prevention

A

use of condoms, limiting sexual partners good hygiene

68
Q

trichomoniasis signs

A

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)

69
Q

trichomoniasis lab findings

A

diagnosis done by wet prep of vaginal secretions.

70
Q

trichomoniasis differntial diagnosis

A

bacterial diagnosis, atrophic vaginitis, and desquamative inflammatory vaginitis

71
Q

trichomoniasis complications

A

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

72
Q

trichomoniasis treatment

A

metronidazole and tinidazole in single dose

73
Q

gonorrhea pathogenesis

A

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

74
Q

gonorrhea prevention

A

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

75
Q

gonorrhea clinical findings

A

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

76
Q

gonorrhea lab findings

A

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.

77
Q

gonorrhea differential diagnosis

A

chlamydia, uti, PID

78
Q

complications of gonorrhea

A

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

79
Q

gonorrhea tx

A

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

80
Q

chlamydia pathogenesis

A

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

81
Q

chlamydia prevention

A

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

82
Q

chlamydia signs

A

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

83
Q

chlamydia labs

A

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.

84
Q

chlamydia differential diagnosis

A

mucopurulent cervicitis

85
Q

chlamydia complications

A

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

86
Q

chlamydia treatment

A

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

AHN 548 Unit 3 (8 decks)

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