Sexually Transmitted Infections Flashcards
(66 cards)
1
Q
What are the common clinical presentations of urethritis?
A
- dysuria
2. urethral discharge
2
Q
State complications of urethritis?
A
- men - acute prostatitis and epididymitis
2. women - salpingitis, endometritis, abscess(PID)
3
Q
Where do bacteria attack in urethritis?
A
Attachment to columnar epithelial cells
4
Q
What are virulence factors of N. gonorrhoea?
A
- pilli
- toxins
- neutrophil infiltration
- lipo-oligosaccharide cell wall antigen
- sialyation
5
Q
What is the morphology of N. Gonorrhea?
A
gram negative diplococci
6
Q
What is the incubation period of N. gonorrhoea?
A
2 - 7 days
7
Q
What are the symptoms of N. gonorrhoea?
A
dysuria + profuse discharge
8
Q
Describe the culture of N. gonorrhoea?
A
Thayer-Martin Agar
9
Q
What is the treatment therapy of N. gonorrhoea?
A
ceftriaxone
10
Q
Describe the life cycle of chlamydia?
A
11
Q
What is the morphology of C. trachomatis?
A
intracellular pathogen 18 serovars (MOMP)
12
Q
What is the incubation period for C. tracomatis?
A
7 - 21 days
13
Q
What are the symptoms of C. trachomatis?
A
- Dysuria with or without discharge;
2. Cervical discharge may be present
14
Q
What is the culture for C. trachomatis?
A
McCoy cells culture
15
Q
What is the treatment therapy for C. trachomatis?
A
azithromycin, doxycycine
- 7 days
16
Q
Describe the laboratory diagnosis of urethritis?
A
Examining first void urine
- 5 WBC /hpf - above 5 indicates infection
- Gram stain - swab up the urethra to get the sample
17
Q
What tests can be done in the laboratory diagnosis of urethritis?
A
- Enzyme immunoassay
- FISH
- Nucleic acid hybridization
- NAATs
- Cultures - are less sensitive to molecular methods but will provide AST data
18
Q
What is cevicitis?
A
Inflammation of columnar and subepithelial cells of the endocervix
- Most common STD affecting half of all adolescents
19
Q
What is cervicitis caused by?
A
C. trachomatis, N. gonorrhoeae, Ureaplasma and Mycoplasma
20
Q
What is the clinical presentation of cervicitis?
A
vaginal discharge bleeding itching spotting post-coital irritation dyspareunia
21
Q
How do you diagnose cervicitis clinically?
A
History and examination
22
Q
How do you diagnose cervicitis in the the lab?
A
Microscopy (10WCC phpf) Evaluate for bacterial vaginosis Rapid antigen tests Culture PCR Fluorescent antibody tests
23
Q
How do you treat cervicitis?
A
- N. gonorrhoeae - ceftriaxone
- C. trachomatis - azithromycin, doxycycline 7 days
- Avoid coitus to prevent re infection during therapy
24
Q
What is vulvovaginitis?
A
Inflammation of the mucosal lining of the vagina
25
What are non infectious causes of vulvovaginitis?
clothes, feminine products and soaps
26
What is the clinical presentation of vulvovaginitis?
Vagina discharge
vulvar itching and irritation
often odor
27
Name the 3 diseases of the vagina?
bacterial vaginosis, trichomoniasis and candiadisis
28
What is bacterial vaginosis?
When normal vagina biota (Lactobacillus) is replaced by specific organisms
e.g. Gardnerella vaginalis
- Changes the pH of the vaginal environment
Note: Normal pH is 3.8 to 4.5
29
What are the risk factors for bacterial vaginosis?
1. sexual activity at an early age
2. having numerous, anonymous, or frequently changed sex partners,
3. having female sex partners,
4. frequent douching
30
What role does coitus take in the pathogenesis of bacterial vaginosis?
bacterial vaginosis is a sexually transmitted infection
31
What is the Amsel criteria?
criteria in the diagnosis of bacterial vaginosis
1. vaginal pH greater than 4.5
2. positive whiff test
3. milky discharge
4. presence of clue cells on microscopic examination of vaginal fluid
32
Describe what is seen on a wet mount when testing for BV?
1. clue cells - vaginal squamous epithelial cells typically coated with gram-variable G. vaginalis
2. Polymorphonuclear leukocytes (PMNs)
33
How to do an amine or whiff test and what you should detect?
performed by adding of one or two drops of 10% KOH and detecting “fishy odour” and vaginal pH greater than 4.5
34
How do you find out which organsism is causing BV?
1. Culture; needs specialised media
| 2. DNA hybridization test for G vaginalis, Trichomonas vaginalis
35
What is the treatment for BV?
1. Oral metronidazole - 7 days
| 2. clindamycin - intravaginally 7 days
36
What are the complications of treatment of bacterial vaginosis?
preterm labour
low birth weight
PROM - premature rupture of membranes (amniotic sac)
miscarriage
37
What is Trichomonas vaginalis?
is a flagellate protozoa
- Adhesive factors and proteases
causes mild irritation to severe inflammation
38
What is the epidemiology of Trichomonas vaginalis?
- 70% or women no symptoms
| - May also affect men
39
What is the clinical presentation of Trichomonas vaginalis?
1. itching, burning, dysuria, lower abdominal pain, genital redness or soreness, and a smelly vaginal discharge that can be clear, white, yellowish, or greenish
2. Elevated pH
40
What is the laboratory diagnosis of TV?
```
Microscopy in wet saline
Culture(Diamond medium)
POC rapid antigen test
Oligonucleotide probe test in the office
In-house PCR
```
41
What is the treatment of TV?
Metronidazole or tinidazole
| - Treat sexual partner and all asymptomatic patients/clients
42
What is candidiasis?
- vaginal thrush
- Result of imbalance : yeasts are there in small amounts
- C. albicans (sometimes C. parapsilosis, C. glabrata, C. tropicalis, C. krusei)
43
What are the risk factors for candiasis?
- pregnancy, ovulation, menopause, oral contraceptives, and estrogen replacement therapy
- Immunosuppressive conditions such as diabetes mellitus, iron deficiency, or HIV
44
What is the laboratory diagnosis of Candidiasis?
1. Gram stain and culture
- KOH preparation
2. pH remains unchanged
45
What is the treatment of Candidiasis?
Azole antifungal drugs
46
What is genital ulcer disease?
- Disruption in the skin/ mucosal layer of the genitals
- Mainly caused by herpes, syphilis or chancroid
- Multiple infections may occur with GUD
- Increased risk of HIV transmission
- Agent specific diagnosis may be compounded by co-infections
47
Describe genital herpes?
1. caused by HSV-1 and HSV-2
- HSV-1 usually causes oral sores
2. Female to male transmission is less than male to female transmission
3. Asymptomatic individuals may serve as reservoirs of infections
4. 1 to 26 days incubation period
5. Enters the body through the skin or mucous membranes by secretions of infected individual
48
Describe the manifestations of genital herpes?
1. Extensive painful vesicles, Fever, Myalgias, Malaise, Dysuria and Inguinal lymphadenopathy
Meningitis
2. Lesions develop into ulcers containing HSV particles
- May take 2-4 weeks to heal
3. HSV ascends along sensory nerve roots to the dorsal root ganglion
- With reactivation the virus travels back down from the dorsal ganglion back to the root
49
What is the most serious complication of genital herpes?
neonatal infection
50
What is the laboratory diagnosis of genital herpes?
1. PCR
2. culture
- Fluids from vesicles
- Cervical swabs or mucosal swabs
51
What is the treatment for genital herpes?
Lifelong, no cure
acyclovir, valacyclovir, and famciclovir
Suppressive therapy may reduce recurrence
52
Describe syphilis?
1. caused by T. pallidum subsp pallidum
2. is a multistage disease
- Primary, secondary and tertiary (or late) syphilis
3. Lesion (chancre) progresses to ulcer but not purulent
- Heals in 3-6 wks
4. Lymphadenopathy accompanies the first stage
5. From 6 wks to 6 months spirotaemia is responsible for secondary syphilis
53
What is the clinical presentation of of secondary syphilis?
1. Fever, skin rash, myalgia anorexia
2. Hepatitis, osteitis, keratitis
3. Macular or popular lesion of soles and palms
4. Condylomata lata
- These disappear in a few weeks even without treatment and enter a latent phase
- After lesions heal patients no longer infectious
54
What are the stages of latent syphilis?
1. Early latent syphilis: 1 year post infection
| 2. Late latent syphilis: > 1 year post infection or unknown infection
55
Describe latent syphilis?
```
CSF abnormalities without symptoms
A third of patient ,may develop tertiary syphilis associated with immune sequale of primary and secondary syphilis
- Neurologic and cadovascular disease
- Gummas
Congenital syphilis may follow
```
56
What is the diagnosis of syphilis?
1. Treponemal tests
- FTA-ABS
- TP-PA
- Do not disappear after treatment
2. Non treponemal tests
- RPR
- VDRL
- Antibodies to cardiolipin
57
What is the treatment for primary and secondary syphilis?
Benzathine Pen G 2.4 million units I.M stat dose
Alt: Doxycycline 100 mg bc x 14 days or IM/IV Ceftraiaxone 1 gm od x 10-14 days
Azithromycnin 2 gm p.o stat
58
What is the treatment for the late latent phase of syphilis?
Pen 2.4 MU IM q week X 3 wks
59
What is the clinical presentation of chancroid?
1. painful genital ulceration
2. inflammatory inguinal adenopathy
3. bubo formation.
4. The chancroid is a painful lesion with ragged or uneven soft edges and a grey to yellow purulent exudate
5. Lymphadenopathy in these patients is usually unilateral and is more frequently observed in men
60
What is the pathogenesis of chancroid?
1. Pathogen enters through microabrasions in the skin following sexual intercourse
2. A tender erythematous papule develops at the site of infection 4 to 7 days after exposure before progressing to the pustular stage
61
What is the laboratory diagnosis of chancroid?
Culture for H. ducreyi
| PCR
62
What is the treatment for chancroid?
azithromycin Stat dose
| Oral ciprofloxacin 500 mg b.d x 3/7
63
What is lymphogranuloma venereum?
1. C. trachomatis serovars L1, L2a L2b and L3
2. 3 stages of disease
- primary(chancre)
- secondary(lymphadenopathy)
- tertiary
64
What is the diagnosis of LV?
diagnosis by exclusion
1. PCR
2. immunofluorescence
65
What is the treatment for LV?
doxycycline
66
Describe Donovanosis?
1. caused by K. granulomatis
- Rare in developed countries
2. diagnosis by giemsa stain and charactistic Donovan bodies(within macrophages)
- PCR developed
3. treatment same as LGV
