Sexually Transmitted Infections-2 Flashcards
(24 cards)
What is urethritis?
Mucopurulent or purulent discharge
Most infections are asymptomatic
The 2 most common causes are Neisseria gonorrhea and chlamydia trachomatis
Reportable diseases
How to confirm urethritis?
Discharge
Gram stain f secretions - >5 WBC/oil immersion field
Gonorrhea present with intracellular gram negative diplococci in smear
Positive leukocyte esterase on first void urine (WBC>10/hpf)
Nucleic acid amplification tests are available for diagnosis
What is cervicitis?
Purulent or mucopurulent endocervical exudate visible in endocervical canal or on swab
Often asymptomatic
If symptomatic- abdominal vaginal discharge and bleeding
Can lead to external dysuria, urgency and frequency are less common
What is gonorrhea?
Infection of the columnar and transitional epithelial cells by Neisseria gonorrhea
Gram negative kidney bean shaped diplococcus
Very fragile organism
Killed by cotton swab
Isolated on Thayer Martin plates
Human are the only known host
What are the manifestations of gonorrhea in females?
30% are asymptomatic Cervicitis Anorectal infection Urethral infection Bartholinitis Fitz- Hugh- Curtis syndrome- inflammation of liver creating adhesions
What are the manifestations of gonorrhea in heterosexual males?
Erythema and inflammation of the urethral opening, purulent discharge, dysuria (urethritis)
Usually symptomatic
What are the manifestations of gonorrhea in homosexual males?
Urethritis
Anorectal infection
Pharyngitis
What are the manifestations of disseminated gonococcal infections?
Represent 1-3% of cases Usually asymptomatic Low grade fever Migratory polyarthralgia Tenosynovitis- skin rashes
What are the manifestations of gonorrhea in children and infants?
During childbirth can infect conjunctiva, pharynx, respiratory and GI tract
Eye infections- ophthalmia neonatorum
How to diagnose gonorrhea ?
Evaluate signs and symptoms
Gram stain
Culture of exudate on Thayer Martin
How to interpret the stained smears of gonorrhea?
Presence of intracellular gram negative diplococci suggests positive test
Test is questionable if only extracellular gram negative diplococci are present
In males urethral swab confirms diagnostic
In females cervical swab does not confirm diagnostic , diagnosis confirmed by culture
How to treat gonorrhea?
Antibiotics- ceftriaxone or azithromycin
If can’t rule out chlamydia add doxycycline
No vaccine available
Best prevention is educating patients
Chemoprophylaxis to prevent ophthalmia neonatorum
What is Non gonococcal urethritis (NGU)?
Most frequent cause of urethritis in heterosexual men
Most cases are of unknown cause
Chlamydia trachomatis is most common
What are the signs and symptoms of NGU?
Urethral discharge- clear rather than purulent
Pain on urination
Itch in the meatal region
History of genital infection in a male or female partner
Who are more affected by NGU?
Men between the age 15-30 with multiple sexual partners
Commonly seen in college campuses and in rural America
Spread almost exclusively through sexual contact
How to diagnose NGU?
No gonorrhea by culture, gram stain
Documentation of urethritis
How to treat NGU?
Antibiotics - doxycycline or azithromycin
Trichomonas vaginalis Infections- treat with metronidazole plus azithromycin
What are the characteristics of chlamydia infections?
Most frequently reported notifiable infectious disease
Many are asymptomatic- 80% women, 50% men
Can lead to PID
Common cause of involuntary infertility
What are the chlamydial diseases in women?
Cervicitis
PID- more common in adolescent and young women
Can result in infertility and ectopic pregnancy
What are the chlamydial diseases in men?
Urethritis
Epididymitis (rare)
Reiter’s Syndrome associated complication (reactive arthritis)
Can’t see, can’t pee, can’t climb a tree
Who are more affected by chlamydial infections ?
Highest in sexually active under persons under 25 years of age
Rate of infection is much higher in Africans Americans than Whites
How to treat chlamydial infections?
Doxycycline or azithromycin
In pregnancy azithromycin or erythromycin
How to prevent chlamydial infections?
Annual screening of women 20-25
Annual screening of women>25 with risk factors ( new partner or multiple sex partner)
What are the 2 chlamydial diseases in neonates?
Ophthalmia neonatorum 5-12 days after birth
Pneumonia 1-3 months of age
Treated with erythromycin
Prevented by testing and treated infected pregnant women
