STD/STI Flashcards
1
Q
Dark Field
A
Treponema Pallidum
2
Q
Non-culturable Organisms
A
Treponema Pallidum
3
Q
Treponema Pallidum bacterial characteristics
A
GN, spirochete, motile, slow growing, sensitive to desiccation and temperature
4
Q
Endarteritis
A
T. pallidum; inflammation causing proliferation of endothelial and fibroblast cells - > blocking lumen
5
Q
Periarteritis
A
T. pallidum; inflammation causing proliferation of adventitial cells/pericytes & cuffing of vessel by monocytes, lymphocytes, & plasma cells
6
Q
Treponema Pallidum Virulence Factors
A
No LPS (few OMPs), Lipoprotein (act spike endotoxin, immunomodulator), antigenic variation (Tpr)
7
Q
Transmission of Treponema Pallidum
A
No fomites (unstable), rare during latency, direct contact, transplacentally, blood transfusions
8
Q
Treponema Pallidum incubation period
A
~21d (3-90d)
9
Q
IgM w/ Treponema Pallidum
A
Peaks in 2nd Syphilis, but rapidly declines and goes away
10
Q
IgG w/ Treponema Pallidum
A
Peaks at the end of 2nd Syphilis, but never goes away
11
Q
Immune response to Treponema Pallidum
A
Th1 during Primary Syphilis, agent drives conversion to Th2 during Secondary Syphilis
12
Q
Treponema Pallidum Reservoir
A
Humans
13
Q
Endarteritis and Periarteritis are results of
A
Inflammatory reaction to Treponema Pallidum
14
Q
Primary Syphilis Manifestations
A
Chancre/Genital Ulcer: indurated, sharply demarcated, eroded center, serous discharge, painless, highly infectious + regional LAD 7-10d after chancre appearance
15
Q
Primary Syphilis chancre is d/t
A
immune response to local replication
16
Q
Primary Syphilis often occurs _______ on the male penis
A
in the sulcus
17
Q
Regional LAD may appear when during Syphilis
A
7-10d after primary chancre appearance, & during Secondary Syphilis
18
Q
Secondary Syphilis appears
A
6 weeks after exposure
19
Q
Manifestations of Secondary Syphilis
A
VARY, but include: non-pruritic rash on palms/soles,mouth/anus & spreads, condylomata lata, alopecia, fever, HA, malaise, arthralgia, LAD
20
Q
Primary Syphilis chancre lasts
A
2-6wks
21
Q
Infectious periods during Syphilis
A
Primary Syphilis & all bouts of Secondary Syphilis; Early Latent Stage (w/in year 1)
22
Q
Condylomata lata
A
occurs during Secondary Syphilis; highly infectious, raised, painless, central erosion & covered w/ a thin membrane – found on genital, oral, &/or rectal mucosa
23
Q
Rash of Secondary Syphilis
A
b/l symmetrical, non-pruritic, infectious skin rash, starting on palms/soles/mouth/anus and spreads, fever, LAD
24
Q
In utero Syphilis infection can occur
A
anytime during latent syphilis or active syphiis
25
Alopecia
Secondary Syphilis
26
Why is Syphilis a disease of 1/3
1/3 untreated secondary syphilis pts will spontaneously cure, 1/3 secondary syphilis pts remain infected, but asymptomatic, 1/3 will progress to tertiary syphilis
27
What additional Manifestations may be present during secondary syphilis
hepatitis, IC-glomerulonephritis, meningitis/encephalitis, arthritis, GI and eye problems
28
secondary syphilis resolves
w/ or w/o treatment
29
Latent Syphilis
Asymptomatic phase but w/ (+) serology
30
Early Syphilis
1st year after exposure, considered Infectious, Most secondary syphilis relapses occur in early phase of latent syphilis
31
Late Syphilis
Year 1-4, not considered infectious, low rate of relapse
32
Tertiary Syphilis
Slow, degenerative progressive inflammatory disease, refractory to Abx, ~10yrs after exposure
33
Tertiary Syphilis Manifestations
Cardiovascular/Aortitis, Neurosyphilis, Gumma
34
Syphilitic Aortitis
Endarteritis of vasa vasorum -> ischemia of aortic arch/ascending aorta -> aortic aneurysm, stenosis, regurgitation
35
Early Neurosyphilis
Asymptomatic (+ CSF), Meningitis, stroke w/ focal S/S
36
Late Neurosyphilis
General Paresis, Tabes Dorsalis, Argyll-Robertson Pupil
37
General Paresis
Dementing illness (personality, affect, reflexes, eyes, sensorum, intellect, speech)
38
Tabes Dorsalis
P.C. - loss of proprioception & sensation -> ataxia/wide-based gait
D.R. - loss of pain & temp sensation, areflexia
39
Argyll-Robertson Pupil
Constriction to accommodation, but not light
40
Gumma
chronic granulomas found in various tissues, benign unless affecting organ
41
Early Congenital Syphilis
most are born without clinical evidence of disease (but would be STORCH test positive) & develop Sx ~3-4mo old
42
Early Congenital Syphilis Sx typically begin
3-4mo of age
43
Early Congenital Syphilis Sx
persistent rhinitis -> maculopapular, desquamative rash, condylomata lata, diffuse rhinitis, lesions on any organ
44
Latency in Congenital Syphilis
occurs ~6-12mo of age and persists typically to 5-15y/o -> Late Syphilis
45
Late Syphilis/Stigmata Sx
Hutchinson's Triad, frontal bossing, bulldog jaw, higoumenakia sign, saber shins, cluttons joints
46
Most common outcome w/ Congenital Syphilis
Stillbirth
47
Hutchinson's Triad
saddle nose, skin rhagades (radial scars), corneal ulcers and opacities, Hutchinson’s teeth and mulberry molars
48
Microscopy for Treponema pallidum
Darkfield
49
Which Abs rise first in response to Treponema pallidum
Specific-Treponema Abs
50
What is the 1st diagnostic test that is (+) in syphilis?
Darkfield
51
What is the 1st serologic test that is (+) in syphilis?
Specific-Treponema Abs
52
Screening Test for Syphilis
Non-Specific Antibody Test
53
DFA-TP for Syphilis
Specific Fluorescent Ab test to T. pallidum
54
Non-Specific Treponema Antibody
anti-phospholipid Abs, used for screening tests, VDLR, RPR, monitor Tx
55
Diagnosis of Neurosyphilis
VDLR (non-specific)
56
Monitor Syphilis Tx
RPR (non-specific)
57
Confirmatory Tests for Syphilis
Specific-Treponema Abs, FTA-ABS, used to diagnose late syphilis or neurosyphilis
58
Treatment for Syphilis
Benzathine Penicillin G
59
Treatment for Syphilis in pregnant female
Benzathine Penicillin G; if HSN -> Azithromycin
60
Treatment for Syphilis in penicillin-hsn pt
Azithromycin, Doxycycline, Tetracycline
61
Syphilis resistance to Tx
rRNA mutation confers resistance to Azithromycin in strains spontaneously
62
Jarisch-Herxheimer Reaction
endotoxic shock-like response due to dying agents released into blood (fever, HA, myalgia, chills, tachycardia)
63
Tx for Jarisch-Herxheimer Reaction
NSAID, prednisone
64
Reportable diseases
Syphilis
65
Haemophilus Ducreyi bacterial characteristics
GNR pleomorphic, highly fastidious
66
Culture of Haemophilus Ducreyi on
Chocolate agar
67
Chancroid is found primarily in
3rd world countries, and under diagnosed in the US
68
Most commonly associated w/ HIV transmission
Chancroid
69
Chancroid or Syphilis has a immune response during the primary stage
Syphilis
70
Why is Chancroid so highly associated w/ HIV transmission?
CD4+ Tcells & Monocytes are attracted to primary site
71
Chancroid Incubation period
7 days
72
Primary Chancroid Manifestation
genital ulcer: 1 or more painful, pustule, erodes & ulcerates w/ ragged edges +/- Bubo
73
Bubo
painful inguinal LAD, U/L, reddened skin, may suppurate & rupture
74
Bubo occurs
7-10days after chancre or during
75
Microscopy of Chancroid
GNR in chains in or outside of PMNs "school of fish" appearance
76
Treatment of Chancroid
Azithromycin, Erythromycin, Ceftriaxone
77
Chancroid may be resistant to what Tx
TMP-SMX; plasmid-mediated
78
Chlamydia trachomatis bacterial charcteristics
GN, obligate intracellular, biphasic (elementary & reticular bodies), cytoplasmic inclusions
79
Which strains of Chlamydia trachomatis cause LGV?
L1, L2, L3
80
Chlamydia trachomatis L1, L2, L3 preferentially infect
Macrophages
81
Immune response to Chlamydia trachomatis L1, L2, L3
CMI: Th1 -> IFN-gamma -> activate macrophages
82
LGV Incubation period
3-30days
83
Primary LGV Manifestations
small, inconspicuous genital papule or herpetiform ulcer of short duration and few symptoms (may go unnoticed)
84
Secondary LGV incubation
2-6 weeks after exposure
85
Secondary LGV Manifestations
fever, extensive inguinal LAD (acute inflammation) w/ bubo formation, groove's Sign
86
Groove's Sign
Secondary LGV; bubo formation and may bisect the inguinal mass by Poupart’s ligament
87
Tertiary LGV
genital ulcers, fistulas, & rectal strictures; genital elephantiasis due to lymphatic obstruction
88
Diagnosis of LGV
detection of chlamydial antigens by EIA, PCR
89
Treatment of LGV
Macrolides
90
Klebsiella granulomatis bacterial characteristics
encapsulated GNR, fastidious
91
Klebsiella granulomatis can only be cultured with
human monocytes/macrophages
92
Klebsiella granulomatis: Granuloma Inguinale is found
in the tropics
93
Granuloma Inguinale is characterized by
Chronic ulcerative, degenerative and mutilating disease of the urogenital tissue and draining lymphatics
94
Stain for Klebsiella granulomatis
Giemsa or Wright
95
Microscopy for Klebsiella granulomatis would show
```
Donovan bodies: clusters of organism in the cytoplasm of monocytes and macrophages
Bipolar staining (safety pin)
```
96
Treatment of Granuloma Inguinale
Ciprofloxacin, TMP-SMX, Macrolides, Doxycycline
97
Donovan Bodies
Klebsiella granulomatis
98
HSV-2 viral characteristics
dsDNA, enveloped, latent in sacral ganglia
99
Transmission of HSV-2
Asymptomatic sexual contact, in utero or parturition, autoinoculation
100
HSV-2 incubation period
2-7 days
101
Immunocompetent pts w/ HSV-2 Manifestations
mostly asymptomatic, classic S/S: clear, fluid-filled vesicles on erythematous base (vesicle -> pustule -> ulcer -> crust); inguinal LAD; aseptic meningitis if disseminated
102
Immunocompromised pts w/ HSV-2 Manifestations
perirectal herpetic lesions (AIDS), viremia -> hemorrhagic necrosis in affected organs
103
Recurrent HSV-2 infection
prodrome (pain & tingling), milder lesions ~4d & healing in 10d
104
Perinatal Herpes S/S appear
9-14d after birth (contracted during birth)
105
Perinatal Herpes S/S
SEM, Disseminated, Encephalitis (fatal)
106
Stain for HSV-2
Tzanck or Pap
107
Microscopy of HSV-2
Syncytia formation + Intra-nuclear inclusions (Cowdry A)
108
Serology test for HSV-2
EIA or NAAT
109
Treatment for HSV-2
Acyclovir
110
Acyclovir MOA
activated by thymidine kinase, nucleoside analogue that gets incorporated into the growing viral genome, causing chain termination
111
Acyclovir is not a cure for HSV but does
reduce duration of lesions, stops shedding, prevents Sx of recurrence
112
N. gonorrhoeae bacterial charcteristics
GN diplococci, facultative intracellular, oxidase (+), antigenic pili, IgA protease
113
N. gonorrhoeae transmission
while Sx or aSx, auto-inoculation, perinatally
114
N. gonorrhoeae Tx
Ceftriaxone (2nd or 3rd Cephalosporin)
115
C. trachomatis D-K causes
cervicitis, urethritis, PID
116
C. trachomatis D-K infects
the columnar epithelial cells of the mucosal surface
117
C. trachomatis D-K transmission
while Sx or aSx, auto-inoculation, perinatally
118
C. trachomatis D-K Tx
Tetracycline, Azithromycin, Doxycycline
119
Cervicitis Sx
"tender, friable cervix" mucopurulent exudate, vaginal discharge, erythema, edema, dyspareunia, dysuria
120
Gonococcal Cervicitis may involve
Infection may involve the Skene’s and Bartholin’s glands
121
Cervicitis is asymptomatic how often with each agent
60-85% for C. trachomatis & ~50% for N. gon
122
PID may spread to cause
produce acute peritonitis and acute perihepatitis
123
PID can lead to
Tubal factor infertility, ectopic pregnancy, chronic pelvic pain, Fitz-Hugh-Curtis Syndrome
124
PID Sx
asymptomatic, or fever, lower and pain, dysmenorrhea, irregular menses, cervical motion tenderness, adnexal tenderness/mass
125
Fitz-Hugh-Curtis Syndrome Sx
RUQ pain, jaundice, ascites, adhesions w/ perihepatitis
126
PID Tx
2nd or 3rd generation Cephalosporin (Gonorrhea)
Tetracycline, Doxycycline (Chlamydia)
Metronidazole (Anaerobes)
127
Urethritis asymptomatic by agent
C. trachomatis 50-60%; N. gonorrhoeae 5-10%
128
Sx of Urethritis
Painful urethritis, mucopurulent discharge &/or dysuria (esp w/ gonorrhea), “bonjour spots” discharge on under garments in morning
129
Incubation period for Urethritis
2-10d, longer for C. trachomatis
130
Disseminated Gonococcal Infection (DGI)
rare, several days after genital infection
131
Sx of Disseminated Gonococcal Infection (DGI)
fever, joint pain (septic arthritis), rash (variable – sparse pustular or hemorrhagic)
132
Reactive Arthritis after cervicitis/urethritis
no systemic signs, sterile, aseptic conjunctivitis & urethritis, arthralgia
133
Opthalmia neonatorum
hyperacute, mucopurulent conjunctivitis contracted by the neonate during birth d/t untreated gonococcal infection
134
Inclusion conjunctivitis
conjunctivitis contracted by the neonate during birth d/t untreated Chlamydia infection
135
Agar used for N. gonorrhoeae
Thayer-Martin
136
Diagnosis of N. gonorrhoeae
Gram stain: GN diplococci in PMNs
137
Diagnosis of Chlamydia trachomatis
DFA, NAAT, LCR
138
Non-gonococcal Urethritis
50-90% is C. trachomatis
139
Other agents of Cervicitis/Urethritis/PID
Ureaplasma, Mycoplasma, T. vaginalis
140
N. gonorrhoeae is resistant to
beta-lactams, tetracycline, fluoroquinolones, Cefixime
141
HPV characteristics
Small, non-enveloped, icosahedral dsDNA virus
142
Strains causing Dysplasia/Cervical Carcinoma
HPV-16 & 18
143
Strains causing Genital Warts
HPV-6 & 11
144
HPV has a tropism for
squamous mucosal epithelium (stratum granulosum & corneum)
145
HPV oncogenes MOA
E6, E7 bind & inactivate p53 & p105
146
HPV microscopy
koilocytosis: cells w/ large perinuclear cytoplasmic vacuoles surrounded by dense cytoplasm
147
Immune response to HPV
CMI, but it has limited access to the stratum granulosum and corneum
148
incubation period for HPV
3-4mo
149
Condyloma acuminatum
1 or more soft, fleshy cauliflower-like raised lesion of the squamous epithelium of the anogenital region
150
Cervical papillomas
dysplasia -> cancer (16, 18, 31, 33)
151
Diagnosis HPV dysplasia
Colposcopy - Actowhite test (acetic acid -> white patches)
152
Treatment for HPV
Wart removal, interferon Tx, antiviral cream, imiquimod
153
Imiquimod MOA
immune response modifier; binds TLR7 to promote Th1 CMI -> production of IFN, TNF, IL-6, IL-8 to induce an immune response at the infection site
154
HPV quadrivalent vaccine
Gardasil: HPV-16, 18, 6, 11 (capsid particles)
155
HPV bivalent vaccine
Cervavix: HPV-16, 18 (L1 proteins)
156
Vaginal NF
anaerobes > aerobes
157
Agents of Vaginal NF
Lactobacillus, Peptostreptococcus, Bacteroides, Staphylococcus, Streptococcus (GNR, GPR, GPC)
158
Lactobacillus's role in protection of the urogenital tract
fermentation of glucose to lactic acid (pH ~4) & H2O2 production -> Cl- to kill pathogens
159
Normal cellular makeup of vagina
VEC:PMNs should be 1:1
160
Conditions that predispose to vaginal infections
menses, oral BC, diabetes, feminine products
161
Trichomonas vaginalis characteristics
Pear-shaped, flagellated, facultative anaerobic protozoan, w/ jerky motion
162
Signs of vaginitis or vaginosis
increased PMNs, clue cells, KOH (+)
163
Trichomonas vaginalis engulfs
bacteria, PMNs, RBCs
164
Trichomonas vaginalis pathogenesis
causes desquamation of mucosal epithelium, but not invasive
165
Trichomonas vaginalis Sx
profuse, watery or foamy leukorrheal discharge that is highly irritating to the vagina, labia, vulva, & perineum; desquamation + intense pruritis is common
166
Trichomonas vaginalis incubation period
5-28d
167
Trichomonas vaginalis Diagnosis
wet mount w/ motile protozoans
168
Labs for Trichomonas vaginalis
elevated vaginal pH, high PMNs, KOH (-)
169
Treatment for Trichomonas vaginalis
Metronidazole, vinegar (acid douche)
170
Only protozoan STD
Trichomonas vaginalis
171
Candida characteristics
Yeast, invasive in all 3 forms (yeast, pseudohyphae, hyphae)
172
Candida albicans is different from other candida bc
forms germ tubes at 37C
173
Immune response to Candida
CMI + Neutrophils
174
Sx of Candidiasis
Pseudomembranous patches on the vaginal mucosa, labia and perineum; Thick yellow-white cottage cheese-like discharge w/ inflammation of the vaginal mucosa, Intense pruritis
175
Diagnosis of Candidiasis
Wet mount -> KOH -> methylene blue stain showing budding yeast, hyphae, pseudohyphae
176
Treatment of Candidiasis
ketoconazole, nystatin, miconazole, gentian violet, boric acid capsule
177
Labs for Candidiasis
normal pH, high PMNs, KOH (-)
178
Refractory cases of Candidiasis
C. glabrata, Tx w/ Gentian violet
179
Gardnerella vaginalis characteristics
anaerobic, nonmotile, small rod w/ Gram (+) cell wall architecture, but gram variable staining; NF
180
Bacterial vaginosis Pathogenesis
Decreased lactobacillus -> increased pH & anaerobe growth
181
Anaerobes produce which enzymes
Proteolytic carboxylic enzyme -> malodours amines
| Succinate -> inhibit infiltration of PMNs
182
Other agents causing Bacterial vaginosis
Mobiluncus: GP curved rod, motile, anaerobe, stains gram-variable
Atopobium vaginae: anaerobe
183
Sx of Bacterial vaginosis
Malodorous discharge (gray, off-white, thin, discharge), fishy-odor most noticeable after intercourse or during menses; no erythema, edema, itching, burning, pain, or dysuria
184
Diagnosis of Bacterial vaginosis
Wet mount: clue cells (>20% of VEC); KOH (+) fishy-smelling amines
185
Labs for Bacterial vaginosis
high pH, normal PMNs, KOH (+)
186
Treatment for Bacterial vaginosis
Metronidazole
187
Agents of Menstrual TSS
S. aureus, CoNS, Group A b-hemolytic Strep, Mycoplasma
188
Immune response to TSS
Neutralizing Ab
189
Risk factors for TSS
colonization w/ S. aureus producing TSST-1, lack of neutralizing Ab
190
Super absorbent tampons may favor TSS bc
Low Mg2+ (chelator), surfactants released, higher O2 tension,
191
Sx of Menstrual TSS
w/in 2 days of period: Fever, hypotensive shock, intense mucosal hyperemia/erythema, diarrhea, vomiting, myalgias, rash (diffuse macular) followed by desquamation 1-2wks after onset of illness
192
TSST-1 is acquired by
lysogenization
193
Treatment of Menstrual TSS
Supportive, Macrolides
194
TSS agents are often resistant d/t
penicillinases/beta-lactamases
195
Prevention of Menstrual TSS
abx prophylaxis to prevent colonization
196
Bacteriuria >10^5 CFU, w/o Sx, Tx
no Tx required, unless pregnant!!
197
Pyuria
>10WBCs/HPF (sedimented) or 50-100WBC/mL
198
Agents of Acute Uncomplicated Cystitis in Females
```
E. coli
S. saprophyticus
K. pneumoniae
Proteus mirabilis
Enterococcus spp
Mixed
```
199
Agents of Acute Uncomplicated Pyelonephritis in Females
E. coli
Proteus mirabilis
K. pneumoniae
Mixed
200
Agents of Complicated UTI
```
E. coli
Enterococcus spp
Pseudomonas spp
S. epidermidis
Mixed
Proteus mirabilis
K. pneumoniae
Yeasts
S. saprophyticus
```
201
Agents of Catheter-Associated UTI
```
Yeast – Candida
E. coli
Mixed
Pseudomonas spp
K. pneumoniae
S. epidermidis
Enterococcus spp
```
202
Tamm-Horsefall
Uromodulin; prevents attachment of uropathogens to the epithelium & prevents kidney stone formation
203
Immune response to UTI
PMNs, Neutralizing Abs
204
UTI in children < 2y/o Sx
failure to thrive, vomiting, irritability, suprapubic tenderness, fever
205
UTI in Elderly Sx
dehydration, vertigo, fever, loss of appetite
206
Acute Uncomplicated Cystitis Sx
Abrupt or insidious onset of micturition, urgency, dysuria (voiding small amts of turbid urine), hematuria, suprapubic pain/tenderness
207
Labs of Acute Uncomplicated Cystitis
bacteriuria, pyuria, hematuria
208
Acute Uncomplicated Pyelonephritis Sx
fever, chills, malaise, n/v, HA, dysuria, micturition, urgency, excruciating flank or low back pain
209
Nephrolithiasis – Complicated UTI Sx
Flank pain, hematuria, ammonia-smelling urine (pH 7)
210
Risk factors for UTI
females, BPH in males > 50, immune deficiency (IL-8R mutation, neutropenic, agammaglobulinemia), ABH non-secretors, catheters, diabetes
211
Labs of Acute Uncomplicated Pyelonephritis
bacteriuria, pyuria, hematuria, paralytic ileus
212
Agents that produce urease and cause Nephrolithiasis
Corynebacterium urealyticum, Proteus mirabilis, K. pneumoniae, S. saprophyticus
213
Urease role in Nephrolithiasis
cleaves urea, increasing pH, causing precipitation of struvite stones (MgNH3 + CaCO3-apatite)
214
Acute Prostatitis Sx
E.coli
| Fever, chills, flank pain, dysuria, micturition, urgency
215
White Cast cells
suggestive of pyelonephritis
216
Diagnosis for UTI
Urine sample (bacteria, WBC, WBC, pH, NH3)
Culture: MacConkey or Blood agar
Urine Dipstick: Esterase, Nitrite
217
Treatment for UTI
TMP-SMX, however may be resistance
Ampicillin if resistance to beta-lactams is low
Fluoroquinolones (Cipro)
Nitrofurantoin for pregnant females
218
Diagnosis of Pyelonephritis
CT scan - hypodense regions; White cast cells
219
Normal Urine
pH ~5, mildly urea, clear/yellow
