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Clinical 2 (Sam) > STI's > Flashcards

STI's Flashcards

1
Q

Urethritis:

Description

A

Inflammation of urethra

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2
Q

Urethritis:

Pathogen

A

N. gonorrhoea

C. trachomatis

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3
Q

Urethritis:

Symptoms

A

Dysuria, frequency, purulent or mucopurulent discharge (minimal or asymptomatic)

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4
Q

Cervicitis:

Description

A

Inflammation of cervix

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5
Q

Cervicitis:

Pathogen

A

N. gonorrhoea

C. trachomatis

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6
Q

Cervicitis:

Symptoms

A

Purulent/mucopurulent discharge, endocervical bleeding; asymptomatic

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7
Q

Genital ulcer disease:

Description

A

ulcer genital, anal or perianal

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8
Q

Genital ulcer disease:

Pathogen

A

syphillis, chancroid

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9
Q

Genital ulcer disease:

Symptoms

A

superficial ulcer on genitalia (defined/ill-defined margins; painless/pain)

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10
Q

Prostatitis:

Description

A

prostate gland infection

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11
Q

Prostatitis:

Symptoms

A

Dysuria, bloody urine, lower groin/back pain, pain in testes/penis

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12
Q

Vaginal discharge:

Description

A

Discharge may be due to bacterial vaginosis/vulvovaginal candidiasis/trichomonas/chlamydia/gonorrhea and non-infectious causes

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13
Q

Vaginal discharge:

Symptoms

A

Vaginal discharge, purulent/mucopurulent discharge, occasional blood; vaginal pruritus/pain +/- odour

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14
Q

Pelvic inflammatory disease:

Description (pathogen)

A

Ascending spread of pathogens from vagina/cervix to upper female genital tract (endometrium, fallopian tubes, pelvic peritoneum and other structures). May present as any combination of endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis

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15
Q

Pelvic inflammatory disease:

Symptoms

A 
Subtle-mild-severe symptoms:
-Adnexal tenderness (abd/pelvic pain)
-Cervical motion tenderness
-Vaginal/urethral discharge
\+/- fever
\+/- elevated WBC
intermenstrual bleeding
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16
Q

NAT or NAAT

A

nucleic acid amplification test (PCR) detects specific DNA sequence of pathogen

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17
Q

DFA

A

direct fluorescent antigen

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18
Q

Serology

A

measures/detects antibodies to pathogen/organism

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19
Q

List the 3 most common STIs

A
  • gonorrhea (GC)
  • chlamydia
  • syphillis
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20
Q

List some other STIs

A
  • HPV
  • HSV
  • Hep B
  • Hep C
  • HIV
  • Trichomoniasis
  • Lice/scabies
  • Yeast
  • Protozoa
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21
Q

Patients with gonorrhoea may be co-infected with _____

A

chlamydia

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22
Q

Patients with syphillis may be co-infected with _____

A

HIV

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23
Q

What are risk factors for STIs

A
  • Unaware/lack of knowledge
  • Gender (generally female > male)
  • Unprotected sex
  • Sexual contact with infected person
  • Number of sexual partners
  • Anonymous sex
  • MSM
  • Host susceptibility
  • Age (15-25)
  • Socioeconomic
  • Sex worker and contacts
  • Societal stigma
  • Co-infection
  • Unreported infections
  • Asymptomatic patients
  • Missed symptoms
  • Geographic
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24
Q

Describe the Clinical Workup

A
  • Presentation, History, travel, contacts
  • Lab tests including HIV test
  • Public health/health care team (notification, contact tracing)
  • Treatment
  • Follow-up
  • Counselling
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25
Q

Complications of PVD

A

infertility, abscesses, chronic pelvic pain, ectopic pregnancies

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26
Q

Complications greater in what gender

A

women

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27
Q

Pelvic inflammatory disease: 1/3 PID attributed to ?

A

gonorrhoea and/or chlamydia

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28
Q

HPV can cause _____ _____

A

cervical cancer

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29
Q

STI’s can cause damage to _______ tract

A

reproductive

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30
Q

What else is associated with STI’s?

A
  • congenital or perinatal infections
  • infant mortality
  • social stigma
  • economic
  • antibiotic resistance
  • spread of other infectious diseases (ex. HIV)
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31
Q

Chlamydia:

Highest rates are found in _____

A

females

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32
Q

Chlamydia:

Prevalent in females between which ages?

A

15-24

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33
Q

Chlamydia:

Prevalent in males between which ages?

A

20-29

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34
Q

Gonorrhea:

Highest rates are found in _____

A

female

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35
Q

Gonorrhea:

Prevalent in females between which ages?

A

15-24

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36
Q

Gonorrhea:

Prevalent in males between which ages?

A

20-29

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37
Q

Syphilis:

Majority cases ____

A

male

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38
Q

Syphilis:

Prevalent in males between which ages?

A

20-24 and 30-39

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39
Q

Syphilis:

Prevalent in females between which ages?

A

25-39

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40
Q

What is involved in STI patient education?

A
  • Risk of reinfection
  • Risk of untreated infection
  • Abstain from sex for at least 3 days after treatment completed
  • Barrier protection
  • Reduce risk of sexual activity
  • Return to care if symptoms not improved
  • Testing
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41
Q

Gonorrhea:

What is caused by?

A

Neisseria gonorrheae, a gram negative diplococci

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42
Q

Describe Neisseria gnorrheae

A 
Exclusive human pathogen
Aka 'the clap', 'the drip'
Most common infection; urethritis, cervicitis
Other sites/infection: 
-Oropharyanx
-Ocular
-Disseminated gonococcal infection (DGI)
-Neonatal conjunctivitis (ophthalmia neonatorum)
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43
Q

N. gonorrhoea have _____ (aka fimbriae) attach to mucosal surfaces

A

pili

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44
Q

Gonorrhea elicits a strong ______ reaction and may cause scarring of the infected tissues (ex. fallopian tubes - can lead to infertility and atopic pregnancies in women)

A

inflammatory

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45
Q

Gonorrhea in males:

Symptoms appear in how many days?

A

2-8 days

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46
Q

Gonorrhea in females:

Symptoms appear in how many days?

A

10 days

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47
Q

Gonorrhea in males:

site?

A
  • urethra (common)

- rectum, eye, oropharynx (other)

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48
Q

Gonorrhea in females:

site?

A
  • endocervical canal

- urethra, rectum, eye, oropharynx (other)

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49
Q

Gonorrhea in males:

Symptoms

A
  • symptom > asymptomatic
  • Urethral: dysuria, frequency
  • Anorectal: asymptomatic to severe pain
  • Pharyngeal: asymptomatic to mild pharyngitis
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50
Q

Gonorrhea in females:

Symptoms

A
  • asymptomatic or minimally symptomatic
  • Endocervical: Asymptomatic or minimally symptomatic
  • Urethral: dysuria, frequency
  • Anorectal: asymptomatic to severe pain
  • Pharyngeal: asymptomatic to mild pharyngitis
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51
Q

Gonorrhea in males:

Signs

A

Purulent urethral or rectal discharge can be scant to profuse
Anorectal: pruritus, mucopurulent discharge, bleeding

52
Q

Gonorrhea in females:

Signs

A

Abnormal vaginal discharge or uterine bleeding;

Purulent urethral or rectal discharge can be scant to profuse

53
Q

Complications of gonorrhoea in males?

A

Rare (epididymitis, prostatitis, inguinal lymphadenopathy, urethral stricture), DGI - disseminated gonorrhoea infection

54
Q

Complications of gonorrhoea in females?

A

Pelvic inflammatory disease (PID), ectopic pregnancy, infertility

55
Q

What is DGI (disseminated gonorrhoea infection) ?

A
  • N. gonorrhoea bacteremia seeds sites outside reproductive tract
  • Symptoms: fever, chills, joint pain, joint swelling, skin rash red spots (May disseminate to other organs - meningitis, endocarditis)
56
Q

List 3 special populations in gonorrhoea infections

A
  • Pregnant women
  • Children
  • Newborns
57
Q

Considerations in pregnant women with gonorrhoea ?

A
  • choice of medication
  • risk of transmission
  • neonatal prophy
58
Q

Considerations in children with gonorrhoea?

A
  • Children infection of genital tract is sexually transmitted; vaginitis common in prepubertal females; urethritis uncommon in males
  • Pharyngeal, anorectal or ocular infections suggests sex abuse
59
Q

Considerations in newborns with gonorrhoea?

A

-Neonatal conjunctivitis aka ophthalmia neonatorum - acquisition of N. gonorrhoea during delivery - infection may lead to blindness

60
Q

What is the prophylactic treatment for all newborns in Mb for gonorrhoea?

A

erythromycin 0.5% eye ointment applied to newborns as GC prophylaxis

61
Q

Child abuse most likely if ??

A
  • Multiple sites
  • Gonorrhea 1-6 month old
  • Genital or rectal chlamydia > 6 months
  • HPV > 18 months
  • HSV > 3 months
  • Trichomonas > 6 months
62
Q

Diagnosis of Gonorrhoea ?

A

Symptoms, History
Lab work
-Gram stain - GN diplococci
-Culture N. gonorrhoea from (urine, cervix, urethral, other)
-Test of cure, sex abuse/assault, children under 12, PID or disseminated disease
-Other sites
-NAAT urine, endocervical and urethral swabs

63
Q

Treatment issues with gonorrhoea infections?

A
  • Emergence of antibiotic resistance from sulphonamides to ceftriaxone
  • Increased gonorrhoea treatment failure, concern with ‘superbug’
  • Increasing antibiotic resistance in Canada (PHAC)
64
Q

39% of N. gonorrhoea resistant to ________

A

ciprofloxacin

65
Q

Gonorrhoea infections:

Increased _______ resistance

A

azithromycin

66
Q

Gonorrhoea infections:

Decreased _____ and ______ susceptibilities

A

cefixime and ceftriaxone

67
Q

Gonorrhoea infections:

_______ resistance

A

tetracycline

68
Q

Gonorrhoea infections:

Loss of _____, ______ and ________ over the decades

A

penicillin, ampicillin, and FQs over the decades

69
Q

Gonorrhoea infections:
_______ was alternative for beta-lactam allergic patients. Rarely used and hard to get. (discontinued by manufacturer in 2017)

A

Spectinomycin

70
Q

Gonorrhoea infections:

Treat patients for both ??

A

gonorrhoea and chlamydia due to high rate of concomitant infection

71
Q

What is the preferred treatment for anogenital infection (urethral, endocervical, vaginal, rectal) in adults and youth > 9 years of age?

A

Ceftriaxone 250 mg IM in a single dose
PLUS
Azithromycin 1 g PO in a single dose

OR

Ceftriaxone 800mg PO in a single dose
PLUS
Azithromycin 1 g PO in a single dose

72
Q

What is the preferred treatment for pharyngeal infection in adults and youth > 9 years of age?

A

Ceftriaxone 250mg IM in a single dose
PLUS
Azithromycin 1 g PO in a single dose

73
Q

What is the preferred treatment for anogenital infection (urethral, rectal) in MSM?

A

Ceftriaxone 250mg IM in a single dose
PLUS
Azithromycin 1 g PO in a single dose

74
Q

What is the preferred treatment for pharyngeal infection in MSM?

A

Ceftriaxone 250mg IM in a single dose
PLUS
Azithromycin 1 g PO in a single dose

75
Q

What is the ALTERNATE treatment for anogenital infection (urethral, endocervical, vaginal, rectal) in adults and youth > 9 years of age?

A

Azithromycin 2 gram PO in a single dose

76
Q

What is the ALTERNATE treatment for pharyngeal infection in adults and youth > 9 years of age?

A

Cefixime 800 mg PO in a single dose
PLUS
Azithromycin 1 g PO in a single dose

OR

Azithromycin 2 g PO ina single dose

77
Q

What is the ALTERNATE treatment for anogenital infection (urethral, rectal) in MSM?

A

Cefixime 800 mg PO in a single dose
PLUS
Azithromycin 1 g PO in a single dose

OR

Azithromycin 2 g PO ina single dose

78
Q

What is the ALTERNATE treatment for pharyngeal infection in MSM?

A

Cefixime 800 mg PO in a single dose
PLUS
Azithromycin 1 g PO in a single dose

OR

Azithromycin 2 g PO ina single dose

79
Q

For children < 9:

What is the preferred treatment for Anogenital infection (urethral, vaginal, rectal) of gonorrhoea ?

A

Cefixime 8 mg/kg PO BID x 2 doses (maximum 400 mg per dose)
PLUS
Azithromycin 20 mg/kg (maximum dose of 1 g) PO in a single dose

OR

Ceftriaxone 50 mg/kg IM up to 250 mg in a single dose
PLUS
Azithromycin 20 mg/kg (max dose of 1 g) PO in a single dose

80
Q

For Children < 9:

What is the preferred treatment for a pharyngeal infection of gonorrhoea ?

A

Ceftriaxone 50mg/kg IM up to 250 mg in a single dose
PLUS
Azithromycin 20 mg/kg (maximum dose of 1 g) PO in a single dose

81
Q

For Children < 9:

What is the alternate treatment for a pharyngeal infection of gonorrhoea ?

A

Cefixime 8mg/kg PO BID x 2 doses (max 400mg per dose)
PLUS
Azithromycin 20 mg/kg (maximum dose of 1g) PO in a single dose

82
Q

In what type of gonorrhoeal infections is it important to follow up in?

A
  • All pharyngeal infections
  • Persistent symptoms or signs post-therapy
  • Case treated with a regimen other than the preferred regimen
  • Case is linked to another case with documented antimicrobial resistance to the treatment given
  • Antimicrobial resistance to the administered therapy is documented
  • Case is linked to a treatment failure case that was treated with the same antibiotic
  • Treatment failure for gonorrhoea has occurred previously for current infection in the individual
  • There is re-exposure to an untreated partner
  • Infection occurs during pregnancy
  • Disseminated gonococcal infection is diagnosed
  • Case is a child
  • Follow up testing should be considered for PID if N. gonorrhoea was initially isolated
  • Women undergoing therapeutic abortion (TA) who have a positive test result for gonococcal infection, as they are at increased risk of developing pelvic inflammatory disease
83
Q

What causes pelvic inflammatory disease

A

Ascending pathogens from cervix or vagina to upper genital tract

84
Q

1/3 of PID cases attributed to ______________

A

gonorrhea/chlamydia

85
Q

What does PID present as?

A
  • endometritis
  • salpingitis
  • tubo-ovarian abscess and pelvic peritonitis
86
Q

What are symptoms of PID

A
  • lower ab pain/mild pelvic pain
  • increased vaginal discharge
  • irregular menstrual bleeding
  • fever
  • pain with intercourse
  • painful and frequent urination
  • abdominal tenderness
  • pelvic organ tenderness
  • uterine tenderness
  • adnexal tenderness
  • cervical motion tenderness
  • inflammation
87
Q

Complications with PID?

A
  • tuba-ovarian abscess
  • infertility
  • ectopic pregnancy
  • chronic pelvic pain
88
Q

Diagnosis of PID ?

A
  • combination of signs and symptoms

- gonorrhea/chlamydia positive

89
Q

What is the inpatient treatment for PID ?

A

IV cefoxitin + oral doxycycline
OR
Clindamycin IV + gentamycin

(ceftriaxone + doxy + metronidazole)

90
Q

What is the outpatient treatment for PID ?

A 
Ceftriaxone 250 mg IM x 1
\+
Oral doxy (or azithromycin as alternative
\+
Oral metronidazole
91
Q

Chlamydia is less virulent than ______

A

gonorrhea

92
Q

Describe a chlamydia infection (less acute, more subtle than gonorrhoea)

A
  • many patients asymptomatic
  • C. trachoma’s servers D to K responsible for genital/perianal infections
  • Asymptomatic in up to 70% women and 50% men; males largest reservoir
  • Urethritis may be hard to differentiate from gonorrhea
  • Similar to GC, untreated disease may lead to PID, chronic pelvic pain, ectopic pregnancy
  • Increased risk of acquiring HIV
93
Q

Onset of chlamydia infections?

A

7-21 days

94
Q

Site of chlamydia infection in males

A

urethra, oropharynx

95
Q

Site of chlamydia infection in females

A

endocervical canal

96
Q

Symptoms of chlamydia infection in males

A

Symptomatic common > asymptomatic

Urethral: mild dysuria, discharge
Pharyngeal: asymptomatic to mild pharyngitis

97
Q

Symptoms of chlamydia infection in females

A

Urethral: subclinical, dysuria/frequency uncommon

Anorectal and pharyngeal: same for men

98
Q

Signs of chlamydia infection in males

A

Discharge scant to purulent urethral/rectal discharge

Rectal pain, discharge, bleeding

99
Q

Signs of chlamydia infection in females

A

Abnormal vaginal discharge or uterine bleeding; Purulent urethral or rectal discharge can be scant to profuse

100
Q

Complications of chlamydia infection in males

A

Epididymitis

Reiter’s syndrome (rare)

101
Q

Complications of chlamydia infection in females

A

Pelvic inflammatory disease (PID), ectopic pregnancy, infertility, Reiter’s syndrome (rare)

102
Q

What are 2 special populations with chlamydia infections

A

1) Pregnant women
- Pregnant women should be screened for STIs, chlamydia test as 1st prenatal visit
- Test for other STIs if chlamydia positive

2) Newborn
- 2/3 acquire chlamydia infection from chlamydia + mother via endocervical exposure
- 50% neonatal conjunctivitis potential for scarring of cornea
- 16% pneumonia - generally mild but can be severe

103
Q

Diagnosis of Chlamydia infection ?

A

Symptoms, History
Lab
-NAAT (urine, eye, cervical)
-DFA (throat, rectal, nasopharyngeal, pulmonary, eye)
-Culture if treatment failure (not routinely done)
-Other tests

104
Q

What are some treatment recommendations for chlamydia infections?

A
  • Start treatment if clinical signs/symptoms of chlamydial infection
  • Treat for both chlamydia and GC
  • Asymptomatic chlamydia positive but GC negative; no GC treatment needed
  • Test for other STIs
  • Manitoba Chlamydia Protocol under revision as of October 2017
105
Q

look at chart on page 13

A

okay

106
Q

What is syphillis caused by?

A

Treponema pallidum (spirochete)

107
Q

Syphillis:

Exclusively ______ disease, infects/invades through mucous membranes or open lesions

A

human

108
Q

Syphillis:

Describe the different stages of infection (if untreated)

A

Primary, Secondary, Tertiary (neurosyphilis, cardiac)

-Congenital disease (early <2yo, late >2yo) uncommon

109
Q

Co-infection of HIV and syphillis is common, describe this.

A
  • Syphillis can enhance acquisition of HIV
  • HIV patients produce atypical serologic response to syphilis; delayed response, false positives
  • HIV patients with syphillis can progress form primary to tertiary syphillis if untreated over years rather than decades
110
Q

Describe the primary and secondary and tertiary infection of syphillis

A

Primary:

  • chancre (ulcer) at the site of infection
  • lymphadenopathy

Secondary:

  • disseminated rash all over the body (spread elsewhere from site of infection)
  • generalized lymphadenopathy

Latent:
-asymptomatic

Tertiary:
CV: aortic aneurysm, aortic regurgitation, coronary artery postal stenosis

Neurosyphillis (CNS, eyes): Ranges from asymptomatic to symptomatic with headaches, vertigo, personality changes, dementia, ataxia, presence of Argyll Robertson pupil

Gumma: Tissue destruction of any organ; manifestations depend on site involved

111
Q

What are some special populations in syphillis infections?

A

a) Pregnant women
- Screen for STIs first prenatal visit preferably 1st trimester
- High risk - screen at 28-32 weeks and again at delivery

b) Newborn
- T. palladium can cross placenta; fetal risk highest when mom primary/secondary syphillis
- Congenital syphillis early (<2 years) vs late (>2 years)
- 2/3 asymptomatic; infection can lead to fetal death

112
Q

Diagnosis of Syphillis?

A

a) History and Clinical Presentation
b) Laboratory - difficult to grow
- Dark field microscopy - classic method, not practical
- NAAT
- Serologic - Treponemal, Non-treponemal

113
Q

Management of syphillis?

A
  • Treat with antibiotics
  • Follow-up with contacts and treat as needed
  • Counselling and Prevention
114
Q

What is the preferred treatment for Syphilis for non -pregnant adults in the primary, secondary or early latent stage?

A

Benzathine penicillin G 2.4 MU IM as a single dose

*slow release penicillin released over a few weeks

115
Q

What is the preferred treatment for Syphilis for non-pregnant adults with late latent syphilis, latent syphilis of unknown duration, or CV syphilis and other tertiary syphilis NOT involving the CNS?

A

Benzathine penicillin G 2.4MU IM weekly for 3 doses

116
Q

What is an alternative treatment for Syphilis for non -pregnant adults in the primary, secondary or early latent stage?

**Penicillin allergy

A

-Doxycycline 100 mg PO bid for 14 days

Alternative agents (to be used in exceptional circumstances):
-Ceftriaxone 1g IV or IM daily for 10 days
117
Q

What is the alternative treatment for Syphilis for non-pregnant adults with late latent syphilis, latent syphilis of unknown duration, or CV syphilis and other tertiary syphilis NOT involving the CNS?

**Penicillin allergy

A
  • Consider penicillin desensitization
  • Doxycycline 100 mg PO bid for 28 days
Alternative agents (to be used in exceptional circumstances):
-Ceftriaxone 1 g IV or IM daily for 10 days
118
Q

What causes Trichomoniasis infection?

A

Trichomonas vaginalis (flagellated, motile protozoan)

119
Q

Trichomoniasis is a _____ only disease

A

humans

120
Q

Treatment of Trichomoniasis ?

A

Metronidazole 2 g PO in a single dose
OR
Metronidazole 500 mg PO bid for 7 days

121
Q

How does Trichomoniasis affect pregnancy?

A

Trichomoniasis may be associated with premature rupture of the membranes, preterm birth and low birth weight

122
Q

Does treatment differ for pregnant women with Trichomoniasis infection?

A

No, it is the same.

123
Q

HPV infects where?

A

moist mucosa of anogenital tract, oral cavity and oropharynx

124
Q

HPV has a ___% lifetime risk of infection

A

75

125
Q

Which serotypes account for 90% of anogenital warts

A

HPV-6

HPV-11

126
Q

Which serotypes account for 70% of cervical cancers

A

HPV-16

HPV-18

127
Q

Prevention of HPV ?

A
  • Condoms
  • Counselling/Education
  • Screening - pap smear, regular MD visits, voice issues
  • HPV Vaccination

Clinical 2 (Sam) (18 decks)

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