STI's Flashcards
(127 cards)
1
Q
Urethritis:
Description
A
Inflammation of urethra
2
Q
Urethritis:
Pathogen
A
N. gonorrhoea
C. trachomatis
3
Q
Urethritis:
Symptoms
A
Dysuria, frequency, purulent or mucopurulent discharge (minimal or asymptomatic)
4
Q
Cervicitis:
Description
A
Inflammation of cervix
5
Q
Cervicitis:
Pathogen
A
N. gonorrhoea
C. trachomatis
6
Q
Cervicitis:
Symptoms
A
Purulent/mucopurulent discharge, endocervical bleeding; asymptomatic
7
Q
Genital ulcer disease:
Description
A
ulcer genital, anal or perianal
8
Q
Genital ulcer disease:
Pathogen
A
syphillis, chancroid
9
Q
Genital ulcer disease:
Symptoms
A
superficial ulcer on genitalia (defined/ill-defined margins; painless/pain)
10
Q
Prostatitis:
Description
A
prostate gland infection
11
Q
Prostatitis:
Symptoms
A
Dysuria, bloody urine, lower groin/back pain, pain in testes/penis
12
Q
Vaginal discharge:
Description
A
Discharge may be due to bacterial vaginosis/vulvovaginal candidiasis/trichomonas/chlamydia/gonorrhea and non-infectious causes
13
Q
Vaginal discharge:
Symptoms
A
Vaginal discharge, purulent/mucopurulent discharge, occasional blood; vaginal pruritus/pain +/- odour
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
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
16
Q
NAT or NAAT
A
nucleic acid amplification test (PCR) detects specific DNA sequence of pathogen
17
Q
DFA
A
direct fluorescent antigen
18
Q
Serology
A
measures/detects antibodies to pathogen/organism
19
Q
List the 3 most common STIs
A
- gonorrhea (GC)
- chlamydia
- syphillis
20
Q
List some other STIs
A
- HPV
- HSV
- Hep B
- Hep C
- HIV
- Trichomoniasis
- Lice/scabies
- Yeast
- Protozoa
21
Q
Patients with gonorrhoea may be co-infected with _____
A
chlamydia
22
Q
Patients with syphillis may be co-infected with _____
A
HIV
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
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
25
Complications of PVD
infertility, abscesses, chronic pelvic pain, ectopic pregnancies
26
Complications greater in what gender
women
27
Pelvic inflammatory disease: 1/3 PID attributed to ?
gonorrhoea and/or chlamydia
28
HPV can cause _____ _____
cervical cancer
29
STI's can cause damage to _______ tract
reproductive
30
What else is associated with STI's?
- congenital or perinatal infections
- infant mortality
- social stigma
- economic
- antibiotic resistance
- spread of other infectious diseases (ex. HIV)
31
Chlamydia:
| Highest rates are found in _____
females
32
Chlamydia:
| Prevalent in females between which ages?
15-24
33
Chlamydia:
| Prevalent in males between which ages?
20-29
34
Gonorrhea:
| Highest rates are found in _____
female
35
Gonorrhea:
| Prevalent in females between which ages?
15-24
36
Gonorrhea:
| Prevalent in males between which ages?
20-29
37
Syphilis:
| Majority cases ____
male
38
Syphilis:
| Prevalent in males between which ages?
20-24 and 30-39
39
Syphilis:
| Prevalent in females between which ages?
25-39
40
What is involved in STI patient education?
- 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
41
Gonorrhea:
| What is caused by?
Neisseria gonorrheae, a gram negative diplococci
42
Describe Neisseria gnorrheae
```
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)
```
43
N. gonorrhoea have _____ (aka fimbriae) attach to mucosal surfaces
pili
44
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)
inflammatory
45
Gonorrhea in males:
| Symptoms appear in how many days?
2-8 days
46
Gonorrhea in females:
| Symptoms appear in how many days?
10 days
47
Gonorrhea in males:
| site?
- urethra (common)
| - rectum, eye, oropharynx (other)
48
Gonorrhea in females:
| site?
- endocervical canal
| - urethra, rectum, eye, oropharynx (other)
49
Gonorrhea in males:
| Symptoms
- symptom > asymptomatic
- Urethral: dysuria, frequency
- Anorectal: asymptomatic to severe pain
- Pharyngeal: asymptomatic to mild pharyngitis
50
Gonorrhea in females:
| Symptoms
- asymptomatic or minimally symptomatic
- Endocervical: Asymptomatic or minimally symptomatic
- Urethral: dysuria, frequency
- Anorectal: asymptomatic to severe pain
- Pharyngeal: asymptomatic to mild pharyngitis
51
Gonorrhea in males:
| Signs
Purulent urethral or rectal discharge can be scant to profuse
Anorectal: pruritus, mucopurulent discharge, bleeding
52
Gonorrhea in females:
| Signs
Abnormal vaginal discharge or uterine bleeding;
| Purulent urethral or rectal discharge can be scant to profuse
53
Complications of gonorrhoea in males?
Rare (epididymitis, prostatitis, inguinal lymphadenopathy, urethral stricture), DGI - disseminated gonorrhoea infection
54
Complications of gonorrhoea in females?
Pelvic inflammatory disease (PID), ectopic pregnancy, infertility
55
What is DGI (disseminated gonorrhoea infection) ?
- 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
List 3 special populations in gonorrhoea infections
- Pregnant women
- Children
- Newborns
57
Considerations in pregnant women with gonorrhoea ?
- choice of medication
- risk of transmission
- neonatal prophy
58
Considerations in children with gonorrhoea?
- 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
Considerations in newborns with gonorrhoea?
-Neonatal conjunctivitis aka ophthalmia neonatorum - acquisition of N. gonorrhoea during delivery - infection may lead to blindness
60
What is the prophylactic treatment for all newborns in Mb for gonorrhoea?
erythromycin 0.5% eye ointment applied to newborns as GC prophylaxis
61
Child abuse most likely if ??
- Multiple sites
- Gonorrhea 1-6 month old
- Genital or rectal chlamydia > 6 months
- HPV > 18 months
- HSV > 3 months
- Trichomonas > 6 months
62
Diagnosis of Gonorrhoea ?
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
Treatment issues with gonorrhoea infections?
- Emergence of antibiotic resistance from sulphonamides to ceftriaxone
- Increased gonorrhoea treatment failure, concern with 'superbug'
- Increasing antibiotic resistance in Canada (PHAC)
64
39% of N. gonorrhoea resistant to ________
ciprofloxacin
65
Gonorrhoea infections:
| Increased _______ resistance
azithromycin
66
Gonorrhoea infections:
| Decreased _____ and ______ susceptibilities
cefixime and ceftriaxone
67
Gonorrhoea infections:
| _______ resistance
tetracycline
68
Gonorrhoea infections:
| Loss of _____, ______ and ________ over the decades
penicillin, ampicillin, and FQs over the decades
69
Gonorrhoea infections:
_______ was alternative for beta-lactam allergic patients. Rarely used and hard to get. (discontinued by manufacturer in 2017)
Spectinomycin
70
Gonorrhoea infections:
| Treat patients for both ??
gonorrhoea and chlamydia due to high rate of concomitant infection
71
What is the preferred treatment for anogenital infection (urethral, endocervical, vaginal, rectal) in adults and youth > 9 years of age?
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
What is the preferred treatment for pharyngeal infection in adults and youth > 9 years of age?
Ceftriaxone 250mg IM in a single dose
PLUS
Azithromycin 1 g PO in a single dose
73
What is the preferred treatment for anogenital infection (urethral, rectal) in MSM?
Ceftriaxone 250mg IM in a single dose
PLUS
Azithromycin 1 g PO in a single dose
74
What is the preferred treatment for pharyngeal infection in MSM?
Ceftriaxone 250mg IM in a single dose
PLUS
Azithromycin 1 g PO in a single dose
75
What is the ALTERNATE treatment for anogenital infection (urethral, endocervical, vaginal, rectal) in adults and youth > 9 years of age?
Azithromycin 2 gram PO in a single dose
76
What is the ALTERNATE treatment for pharyngeal infection in adults and youth > 9 years of age?
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
What is the ALTERNATE treatment for anogenital infection (urethral, rectal) in MSM?
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
What is the ALTERNATE treatment for pharyngeal infection in MSM?
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
For children < 9:
| What is the preferred treatment for Anogenital infection (urethral, vaginal, rectal) of gonorrhoea ?
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
For Children < 9:
| What is the preferred treatment for a pharyngeal infection of gonorrhoea ?
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
For Children < 9:
| What is the alternate treatment for a pharyngeal infection of gonorrhoea ?
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
In what type of gonorrhoeal infections is it important to follow up in?
- 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
What causes pelvic inflammatory disease
Ascending pathogens from cervix or vagina to upper genital tract
84
1/3 of PID cases attributed to ______________
gonorrhea/chlamydia
85
What does PID present as?
- endometritis
- salpingitis
- tubo-ovarian abscess and pelvic peritonitis
86
What are symptoms of PID
- 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
Complications with PID?
- tuba-ovarian abscess
- infertility
- ectopic pregnancy
- chronic pelvic pain
88
Diagnosis of PID ?
- combination of signs and symptoms
| - gonorrhea/chlamydia positive
89
What is the inpatient treatment for PID ?
IV cefoxitin + oral doxycycline
OR
Clindamycin IV + gentamycin
(ceftriaxone + doxy + metronidazole)
90
What is the outpatient treatment for PID ?
```
Ceftriaxone 250 mg IM x 1
+
Oral doxy (or azithromycin as alternative
+
Oral metronidazole
```
91
Chlamydia is less virulent than ______
gonorrhea
92
Describe a chlamydia infection (less acute, more subtle than gonorrhoea)
- 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
Onset of chlamydia infections?
7-21 days
94
Site of chlamydia infection in males
urethra, oropharynx
95
Site of chlamydia infection in females
endocervical canal
96
Symptoms of chlamydia infection in males
Symptomatic common > asymptomatic
Urethral: mild dysuria, discharge
Pharyngeal: asymptomatic to mild pharyngitis
97
Symptoms of chlamydia infection in females
Urethral: subclinical, dysuria/frequency uncommon
Anorectal and pharyngeal: same for men
98
Signs of chlamydia infection in males
Discharge scant to purulent urethral/rectal discharge
Rectal pain, discharge, bleeding
99
Signs of chlamydia infection in females
Abnormal vaginal discharge or uterine bleeding; Purulent urethral or rectal discharge can be scant to profuse
100
Complications of chlamydia infection in males
Epididymitis
| Reiter's syndrome (rare)
101
Complications of chlamydia infection in females
Pelvic inflammatory disease (PID), ectopic pregnancy, infertility, Reiter's syndrome (rare)
102
What are 2 special populations with chlamydia infections
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
Diagnosis of Chlamydia infection ?
Symptoms, History
Lab
-NAAT (urine, eye, cervical)
-DFA (throat, rectal, nasopharyngeal, pulmonary, eye)
-Culture if treatment failure (not routinely done)
-Other tests
104
What are some treatment recommendations for chlamydia infections?
- 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
look at chart on page 13
okay
106
What is syphillis caused by?
Treponema pallidum (spirochete)
107
Syphillis:
| Exclusively ______ disease, infects/invades through mucous membranes or open lesions
human
108
Syphillis:
| Describe the different stages of infection (if untreated)
Primary, Secondary, Tertiary (neurosyphilis, cardiac)
| -Congenital disease (early <2yo, late >2yo) uncommon
109
Co-infection of HIV and syphillis is common, describe this.
- 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
Describe the primary and secondary and tertiary infection of syphillis
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
What are some special populations in syphillis infections?
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
Diagnosis of Syphillis?
a) History and Clinical Presentation
b) Laboratory - difficult to grow
- Dark field microscopy - classic method, not practical
- NAAT
- Serologic - Treponemal, Non-treponemal
113
Management of syphillis?
- Treat with antibiotics
- Follow-up with contacts and treat as needed
- Counselling and Prevention
114
What is the preferred treatment for Syphilis for non -pregnant adults in the primary, secondary or early latent stage?
Benzathine penicillin G 2.4 MU IM as a single dose
*slow release penicillin released over a few weeks
115
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?
Benzathine penicillin G 2.4MU IM weekly for 3 doses
116
What is an alternative treatment for Syphilis for non -pregnant adults in the primary, secondary or early latent stage?
**Penicillin allergy
-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
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
- 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
What causes Trichomoniasis infection?
Trichomonas vaginalis (flagellated, motile protozoan)
119
Trichomoniasis is a _____ only disease
humans
120
Treatment of Trichomoniasis ?
Metronidazole 2 g PO in a single dose
OR
Metronidazole 500 mg PO bid for 7 days
121
How does Trichomoniasis affect pregnancy?
Trichomoniasis may be associated with premature rupture of the membranes, preterm birth and low birth weight
122
Does treatment differ for pregnant women with Trichomoniasis infection?
No, it is the same.
123
HPV infects where?
moist mucosa of anogenital tract, oral cavity and oropharynx
124
HPV has a ___% lifetime risk of infection
75
125
Which serotypes account for 90% of anogenital warts
HPV-6
| HPV-11
126
Which serotypes account for 70% of cervical cancers
HPV-16
| HPV-18
127
Prevention of HPV ?
- Condoms
- Counselling/Education
- Screening - pap smear, regular MD visits, voice issues
- HPV Vaccination
