STIs Flashcards
1
Q
What STIs are caused by Bacteria?
A
Chlamydia
N. Gonorrhea
T. Pallidum (syphilis_
2
Q
What STIs are caused by viruses?
A
- HSV
- HIV
- HPV
3
Q
Gonorrhea is caused by?
A
- N. Gonorrhea
4
Q
N. Gonorrhea
A
- Gram (-) diplococcus
- aerobic
- requires moisture and pH
- killed by drying
- Transmission:
- sexual contact
- no fomites
- Replicates in transitional epithelium better than squamous epithelium
- oral cavity=rare
- oropharyngeal transition region
- oral cavity=rare
5
Q
Where is oral gonorrhea most commonly found?
A
- Oropharyngeal transition region
6
Q
Gonorrhea: Men vs Women
A
- Men:
- mostly symptomatic
- 40% asymptomatic
- urethral infection
- purulent urethral discharge
- pain w/urination
- urgency of urination
- frequency of urination
- mostly symptomatic
- Women
- Mostly asymptomatic (80%)
- intra-menstrual bleeding
- results in pelvic inflammatory disease: 1 milll/yr
7
Q
Oral Gonorrhea
A
- Spread by oral sex
- Exudates
- yellowish fluid discharge
- spreads across mucous membranes→spreads infection
- Symptoms: (mostly asymptomatic)
- slight discomfort when eating
- sore throat
-
Gonococcal pharyngitis
- uncommon
- 1-22% have oral infections
- most common in gay men
- asymptomatic
- infrequent transmission
8
Q
Gonorrhea Treatment options:
A
- Recommended: (& Gonococcal Pharyngitis)
- Ceftriaxone + Azithromycin
- Alternative:
- If ceftriaxone is not available
- Cefixinae + Azithromycin
- If ceftriaxone is not available
9
Q
Gonorrhea: Dental Considerations
A
- pt w/history of gonorrhea +. no signs of infection= Little threat
- clinical exam should include assessment for active infection
- referral if signs are present
- tx all sex partners
- Avoid elective tx w/active oral infection
10
Q
What is Syphilis is caused by?
A
- T. pallidum
11
Q
T. Pallidum
A
- Fragile spirochete
- anaerobe
- Killed by heat, drying, oxygen, soap & water
- Transmission:
- sexual contact (Vaginal, anal, oral)
- person to person by direct contact w/a Chancre (Syphilitic spore)
- occur on or around external genitals
- vagina, anus, rectum, mouth
- occur on or around external genitals
- person to person by direct contact w/a Chancre (Syphilitic spore)
- fomites-Rare
- sexual contact (Vaginal, anal, oral)
12
Q
What are some groups at risk for syphilis?
A
- 15-25 y.o.
- multiple sex partners
- urban dweller
- Males 3:1 F
13
Q
What are the different stages of infection in Syphilis?
A
- Primary
- Secondary
- Latent
- Tertiary
14
Q
When do symptoms first appear when you have syphilis?
A
- on avg 21 days after infection
- range: 10-90 days
15
Q
Primary Stage of Syphilis
A
- Appearance of a single sore=Chancre
- can have multiple
- No tx→Secondary stage after 6 weeks
- Chancre:
- firm, round, small, painless
- appears at the spot where syphilis entered the body
- lasts 3-6wks→heals w/o tx
16
Q
Secondary Stage of Syphilis
A
- Skin Rash & Mucous Membrane lesions
- Rash:
- appears as the chancre is healing or wks after its healed
- rough, red or reddish brown spots on the palm of hands and bottom of feet
- DOES NOT ITCH
- Symptoms:
- Fever
- swollen lymph glands
- patchy hair loss
- weight loss
- Signs & Symptoms resolve with or w/o tx
- w/o tx→ Latent & Late stages
17
Q
Latent Syphilis
A
- untreated infection
- Seroreactive
- RPR, VDRL, FTA
- no other evidence of disease
- early latent syphilis < 1 yr
- Late latent syphilis > 1 yr
18
Q
Tertiary Syphilis
A
- Aka Late syphilis
- The destructive Phase
- non-infectious
- years after initial infection
-
Obliterative endarteritis of:
- epithelium
- bone
- nervous system
- vascular system (aortic aneurysm)
- Signs & Symptoms: 80% vascular
- difficulty coordinating muscle movements
- paralysis
- numbness
- gradual blindess
- dementia
19
Q
Congenital Syphilis:
A
- concern in the US
- 500 cases in 2015 vs 125 perinatal HIV
- declining rate
- passed from mother to fetus after week 16
-
Late Congenital Syphilis
- Hutchisons Triad
- Hutchinson’s Teeth
- Interstitial Keratosis
- CN8→Deaf
- Other manifestations:
- Saddle Nose
- Frontal Bossing
- Clutter joints
- painless swelling of joint
- within 3 months:
- anemia
- skin rash
- hepatosplenomegaly
- nasal discharge
- multi-organ infection
- neurological manifestations
- musculoskeletal handicap
- rhagades
- saddle nose
- Death
- Hutchisons Triad
19
Q
Congenital Syphilis:
A
- concern in the US
- 500 cases in 2015 vs 125 perinatal HIV
- declining rate
- passed from mother to fetus after week 16
-
Late Congenital Syphilis
- Hutchisons Triad
- Hutchinson’s Teeth
- Interstitial Keratosis
- CN8→Deaf
- Other manifestations:
- Saddle Nose
- Frontal Bossing
- Clutter joints
- painless swelling of joint
- within 3 months:
- anemia
- skin rash
- hepatosplenomegaly
- nasal discharge
- multi-organ infection
- neurological manifestations
- musculoskeletal handicap
- rhagades
- saddle nose
- Death
- Hutchisons Triad
20
Q
Syphilis: Treatment
A
- Penicillin G:
- kills the syphilis bacterium
- prevents further damage
- does not repair damage
- prevents maternal transmission & treats fetal infection
- No sexual contact w/new partners until syphilis sores are completely healed
- Must notify sex partners
- test & tx if positive
- Benzathine penicillin G
- 1 IM Injection
- cures Primary, Secondary, or early latent syphilis
- 3 doses at weekly intervals recommended for
- late latent syphilis
- late syphilis of unknown duration
- 1 IM Injection
- Aqueous crystalline penicillin G or Procaine Penicillin G
- Congenital Syphillis
21
Q
HIV Infection
A
- Retrovirus that causes AIDs
- Transmission:
- sexual contact
- exposure to contaminated blood
- perinatal transmission
- any bodily fluid
22
Q
What tells you that the patient has progressed from HIV+ to AIDs?
A
- CD4+ Count< 200 + 1 opportunistic infection
- disease related to AIDs
- Untreated pts: 10+ years
23
Q
HIV Infections: Characteristics
A
- Severe immunodeficiency w/opportunistic infections:
- Viral Infections:
- Herpes Simplex
- Varicella
- Epstein-Barr
- Cytomegalovirus (CMV)
- Fungal Infections:
- Protozoal Infections:
- Toxoplasmosis
- Cryptococcus
- Mycobacterium infection→ Tuberculosis
- Viral Infections:
- Viral & Parasitic Diarrhea
- Kaposi’s Sarcoma
- Lymphoid malignancies
- encephalopathy (brain fxn by virus)
24
HIV Infections: What tests are available?
* **NAT: (Nucleic Acid Tests)**
* look for actual virus in blood
* result: +/- or amount of virus present (HIV viral load test)
* very expensive, not routine
* except high risk exposure or possible exposure w/early symptoms
* **Antigen/Antibody Test**
* looks for HIV antibodies and antigens in blood
* HIV+: antigen **p24** produced before antibodies
* **Antibody Tests**
* look for HIV antibodies in blood or oral fluid
* rapid test & home tests
* use blood from vein=detects faster
* vs blood from finger prick or oral fluid
25
HIV Infection: Oral Manifestations
* Hairy Leukoplakia
* HPV
* Kaposi's Sarcoma
* Flucanazole resistant Candida albicans
* recurrent fungal infection
26
Can a HIV patient with an undetectable viral load infect others?
* No
27
HIV: Treatment
* HAART
* Highly Affective Antiretroviral Therapy
* Medicine options:
* Nucleosid/nucleotid reverse transcriptase inhibitors
* abacavir
* tenofovir
* Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
* nevirapine
* Protease Inhibitors (PIs)
* (-navir)
* Entry Inhibitors:
* maraviroc
* Integrase inhibitors:
* (-gravir)
28
HIV: Dental Considerations
* Aggressive Management of HIV associated perio disease
* debridement w/antiseptic rinses
* metronidazole and/or amoxicillin
* 5-7 days
* Check CD4+ count→ Disease Progression
* Neutrophil count
* better indicator for risk of infection from invasive procedure
* Normal NAC: 1.5-8.0 (1500-8,000 mm3)
* Antibiotics:
* no evidence
* but give if neutrophil count \<500
* at risk of fungal infection
* Long term anti fungal meds not needed if on HAART
* Oropharyngeal Candidiasis
* common when CD4\<200
* HSV Lesions
* Treat with (-clovir)
* acyclovir
* HIV affected children
* psychosocial issues
29
HPV
* Genital Human Papillomavirus
* most common STI in US
