STIs Flashcards
(94 cards)
1
Q
What is required of all STDs?
A
Reportable by law
2
Q
What are the 3 ulcerative STDs?
A
Syphilis, Chancroid, Genital herpes
3
Q
What are the 3 non-ulcerative STDs?
A
Gonorrhea, Trichomoniasis, Chlamydia
4
Q
What genus includes species that are normal flora on mucosal surfaces, cause various non-STD diseases such as yaws, pinta, and bejel, and is transmitted from person to person via direct contact?
A
Treponema
5
Q
What is the causative agent of Syphilis?
A
Treponema pallidum
6
Q
Which organism is G-, spirochete with a slow rotational motility, is an obligate internal parasite, and uses rabbits as an animal model?
A
Treponema pallidum
7
Q
What are the virulence factors of Treponema pallidum? (3)
A
- Adherence- membrane proteins
- Hyaluronidase- perivascular infiltration
- Fibronectin coat- antiphagocytic
8
Q
What are the lesions of Treponema pallidum a result of?
A
The inflammatory response
9
Q
What STD is exclusively a human pathogen and is transmitted via sexual contact with a person who has an active primary or secondary lesion?
A
Syphilis
10
Q
How can Syphilis be acquired via nongenital contact? (3)
A
Lesion near mouth, needle sharing, transplacental transmission
11
Q
How does primary Syphilis enter the skin?
A
Break in skin or passage between epithelial cells
12
Q
Once Syphilis enters the skin, what happens locally?
A
Local multiplication and dissemination via blood
13
Q
What occurs clinically with primary Syphilis?
A
Primary lesion (indurated swelling) develops and surface necrosis results in chancre formation
14
Q
How long will it take for an untreated primary Syphilis lesion take to heal?
A
Heals in 3-8 weeks, with fibrosis
15
Q
What is the principle lesion of primary Syphilis called?
A
Chancre
may occur in areas other than genitalia, cervical may be painless, often more atypical than typical
16
Q
How does a chancre begin?
A
Papule/ superficial erosion
17
Q
What lesion develops a scanty serous exudate with a thin, grayish, slightly hemorrhagic crust, has a usually smooth base with a raised firm border and is indurated?
A
Primary Syphilis chancre
18
Q
How long is the dormancy period of secondary Syphilis?
A
2-10 weeks
19
Q
What 3 things develop in secondary Syphilis?
A
- Maculopapular rash (highly infectious)
- Condylomata lata (warty lesions)
- Immune complexes (in arteriolar walls)
20
Q
Does latent Syphilis display signs and symptoms?
A
No
21
Q
When is considered the early and late phases of latency of Syphilis?
A
Early latency within 1 year of infection, late latency greater than 1 year after infection
22
Q
What are the 3 outcomes of latent Syphilis?
A
Spontaneously cure, seropositivity without disease, tertiary syphilis
23
Q
How long after infection does tertiary (4) Syphilis manifest?
A
5-30 years after infection
24
Q
What are the 3 primary characteristics of tertiary Syphilis?
A
- Neurosyphilis
- CV syphilis
- Granulomata (gummas)
25
What is defined as meningovascular changes with focal neurological changes and cortical degeneration?
Neurosyphilis
26
What is defined as CV changes with aneurysm of ascending aorta?
CV syphilis
27
Where are granulomata (gummas) found?
Any tissue but especially skin, bones, joints
28
What type of syphilis involves signs and symptoms developing at around 3 weeks of age, has maculopapular cutaneous lesions, nasal obstruction with infectious mucoid discharge, and osteitis of nasal bones?
Congenital syphilis
29
What is Hutchinson's triad and what is it associated with?
Associated with congenital syphilis
| Triad = notched incisors, interstitial keratitis, 8th nerve deafness
30
What should every genital lesion be considered unless proven otherwise?
Syphilitic
31
What technique is used to detect treponemes from primary or secondary syphilis lesions?
Darkfield microscopy
| can also use direct immunofluorescence
32
In diagnosing syphilis, what tests include cardiolipin flocculation tests (VDRL, RPR) that are nonspecific and used as screening tests?
Nontreponemal tests
33
In diagnosing syphilis, what tests include specific antibody tests (FTA-ABS, MHA-TP) and are confirmatory for positive screening tests?
Treponemal tests
34
What is the causative agent of Gonorrhea?
Neisseria gonorrhoeae
35
What organism is gonococcus, G- diplococcus with kidney bean-shaped cells and has fastidious growth requirements?
N. gonorrhoeae
36
What are the virulence factors of N. gonorrhoeae? (5)
1. Antigenic variation of pili
2. Nonpiliated phase variants
3. Porin proteins (attachment)
4. IgA protease
5. Plasmid and chromosome- mediated resistance
(to PCN, tetracyclines, spectinomycin, fluoroquinolones)
37
What is the major reservoir for N. gonorrhoeae and how is it transmitted?
Reservoir = asx pt
| Genital, oral-genital, rectal intercourse transmission
38
What disease has become more prevalent due to changed sexual practices, ineffective methods for detection/ asx cases, presence of beta-lactamase + strains, and lack of public appreciation of its importance?
Gonorrhea
39
What is a critical step in the pathogenesis of N. gonorrhoeae?
Attachment to epithelia via pili and surface proteins
40
How does N. gonorrhoeae adapt to the host environment?
Alter their surface properties
| non-immunity due to antigenic variation of pili and retardation of phagocytic activity
41
How do N. gonorrhoeae organisms cause injury to cells?
Released lipooligosaccharide and peptidoglycan
42
What disease manifests itself in females as having a presence in the endocervix accompanied by urethral colonization?
N. gonorrhoeae
| entry and exit via mucosal surface
43
What disease manifests itself in males as having a presence in the anterior urethra with a thick mucopurulent discharge?
N. gonorrhoeae
| entry and exit via mucosal surface
44
What are the main complications of Gonorrhea? (3)
1. Various local effects
2. Acute salpingitis or pelvic inflammatory disease (PID)
3. Disseminated gonococcal infection (DGI)
45
What do the following clinical presentations represent?
- Pain w/ abn menses, bleeding due to organisms spreading along fallopian tubes and into pelvic cavity
- Long-term- chronic pelvic pain, infertility, ectopic pregnancy
Acute salpingitis or pelvic inflammatory disease (PID)
| complication of N. gonorrhoeae
46
What other organisms can cause complications similar to that of gonorrhea?
Chlamydia trachomatis and anaerobes
47
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What does the following clinical presentation represent?
Purulent arthritis (arthritis-dermatitis syndrome), endocarditis, meningitis
```
Disseminated gonococcal infection (DGI)
| complication of N. gonorrhoeae
48
What is the gold standard for diagnosis of gonorrhea?
Culture (nucleic acid amplification PCR)
49
What are the 3 etiologies of nongonococcal urethritis?
Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma genitalium
50
What disease is caused by Chlamydophila psittaci?
Psittacosis
51
What disease is caused by Chlamydophila pneumoniae?
Acute pneumonia
52
What is the causative agent for trachoma, inclusion conjunctivitis, lymphogranuloma venereum, and NGU?
Chlamydia trachomatis
53
What organism is an obligate intracellular bacteria, G-, metabolically deficient, and have both an infectious form and fragile intracellular form?
Chlamydia trachomatis
54
What population has the highest prevalence of infection with Chlamydia trachomatis?
Teenagers
55
What organism is described by the following things:
- Ascension in females results in salpingitis and PID
- Complications of scarring include sterility and ectopic pregnancy
- Many infants born to infected mothers show evidence of infection +/- pneumonia
Chlamydia trachomatis
56
What areas of the US are most affected by Chlamydia trachomatis?
Southeast US
57
The clinical presentation of Chlamydia trachomatis resembles that of N. gonorrhoeae with the addition of what?
Watery discharge
58
Chronic inflammation from C. trachomatis is due to what?
Toxin-producing strains
| functions like Toxin B of Clostridium difficile
59
What causes mucosal cell separation with C. trachomatis infection?
Protein scaffolding of infected cells collapse
60
What is the gold standard for diagnosis of chlamydial infections?
Isolation in cell culture
61
Isolation in cell culture is the gold standard for diagnosis of chlamydial infections. What is preferred in the non-culture based group?
Nucleic acid amplification (NAAT)
62
What are the 2 mycoplasma causative agents of NGU?
Mycoplasma genitalium and Ureaplasma urealyticum
(responsible for ~50% of nongonococcal, nonchlamydial urethritis in men and chorioamnionitis and postpartum fever in women)
63
What is the main reservoir for mycoplasma STDs?
Genital tract of sexually active persons
64
What trichomoniasis organism is commensal in the mouth?
Trichomonas tenax
65
What trichomoniasis organism is commensal in the intestine?
Trichomonas hominis
66
What trichomoniasis organism is the cause of STDs?
Trichomonas vaginalis
67
What organism is a flagellated protozoan, exists only as a trophozoite and is an extracellular anaerobe?
Trichomonas vaginalis
68
How is Trichomonas vaginalis transmitted?
Sexual intercourse
| trophozoite acquired during sex, parasite establishes on mucosa and multiples, parasite transmitted
69
Although a male infected with Trichomoniasis is usually asx, what clinical signs/ sxs would they present with if sx?
Scanty, clear to mucopurulent discharge
70
If a female presents with profuse vaginal discharge that is frothy and malodorous, what should you be concerned for?
Trichomoniasis
| creates environment for Trichomonas vaginalis
71
How is Trichomoniasis diagnosed?
Wet mount exam commonly used but culture more sensitive
72
Is bacterial vaginosis an STI?
No, caused by overgrowth of opportunistic pathogen in vagina due to change in pH
73
History of previous STDs, history of sexual activity, and current use of intrauterine devices places someone at a higher risk for what?
Bacterial vaginosis
74
What will the vaginal secretion pH be for someone with vaginosis?
5.0-6.0 (N < 4.5)
75
What type of cells will be present in the vaginal secretions of someone with vaginosis?
Clue cells
76
What are the criteria (in which you must have 3 of 5) for diagnosing an infection with bacterial vaginosis?
- Homogenous secretions
- Clue cells
- Amine odor with KOH
- pH > 4.5
- Curved G- or G variable rods
77
While the raised vaginal pH and increased concentrations of anaerobes + products are similarities between vaginosis and trichomoniasis, how can you differentiate between the quality of the discharge?
Both thin and homogeneous but vaginosis = grey and trichomoniasis = yellow-grey
78
What are the most commonly encountered opportunistic mycoses (fungal infections) found on the normal flora of the skin and mucous membranes?
Candidiases (Candida spp.)
79
The following are underlying causes of what infection?
- Absence of competing normal flora
- Intro to abn site
- "Pathologic" change in microenvironment
- Inborn/ acquired immune defect
- Broad spectrum abx
Candidiasis
80
Vulvovaginal candidiasis is more commonly known as what?
Yeast infection
81
What is the #1 cause of infection with Vulvovaginal candidiasis (aka yeast infection)?
Candida albicans
| remainder with C. tropicalis or C. glabrata
82
The following clinical sxs are concerning for what?
- Thick, white, frothy discharge in women
- Itching, irritation
- Burning sensation
- Vaginal pain/ soreness
Candidiases ( STI but usually an endogenous infection)
83
Which Haemophilus organism is non-motile, G- coccobacillus and is responsible for causing chancroid?
H. ducreyi
84
How soon post-infection does a soft chancre of chancroid develop?
3-5 days (rather quickly)
85
The following characteristics describe what?
- Vesicle or papule that progresses to pustulation and ulceration
- Enlargement and development of multiple ulcers
- Ulcer is painful and tender, bleeds readily, and lacks induration?
Soft chancre of chancroid
86
Does a chancroid or chancre sore have a soft ragged edge and pus?
Chancroid
87
Does a chancroid or chancre sore have a hard raised edge?
Chancre sore
88
How is a chancroid diagnosed?
ID of H. ducreyi from genital ulcer or swollen lymph node
89
Why is direct examination of H. ducreyi sometimes difficult when trying to diagnose chancroid?
Misleading due to presence of polymicrobial flora in ulcer material
(also lymph material frequently sterile)
(media for primary isolation requires presence of growth supplements)
90
What syndrome results when microorganisms ascend to the endometrium, fallopian tubes, and pelvic structures?
Pelvic inflammatory disease (PID)
91
The following things place someone at higher risk for what condition?
- STD
- Prior episode
- Sexually active adolescent
- Multiple sexual partners
- Frequent douching
Pelvic inflammatory disease (PID)
92
The following sxs are indicative of what condition?
Lower abd pain, abn vaginal discharge, painful intercourse, increased pain during menstruation, irregular menstruation, fever and chills, scarring
Pelvic inflammatory disease (PID)
93
How is pelvic inflammatory disease (PID) diagnosed?
Clinical criteria (but often inaccurate) so use evidence of inflammation (fever, leukocytosis, elevated ESR)
94
What 2 things should be treated with respect to pelvic inflammatory disease (PID)?
Both infection and inflammation
