kidney stones

-NOT caused by infection

-Agents produce urea->increase pH of urea to neutral -> cause salt

etiology: 1) E.coli 2) P.aeruginos 3) Klebsiella pneumoniae

predisposing factor: 1)Female 2) Pregnancy 3)Hetero Sex 4)Menses 5) Antibiotic

-Inflammation of the bladder

Localized Symptoms: 1)abrupt onset 2)micturition, urgency 3) dysuria/painful urination 4)Fever or sometimes fever alone

Treat: Bactrim, then fluoroquinolones if doesn't work

Prevention: modify host behavior

Inflammation of the Kidney

Systemic Signs: 1)spike fever 2)chills 3)N/V

Localized Symptoms: 1)Excruciating pain in 1 or both flanks 2)abrupt and micturition, urgency

Treat: Bactrim, then fluoroquinolones if doesn't work

Prevention: modify host behavior

Inflammation of Vagina

Etiology: Trichomonas vaginalis (protozoan)

Description: Only protozoan STD; NON-INVASIVE; Jerky, non-directional, twitching motility

Predisposing factors:Poor hygiene

Manifestation: Pruritis; Malodorous (musty or fishy odor),dysuria

Female = Symptomatic. Vice Versa for Male

Amine Test: May be Positive

Treatment: Metronidazole

Inflammation of Vagina

Etiology: Candida albicans (Fungi; yeast cell; Eukaryotic)

Description: Invasive,caused by normal flora or sex

Predisposing factor: Immunocompromised, diabetes, preggo, oral contraceptives

Amine Test: Negative

Symptoms: 1)Pruritis,later 2)White/cottage cheese-like discharge forms 3)erythematous

Female: Infection Common. Vice Versa for Males

Treatment:Imidazole & Triazole; use gentian violet, boric acid gel caps; lactobacillus (for recurrent)

Non Inflammation Vagina

Etiology: Gardnerella vaginalis, Mobiluncus, Mycoplasma, Ureaplasma (bacteria)

Description: Non-invasive; 50% of all cases; Clue Cells Increase

Symptoms: Adherent, malodorous (fishy smell); milky white discharge; absence of inflammation and pruritis; important cause of spontaneous premature labor or low-birth weight babies

Treatment: Metronidazole; Clindamycin vaginal gel

Hard Chancre

Etiology: Treponema pallidum (gram - spirochete)

Pathogenesis: Incubation Period (3 weeks) -> Primary Syphilis -> Latent Period -> Secondary Syphilis (resolve w/w/o treatment ->Tertiary Syphilis (fatal)

Symptom: 1st button-like duration; bilateral inguinal lymphadenopathy 2nd - bilateral symmetrical rash starts on palms of the hands and soles of the feet; latent - asymptomatic; 3rd-slow, progressive inflammatory, degenerative disease (affect all organs)

Diagnosis: Agent NOT observed in blood; Use Rapid Plasma Reagin (RRR) screening test

Treatment: Benzathine penicillin G; Azithomycin 

Soft Chancre 

Etiology:Haemophilus ducreyi - Gram - rod

Epidemiology:Major STD in 3rd World Country

Manifestation: Incubation (1 week); 1+ PAINFUL non-indurated (soft) chancres/ulcers

Treatment: Azithromycin, Erythromycin, Cefrtiaxone

Etiology: HSV-1 (oral herpes in children and adoelscents) HSV-2 (genital herpes)

Pathogenesis: Short Incubation Period (2-7d); Life-long latency -> If Stressed, HSV will manifest (nerve highway)

Manifestation:

Immunocompetent: Painful clear, fluid-filled vesicle w/ erythematous base ("dewdrop on a rose petal"); vaginal or urethral discharge; dehydration

Vesicle -> Pustules -> Ulcerate -> Crust

Immunocompromised: Visceral dissemination -> hemorrhagic necrosis in CNS; severe perirectal herpetic lesions

Reactivated HSV-2:PRODROME (tingling); smaller lesions

Pregnancy: 70% mortality rate

Neonates: 3 Presentations:

1)Localized (Skin, Mouth, Eyes)

2)Dissemeinated (Systemic infection, 70% MR, neurological sequelae)

3) CNS disease (Diffuse or focal encephalitis, neurological sequelae, 50% MR)

Diagnosis: TORCH test

Treatment: Acyclovir

Neisseria gonorrhoeae - Gran - Coc

Chlamydia trachomatis - obligate intracellular bacteria lack peptidoglycan

Pathogenesis

Women: Cervicitis (infection of cervix); asymptomatic(>50%); Symptomatic: Tender, friable (easily crumbled) cervix; mucopurulent cervical exudate, erythema, edema, dyspareunia (pain during intercourse), dysuria Complication: Pelvic Inflammatory disease (PID) can be asymptomatic but if not FEVER, Lower abdominal pain, dysmenorrhea (painful menstruation)

Men: More Symptomatic cases, PAINful urethritis w/discharge and/or dysuria 

Complication:Uncomplicated gonorrhea (hasn't spread to blood or CNS); Disseminated gonococcal infection (DGI) Fever, joint symptoms, rash; Reactive Arthritis (caused by cross-reactve antibodies) no systemic signs, aseptic conjunctivitis, urthritis, arthalgias; Ophthalmia neonatrum

Treatment: For both Chlamydia and gonorrheae Z-pak, Cephalosporin

Chlamydial STD - Serotype L1,L2, L3

Epidemioology: Homosexual Population

Manifestation: Primary Lesion: small genital papulae or herpetiform ulcer; Secondary Stage: Inguinal Syndrome Tertiary Stage: Genital ulcers, elephantiasis, rectal strictures

Human papillomavirus (HPV)

Benign neoplasms differ from Malignant neoplasm

Epidemiology: Cerv. papi = benign mucosal dysplasia

small % infected (1.4M) Condyloma acuminatum (external anogenital (anus and genital) warts (benign cutaneous)

3rd leading cause of cancer-related death in women

Causes head and neck squamous cell carcinomas

Pathogenesis: Induces epithelial cell proliferation; nuclear changes w/ large perinuclear cytoplasmic vacuoles surrounded by dense cytoplasm (koilocytosis); 3-4M then Wart

Treatment: Remove Wart; Aldara Cream,

Gardasil (3 IM upper arm over 6 m period)

HPV 16, 18 = Cervical cancer

HPV 6, 11 = Genital warts

Cervarix: HPV 16, 18, and MAY 31, 33, 45 Prevents 70% of excisional therapy, but no protection against warts

Strep. Agalactiae (B-hemolytic)

Neonates; Leading cause of Bacteremia

Infection/disease in pregnant and non-preggo w-men ->Screening to prevent

Offer antimicrobials during birth to preggo with risk factors (others, will not work)

E.COLI

Bacterial Meningitis

Listeria monocytogenes

Bacterial Meningitis