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OB-GYN- STD
asdf
87
Anatomy
3rd Grade
08/15/2010

Additional Anatomy Flashcards

 


 

Cards

Term
What is the most preventable cause of infertility?
Definition
STDs
Term
What are three ways STDs are spread?
Definition
oral, vaginal, anal sex
Term
STDs are strongly associated with ________
Definition
ectopic pregnancies
Term
In women, many STDs are ______
Definition
Many  STIs are asymptomatic in women or are asymptomatic during the initial stages 
Term
What should definitely be inspected during a PE if you suspect STDs?
Definition

•Thorough sexual history and physical exam is essential

•Many STDs are characterized by genital ulcer or infection of the cervix, urethra or both

•Inguinal region, vulva, perineum and perianal areas should be inspected

•Bartholin glands, Skene ducts and urethra should be evaluated

•In patients with urinary symptoms the urethra should be gently milked to express any discharge

•Vagina and cervix should be inspected for lesions and discharge

•Oral cavity and cervical lymph nodes should be evaluated

Term
A patient diagnosed with cervicitis, should also be screened for .....(5)
Definition
PID, Chlamydia infection, gonorrhea, bacterial vaginosis and trichomoniasis
Term
Patients diagnosed with PID should be tested for .....(3)
Definition
Chlamydia, gonorrhea and HIV
Term
What are ways to prevent spread of STDs?
Definition

•Education:

      Delaying sexual activity

        Limiting number of sexual partners

        Use of condoms

•Immunizations to prevent or reduce some STI:

        HPV, Hepatitis B

•Patient notification- when an STD is diagnosed the patient’s partner should be evaluated

•Expedited Partner Therapy- patient’s sexual partner receives drug therapy for an STD without undergoing physical evaluation or testing 

Term
Gram-negative obligate intracellular bacterium
Definition
chlamydia
Term
What is the most frequently reported infectious disease in the US?
Definition
chlamydia
Term

If chlamydia goes untreated, what can you develop?

 

what can it also cause?

Definition

PID

 

Also responsible for nongonoccal urethritis and inclusion conjunctivitis 

Term

True or False:

 

Pts with chlamydia are usually symptomatic.

Definition

FALSE

 

ASYMPTOMATIC USUALLY

Term
What are some subtle and nonspecific symptoms you may see with chlamydia?
Definition

         -cervicitis with mucopurulent discharge and intermittent cervical bleeding

         -Ascending infection causing salpingitis

       - Chlamydia frequently found in conjunction with gonorrhea

Term

What does the ACOD recommend for screening?

 

Who should be screened?

 

Who should be screened for HIV?

Definition

ACOD STD Screening Recommendations

Routine Screening:

•Sexually active women 25 years and younger should be routinely screened for Chlamydia infection

•All sexually active adolescents should be routinely screened for gonorrhea

•Women with developmental disabilities should be screened for STDs

•HIV screening is recommended for all women who are or ever been sexually active. (Physicians should be aware of and follow their states’ HIV screening requirements)

Term

Would you screen this person:

 

•Women with a history of multiple partners or a sexual partner with multiple contacts, sexual contact with culture-proved STDs, a history of repeated episodes of STDs, or attendance at clinics for STDs 


Definition
YES!
Term

Would you screen this pt? And for what?

 


•Asymptomatic women aged 26 and older who are at high risk for infection 

 


Definition
should be routinely screened for Chlamydia infection and gonorrhea
Term
What type of labs do you do to test for chlamydia?
Definition

Lab testing include:

•Culture

•Direct immunofluorescence,

•enzyme immunoassay (EIA)

•Nucleic acid hybridization tests

•Nucleic acid amplification tests (NAATs) of endocervical swab specimens

NAATS are the most sensitive tests for endocervical swab specimens and are FDA-approved for use with vagina swab specimens

Patients reluctant or unable to have pelvic exams can be tested with urine screening

Term
In a pt you suspect has chlamydia but they are reluctant or unable to have pelvic exams- what can you do?
Definition
urine screening
Term
What type of treatment do you give for chlamydia?
Definition

•Antibiotics (azithromycin or doxycycline)

•Alternative antibiotic therapies include erythromycin, ofloxacin or levofloxacin

•Patients with persistent symptoms or suspected to be noncompliant with treatment or who have become re-infected should have test of cure (repeated testing) 3-4 weeks after initial treatment is completed

•Because of the high rates of re-infection, all women with Chlamydia infection should be advised to be retested 3 months after treatment

Term

Gram-negative intracellular diplococcus

•Second most common STD in the U.S. 

Definition
gonorrhea
Term
What populations are at high risk for gonorrhea?
Definition
Greatest incidence in adolescents and young adults
Term

True or False.

 

Gonorrhea is NOT a reportable disease in all states.

Definition

FALSE

 

IT IS A REPORTABLE DISEASE

Term
Gonorrhea can lead to...
Definition
PID
Term

male pt presents with urethritis, a mucopurulent or purulent discharge from the urethra


What are you thinking?

Definition
Gonorrhea
Term

Female pt presents with purulent discharge from the urethra, Skene duct, cervix, vagina, or anus

 


What could it be?

Definition
Gonorrhea
Term
What type of discharge should raise your suspicion of gonorrhea or chlamydia in a female?
Definition
Yellow or greenish discharge from the cervix should raise suspicion to gonorrhea or Chlamydia
Term
Signs and symptoms assoc with gonorrhea usually appear within _-__ days of infection
Definition
3-5 days
Term
Where can you get your specimens to test for gonorrhea? (5)
Definition
Specimens can be tested from the endocervix, vagina, urine, rectum or pharynx. 
Term

In terms of gonorrhea:

 

What is the most widely used testing modality for specimens obtained from the pharynx or rectum?

 

Why?

Definition
Culture is the most widely used testing modality for specimens obtained from the pharynx or rectum as there are no non-culture tests that are FDA-approved for the testing of these specimens
Term
What types of test do you do to look for gonorrhea? (3)
Definition
Specimens can be tested by culture, nucleic hybridization or NAAT
Term

Male urethral specimens may be tested by______ in symptomatic men, but not recommended as definitive testing for women or asymptomatic men

Definition

Male urethral specimens may be tested by Gram-stain in symptomatic men, but not recommended as definitive testing for women or asymptomatic men

Term

What's the treatment for gonorrhea?

 

What's no longer used?

Definition

•Quinolone antimicrobials no longer used because of quinolone-resistant strains

•Antimicrobials currently used are Ceftriaxone, cefixime, ciprofloxacin

•Due to high likelihood of concurrent Chlamydia infection, patients should be treated for Chlamydia as well, if Chlamydia infection is not ruled out by NAAT

Term
What are the predominant organisms in PID?
Definition
Predominant organisms are C. trachomatis and N. gonorrhea
Term

Involves infection of the upper genital tract (endometrium fallopian tubes, ovaries and pelvic peritoneum) as a result of direct spread of pathogenic organisms along mucosal surfaces after initial  infection of the cervix.

 

What is this?

Definition
PID
Term

These organisms are associated with what disease?

Mycoplasma, Streptococcus, Staphylococcus, Haemophilus, Escherichia Coli, bacteroides, Peptostreptococcus, Clostridium and Actinomyces

Definition
PID
Term
Why is timing of cervical infection important in PID?
Definition
Timing of cervical infection in relation to the menstrual cycle is important, the endocervical mucus resists upward spread, especially during the progesterone-dominant part of the cycle. 
Term
What are risk factors and consequences of PID?
Definition

•Greatest risk is prior PID

•Adolescence

•Multiple sexual partners

•Not using condoms

•10%-40% of women with untreated Chlamydia or gonorrhea develop PID

•Infertility occurs in approximately 15% of patients after first episode of salpingitis increasing to 75% after three or more episodes

Term

Female pt presents with the following symptoms.What could it be?

 

muscular guarding, cervical motion tenderness, rebound tenderness

•Purulent cervical discharge is often seen

•Adnexa are often very tender, and enlarged

•Fever and chills may be present

•White count is often elevated

Definition
PID
Term

What is this? What is it associated with?

 

inflammation leading to localized fibrosis and scarring of the anterior surface of the liver and adjacent peritoneum

Definition
perihepatitis (Fitz-Hugh Curtis syndrome)
Term

If a patient becomes acutely ill with fever, chills, tachycardia, nausea and vomiting..what could it be?

Definition
tubal ovarian abscesses--related to PID
Term
What is the clinical criteria necessary to diagnose acute salpingitis?
Definition

All three of the following are necessary:

1-Abdominal tenderness with/without rebound

2-Adnexal tenderness

3-Cervical motion tenderness

Plus

One of more of the following:

Gram stain of endocervix positive for gram-negative, intracellular diplococci

Temperature >/= 38 Celsius

WBC > 10,000

Pus on culdocentesis or laparoscopy

Pelvic abscess on bimanual exam or sonogram

Term
If you suspect patient has PID...but there are no signs and symptoms. What do you do?
Definition
Because PID may not be associated with specific signs and symptoms, empiric treatment for PID is recommended for sexually active young women who appear to have no other cause of illness and who are found to have uterine tenderness, adnexal tenderness, or cervical motion tenderness on pelvic examination
Term
What's the treatment for PID?
Definition

Mild or moderate cases can be managed with oral antibiotics

•Many patients require hospitalization for adequate care

•Hospitalization allows for high-dose IV antibiotic therapy covering aerobic and anaerobic organisms

•TOA may need to be drained or removed  if favorable response is not obtained

•Rupture of a TOA with septic shock is a life-threatening complication with mortality approaching 10%

Term
What's the criteria to be hospitalized?
Definition

•Surgical emergencies (e.g.., appendicitis) cannot be excluded.

•The patient is pregnant

•The patient does not respond clinically to oral antimicrobial therapy

•The patient is unable to follow or tolerate and outpatient oral regimen

•The patient has a severe illness, nausea and vomiting, or high fever

•The patient has a tuboovarian abscess

Term
What are the two types of herpes?
Definition

•Two types:

     HSV-1 associated with cold sores but can cause genital lesions and

     HSV-2 often associated with genital infections

Term

What type of herpes is becoming more common among adolescent and young women?

 

Definition
HSV 1
Term

True or false.

 

The first episode of herpes is the most severe.

 

Recurrent outbreaks may be milder

Definition
TRUE
Term
What's unique about first episode of genital herpes?
Definition
prominent flu-like syndrome and frequent neurologic involvement which occur2-3 days following infection
Term

What is this:

 

Painful vesicular and ulcerated lesions appear on the vulva, vagina, cervix, often extending to perianal area and buttocks, 3-7 days after exposure and usually resolve in 1 week

•Vesicles lyse and progress to shallow, painful ulcers with a red border

Definition
genital herpes
Term
What occurs in some pts with genital herpes 5-7 days after genital lesions appear?
Definition

Aseptic meningitis with fever, headache and meningismus occurs in some patients 5-7 days after genital lesions appear

Term
Where does HSV migrate to and become dormant?
Definition
dorsal root ganglia
Term

True or False

 

Recurrences are usually milder, may be unilateral as opposed to bilateral and may appear as fissures or irritation rather than vesicular in appearance

Definition

TRUE

Term
Female pt presnts with abrasions, fissures or itching without obvious lesions. What could it be?
Definition
Genital herpes
Term

What is the lab test most often used for herpes diagnosis?

 

pros vs cons

Definition

viral culture

 

Culture is highly specific but not very sensitive, with a 25% false-negative rate with primary infections and 50% with recurrent infection

Term
Viral shedding can occur for up to __weeks after lesions appear
Definition
three
Term

What three types of medication are used in treatmetn of genital herpes?

 

How long?

Definition

•Antiviral drugs-mainstay of treatment

•Reduces duration of viral shedding and shorten the initial symptomatic disease course

•Does not affect the long term course or cure disease

•Acyclovir, famciclovir or valacyclovir usually used for 7-10 days or longer if necessary

Term
How are recurrences treated in herpes?
Definition
oral meds
Term
When is episodic meds used in herpes treatment?
Definition
for recurrences decreases the duration of the episode (lesion, pain, and shedding) and is most effective when initiated at prodrome or beginning of episode
Term
When is suppressive therapy used for genital herpes?
Definition
(medication taken daily) prevents 80% of recurrences and results in 48% reduction in viral transmission between sexual partners. Most effective for patients with frequent recurrences or when only one partner has the infection
Term

Genital herpes in pregnant woman:

 

what do you worry about happening to the fetus?

Definition
neuronal damage- encephalitis, meningitis
Term
When pt has active lesions or a typical prodrome at the time of delivery..what type of delivery is indicated?
Definition
Cesarean delivery
Term
What percent of women will get HPV by age 50?
Definition
80%
Term
Infection occurs through ___________, _________ or ____________ from a partner with either overt or sub-clinical infections
Definition
Infection occurs through contact with infected genital skin, mucous membranes, or body fluids from a partner with either overt or sub-clinical infections
Term

True or False

 

HPV spreads quickly into sequelae.

Definition
FALSE- slow process over years
Term
What subtypes of HPV area ssociated with genital condyloma?
Definition
Low-risk subtypes  6 and 11 are associated with genital condyloma
Term
What HPV subtypes are associated with cervical dysplasia and cervical cancer?
Definition
High-risk subtypes  16, 18, 31, 33 and 45 are classified high-risk because of their association with cervical dysplasia and cervical cancer
Term
Also known as genital or venereal warts
Definition

CONDYLOMA ACUMINATA

Term

Pt presents with

Soft, fleshy growths, on vulva, vagina, cervix, urethral meatus, perineum, and anus

•Can also be found on the tongue or oral cavity

 

How do you diagnose?

 

What's treatment?

Definition

CONDYLOMA ACUMINATA

Diagnose: Diagnosis by visual inspection or biopsy

Treatment includes: chemical treatment, cautery, and immunologic treatments

Term
How are condyloma acuminata spread?
Definition
skin-to-skin contact
Term
What does the quadrivalent HPV vaccine protect against?
Definition
Quadrivalent HPV vaccine protects against HPV genotypes 6,11, 16 and 18 (the strains of HPV that cause 90% of genital warts and 70% of cervical cancer)
Term

True or False:

ACOG currently recommends that all girls and women aged 9 to 26 years be immunized against HPV.

Definition
True
Term
What is the causative agent in syphillis?
Definition
Treponema pallidum-is the causative agent, a small anaerobic spirochete capable of rapidly invading mucosa
Term

Pt presents with chancre that is small firm and painless, with punched out appearance and rolled edges.

What could it be?

Definition
primary syphillis
Term

In primary syphillis, serologic testing can confirm your diagnosis.

 

True or false?

Definition
False- usually negative at this stage
Term

Secondary syphillis:

 

symptoms appear _-_ weeks after primary chancre

Definition
4-8
Term

What stage of syphillis could this be?

 

This stage is characterized by skin rash appearing as rough red or brown lesions on the palms of hands or soles of the feet.

Lymphadenopathy, fever, headache, weight loss, fatigue, muscle aches and patch hair loss.

What type of patches occur in 30% of pts?

Definition

Secondary Syphillis

 

Mucocutaneous mucus patches, highly contagious eruptions occur in 30% of patients in this stage

Term

What type of syphillis:

 

Patient has no signs or symptoms but serologic tests are positve

How could pt have gottten it?

What type of organ systems could be impacted?

Definition

Transmission is unlikely except by transfusion or placental transfer

Central nervous and cardiovascular system as well as ophthalmic and auditory abnormalities may develop

Term

destructive, necrotic, granulomatous lesions may develop 1-10 years after tertiary syphillis infection.

What is this called?

Definition
Gummas
Term

If you find this: what is it associated with?

 

Identification of motile spirochetes on dark-field microscopic examination and direct fluorescent antibody tests of material from primary and secondary lesions or lymph nodes

Definition
Syphillis
Term

how do you diagnose syphillis?? What tests?

 

What will remain positive irresptive of treatment or activity of the disease?

Definition

Presumptive diagnosis is possible with nontreponemal tests (Venereal Disease Research Laboratory [VDRL] and rapid plasma reagin [RPR] and treponemal tests (e.g., fluorescent treponemal antibody absorption [FTA-ABS] and Treponema pallidum particle agglutination

The use of only one serologic test is insufficient; false-positive nontreponemal tests results are sometimes associated with medical conditions unrelated to syphilis

Positive treponemal test will usually remain positive for life irrespective of treatment or activity of the disease

Term
What is the treatment for syphillis?
Definition

Syphillis Treatment

•Benzathine Penicillin G

•Serial quantitative VDRL titers at 3,6, 12 months

•Sexual abstinence until lesions are completely healed

Term
What cells are targetd in HIV?
Definition
Helper T cells (those with CD4 marker)
Term

What type of HIV is most common in US?

 

What type is most common in Western Africa?

Definition

What type of HIV is most common in US? HIV 1

 

What type is most common in Western Africa? HIV 2

Term
Third leading cause of death in black women aged 24-44 years and the fourth leading cause of death in Hispanic women in the same age group
Definition
AIDS
Term
What are three primary methods of contacting HIV/AIDS?
Definition
Three primary methods of contacting disease are: (1) intimate sexual contact, (2) use of contaminated needles or blood products and (3) perinatal transmission from mother to child
Term
How can you make the HIV diagnosis?
Definition
Enzyme –linked immunosorbent assays (ELISA) for antibodies against HIV
Term
What is prevention and drug therapy for HIV/AIDS management?
Definition

Prevention

•Condoms

•Safe sex practices

 

Drug therapy

•Nucleoside reverse transcriptase inhibitors (NRTIs)

•Nonnucleoside reverse transcriptase inhibitors (NNRTIs)

•Antiretroviral therapy consisting of at least three agents is recommended because of development of drug resistance

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