Term
| what causes are related to the increased prevalence of STIs? |
|
Definition
| increase in extramarital sex, sexual activity at a younger age, greater sexual freedom at all ages, increased use of non-barrier contraception, and asymptomatic STIs. |
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Term
| what characterizes neisseria gonorrhea? |
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Definition
| this fastidious gram (-) *intracellular* diplococci incubates for 2-8 days and prefers mucus membranes of the genital tract (endocervix/fallopian tubes). there is no immunity to infection and 5% of asymptomatic women test positive for it. |
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Term
| what capacity do gonorrhea and chlamydia have to affect the oviduct? |
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Definition
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Term
| do IUD/tampon usage affect transmission/susceptibility w/gonorrhea? |
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Definition
| no - but OCPs do provide some protection (thicken cervical mucus) |
|
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Term
| what does ascending STI (gonorrhea) infection follow? |
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Definition
| the mucosal lining, so cervicitis, leads to endometritis, salpingitis, oophoritis, peritonitis, and so on |
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Term
| what is the most sensitive organ to gonorrhea infection? what characterizes the effect of this infection? |
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Definition
| the fallopian tube - where destruction of the tubal epithelium/folds can lead to partial/complete obstruction due to fimbrial agglutination, adhesions, and adnexal masses. |
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Term
| *how is gonorrhea diagnosed?* |
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Definition
| a gram stain of vaginal/cervical discharge showing *2 gram negative kidney beans aligned along long axes in PMNs* PMNs will be generally be increased. (if this is seen on a young boy, this is diagnostic for gonorrhea and child protective services needs to be alerted. if this is found on a young girl, you have to wait for a cx, b/c neisseria catarrhalis is normal flora). cultures can be taken from the cervix, urethra, anus, pharynx, and joint aspirates and grown on thayer-martin medium (likes anaerobic environment). |
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Term
| what are the signs and symptoms of gonorrhea? |
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Definition
| from none to pelvic abscess, septicemia, and bowel obstruction. 50% of cases are asymptomatic and never diagnosed until the pt presents w/infertility. |
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Term
| what syndromes are associated with gonorrhea? |
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Definition
| urethritis (dysuria, frequency, discharge), cervicitis (mucopurulent discharge, spotting, staining, dyspareunia, fever), salpingitis (ileus, abdominal pain), pharyngitis (usually asymptomatic, sore throat, fever), and disseminated gonococcal infection (DGI) |
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Term
| what are the presentations of disseminated gonococcal infection (DGI)? |
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Definition
| arthritis (tenosynovitis -> septic arthritis in wrists, knees, ankles), dermatitis (macules -> pustule on erythematous base w/a black necrotic center developing on extremities), and conjunctivitis/iridocyclitis (purulent drainage - particularly a risk for babies, *treat w/erythromycin*) |
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Term
| what is fitz-hugh-curtis syndrome? |
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Definition
| perihepatitis - hepatic capsular (glisson's capsule) inflammation w/o liver involvement (violin-string/piano-string adhesions). it can cause inspiratory upper abdominal pain, mimic cholecystitis, and dx is made via laparoscopy. |
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Term
| *what is treatment for gonorrhea?* |
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Definition
| *125 mg ceftriaxone IM or cefixime* alternatives: 2nd gen cephalosporins (cefoxitin or cefotetan), cipro, and quinolones (some resistance). (can also use doxycycline, ampicillin, spectinomycin). testing for cure w/repeat cx is also advised. |
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Term
| is gonorrhea a reportable disease? |
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Definition
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Term
| what % of gonorrhea pts also have chlamydia? |
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Definition
| 45% (used to tx for both at once, now w/PCR - can specifically tx for whichever or both) |
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Term
| what characterizes syphilis as a STI? |
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Definition
| syphilis is due to treponema pallidium - a slender cork-screw-like treponeme w/characteristic motility. it has an incubation of 10-90 days (avg 21). it is almost transmitted due to intimate sexual contact, though other routes are possible. it can be transmitted in utero at 4 mos gestation and has the capacity to affect almost every part of the body. |
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Term
| what characterizes an early/primary syphilis infection? |
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Definition
| a painless chancre w/ or w/o nodes which begins as a nodule, then indurates, and suppurates - then may lead to regional adenopathy. this may occur on the vulva, vagina, cervix, anus, perineum, fingers, mouth, and lips and will disappear in 1-5 wks. |
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Term
| how is early/primary syphilis diagnosed? |
|
Definition
| darkfield exam (microscope objective that changes phase so that spirochetes appear white on a black background), screening tests: RPR and VDRL then FTA for more specific dx/following therapy. also need to cx for gonorrhea/chlamydia each time. |
|
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Term
| what characterizes an early/secondary syphilis infection? |
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Definition
| this is a continuation of untreated primary/early syphilis, where in 6 wks or more (after lesions disappear), cutaneous/mucus membrane/mucocutaneous lesions appear as well as eye/CNS involvement. screening tests will be positive. |
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|
Term
| what characterizes the lesions seen in secondary/primary syphilis? |
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Definition
| cutaneous lesions: macular, papular, maculopapular, papulosquamous, nodular. maculopapular rash: *most common, non-pruritic on palms/soles*, trunk, extremities. annular syphilid (yearly): maculopapular lesion w/central hyperpigmentation and papular border (occasionally hypopigmented). mucous membranes: lesions w/thin grayish exudate. condyloma lata: flat, wartlike lesions in anogenital area - very infectious (differentiate from condyloma acuminata w/RPR). patchy alopecia: moth-eaten appearance w/non-tender lymphadenopathy. eyes: iritis/neuroretinitis. periostitis. meningitis/paralysis of cranial nerves. |
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|
Term
| how is early/secondary syphilis diagnosed? |
|
Definition
| darkfield exam of lesions, positive screening test (STS - 99% are positive), and bx |
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|
Term
| what characterizes latent syphilis? |
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Definition
| this is the asymptomatic interval when clinical signs/symptoms are absent (early infection is < 2 yrs, late is > 2). pts are non-communicable at this point, but RPR is reactive. physical exam: non-revealing. |
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|
Term
| what characterizes late syphilis? |
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Definition
| destruction of tissue, organs, organ systems: cardiovascular, cerebrospinal, cutaneous, osseous. serology, spinal fluid and x-ray are necessary to dx. gummas are late syphilitic lesions of skin/bone which appear as tumors but do not cause severe incapacitation/death. |
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|
Term
| how is late syphilis diagnosed? |
|
Definition
| clinical picture, screening tests (STS), bx, and response to tx |
|
|
Term
| what are some clinical signs of late syphilis? |
|
Definition
| gummas, hole in anterior palate, geographic tongue, and *saber shins* |
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|
Term
| what is a cardiovascular effect of late syphilis? |
|
Definition
| medial necrosis of the thoracic aorta which can lead to *aneurysm or *aortic insufficiency |
|
|
Term
| can the lungs be affected by late syphilis? |
|
Definition
|
|
Term
| what is meningovascular neurosyphilis? how can it be diagnosed? |
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Definition
| localized/generalized involvement of the meninges/vascular structures of the CNS - the meninges or sulci of the brain may widen. this can be diagnosed via lumbar puncture or **ocular light/accommodation testing of the argyll-robertson pupil: pupils do not constrict w/light, only w/accommodation** (due to lesion at *edinger westphal nucleus - cranial nerves II & III). *tabes dorsalis* may also occur - which is where pts walk w/wide-stance gait b/c they have lost proprioception in feet due to spinal cord injury (generalized paresis from degeneration of ascending sensory neurons in posterior columns affecting posterior sensory ganglia/nerve roots). |
|
|
Term
| what are charcot's joints? |
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Definition
| joints can become deranged/enlarged bilaterally due to late syphilis |
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|
Term
| what characterizes congenital syphilis? what is the difference between early and late congenital syphilis? |
|
Definition
| treponemal showers can cause in utero infection across the placenta depending on frequency of occurrence. these occur at all stages of pregnancy, but the langerhans layer will protect the fetus for the first 4 months of pregnancy. early congenital syphilis: signs/symptoms before 2 yrs old, late is after 2 yrs. |
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|
Term
| what are the clinical manifestations of congenital syphilis? |
|
Definition
| prematurity, rhinitis (snuffles), general lymphadenitis, nutritional deficiencies, celiac disease, osteochondritis/other bone changes, nephrosis, hepatosplenomegaly, neurologic changes, hutchisons triad (teeth, interstitial keratitis, 8th nerve deafness), frontal bossing, short maxilla, moon/mulberry molars, saddle nose, saber shins, grave's scaphoid scapula, and clutton's joints. *however positive RPR may be the only positive manifestation* |
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|
Term
| how is syphilis tested for? |
|
Definition
| nonspecific/non-treponemal: RPR or VDRL. specific/treponemal: TPI (t. pallidum immobilization test), FTA (fluorescent treponemal antibody absorption test) & MHA-TP. false positives often occur with the nonspecific/screening tests, which is what the specific tests are for. (false positives can be due to the fact the RPR is similar to a pregnancy test, so pregnant pts may test false positive as well as those w/connective tissue disease) |
|
|
Term
|
Definition
| PCN: need 2.4 M units, will hurt - but necessary amount, also the only option for pregnant pts even if they are PCN-allergic b/c it will cross the placenta. tetracyclines (teratogenic) and erythromycin (will not cross placenta) will also work for the non-pregnant adult. |
|
|
Term
| *what is the jarish-herxheimer reaction?* |
|
Definition
| chancre, edema, rash, fever, malaise, mental confusion, convulsions - due to load of *antigenic material released by many simultaneous treponemal deaths due to antibiotics. |
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Term
| what characterizes chlamydia? |
|
Definition
| chlamydia has bacterial/viral characteristics. it contains DNA/RNA (can synthesize proteins & reproduce by binary fission), but cannot generate its own ATP - so part of its lifecycle is intracellular. it is susceptible t antibx and has an incubation period of 7-14 days. there are many serological groups. |
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Term
| what are the subtypes of chlamydia? |
|
Definition
| c. psittaci - psittacosis from parrots. c. trachomatis - A,B,C cause trachoma (loa loa), D-K cause genital infections, and L1-3 cause lymphogranuloma venereum (LGV). |
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|
Term
| what is the most prevalent STD today? |
|
Definition
| chlamydia 3-4 millions cases a year, 60-80% of which are asymptomatic. |
|
|
Term
| how does chlamydia affect males? |
|
Definition
| nonspecific/non-gonococcal urethritis (have to RPR & DNA/PCR probe for GC/chlamydia ), epididymitis, prostatitis, proctitis, reiter's, adult inclusion conjunctivitis, and TWAR (adult pneumonia) |
|
|
Term
| how does chlamydia affect females? |
|
Definition
| can be anywhere from asymptomatic to peritoneal infections, hypertrophic cervicitis, abacterial urethritis, acute salpingitis (involuntary sterility), fitz-hugh-curtis syndrome, and adult inclusion conjunctivitis |
|
|
Term
| how does chlamydia newborns? |
|
Definition
| inclusion conjunctivitis and pneumonia |
|
|
Term
| what are general symptoms of chlamydia infection? |
|
Definition
| urethral discharge (purulent/mucopurulent), dysuria, frequency, urgency, nocturia, cervicitis (hypertrophied, friable cervix; erosion), and PID |
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|
Term
| how is chlamydia diagnosed? |
|
Definition
| endocervical smear (increased PMNs), direct-smear FTA (fluorescent antibody testing), tissue cx (difficult and expensive), DNA probe, and PCR (the last 2 are (very sensitive, very specific, very easy). |
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|
Term
| what is tx for chlamydia? |
|
Definition
| tetracycline 500 mg QID, doxycycline 100 mg BID, erythromycin (less effective), or *one-time dose of azithromycin (safe in pregnancy, good compliance, but more expensive). then repeat testing for cure. |
|
|
Term
| what characterizes lymphogranuloma venereum? dx? |
|
Definition
| this is due to c. trachomatis L1-3, has incubation of 2-5 days and causes transient, painless genital/ano-rectal ulcers followed by buboes 2-3 wks later (multiple, large, confluent nodes which suppurate). they can cause lymphatic obstruction = elephantiasis distal to lymph nodes or fistulas. dx: have to do cx (aspirate bubo and cx), serology, RPR, and FTA. |
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|
Term
| how is lymphogranuloma venereum treated? |
|
Definition
| tetracycline, erythromycin, azithromycin and I & D buboes. |
|
|
Term
| what are symptoms of a genital herpes infection |
|
Definition
| primary vesicles which rapidly coalesce and ulcerate w/severe exquisite *pain and tenderness on the vagina, cervix, perineum, penis, prepuce, glans, and scrotum. these vesicle w/contain viral particles which shed until the skin heals. in the dormant state, the viral particles travel to the regional sensory ganglia and stress/menses/nutritional deficiencies can reactivate them (lifetime disease). |
|
|
Term
| what characterizes genital herpes simplex as a virus? |
|
Definition
| it is an intracellular DNA virus, type II accounts for 75-85% of genital infections, while type I accounts for the rest. it has an incubation period of 3-7 days. |
|
|
Term
| what is the most common of vulvar ulcers? |
|
Definition
|
|
Term
| how is herpes tested for? |
|
Definition
| cx: gold standard. smear: look for intracellular inclusions/multinucleated giant cells. |
|
|
Term
|
Definition
| acyclovir (topical/PO) for chronic tx (suppression) |
|
|
Term
| what can fetal exposure to herpes during delivery result in? |
|
Definition
| hepatoadrenal necrosis, degenerative changes in other organs, microcephaly, microphthalmos and death. *if the pt has an active lesion w/in 2 wks of delivery, need to do a cesarean section (b/c IgM does not cross placenta, but IgG does, and it takes 2 wks to make IgG - every lesion is a new mutation). |
|
|
Term
|
Definition
| a soft chancre w/painful ulceration, kissing ulcers, and tender unilateral buboes (suppurate 50% of the time) due to *hemophilus ducreyi - gram (-) bacterium w/an incubation of 2-5 days. |
|
|
Term
| how is chancroid diagnosed? tx? |
|
Definition
| dx: aspirate bubo and cx (ddx: syphilis, genital herpes, LGV). tx: erythromycin, tetracycline, or azithromycin |
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|
Term
| what is granuloma inguinale? tx? |
|
Definition
| papules which ulcerate and form red granulomas covered w/thin gray membranes. these may coalesce and lead to scarring/vitiligo and painless lymphatic node obstruction -> elephantiasis (non-suppurating). it is due to calymmatobacterium granulomatis, a tropical gram (-) intracellular parasitic bacterium. *donovan bodies, intracytoplasmic rods* may be seen. tx: tetracycline, erythromycin, azithromycin. |
|
|
Term
| what is bacterial vaginosis? |
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Definition
| not really an STD, but can be transmitted. it is the result of normal lactobacilli being dominated w/a combination of profuse, mixed anaerobic flora and is characterized by low virulence, fishy odor, discharge. |
|
|
Term
| how is bacterial vaginosis diagnosed? tx? |
|
Definition
| **vaginal pH > 4.5** clue cells, fishy odor on whiff test, cx discharge. tx: metronidazole (remember disulfiram rxn) |
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|
Term
| what characterizes trichomoniasis? |
|
Definition
| trichomonas vaginalis is an anaerobic flagellated protozoan which causes a profuse fishy discharge w/irritation, external dysuria, and pruritus. in males, the urethra/prostate can be affected. in females, the vagina, urethra, bladder, and skene's glands can be affected (only 1/3 of women are symptomatic). strawberry cervix in women and vaginal pH > 4.5. |
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|
Term
| how is trichomoniasis diagnosed? tx? |
|
Definition
| dx: cx or wet mount. tx: metronidazole (single dose - safe in pregnancy) |
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|
Term
| what characterizes candidiasis/moniliasis? |
|
Definition
| overgrowth of candidiasis albicans can alter tissue and is often seen in pts w/DM, on antibx or OCP. need to wet mount to dx pseudohyphae regardless of what pt says. |
|
|
Term
| what are the symptoms of candidiasis? |
|
Definition
| pruritus, dysuria, curd-like discharge, dry/irritated/white vagina w/adherent plaques which can be scraped off. |
|
|
Term
| how is candidiasis diagnosed? |
|
Definition
| wet mount w/KOH prep. *cx on sabouraud’s or nickerson’s medium (specific for fungi)* |
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|
Term
| what is tx for candidiasis? |
|
Definition
| correct underlying pathology (DM, antibx, check for HIV), boric acid capsules if chronic - otherwise fluconazole or terconazole (which is better for c. glabrata and c. tropicalis - do not have classic pseudohyphae appearance, but instead have chlamydospores). if severe: ketoconzole (bad ADRs). need to r/o lactobacillus or mobiluncus (wiggles) |
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|
Term
| what causes condyloma acuminatum? |
|
Definition
| HPV (6,11) which incubates for 3 mos, thrives in moist areas, is very common and is sexually transmitted. they may become obstructive (giant condyloma of lowenstein bushkne - r/o sarcoma) or malignant (16, 18) |
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|
Term
| why does incidence of condyloma acuminata increase w/pregnancy? |
|
Definition
| *cellular immunity is decreased* |
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|
Term
| what is in the ddx for condyloma acuminata? |
|
Definition
| condyloma lata (syphilis) and vulvar CA |
|
|
Term
| what is tx for condyloma acuminata? |
|
Definition
| podophylin (toxic, less common now), condylox, bi/tricholoracetic acid, laser, cryotherapy, and *imiquimod* (aldara) which raises IFN levels to increase cellular immunity. |
|
|
Term
| what is pediculosis pubis? |
|
Definition
| a blood sucking ectoparastic louse which cannot live more than 24 hrs w/o feeding. it is contagious (often sexually) and is found in hairy areas. |
|
|
Term
| what are symptoms of pediculosis pubis? tx? |
|
Definition
| symptoms: itching, scratching, infection, scarring. tx: lindane, if pregnant - permethrin and sterilize clothing. |
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|
Term
|
Definition
| sarcoptes scabiei is an ectoparasitic mite which is highly contagious from intimate contact. it burrows under the skin leaving a tunnel and pts will have nighttime itching/*track marks*. tx: lindane/permethrin. |
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|
Term
| what is molluscum contagiosum? |
|
Definition
| the largest DNA virus of the pox group, molluscum will form firm, blister-like lesions that are round, smooth, shiny and have central umbilication on the trunk and anogenital region. they are symptomatic and are treated w/curette, cryo, or imiquimod |
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