835 > STDs > Flashcards

STDs Flashcards

(43 cards)

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1
Q

STD + HIV Transmission

A
  • Disruption of epithelial/mucosal barriers
  • Increased numbers of HIV target cells in genital tract
  • Increased expression of HIV co-receptors
  • Induce secretions of cytokines (increase HIV shedding)
  • HIV alters natural history of some STDs
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2
Q

“Sores” STDs

A
  • Syphilis

- Genital Herpes

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3
Q

“Drips” STDs

A
  • Gonorrhea
  • Chlamydia
  • Nongonococcal urethritis/mucopurulent cervcitis
  • Trichomonas vaginitis/urethritis
  • Bacterial vaginosis
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4
Q

Other STDs of Concern

A
  • Genital HPV

- Cervical/Anal/Oral Cancers

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5
Q

Gonorrhea

A
  • 2nd most common bacterial STD
  • Caused by Neisseria gonorrhea
  • Gram “-“ diplococcus
  • Intracellular parasite
  • Humans are only natural host
  • Grows in warm/moist areas of reproductive tract
  • Also grows in mouth, throat, anus, and eyes
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6
Q

Men + Gonorrhea

A
  • Onset: 1-14 days after infection
  • Some have no symptoms but more likely to have them than women
  • Site of infection: urethra, rectum, oropharynx, eye
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7
Q

Men + Gonorrhea Signs/Symptoms

A
  • Purulent urethral or rectal discharge
  • Burning sensation when urinating
  • Painful and swollen testicles
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8
Q

Women + Gonorrhea

A
  • Most have no or only mild symptoms

- Site of infection: Endocervical canal, rectum, oropharynx, eye

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9
Q

Women + Gonorrhea Signs/Symptoms

A
  • Painful, burning sensation when urinating
  • Abnormal vaginal discharge
  • Uterine bleeding
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10
Q

Male + Gonorrhea Complications

A
  • Rare b/c most of the time sx will lead to treatment
  • Epididymitis
  • Prostatitis
  • Urethral stricture
  • Inguinal lymphadenopathy
  • Disseminated gonorrhea
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11
Q

Female + Gonorrhea Complications

A
  • Most don’t have recognizable symptoms until complications arise
  • Pelvic inflammatory disease: infertility, ecotopic pregnancy
  • Fitz-Hugh-Curtis Syndrome: perihepatitis
  • Disseminated gonorrhea (more likely in women than men)
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12
Q

DGI

A
  • Disseminated gonoccocal infection
  • Presentation: joint, tendon pain, low grade fever (<39C)
  • Tenosynovitis, dermatitis, migratory polyathralgia
  • Second stage: septic arthritis, most common in knee
  • Skin lesions disappear and blood cultures are negative
  • Rarely progress to meningitis and endocarditis
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13
Q

Gonorrhea Diagnosis

A
  • Gram stain smear: positive when gram negative diplococci are identified within PMNs, most sensitive/specific for symptomatic urethritis in men
  • Culture: most reliable in non-symptomatic patients
  • Other: NAAT, rapid with increased sensitivity/specificity
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14
Q

Gonorrhea + Treatment

A
  • Uncomplicated gonococcal infections of the cervix, urethra, pharynx, and rectum
  • Ceftriaxone + Azithromycin as a single dose
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15
Q

Chlamydia

A
  • Caused by C. trachomatis (intracellular parasite)
  • Most common cause of bacterial STD
  • Co-infection with gonorrhea is typical
  • 5x increased risk of acquiring HIV
  • Causes genital, ocular, pharyngeal, and rectal infections
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16
Q

Women + Chlamydia Signs/Symptoms

A
  • Onset: 7-21 days
  • 66% are asymptomatic
  • Cervix: abnormal discharge, bleeding
  • Rectum: bleeding, pain, discharge
  • Complications: PID and Reiter’s syndrome
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17
Q

Men + Chlamydia Signs/Symptoms

A
  • Onset: 7-21 days
  • 50% are asymptomatic
  • Urethra: mild dysuria, discharge
  • Rectum: bleeding, pain, discharge
  • Complications: epidydmitis, Reiter’s syndrome
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18
Q

Chlamydia + Neonates

Study These Flashcards
A
  • Can be transmitted by cervicovaginal secretions
  • 50% develop neonatal conjunctivitis: can cause scarring
  • 16% develop pneumonia
19
Q

Chlamydia + Diagnosis

Study These Flashcards
A
  • DNA amplification: NAAT, to detect DNA from vaginal, cervical, or urethral swabs or first void urine
  • All sexually active females from 13-25 and females with multiple partners should be screened
20
Q

Chlamydia + Treatment

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A

-Azithromycin once
OR
-Doxycycline x 7 days
-Difference of 87% and 98% cure

21
Q

Syphilis

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A
  • Caused by spirochete bacteria, Treponema pallidum
  • Highly contagious
  • Associated with increased risk for HIV
  • Route of transmission: typically sexual contact, can also be congenital or rarely nonsexual
22
Q

Primary Syphilis

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A
  • Manifests after 10-90 days with an average of 21 days
  • Highly contagious, but individuals are asymptomatic
  • Sore appears on penis, vagina, or rectum
  • Sore can be single or multiple, usually painless
  • Persists 4-6 weeks then heals spontaneously
23
Q

Secondary Syphilis

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A

Results from hematogenous and lymphatic spread

  • Skin rash that appears 1-6 months after primary infection
  • Symmetrical, reddish-pink non-itchy rash on trunk and extremities involving palms/soles
  • Nonspecific symptoms: malaise, fever, pharyngitis, headache, weight loss, arthralgia
  • Disappears in 4-10 weeks
  • Most contagious
24
Q

Latent Syphilis

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A
  • Patients with positive serologies, other asymptomatic
  • Divided into early and late stages
  • Requires therapy because we can’t predict who will or won’t progress
25
Early Latent Syphilis
- Less than 1 year from secondary syphilis | - Infectious: 25% mucocutaneous relapse
26
Late Latent Syphilis
- >1 year after secondary syphilis - Generally considered non-infectious except in pregnancy - 25% will progress
27
Tertiary Syphilis
- Occur 3-15 years after initial infection - Develops in 1/3 of those not treated and isn't infectious - 3 Different forms: cardiovascular, gummatous, neurosyphilis (rarest)
28
Cardiovascular Syphilis
- 10% - Aortic insufficiency - Aneurysm formation
29
Gummatous syphilis
- Non specific granulomatous lesion - Develop in 50% of patients with disease progression - Chronic, destructive lesions (skin, bone, soft tissue, liver, brain, heart)
30
Syphilis Treatment
- Preferred: Parenteral Penicillin G, single-dosed prolonged exposure - If >1 year duration: 3 consecutive weekly doses given - Give doxycycline if allergic to PCN
31
Patients + PCN Allergy
- No alternatives identified for neurosyphilis, congenital syphilis, and syphilis in pregnant women - Recommend skin testing - Negative: administer PCN appropriate for stage - Positive: desensitize
32
Jarisch-Herxheimer Rxn
- Idiosyncratic response to therapy - Not PCN allergy - Self limiting: headache, fever, chills malaise, arthralgia/myalgia - Usually occurs within first 24 hours of syphilis allergy and resolves in 12-24 hours - Occur most in early syphilis patients - Antipyretics may be used but not proven to prevent reaction
33
Genital Herpes
- 1/6 of Americans have it and is associated with increased HIV risk - DNA virus with humans as only known hosts - HSV-1: acquired in childhood and causes orolabial ulcers - HSV-2: transmitted sexually and causes anogenital ulcers
34
Herpes Pathophysiology
- Transmission via virus from secretions onto mucosal surface or abraded skin - 5 stage life cycle: primary infection, infection of ganglia, establishing latency, reactivation, recurrent infection - When outbreak passes, virus only present in ganglia - Dormancy of virus contributes to its difficulty in treating
35
Herpes First-Episode Infections
- Multiple painful or ulcerative lesions on external genitalia - Appears ~6 days after sexual contact and lasts 2-6 weeks - Contains numerous HSV particles - Viral shedding lasts longest in first episode (15-16 days) - Women have more severe disease: cervical ulcerative lesions, intermittent bleeding and vaginal discharge, dysuria and urinary retention syndromes
36
Herpes + Recurrent Infections
- 50% will have prodrome: mild burning, itching, or tingling - Fewer and more localized lesions, shorter duration, and milder symptoms than initial infection - Viral shedding is [lower] and shorter (~3 days) - HSV-2 is more severe and has higher recurrence rates
37
Herpes Complications
- From genital spread or autoinoculation to eye, rectum, pharynx, fingers - CNS infections occasionally occur
38
Neonatal Herpes
- Exposure to HSV in birth canal - Risk greater for first-episode infections - Mortality rate ~50% - Significant morbidity including permanent neurologic damage
39
Herpes Diagnosis
- Tissue culture - Serological tests: differentiates between HSV-1 and HSV-2 - PCR: more sensitive than tissue and choice for CNS infection
40
Herpes Treatment
- Initial episode: w/in 24 hours of first lesion appearance - Episodic: administered within 24 hours of lesion appearance but patients with severe or prolonged symptoms may also benefit - Suppressive: benefit of reducing shedding and transmission risk - Suppression Drug: Valacyclovir 500 mg once a day, not as effective if patient has very frequent recurrences
41
HPV
- Human Papillomavirus - Most common viral infection in US - Can range from genital warts to cancer depending on strand - Many sexually active teens will get HPV but spontaneously clear the infection
42
HPV Symptos
- Most are subclinical - <1% have visible warts - Warts can occur anywhere that experienced sexual contact
43
HPV Treatment
WARTS - Goal: removal - Can spontaneously resolve - Patient applied: podofilox, imiquimod, sinecatechins - Provider administrated: cryotherapy, trichloracetic acid or bichloracetic acid, surgical removal - VACCINE AVAILABLE
835
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