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30 Cards in this Set

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Venereal Chancres
(1) Syphillis
(2) Chanchroid: Haemophilus ducreyi
(3) Herpes Simplex
Treponema pallidum
Spirochete
Chancre: primary syphilis
Raised border, PAINLESS
Therefore, primary infection underdiagnosed in women/homosexual men
Chancroid
Haemophilus ducreyi
Jagged border, purulent, PAINFUL
Herpes
Multiple vesicles that ulcerate (due to friction w/underwear)
Painful and recurring condition
Non-veneral chancres
(1) Fixed-drug eruption
(2) Trauma
(3) Unknown cause
Fixed drug eruption
Results in non-venereal chancres
Single, round and clean
Genital Warts
(1) HPV
(2) Molluscum contagiosum
(3) Condyloma lata
HPV
Human papillomavirus
Frequent infection, giving rise to genital warts
Molluscum contagiosum
Cause pearl-like lesions that're self-limiting
Pox virus
Condyloma lata
An extension of an untreated primary infection
But before secondary (disseminatd) disease
Secondary syphilis
Maculopapular rash
INVOLVES HANDS AND FEET
Multisystem disease (reflects dissemination): lymphadenopathy; hepatitis; arthritis; gen. asymptomatic CNS involvement
Syphilis and HIV Patient
Little distinction between stages but tendency of primary syphillis toward meningeal or meningovascular involvement
Primary syphilis: diagnosis
Darkfield microscopy
RP
Antibody to cardiolipin (~autoantibody)
100% positive by 2ndary syphilis
Titers often reflection of intensity of infection
Possibility for "false-positives" (i.e. aging)
MHA-TP
Micro Hemoagglutinating Antibody to TP
Positive for life (not diagnostic; only used for exclusion purposes)
Why is MHA-TP not diagnostic of acute infection?
It remains positive for life. You don't know if this is a reflection of current or past infection.
Herpes: diagnosis
Rapid PCR
Treating chancre
Do darkfield/RPR
If darkfield (+), penicillin G (single dose, long release)
If darkfield (-), treat chancroid BUT HAVE LOW THRESHOLD FOR TREATING SYPHILIS ANYWAY
Treating herpes
Acyclovir
Smaller doses on reactivation
When diagnosing STDS . . .
KEEP IN MIND - EXPOSURE TO ONE = EXPOSURE TO SEVERAL (be vigilant!)
Urethritis/Cervicitis
Gonococcal or non-gonococcal
Gonococcal urethritis/cervicitis
Painful, purulent discharge
NOTE: may also cause proctitis/pharyngitis
Non-gonococcal urethritis/cervicitis: clinical presentation
Less painful/purulent
Non-gonococcal urethritis/cervicitis: bacteriology
Chlamydia
Mycoplasma hominis
Ureaplasma urelyticum
Urethritis/cervicitis: diagnosis (general points)
GRAM STAIN IS USEFUL ONLY IN MALES
Can do culture and PCR (for gonorrhea, mycoplasma, chlamydia)
Treatment: urethritis/cervicitis
If gonococcal, SINGLE DOSE
If non-gonococcal, azithromycin for 1 WEEK
PID: symptoms
Pain w/sex; hx of unprotected sex; lower ABDOMINAL PAIN; high WBC count
If female presents w/lower abdominal pain, you should think . . .
PID in addition to appendicitis
PID: complications
Infertility and ectopic pregnancy
Buboes
Enlarged lymph nodes
Overlying skin may thin and ulcerate (chancroid) or thicken (lymphogranuloma venereum)