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28 Cards in this Set
- Front
- Back
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what is STD?
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infections which are primarily sexually transmitted
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syndromic classification of STD
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genital ulcer
urethritis/cervicitis vaginitis/vaginosis exophytic processes extoparasitic infectinos systemic STD syndromes |
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agents of genital ulcer diseases
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syphilis (T. pallidum)
genital herpes (HSV) chancroid (H ducreyi) lymphogranuloma venereum (chlamydia) rare: granuloma inguinale |
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characteristics of t. pallidum
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syphilis
spirochete. can't be cultured humans sole host |
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pathogenesis of syphilis
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penetrates skin and mucous membrane
attaches to epithelial cells, replicate w/o visible inflammation travels to regional lymph nodes and body via blood stream activate lymphocytes / macrophages 1' lesion (chancre) develops at site of inoculations (~ 2 wks from exposure to Sx) |
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stages of syphilis
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1' infection : painless ulcer (chancre)
2' infection: rash, condyloma lata, systemic Sx 3' infection: neurological, CV, ophthalmologic, osseous congenital: fetal demise, mental retardation, long term disability latent phase after secondary 2-20 yrs. 1/3 go into 3' infection |
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what is chancre?
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hallmark of 1' infection
painless indurated, indolent rasied border, punched out appearance red, smooth base scant serous secretion |
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clinical presentation of chancre
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often solitary. multiple lesion possible
develop anywhere in the genital tract, oropharyngeal area, or other body site of initial contact |
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clinical presentation of syphilis
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onset approx 3 weeks after exposure
chancre heals spontaneously 1-6 wks secondary Sx occur 3-6 wks after chancre appears and may persist rash ultimately resolves, but infection is lifelong w/o Tx |
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latent syphilis manifestation
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positive blood test, no clinical Sx
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manifestation of 3' syphilis
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neurosyphilis
aortitis gumma |
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manifestation of congenital syphilis
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"snuffles" - chronic runny nose
hutchinson's incisors - notched central incisors |
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Dx of syphilis
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darkfield examination
serologic tests - RPR or VDRL (screening tset) TP-PA, FTA-ABS (confirmatory tests) |
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Tx of syphilis
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penicillin (needs to be injected)
oral tetracycline are alternative but not preferred azithromycin has activity but resistance is widespread |
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where does HSV -1 and HSV-2 manifest?
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HSV1- mouth lips
HSV2- genital |
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pathogenesis of HSV
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transmission - close contact w/ a person shedding virus.
HSV ascends peripheral sensory nerves, enters nerve root ganglia lifelong persistent infection |
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Sx of initial HSV infection
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1-3 weeks of viral shedding and Sx
systemic Sx - fever, headache, pharyngitis, malaise, myalgia local Sx - pain itching dysuria, vaginal, urethral discharge, tender inguinal adenopathy |
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recurrent infection of HSV
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HSV-1 less likely
HSV-2 80% recur within 12 months sign/Sx localized to genitals 50% experience prodrome - tingling, itching, headache papule and vesicles form no scarring |
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what is subclinical infection of HSV?
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unrecognized lesions which persons can be taught to identify. they are shedding virus
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Dx of HSV
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PCR (standard)
culture HSV antigen cytology serology |
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Tx of herpes
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oral acyclovir
famciclovir |
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what causes chancroid?
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Haemophilus ducreyi
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characteristics of H. ducreyi
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gram negative bacillus. facultative anaerobe
requires hemin for growth break in skin required for infection induces pyogenic inflammatory response endemic in NYC, new orleans |
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presentation of chancroid
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genital ulcer (4-7 days after exposure)
** painful. soft ragged border "serpiginous" dusky base w/ exudate multiple lesions often inguinal adenopathy - occurs in 50% |
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Dx of chancroid
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clinical presentation/ Hx
gram stain culture |
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Tx of chancroid
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ceftriaxone - drug of choice
macrolide (azithro) or fluoroquinolone (cipro) as alternative |
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lymphogranuloma venereum is caused by?
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chlamydia trachomatis serotype L1, L2, L3
transient ulcer -> heaped up inguinal lymph nodes |
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caused by klebsiella granulomatis
painless progressive ulcerations which bleed easily on contact |
granuloma inguinale (donovanosis)
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