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56 Cards in this Set
- Front
- Back
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Which viruses and bugs cause genital ulcers? |
Genital ulcers: HSV-2 (and-1) Priimary syphilis Treponema p LGV: chlamydia trachomatis L1-L3 Chancroid: haemophilis ducreyi |
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Which bugs (3) and fungi (2) and bugs related to BV cause drips? |
Drips: Chlamydia tracomatis D-K Gonorrhea: Neisseria gonorrhea Ureaplasma urelyticum
Trichomoniasis: trichomonas vaginalis Candidiasis: candida albicans and other spp. BV: gardnerella vaginalis and other anaerobes |
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Which bugs cause arts? |
HPV Secondary symphoilis Moluscum contagiousm (a pox virus) |
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What is the DOC for HSV? What is a problem with administration? What is the alternative to this? |
Aclyclovir (poor oral bioavailability)
Valacyclovir greatly improves bioavailability |
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How do you diagnose HSV? How do you distinguish type I from type II? |
PCR, culture of lesions, specific serum Ab assays Tzanck smear = multinucleated giant cells
To distuinguish type 1 from 2, need to look at glycoprotein G. |
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How would you describe herpes vesicles? |
Multiple, small, and painful => can coalesce into larger vesicles.
Can also put in the drip category |
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What type of bug is treponema palladium? Can you see it on gram stain? |
Spirochete, no too thin |
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What is the progression of syphilis? |
Chancre => maculopapular rash => granulomas (gummas), dementia, aortic aneurysm
Primary => secondary => tertiary |
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What are the two test to diagnose symphilis (non-treponemal)?
What is the treponemal test? |
RPR, VDRL (non-treponemal tests) = cardiolipin, cheap and sensitive, if positive then go on to treponemal specific test
FTA-ABS (treponemal) = take actual treponemes grown in rabbits, need to pull out any something that would react (ABS)?, then put on slide and see if you have antibodies to treponemal antigens. |
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What type of microscopy for treponema palladium? What is the drug of choice for treponema palladium (syphilis)? |
Darkfield microscopy DOC = penicillin (one big IM shot) = good for people who you don't think will be very compliant (bezapine what releases PenG from depot site). |
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What is a chancre? Are they painful? When do you only have them (what type of syphilis)? |
Ulceration where the treponema gained access. Not usually painful. With PRIMARY ONLY! |
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What will you see in secondary syphilis? What are some systemic symptoms? |
Rash all over that spreads to the PALMS and SOLES!
Fever, malaise, snail track lesions! |
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What is LGV caused by? What type of lymphadenopathy do you get? Where are an increasing number of infections occurring (what body part)? |
Chlamydia trachomatis L1-L3
Inguinal lymphadenopathy
Colon |
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What is the difference between chancroid and chancre? |
Chancroid = harder outer edge, PAINFUL!!! Chancre of syphilis is NOT PAINFUL! |
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26 yo, married for three years, multiple vesicular lesions on vulva one month before her due date. Flu-like about two weeks ago, denies affair.
How to diagnose? Is this a primary or secondary infection? |
PCR, do immunoassay to look for IgM vs IgG to determine if primary or secondary.
Need to do a thorough history => can have prodromal symptoms with primary or secondary infection (need to tell patients this!), so the flu-like symptoms do not help.
Probably primary because she would have noticed if this happened before (maybe...). |
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Patient goes on to tell you that her neck is bothering her and it makes it even more difficult to sleep. Why is this important? |
Meningitis with herpes infections is associated with type 2 PRIMARY infection.
Encephalitis usually occurs in a new born with disseminated infection. Type II birth, or with ocular infection in adults. |
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How would you diagnose this? (meningitis) |
Lumbar puncture looking at CSF (do PCR on that) => looking to make sure it is not BACTERIAL.
Viral meningitis (aseptic) is not as severe => need to make sure it is NOT BACTERIAL |
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What are the consequences for the fetus? |
Transmission to fetus => encephalitis, multi-organ disseminated disease => child will survive but will have neurologic deficits after that
Most common presentation = SEM (skin, eyes, and mouth) presentation = Zoster form rash. |
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What difference does it make if this is primary or secondary infection?
How do we treat? |
10-fold increase risk if primary infection, because mother will not have had time to develop antibodies for protection.
Acyclovir and C-section (greater than 90% of herpes infection occur AT DELIVERY => need to AVOID THE CANAL).
Acyclovir given late in pregnancy => baby is almost fully developed, so it probably won't have as much of an effect (risk-benefit). |
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What should you be aware of when giving acyclovir? |
Can cause neurotoxicity at elevated levels which could mimic the neurological symptoms of herpes. |
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If this had been a secondary infection, where did it come from? |
Dorsal root ganglia, sensory neurons Lapse in immune system that leads to reactivation. |
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22 year old male truck driber Fever, headache, aching muscles, lack of energy, aspirin over the past 2 days Could be anything. Takes shirt off and see maculpapular rash on body that has spread to palms and soles. What is it? |
Secondary syphilis |
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How can you visualize spichotes without Abs? |
Darkfield microscopy |
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Can you culture syphilis for diagnosis?
What lab test what you call for? |
No! = need to actually have the animal to do this RPR, FTA-ABS
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If the patient had not been treated, will the symptoms eventually go away? Why treat? |
Yes, keep from developing tertiary and to reduce the spread. = MUST TELL THE HEALTH DEPARTMENT TO TREAT ALL WHO CAME IN CONTACT. |
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When you treat patient with penicillin, what will that do to organism? |
Lyse the organisms => don't really have endotoxin like LPS but patient will feel bad for about 24 hours (Jarisch-Herxheimer Reaction) |
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Neisseria gonorrhea: What type of bacteria? What to infections? Why can't you have permanent immunity? What can you get from urine or secretion? Growth on what medium? What is the drug of choice (plus what others? |
Ox+ gram negative diplococcus (kidney bean)
Purulent urethritis, or cervicitis (PID)
Antigenic variation
NAAT (nucleic acid amplification test)
Thayer martin medium (chocolate agar medium = heat it up a little bit to rupture red blood cells and release iron).
LOS is associated with niesseria, NOT LPS.
Ceftriaxone (plus azithromycin or doxycycline) |
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Why do you not use tetracycline for neisseria? |
Significant resistance |
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What are some symptoms of GC infection? |
Purulent discharge, extremely painful urination |
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Chlamydia trachomatis:
Know the cycle, what type of bacteria?
What are the two components for eh replication cycle?
What do you never want to treat with? |
Obligate intracellular bacterial lacking a cell wall:
Replication cycle: elementary body (EB), reticulate body (RB)
Beta-lactam = don't want to lyse the organism? |
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What diseases of chlamydia?
How do you diagnose? What do you treat with? Why is the treatment for chlamydia and gonorrhea exactly the same? |
NOn-gonococcal urethritis, cervicitis, PID Diagnose by NAAT on urine DOC = azithromycin or doxycycline (+/- ceftriaxone)
50% of the time the infections occur simultaneously |
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What is trichomonas vaginalis? Symptoms? Pathogenesis? How do you diagnose? DOC? |
Parasite (flagellate) Painful vaginitis and dysuria Descrutcion of epithelial cellar and inflammatory response (strawberry cervix) Diagnose by wet mount looking for twitching motility of flagellates DOC: metronidazole |
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How will the discharge appear? |
Copious and frothy |
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What will you see on wet mount? |
Flagella, very large organisms, will be moving around. |
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Chlamydia, gonorrhea, and tryp are all sexually transmitted, true or false. |
True! |
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What is a budding yeast that uses pseudohyphae for invasion? Is it an infection? What is the most common presentation? How do you diagnose? What is the DOC? |
Candida spp. Not an infection, part of normal flora Ab therapy, immunosuppres, DM Vulvovaginitis, recurrences common Diagnose by KOH preps looking for budding yeast DOC = azoles or nystatin |
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What is the catch phase for candida? |
Cottage cheese exudate |
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Is bacterial vaginosis from infection? What two common causes? Will this be painful or itchy? What is the main complaint? |
No, from outgrowth of normal flora of vagina. Caused by anaerobes and garderella Not particullary irritating but will see discharge
STINKY! = anaerobes are always smelly (can do whiff test => test with KOH, if BV will give off fishy smell) |
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What type of cell will you see taken from the vagina? |
Large cell with several dots (bacteria) adhering to epithelial cells -> clue cells |
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28 year old woman, complains of dysuria and abdominal pain. Not noted vaginal discharge Genital exam fails to find external lesions => no inguinal lymph nodes => no obvious discharge from vagina,
Is BV likely, what about trich? |
Not BV = no discharge Not trich = no discharge but there is pain |
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Reddened cervix with ectopy and scant discharge
Two endocervical swabs with gram stain? What are you looking for? What would you do with other swab? |
Gram - diplococci if gonorrhea If chlamydia would expect to see nothing
NAAT to distinguish one from the other. |
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Pelvic exam, cervical motion tenderness, left adnexal tenderness. Concern about PID.
You start patient on what treatment? |
Ceftriaxone (+doxicyline or azithromycin) |
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Lab results: gram stain inconclusive, NAAT + for chlamydia, negative for Neisseria
How would you change treatment? |
Drop Ceftriaxone (no worried about GC) and just use azithro or doci |
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Subclinical gonorrhea, IgA response to pili, process of waxing and waning repeats itself 3 times, a few bacteria remain. What is going on here? |
Antigenic variation from new pilus expression |
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HPV:
What type of virus? Disease? Where are persistent infections established? Treatment? Prevention? Vaccine? |
Nonenveloped, circular ds DNA virus Common warts, genital and pharyngeal wards, cervical and head and neck cancer NOn-permissive cells Removal of wart of drug therapy Regular Pap smears Vaccine yes! |
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HPV: How does the genome present in non-malignant tumors? In malignant tumors? Loss of what results in high levels of E6 and E7? What leads to degradation of p53? What inactivates Rb? Is cell cycle control lost? |
Circular, full length, extra chromosomal
Partial genome that has lost E2 is integrated Loss of E2= high level expression of E6 and E7
E6 = p53 E7 = Rb
Cell cycle control lost |
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What will 6 and 11 |
Accuminata (penile, anal) |
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Abnormal pap smear for 25 year old Negative for HPV DNA ASCUS = diagnosis?
If HPV positive,what might have been seen? |
Koilocytotic change |
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If Pap smear had demonstrated koilycuytoic cells, what precode would identify infected areas?
Which genotypes most commonly associated with koilocytic change? |
Brushing with acetic acid
16, 18, 31, 33, etc. |
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What are some of the complications of HSV?
CNS infections? |
Congenital or inutero infection leads to disseminated disease and/or encephalitis
Encephalitis, meningitis
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Complications of HPV? |
Cervical, head and neck, an anal cancers |
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Complicatiosn of syphilis in utero? If survives? |
Still birth or spontaneous abortion May not manifest for two years (scalded skin, snuffles, frontal bossing much later in lie, saddle nose, sharp shin bones, Hutchinson's incisors as adult). = all from tertiary syphilis |
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When do blood complications of syphilis arise? What can tertiary syphilis involve?
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Blood = 2nd and terry form Tertiary = any organ and CNS leading to meningitis or insanity |
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What are some congenital, blood, and GU tract complications of gonorrhea? |
Get from slide |
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What are some complications of chlamydia? Congenital, lower to upper GU tract, what syndrome? |
Get from slide
Fitz-Hugh-Curtis = right upper quadrant pain |
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Final thoughts ... |
Final thoughts... |
