Micro Sti Mjm

Front 1

which pathogen can be transmitted via toilet seat?

Back 1

HPV

Front 2

Reservoirs?

Back 2

Pt who carries the disease but it is not as easily dx. Usually asymptomatic. May have more than one STI

Front 3

normal flora of the vagina?

Back 3

lactobacillus. aided by excess glycogen that improves its numbers

Front 4

Female genital defense?

Back 4

mucous plug (Ig present). usually a continuous flow

Front 5

common flora present in the male urethra?

Back 5

staph, enterococcus, alpha hemolytic strep

Front 6

organisms that cause genital ulcers?

Back 6

HSV, treponema pallidium

Front 7

organisms that cause gonococcal urethritis/cervicitis?
NGU/C?

Back 7

niesseria gonorrhea
chlamydia and ureaplasma

Front 8

organisms that cause vaginitis?

Back 8

trichomonas, gardnerella, candida

Front 9

Niesseria gonorrhea?

Back 9

Lives in PMN, fragile to heat, light, drying. Needs CO2 rich environment. Grows on chocolate agar

Front 10

transmission of N. gonorrhea?

Back 10

women are less likely to transmit to men then men are to women. increased rate of transmission in anal sex and decreased in oral.
females are asymptomatic more often then men. (reservoirs)

Front 11

How does N. gonorrhea adhere to cellular lining?

Back 11

pili and surface proteins. LPS

Front 12

what type of epithelium does N. gonorrhea like to bind to?

Back 12

non-ciliated cuboidal and columnar epi

Front 13

why is it difficult to create a vaccine for N. gonorrhea?

Back 13

there are millions of pili and protein combinations that Ng can use.
LPS releases blebs: outer membrane fragments

Front 14

other virulence factors of Ng?

Back 14

surface proteins, porin channels, adds salicylic acid to outside and mimics host cells. its also encapsulated, lives in WBC and avoids IgA protease

Front 15

how does Ng cause damage?

Back 15

it triggers vigorous immune response from the host defenses against the epithelial cells = major discharge
LPS

Front 16

a disseminated gonococcal infx can show up as?

Back 16

mono-articular arthritis, rash

Front 17

what is the most common bacterial cause of UTIs?

Back 17

chlamydia.
Esp non-gonococcal urethritis and cervicitis, PID

Front 18

McCoy cell culture?

Back 18

living cells culture that Chlamydia needs because it is a obligate intracellular organisms.

Front 19

does gram stain work on chlamydia?

Back 19

not really, geisma stain will show inclusion bodies

Front 20

transmission rates of chlamydia?

Back 20

unlike gonorrhea, chlamydia is transmitted equally from men to women and women to men.

Front 21

entry of chlamydia into the cells?

Back 21

thru micro abrasions in the mucosa, then enters cell thru endocytosis

Front 22

what type of epithelium does chlamydia prefer?

Back 22

squamocolumnar (transitional) present more often in young women

Front 23

why is the previous answer important?

Back 23

because most young women are asymptomatic and they need to be educated and screened

Front 24

life phases of chlamydia?

Back 24

elementary body: attachment and infection of cells
reticulate body: replication

Front 25

how does chlamydia cause damage?

Back 25

it can spread to other cells via blood or lymph, causes scarring of mucosa (infertility),

Front 26

5 P's of sexual history?

Back 26

partners, prevention of preg, protection from STI, practices and past hx of sti

Front 27

what is the difference between a UTI and urethral syndrome?

Back 27

they both have dysuria, urgency, frequency, pyuria
but urethral syndrome does not have bacteruria

Front 28

urethritis causes?

Back 28

gonorrhea most likely, chlamydia 20-35% (most of the non gonococcal)

Front 29

Chlamydia vs Gonorrhea telling the difference?

Back 29

chlamydia's incubation is 5-10, GC= 2-7 days
chlamydia is non-spontaneous, mucoid, scanty
GC = spontaneous, grn/yellow discharge, copious
women can be reservoirs in both men only on CT

Front 30

If left untreated what can happen in CT or NG.

Back 30

PID, infertility, ectopic preg

Front 31

Reiters syndrome?

Back 31

urethritis, iritis, arthritis, mucocutaneous lesions, diarrhea. can be a complication males from CT infx

Front 32

other complication of CT in males

Back 32

epididymitis

Front 33

Dx chlamydia?

Back 33

NAAT immunological test
rapid chlamydia test
EIA, DIA not recommended

Front 34

who should be screened?

Back 34

all women 24 or younger, increased risk (mult partners, drugs use, no condoms, previous sti, pregnant)

Front 35

3 tx options for chlamydia?

Back 35

azythromycin (more expensive, more compliance)
doxycycline (less expensive)
erythromycin

Front 36

are men with gonorrhea usually symptomatic?

Back 36

yes, dysuria, spontaneous purulent discharge

Front 37

presentation of gonorrhea in women?

Back 37

asymptomatic
but can have vaginal discharge, ab discomfort, uterine bleeding, painful menses

Front 38

Dx of gonorrhea?

Back 38

collect sample from all infected/inflammed sites. use calcium alginate swab on men (2 cm)
Gram stain and culture (CO2 rich, living culture)

Front 39

complication of gonorrhea?

Back 39

PID. about the same risk potential as chlamydia

Front 40

dissemination of GC?

Back 40

1st stage: fever, chills, skin rash
2nd stage: arthritis, endocarditis and meningitis (rare)

Front 41

In GC who is dul therapy recommended for?

Back 41

People with co-existing infections

Front 42

Meds for gonorrhea?

Back 42

ceftriaxone (IM), also give azythromycin for CT(PO)

Front 43

Tx if GC has disseminated?

Back 43

ceftriaxone IM or IV for 24 hrs, once improving give cefixime orally 2x a day for a week.
GC arthritis may make trx difficult

Front 44

When should you think PID?

Back 44

multiple risk fators present (previous std, mult partners, early sexual encounter)

Front 45

CDC diagnostic criteria for PID?

Back 45

low ab pain, adnexal pain, cervical motion tenderness (chandeliers)
At least one additional of the following:
elevated temp, discharge, high esr, pos culture

Front 46

Tx of PID?

Back 46

broad spectrum ab can tx as outpt if mild, oral meds if mild (no fever). Follow up 72 hrs the 4-6 weeks

Front 47

Oral tx for PID?

Back 47

levofloxacin for 14 days
can add metronidazole for anaerobes

Front 48

Becomes in patient when?

Back 48

pregnant, abcess, severe dz (fever, N/V), HIV, poorly compliant to med

Front 49

Inpatient tx of PID?

Back 49

cefotetan IV, + PO doxycycline. can switch to oral if symptoms improve. Tx for 14 days

Front 50

IV vs Oral vs IV/Oral

Back 50

Chlamydia: give PO so long as outpatient
GC: give IM PO combo. disseminated give IV or IM every 24 hrs until symptom free for 24-48 hrs then switch to 1 week of oral or IM
PID: oral for mild/mod, once hopitalized give IV. can switch make to oral if symptoms subside

Front 51

causative agent of syphillis?

Back 51

treponema pallidum. difficult to culture

Front 52

what are the implication of syphillis being slow growing?

Back 52

need to tx long and potentially with higher doses

Front 53

How is syphillis dx?

Back 53

serology

Front 54

transmission of syphillis?

Back 54

transplacental and sexual. much more infectious then GC. sex during prim or sec. birth at anytime of dz

Front 55

virulence factors of syphillis?

Back 55

motility, outer membrane, scavenges iron

Front 56

pathogenesis of syphillis?

Back 56

infx 2-6 wks>primary:chancre 1-3 mo>sec:disseminate 1-3 mo >latent can stay dormant or progress to tert gumma/cardio/CNS

Front 57

Gumma

Back 57

cavitary lesions on skin, bone, testis. host response to treponemal antigens. Tertiary phase

Front 58

Tx for syphillis?

Back 58

penicillin

Front 59

differing secondary from primary syphillis?

Back 59

prim: chancre, painless
secondary: maculopapular eruption on palms and soles, systemic involvement

Front 60

testing for syphillis?

Back 60

RPR, VDRL/may give false pos (non trep) if positive do trep test.
latest: moving towards trep test (flouro trep Ab-ABS) first

Front 61

You have a pt with a painless chancre on their penis, you have ordered a VDRL test and it has come back positive. What should you do next?

Back 61

perform a trep test to confirm

Front 62

Tx of penicillin?

Back 62

prim/sec: 2.4 mill units IM once of benzathine penicillin
latent: same
tert: 2.4 million units IM weekly for 3 weeks
neurosyphilis: 3-4 million IV for 10-14 days

Front 63

cause of bacterial vaginosis?

Back 63

gardnerella: KOH whiff test (amine fishy odor). most common cause of symptomatic vaginosis
trich:
candida: yeast overgrowth usually a result of abx, dm, tight cloths

Front 64

differentiating between the 3?

Back 64

Garnerella:scanty, fishy discharge, thin grey, clue cells, ground glass
Trich: labial pruritis, copious grn/yellow discharge, foul, frothy, strawberry cervix
Candida:pruitis, thick curd like discharge

Front 65

pH associated with the 3?

Back 65

candida: normal pH <4.5
trich/gard: pH >4.5

Front 66

Dx criteria for bacterial vaginosis?

Back 66

coaty white vag discharge
clue cells
pos whiff test
elevated pH

Front 67

Trich tx?

Back 67

metronidazole PO

Front 68

candidis tx?

Back 68

miconozole x 3days

Front 69

bacterial vaginosis tx?

Back 69

metronidazole po 7days, gel 5 days

Front 70

Partner Tx?

Back 70

not recommended for candidis or bacterial vag
Tx trich partners