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44 Cards in this Set

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What are the symptoms of cervicitis & what are the 2 main infectious causes?
Sx: Abnl vaginal discharge & intermenstrual vaginal bleeding (eg after sex). May be asymptomatic.
Main causes: Chlamydia, Gonorrhea, (less frequent: trichomonioasis & genital herpes)
What are the sx's of urethritis & what are the main causes?
-Sxs: discharge of mucoperulent or perulent materia; dysuria, or urethral pruritis; (Asymptomatic infection common!)
-Main causes: N gonorrhea & C. trachomatis.
Describe the characteristics of chlamydia.
-Obligate intracellular;
-Elementary (metabolically INACTIVE, infectious form) & reticular bodies (metabolically ACTIVE, non-infectious)
What are the 2 biological variants of Chlamydia trachomatis? ,based on host cells they infect]
1. Trachoma Biovar: infects non-ciliated mucosal epithelial cells & conjunctival cells (causes urogenital infections, neonatal infections & trachoma)
2. Lymphogranuloma venereum Biovar--infects macrophages (causes Lymphogranuloma venereum)
What are the 2 diseases associated w/ C. trachomatis?
1. Urogenital infections
2. Eye infections (trachoma (not sexually transmitted), neonatal conjunctivitis (transmitted from infected mom to baby @ brith)
What is the most frequently REPORTED infectious disease in US?
Urogenital chlamydia.
What are the 2 most common urogenital infections?
1. Urethritis
2. Cervicitis
What are the epidemiological trends of urogenital chlamydia?
1. Chlamydia infection is increasing in men & women despite greater awareness.
2. Infection rate varies by race/ethnicity-->African Americans are the highest.
3. Infection is most commonly reported in women aged 15-24.
What are the specimens needed for diagnosis of C. trachomatis?
-Women -urine or endovercix or vagina swab;
-Men -urethral swab or urine specimen;
-Rectal t. trachomatis infections (receptive anal intercourse) -rectal swab specimen.
What are the diagnostic methods of C. trachomatis?
-NAATs (nucleic acid amplification test)=PCR-->most sensitive!
-Culture-->must be grown in cells b/c its an obligate intracellular organism.
-Direct immunofluroescence (DFA)
-Enzyme immunoassay (EIA)
-Nucleic acid hybridization tests.
If a patient is diagnosed w/ Chlamydia, what should you do next?
1. Test for other STD's!
2. Azithro (1x) or Doxy
3. tx their partner if they've had sex w/ them 60 days before diagnosis or sx onset.
4. tell pt they can't have sex until they've finished meds.
What are the main tx's for chlamydia trachomatis & what is the main difference b/w the 2 regimens?
1. Azithromycin: 1 g orally, single dose!!, ok for pregnant woman,
2. Doxycycline: 2x day for 7 days, cheaper
What are the general characteristics of Neisseria gonorrheae? Whats the unique symptom?
-gram neg diplococci
-epi: sex, mom to baby
-sx's: men-urethritis, proctitis, PHARNYGITIS; women: cervicitis, urethritis, proctitis, PHARYNGITIS
Which gender is more likely to seek tx for gonorrhea & chlamydia (b/c more symptomatic)?
1. Chlamydia: WOMEN
2. Gonorrhea: MEN
How many new N. gonorrhoeae infections occur each yr in US?
Whats the most commonly cause of septic arthritis in sexually active young adults?
(otherwise its Staph)
N. Gonorr.
What are the complications of untreated N. gonorrheae infection in women?
-PID--> tubal scarring -->infertility or ectopic pregnancy
- Disseminated infections
-transmission to baby
What are signs of disseminated gonococcal infections?
-Skin lesions petechial or pustular acral skin lesions
-Jt manifestations: septic arthritis, asymmetrical arthrlgia.
What are the virulence factors of N. gonorrhea?
-STRONG attachment to mucosal cells via PILIN & OPA proteins (give colonies an opaque appearance);
-Porin proteins promote survival w/in neutrophil phagosomes.
-LOS (liopoligosaccharide, similar to LPS, leads to purulent discharge;
What are the epidemiological trends of N. gonorrhea?
-N.gonorrhea rates vary by state--worse in the South!
-N. gonorrhea rates vary by race/ethnicity-->highest in African Americans.
-N. gonorrhea rates vary by age. Rate of women w/ gonorrhea was > than men, 15-24 highest.
What are the diagnostic methods for N. gonorrhoeae?
1. Nucleic acid amplificantion test-PCR (this is most sensitive method)
2. Nucleic acid hybridization test (DNA probe test, molecular probe test)--molecular probe has no NA amplification, can test for chlamydia & gonorrhea co-infection.
3. Chocolate or Thayer Martin agar (get sample from cervix, urethra, eye, rectum, or throat); Inc Abx resistance;
4. Gram stain diagnostic for MALE URETHRAL SPECIMEN (diplococci in neutrophils);
5. ELISA: to detect gonococcal antigens in urethral or cervical secretions.
What is the tx for N. gonorrheae? What is the alternative regimen that is getting inc resistance esp among gay men?
-DOC: cephalosporins: ceftriaxome or cefixime.
-Alt. regiment: quinolones. Strains referred to as Quinolone-Resistant Neisseria gonorrheoeae (QRNG), so don't use QNRG in certain pts of US like Cali & Hawaii or infections from abroad.
Ceftriaxone (as a tx for Gonorrhea) is given in what form? How are the other drugs given to tx this condition?
Ceftriaxone: IM in single dose. All other meds like quinolones are in oral single dose.
When treating gonorrhea what other condition should you tx?
Chlamydia if it hasn't been ruled out. Better to tx onsite w/ single dose. Use cephalosporins for pharyngeal infections.
What is the tx for disseminated gonococcal infection (DGI)?
1. Initial therapy: hospital
2. Ceftriazone IM or IV every 24 hrs, continue until 24-48 hrs after improvement begins.
3. Post improvement, switch to Cefixime, Ciprofloxacin, Ofloxacin, or Levofloxacin for 1 week.
4. If treated for DGI should also be treated for C. trachomatis unless its excluded.
What are the symptoms of Vulvovaginitis?
vaginal discharge &/or vulvar itching & irritation, & possible vaginal odor.
What are the three causes of vulvovaginitis? Which is the most common?
1. Bacterial vaginitis (most common) [anaerobic microorganisms, mycoplasmas, Gardnerella vaginalis[
2. Candidiasis (usually from Candida Albicans-->not transmitted sexually but frequently diagnosed in women being evaluated for STDs).
3. Trichomoniasis (Trichomonas vaginalis)
What is the most prevalent causes of vaginal discharge or malodor?
Bacterial Vaginosis (but 50% are asymptomatic!); discharge is gray, thin, homogenous, may see small bubbles in discharge fluid.
Bacterial vaginosis is a reuslt of what?
polymicrobial infection from replacement of nl vaginal Lactobaciillus w/ hi conc of anaerobic bacteria (Gardnerella vaginalis & Mycoplasma hominis)
What is the nl fxn of lactobacilli that are dec in Bacterial vaginosis?
-Help maintain acidic pH of healthy vaginas & inhibit other anaerobic microorganisms thru elaboration of hydrogen peroside.
What are the predisposing factors for bacterial vaginosis?
Recent Abx use, dec estrogen production of host, wearing an IUD, douching, sex w/ new sexual partner
Describe the characteristics of Garnderella vaginalis.
-Related to Haemophilus
-Facultatuve anaerobic gram variable rod;
-Colonization &/or infection predominantly occurs in women of repro age.
-Men rarely develop infection.
How do you diagnose Bacterial vaginosis?
CLUE CELLS on gram stain. Need 3 of the following clinical criteria:
-homogenous, thin white discharge smoothly coating vag walls
-clue cells (bacteria-coated epithelial cells in vag discharge) on gram stain
-pH of vaginal fluid >4.5
-fishy odor of vag discharge.
What are the complications of Bacterial vaginitis?
-cellulitis post invasive gyn procedure.
-BV assoc w/ adverse pregnancy outcomes.
-All pregnant women who have symptomatic dz require tx.
-Screening (if conducted) & tx should be performed during 1st prenatal visit.
What is the tx for Bacterial Vaginitis?
-Metronidazole: oral or intravaginally for 5-7 days. No alcohol during tx.
-Clindamycin: orally or intravaginally for 7 days; oil-base cream, weakens condoms & diaphragms
Whats the cause of Vulvovaginal Candidiasis?
C. albicans.
What are the sx's of Vulvovaginal Candidiasis?
-most common sx: Pruritis
-odorless, cottage cheese discharge.
-vulvar burning, dysparenuia, & burning w/ urination
What are the risk factors for a yeast infection since the Candida species are in our nl vaginal flora?
OCP, DM, HIV, chronic Abx use, pregnancy, young @ first sex, more frequency of sex, receptive oral sex.
Whats the most common cause of vaginitis?
Vulvovaginal Candidiasis; 75% of women have at least 1 episode;
Whats the difference b/w a complicated & uncomplicated yeast infection?
uncomplicated= sporadic or infrequent, mild-moderate sx's, usually from C. albicans, in immune competent women.
Complicated: recurrent or severe, nonalbicans candidiasis, in women w/ uncontrolled DM, debilitation, or immunosuppression, or those who are pregnant.
How is a definite diagnosis of vulvovaginal candidiasis made?
Wet prep (saline, 10% KOH-->disrupts cell material that might obscure yeast or pseudohyphae); gram stain of vag discharge (cottage cheese), both have yeasts or pseudohyphae;
What is the tx for VVC?
-Intravaginal agents: Butoconazole, Clotrimazole, Miconazole, Tioconazole;
-Oral Agent: Fluconazole (1 tablet in single dose);
-Need to look for underlying condition if sx's persist or recur w/in 2 months after using OTC
What is the 3rd most common cause of bacterial vaginitis? What are the sx's?
Trichomoniasis caused by trichomonas vaginalis. Sx--> women: foul-smelling, frothy vag discharge, severe pruritis; painful sex; Men: asmyptomatic or nongonococcal urethritis.
What is the tx for Trichomoniasis?
Recommended regimens: Metronidazole or Tinidazole.