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101 Cards in this Set
- Front
- Back
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org which causes chancroid
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haemophilus ducrei
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org that causes genital warts
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HPV
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etioloogic agent of syphilus
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treponema pallidum
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describe trep pallidum
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gram -, spiral shaped, hard to visualize under LM b/c cel wall too thin
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where are syphilis rates highest
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GA, LA, NV, CA, FL, IL
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avg rate in US, GA
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3/100K, 7.3/100K
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which ethnic group are syphilis rates highest, which sex and age
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AA, 5.1M, 0.9W
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age range where 1 and 2 syphilis is most common
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30-44, rates increasing most in MSM
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secretion of this enzyme allows organism to migrate into tissuesand into blood stream
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hyaluronaidase
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what are lesions and other clinical manifestations in syphilis due to
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host immune response to bacterial antigens
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what does the org coat itself with to avoid phagocytosis by the host
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host fibronectin
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what are the characteristics of primary syphilis
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regional lymph, ulcer chancre at site of infection, painless ulcer, contains abundant T. pallidum, heals s tx in 2-6 wks
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this stage of syphilis results from dissemination of T. pallidum
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secondary stage
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this rash contains knob like or warty papular lesions, which is typically 1-3 cms and assoc c 2 syphilis
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condylomata lata
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this phase of syphilis occurs in the latent phase which is when 1 or 2 is acq or diag during the preceding yr
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early phase
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seroreactivity in absence of symptoms, greater than 2 yrs after infection
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late phase of syphilis
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result of a chronic prog infl process producing clinical man yrs to decades after infection, wide spread tissue destruction secondary to host response to organism
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tertiarry syphilis
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this causes local destruction of affected organ system, coascelescent granulomatous lesions
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Gumma
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bony overgrowth and instabilty of joints which affects the musculoskeletal system
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charcot joint
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non Treponemal serologic tests
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VDRL and RPR, venerial disease reference lab and rapid plasma raegin test
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what are the laboratory diagnosis for the serology of syphilis
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non trep antibodies and trep Ab
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what exudates are you looking for on the laboratory diagnosis of syphilis
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darkfield qnd direct fluorescent antibody
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what is the problem c non-trep serologic tests
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nonspecific but cost effective, can't rule in dx, sensitivity of 80% in symp primary and 100% c secondary shyphilis
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what are the specific tests to T Pallidum
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confirmatory tests are FTA-ABS(fluorescent trep Ab absorption) and MHA-TP (microhemagglutination assay for T pallidum)
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what is the tx for 1, 2 and early latent syphilis
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Benzathine penicillin G 2.4 mil units
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tx for late latent syphilis or latent syphilis of unknown origin
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benzathine penicillin G 7.2 mil units total, 3 doses of 2.4 at 1 wk intervals
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how can you check to see if the tx worked
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repeat VDRL or RPR at 3, 6, 12 months and if non reactive - worked, but if reactive it could be due to lack of penetration of drug into CNS
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DNA virus which replicates in nucleus
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herpes
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occus in 70% of adults, which can also cause oral lesions
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HSV1
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what are the results of primary genital infections c HSV
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asymp, symp- pain, fever, urethral vag D/C
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how are recurrences prev in HSV
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strong cellular immune response-CD4, CD8 cells
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Does high Ab titer prevent recurrences
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No
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how is genital herpes diagnosed
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clinical appearance, viral isolation c typing, viral antigen detection and serology c typing
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what do antiviral drugs do in the treatment of HSV
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decrease recurrences, shorten duration of lesions and may reduce transmission
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what 3 antivirals are used in treatment
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the cyclovirs, (A, Fami, Vala)
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what are the recommended dosages for the 1st clinical episode of genital herpes
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A 400 mg 3x's day for 7-10 days, A 200 mg 5x's for 7-10 days, Fam 250 mg 3x/day for 7-10 days, Vala 1g twice/d for 7-10 days
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tx for suppressice therapy for recurrent genital herpes
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A 400mg 2/d, Fam 250 mg 2/d, Vala 500 mg or 1g once a day
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which std causes chancroid
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Hamophilus ducreyi
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what areas are chancroid found
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isolated STD and prostitution populations
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how is chancroid diagnosed
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ruling out syphilis and genital herpes
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how does chancroid present
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tender papule c erythematous base
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how is chancroid tx
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Azithromycin, ceftriaxone, cipro, erythromycin
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Ds DNA nonenveloped virus which causes chronic infections
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genital warts
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very common STD which 20 mil in US have, by age 50 80% of women carry infection, 5.5 mil new infec yearly
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HPV
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clinical manifestations 0f benign lesions
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condyloma accuminanta
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clinical man of pre malignat and then malignant lesions
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flat condyloma and CIN --- cervical carcinoma
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how are genital warts diagnosed
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clinical appearance and pre-cancerous lesions are initially by abnormal pap smear
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this test determines if high risk HPV is present
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HPV DNA test but does not detect individuals of low type or individual types
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what is the tx for HPV
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podophyllin, salicylic acid and trichloroacetic acid
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what are the symptoms of cervicitis
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abnormal vag D/C and intermenstrual vag bleeding or may be asymp
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what are the two infec causes of cervicits urethritis
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n. gonorrhea and chlamydia trichomoniasis
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discharge of mucopurulent or purulent material, dysuria or urethral pruirits
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symptoms of urethritis
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obligate intracellular pathogens which can exist as elemantary or reiculate bodies
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chlamydia trachomatis
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metabolically inactive form of chlamydia that is the infec form
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elementary bodies
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metabolically active form of chlamydia that is the noninfec form
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reticulate bodies
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this biovar of chlamydia trach which infects non-ciliated mucosal epi and conjunctival cells, causes urogenital infec, neonatal infec and trachoma
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trachoma biovar
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this biovar infects macrophages and causes lymphogranulosa venerium
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lymphogranuloma venerium biovar
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what dx's are assoc c C. trach
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eye infec- trachoma and neonatal conjunctivitis and urogenital infec
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7 mil people blind due to this, primarily a dx of people in devp countries, repeated infec which lead vision loss
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trachoma
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most freq reported infec dx in US, PID(salphinigits), endometritis, cervicitis and urethritis
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what are the most sensitive diag tests in the diagnosis C trach
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NAATs
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what must you do to patients c chlamydia
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test for other STDs
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what are the recommended regimens for the tx of C Trach
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Azithromycin ( preferred b/c don't have to worry about compliance issues; and Doxycyline ( cheaper)
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what are the alternative tx's of urogenital infec c C. trachomatosis
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Erythromycin, Ofloxacin and Levofloxacin(CI in pregnancy)
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what is essential to reduce the risk of reinfection
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tx of sex partners, refer sexual partners for tx and all partners in past 60 days and refrain from sexual intercourse until they and sex partners have completed tx
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gram neg diplococci that causes urethritis, pharyngitis, proctitis in men and women plus cervicitis in W
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which sex is more likely to have noticable symptoms(urethritis and cervicitis) and seek tx for gonococcal infec
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men b/c infec in women may not produce recognizable symp until complications have occured --- produces 600K new infec/yr eachyr
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what are the complications of untx infec in women
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PID resulting in tubal scarring which can lead to infertility or ectopic pregnancy, disseminated infec and transmission to newborns
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most common cause of septic arthritis in sexually active young adults
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disseminated gonococcal infec
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these virulence factors help N gonorrhea attach to and penetrate the mucousal cells
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pilin-attachment, which promotes survival within neutrophil phagosomes and Opa proteins giving it an opaque appearance
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this virulence factor incites inflammatin leading to purulent D/C and other clinical man of infection
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Lipoligosaccharide (LOS)
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most sensitive test when testing for Neisseria Gonorrhea
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Nuc acid amplification tests (NAAT)- PCR based
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this probe or test will also test for chlamydia and Gonorrhea
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Nucleic acid hybridization test (DNA probe test, molecular probe test)
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in which sex can gram stain be diagnostic for N gonorrhea
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male (urethral specimen)
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what is the culture named for Neisseria G
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thayer martin or chocolate agar
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DOC for tx of Neiss Gonor
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cephalosporins- cephtriaxome or cefixime
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alternative tx that has been gaining resistance to
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quinolones( westeern us, and msm)
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what is the tx for disseminated gonococcal infection
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hospitalization-initial therapy, ceftriaxone for 24-48 hrs, then switch to cefixime, oflaxacin or levofloxacin for 1 week
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what else should you tx for with this infection unless the appriopate testing has ruled it out
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c. trachomatis
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what are manifestations of vulvovaginitis
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vag D/C, &/or vulvar itching, and vaginal odor-possibly
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most common cause of vulvovaginitis
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bacterial vaginitis (anaerobic microorg, mycoplasmas, ams gardnerela vaginalis)
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what is the most prevalent cause of vag D/C or malodor
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bacterial vaginitis, 50% women are asymp
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what is the causes which lead to bacterial vaginosis
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replacement of normal vaginal lactobacillus in c high conc of anaerobic bacteria or gardnerella
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how does BV present
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gray, thin and homogenous D/C that is adherent to vaginal mucosa
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predisposing factors for BV
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recent Ab use, decreased estrogen prod of host, wearing an IUD, douching and sexual activity c new sexual partners
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related to haemophilus sp, facultatively anaerobic gram - variable rod, predominantly occurs in women of repro age
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gardnerella vaginalis
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do men usually get gardenella
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no
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how is BV diagnosed
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clinical criteria or gram stain
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homogenous, thin white D/C that smoothly coats the vaginal walls, prescence of clue cellson micro gram stain, pH of vag fluid> 4.5, fishy odor of vag D/C
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clinical criteria of BV- need 3 of the 4
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tx of BV
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metronidazole- avoid alcohol during tx, clindamycin-cream
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what usually causes vulvovaginal candidiasis
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C. albicans or other candida
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what is the most common symptom of VVC
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pruritus, thick odorless white D/C(cottage cheese)
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definitive diagnosis of VVC
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wet prep- saline, 10% KOH, gram stain of vag d/c both demonstrating yeasts or pseudohyphae
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risk factors for overgrowth in VVC
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oral contraceptive use, diabetes, HIV or other immunocomprimised states, chronic Ab use, pregnancy, young age at 1st intercourse, increased freq of intercourse, receptive oral sex
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2nd most common cause of vaginitis, 75% of women will have at least one episode, 40-45% two or more
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VVC
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the majority of healthy women c this form of VVC have no identifiable precipitating factors
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uncomplicated form
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10-20% have this form which occurs in women c uncontrolled diabetes, debilitation or immunoseppression or pregnant which is recurrent or severe and is non albicans candidiasis
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complicated form of VVC
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tx for VVC
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flucanazole-oral agent, rest of azoles- butocona, clotrim, micon, ticono
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what should one do if symptoms persist or recur c 2 months
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be evaluated for underlying conditions
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in women this dx is assoc c a foul smelling d/c, frothy vag d/c, vulvar irriation, severe pruritis, PAINFUL sexual intercourse and in men can be asymp or assoc c nongonoccoal urethritis
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trichomoniasis
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tx of trichomoniasis
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metronidazole-single dose or tinidazole in a single dose or metronidazole 500 mg orally bid for 7 days, sexual partners should also be tx and sex avoided until they are cured(therapy completed or patient and partners are asymp
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