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40 Cards in this Set

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Herpes on a Tzanck test. See multi-nucleated giant cell. Not characateristic of a specific herpes virus.
What is this cytology?
What are the characteristics of an acute primary HSV infection?
Painful bilateral genital ulcers, dysuria, systemic symptoms (fever), local PAIN, headache
What are the characteristic ulcers in syphilis?
Painless, shallow ulceration
What are the characteristics of secondary syphilis?
Salmon-colored rash involving palms and soles.
Secondary syphilis (this is condyloma lata)
(condyloma accuminata are the warts of HPV)
What is this lesion a sign of?
What are manifestations of tertiary syphilis?
Gummas
Acute syphilitic meningitis
Meningovascular syphilis
General paresis
Tabes dorsalis
Aortic aneurysm
Hutchinson's teeth
What is the treatment for syphilis?
Benzathine penicillin (long-acting injection in buttock)
No resistance yet.
If allergic --> doxycycline
What organism causes Chancroid?
Hemophilus decruyi
Hemophilus ducreyi, the cause of chancroid.
See "school of fish" appearance
What organism is this?
What is the lesion progression in chancroid?
Erythematous papule --> pustule --> ulcer
Confined to genital area and draining LN
Ulcer is 102 cm, painful, typically single in men, multiple in women
Inguinal lymphadenitis is common in men, not in women. Nodes may liquefy and turn into buboes
What is the treatment of chancroid?
Azithromycin, ceftriaxone, ciprofloxacin, erythromycin
Aspirate buboes, treat partners
What is the clinical course of lymphogranuloma venereum?
Primary - Vesicle, papule or ulcer not bothersome
Secondary - regional lymphadenopathy, fever, headache, myalgias "groove sign" in men, inguinal region
Tertiary - suppurative adenitis, bubo, fibrosis
How does LGV cause lymphadenopathy?
Direct extension from primary site to LN, binds epithelial cells, causes necrosis within nodes, followed by abscess formation
Results in inflammation and fibrosis
How is LGV treated?
Doxycycline or erythromycin, or Azithromycin
Aspiration of buboes
Syphilis
Incubation
Early lesion
# lesions
Depth
Adenopathy
Pain
9-90 days
Papule
One
Deep or superficial
Firm, nontender, bilateral
Uncommon
Herpes
Incubation
Early lesion
# lesions
Depth
Adenopathy
Pain
2-7 days
Vesicle
Multiple
Superficial
Firm, tender
Tender
Chancroid
Incubation
Early lesion
# lesions
Depth
Adenopathy
Pain
1-14 days
Pustule
Multiple
Excavated
Tender, may suppurate
Very tender
LGV
Incubation
Early lesion
# lesions
Depth
Adenopathy
Pain
3-6 weeks
Papule, pustule, or vesicle
One
Superficial or deep
Tender, may suppurate
Tender
What are the two main causes of urethral discharge?
Chlamydia trachomatis
Neisseria gonorrhoeae
What is the microscopic appearance of Neisseria gonorrhoeae?
non-motile gram-negative diplococcus
What are the available tests for N. gonorrhea, and what are their sensitivities?
Gram stain (95% in symptomatic, 50-70% in asymptomatic)
DNA probe - 89-95%
LCR/PCR - 90-98%
What are the manifestations of gonorrhea in females?
Cervicitis (vaginal discharge, friable mucosa, pain is atypical)
Anorectal itching, discharge
Pharyngitis
PID
Perihepatitis
Disseminated GC infxn - arthritis
What drugs are used to treat GC?
Third generation cephalosporins, quinolones
Treat presumptively for chlamydia, too.
Resistance to fluoroquinolones in HI and CA
What STD may cause joint swelling and pain?
Gonorrhea
What is the most common cause of the increasing number of tubal pregnancies and infertility problems in women in the US?
Asymptomative chlamydia infection
What are the clinical features of chlamydia in women?
Cervicitis with vaginal discharge and abdominal pain, may be friable or edematous
Dysuria-pyuria syndrome
Perihepatitis (Fitzhugh-Curtis)
PID
What is Reiter's syndrome?
inflammatory syndrome (etiology unknown) predominantly in males; characterized by arthritis and conjunctivitis and urethritis
Can you see chlamydia in gram stain?
No - all you can see are inflammatory cells
Which types of HPV cause visual genital warts?
6 and 11
Which types of HPV are associated with cervical dysplasia?
16, 18, 31, 33, 35
What lesions are associated with HPV?
Cutaneous warts
Condyloma acuminatum (anogenital warts) - well-circumscribed, expophytic papules
Anogenital malignancies
What is bacterial vaginosis?
decrease in concentration of H2O2 producing lactobacilli and increase in Gardnerella vaginalis and other species (unknown etiology)
Clue cell - mottled because G. vaginalis is sticking to it. No WBCs.
What does this cytology indicate?
What is the discharge like in bacterial vaginosis?
Thin, homogeneous, milky white or gray, adherent, often increased. "Fishy" odor (amines). Less acidic than normal.
What is the discharge like in Trichomonas Vaginitis?
Yellow-green, frothy, adherent, increased. Fishy odor may be present. Itching, dysuria.
What is the discharge like in Candida vulvovaginitis?
White, cottage cheese-like, sometimes increased. No odor.
What is the treatment for bacterial vaginosis?
Metronidazole po 7 days, or cream
Topical intravaginal clindamycin cream
What are the findings in trichomonas vaginalis?
vulvar erythema, frothy yellow discharge, vaginal wall inflammation, strawberry cervix
Trichomonas vaginalis
What is this?
What are the vaginal pHs associated with:
Normal
Bacterial Vaginosis
Trichomonas vaginitis
Candida Vulvovaginitis
3.8-4.2
>4.5
>4.5
<= 4.5