Sexually Transmitted Infections

Front 1

What tissue in the body is affected by gonorrhea?

Back 1

columnar and transitional epithelium

Front 2

Epidemiology of gonorrhea?

Back 2

2nd most common reportable infectious dz in US
most common in young sexually active person
highest prev in unmarried person of low SES and education

Front 3

Microbiologic characteristics of n. gonorrhea?

Back 3

gram negative diplococci
dies on drying or cooling, rarely transmitted by fomites
5-10% CO2 for growth in lab
ferments only glucose (other Neisseriae ferment glucose and maltose)

Front 4

Which strains of N. gonorrhea are most virulent? Why?

Back 4

Those with pili
They mediate attacment to columnar epi cells on mucosal surface
Prevent ingestion/killing by PMN
Prevents opsonization by AB

Front 5

What mediates cellular invasion in gonorrhea?
AB against gonorrhea?

Back 5

adhesins
produced following infection, but doesn't provide effective immunity b/c of the many antigenic variants,
IgA proteases cleave IgA made by mucosal cells

Front 6

What plays the biggest role in protecting against gonorrhea?

Back 6

terminal components of complement (6,7,8)

Front 7

CLincal presentation of gonorrhea in males?
Females?

Back 7

urethritis, dysuria, 5-10% asymptomatic
urethritis and/or cervical discharge, asymptomatic in 30-80%

Front 8

What are extragenital syndromes of gonorrhea?

Back 8

proctitis
pharyngitis
progressive pelivc infection (prostatitis, epididimitis, PID)
disseminated infection

Front 9

Clinical features of progressive gonorrhea infection in pelvis of males?

Back 9

pain and tenderness from prostatitis and epidiymitis i
urethral stenosis --> obstruction and sterility

Front 10

Progressive gonorrhea infection in pelvis of woman?

Back 10

PID (--> endometritis, salpingitis, oophoritis) esp around time of menses
fever, chills, lower abdomainl and pelvic pain

Front 11

Who is mroe likely to get a disseminated gonococcal infection? what are the features?

Back 11

women (9:1)
gonococcemia (w fever, chills, polyarthralgia, tenosynovitis, and skin lesions) and gonococcal arthritis
skin lesions on extremities

Front 12

Features of gonococcal arthritis?

Back 12

blood cultures negative
no skin lesions
usually large monoarticular joints
pain, red, swollen, tender

Front 13

Describe gonococcal conjunctivitis?

Back 13

mostly in neonates
infected during vaginal delivery, prevent with topical Ab at birth
ocassionally seen in adults and older children

Front 14

How to make a lab diagnosis of gonorrhea?

Back 14

in males with urethrtis, PMN with organism
in females, less reliable b/c of saprophytic Neisseria

Front 15

what type of agar is needed to culture N. gonorrhea? How to grow them?

Back 15

chocolate agar with antibiotics, incubate in 5-10% CO2

Front 16

what is another way to diagnose gonorrhea w/o culture?

Back 16

molecular probes

Front 17

tx for PID from gonorrhea?

Back 17

broad spectrum AB
give parenterally or orally

Front 18

Rates of transmission of gonorrhea?

Back 18

50-67% of female contact of men wiht GC (15-20% get PID)
20-33% of male contacts of women with GC get infected

Front 19

What is nongonococcal urethritis?

Back 19

syndrome similar to GC urethritis, only men can get this
females are dx'd with acute urethral syndrome

Front 20

Etiologic agents of NGU?

Back 20

chlamydia trachomatis
ureaplama urelyticum
mycoplasm genitalium

Front 21

What is the most common CDC reportable infection?

Back 21

NGU

Front 22

Clinical manifestations of NGU?

Back 22

Urethral exudates +/- dysuria
sx are less severe than GC
dishcarge less purulent, fewer PMN's
some pts are asymptomatic

Front 23

Lab dx of NGU?

Back 23

gram stain of urethral exudate (PMNs but no GNID)
culture available, but not done
can use molecular probes and amplification tests

Front 24

Treatment of NGU?

Back 24

azithromycin
doxycycline

Front 25

Infectious agent for syphilis?

Back 25

Treponema pallidum

Front 26

Micro of Treponema pallidum?

Back 26

thin, motile spirochete
corkscrew-like motility
can't grow in culture, requires animal passage

Front 27

pathogenesis of syphilis (how is it spread? how does infection occur? how does body respond?)

Back 27

transmission by sexual contact, transplaental and blood transfusion
infection occurs when organism penetrates mucous membranes or abraded skin then enters lymphatics and disseminates
CMI and humoral response occurs

Front 28

Primary syphilis sx?

Back 28

chancre
single, painless indurated raised wiht cartilagenous consistency
located at site of innoculation
often with regional lymphadenopathy

Front 29

incubation period of primary syphilis?

Back 29

3-90 days, mean 21

Front 30

How is primary syphilis confirmed?

Back 30

dark field microscopic exam
chancres resolve in 10-14 days wiht no therapy

Front 31

Sx of secondary syphilis?

Back 31

highly varied manifestations
begins 2-8 wks after appearance of chancre
flu-like illness with fever, malaise, lympadenopathy
mucous patches (gray, shallow, irregular ulcerations of mucous membranes)

Front 32

dx of 2ndary syphilis?

Back 32

dark field exam of mucous membrane lesions
serology

Front 33

types of skin lesions in 2ndary syphilis?
location?

Back 33

macular or papular rashes
scaly erythematous lesions
spares palms and soles
condyloma lata (genital areas at mucocutaneous jxns) they are loaded with spirochetes and are highly contagious

Front 34

Stages of syphilis?

Back 34

latent (no sx, si, just + serology)
tertiary (late); may involve CV and CNS, or can be asymptomatic

Front 35

Sx of neurosyphilis?

Back 35

menigovascular (seizures/strokes)
parenchymal (cognitive abnormalities, mental status changes, general paresis, optic atrophy, tabes dorsalis)

Front 36

what is tabes dorsalis?

Back 36

ataxia
peripheral neuropathy

Front 37

CV involvement of syphilis?

Back 37

Aortitis
Aortic aneurysm

Front 38

Cutaneous components of tertiary syphilis?

Back 38

ulcerating gumma
nodular lesions

Front 39

Sx of congenital syphilis?

Back 39

saddle-nose deformity
Hitchinson's teeth

Front 40

when can congenital syphilis be prevented?

Back 40

prevent with screening
if mom is treated in 1st half of pregnancy, can prevent

Front 41

Explain process of darkfield microscopy?

Back 41

scrape lesion
examine by wet prep
use darkfield microscope

Front 42

What types of serological tests are used to dx syphilis?

Back 42

nonspecific reagin tests
specific anti-treponemal AB tests

Front 43

what are the nonspecific reagin tests?
How do they work?
usefulness of these tests?

Back 43

VDRL, RRR, ART
directed against lipid Ag that results from interactions of host tissues with T. pallidum or for T. pallidum itself
Good sensitivity, limited specificity (false + in IVDU, elderly, collagen-vascular dz, HCV)

Front 44

usefulness of specific anti=treponemal Ab tests?

Back 44

more sensitive and specific, more $$
not cost effective if low risk
false + common in SLE, and other treponemal dz
False - in early primary syphilis

Front 45

Treatment of syphilis?

Back 45

for primary, secondary, and latent, single dose of penicillin or doxycylcine if allergy
for late: 2.4 MU benzathine penicillin IM x3 doses

check serology at 3,6,12 months to document efficacy of treatment

Front 46

What is a chancroid?

Back 46

soft chancre
painful, soft ulcer with buboes (swelling of LN) in groin
usually mutliple, tender, with shaggy border
acute, localized process w/o systemic sx

Front 47

what is agent of chancroid? microbio of the organism?

Back 47

H. ducreyi (gram - bacillis)
must differentiate from syphilis (- darkfield and syphilis serologies)
rarely clutured, unless you can get material from bubo

Front 48

treatment of chancroid?

Back 48

azithromycin or ceftriaxone

Front 49

what is lymphogranuloma venereum? Organism?

Back 49

chronic lymphadenitis from chlamydia trachomatis

Front 50

clinical features of lymphogranuloma venereum?

Back 50

large tender inguinal LN, fever, chills, joint pain, HA
skin over LN purplish
enlarge LN on both sides of inguinal liganment (= Groove sign)
some MSM and women may present with priamry anorectal infection (diarrhea, tenesmus, bloody or mucopurulent discharge)

Front 51

complication of lymphogranuloma

Back 51

males: elephantiasis of penis
females: rectal strictures (aso MSM), vaginal fistula

Front 52

Dx of lymphogranuloma venereum

Back 52

serology gives highest yield
cutlures less sensitive

Front 53

Rx for lymphogranuloma venereum

Back 53

doxycycline

Front 54

Which herpesviurs is the most common for genital herpes?

Back 54

HSV2 >> HSV1

Front 55

clinical presentation of genital herpes?

Back 55

painful vesiculopustular lesions
in males: on penis, rectum, perianal in MSM
female: vulva, introitus, vagina, cervix, perianal
can extend to groin and legs
lesions can coalesce
intial vesicle unroofs, crusts and heals

Front 56

how long do herpes incidents last? how often do they recur?

Back 56

7-10 d
3-5 d

Front 57

Dx of genital HSV?

Back 57

observation
can do cell culture, probes or PCR

Front 58

management of HSV?

Back 58

acyclovir and analogs effective, not curitave

Front 59

how to manage women wiht HSV?

Back 59

C section recommended since fetus at risk of neonatal HSV and shdeeing is intermittent and asymptomatic