Sti"s Ii

Front 1

Syphilis

Back 1

Treponema Pallidum, motile spirochete
(replicates q30min)
enters through breaks in skin or mucous membranes

Front 2

Syphilis risk of acquisition of syphilis

Back 2

from an infected 30-60%

Front 3

Syphilis
stage

Back 3

Primary
Secondary
Latent-early
late
Tertiary

Front 4

Primary Syphilis

Back 4

first sign occurs 10-90days after exposure (average 21 days)

Front 5

Secondary Syphilis

Back 5

begins 3wks to 6mo after primary inoculation

Front 6

Primary Syphilis
clinical manifestations

Back 6

painless papule appears at site of inoculation
incase to 0.5-1.5cm and ulcerates into a chancre (indurated and firm), no exudate seen

Front 7

Secondary Syphilis
clinical manifestations

Back 7

system involvement-
flulike symptoms
highly variable rash
generalized lymphadenopaty,
Condyloma lata lesions

Front 8

Condyloma lata

Back 8

large rasised whitish or gray lesions,
commonly seen in are adjacent to primary chancre,
loaded with spirochetes

Front 9

Early latent syphilis

Back 9

less than 1 yr duration,
usually asymptomatic
potentially infectious for 4 yrs
need documented seroconversion or hs or unequivocal signs of primary or secondary syphilis

Front 10

Late latent syphilis

Back 10

greater than 1 yr duration, or duration unknown; if asymptomatic and lesion-free, not infections

Front 11

Tertiary syphilis

Back 11

15-30yrs after initial infection,
neurosyphilis, gumma formation, cardiovascular diseease,

Front 12

Gumma formation

Back 12

in syphilis: subcuatenous process of chronic and progressive inflammation.
granulomatous lesion, most commonly involves skin and bones

Front 13

Primary syphilis

Back 13

darkfield exam (characteristic corkscrew organism with spiraling motion that undulates about midpoint)-obtain specimen from chancre
need 3 neg exams to be negative

Front 14

Non-treponemal test

Back 14

VDRL or RPR
eg. four-fold change in titer to a change of two doubling dilutions 1:8 to 1:32
*primary s. have high viral loads 1:256 reactic serofast reaction

Front 15

False negative non-treponal tests

Back 15

HIV
pregancy
leprosy, malaria,lupus, vaccines,pregnancy, narcotic addiction

Front 16

False positive

Back 16

occur 1-2%, provider needs to prove patient doesn't have syphilis

Front 17

Treponemal tests

Back 17

FTA-ABS 90-95% sensitive
and MHA-TP 80-85% sensitive
tests indicate present or past infection

Front 18

When to screen for syphilis

Back 18

Suspicious lesion,
suspicious rash, pregnant women, presence of other STI, risk factors for syphilis

Front 19

Syphilis, Primary&Secondary
Treatment

Back 19

Benzathine PCN G 2.4 millin units IM in single dose;
mayse use doxyciline for 14 days in non-pregnant PCN sensitive patients

Front 20

Syphilis, Latent
Treatment

Back 20

early latent: Benzathine PCN G 2.4 million units IM x1;
late latent: Benzathine PCN G 2.4 million units IM 1/week x3weeks

Front 21

Syphilis-treat presumptively?

Back 21

presumptively treat if exposed within 90 days, even is serologic testing is neg.

Front 22

Syphilis
Patient Education

Back 22

avoid safe until both pt and partner have completed treatment; HIV testing; follow-up

Front 23

Jarisch-Herxheimer Reaction

Back 23

can occur after treatment of syphilis;
occurse several hrs after treatment
symptoms last 24-48hrs: fever,malaise, HA, myalgia, nausea, tachycardia, chancre may swell or develop sympotoms of disease for first time
cause: rapid relase of treponemal antigens
(endotoxin reaction)
TREAT w/ ASPIRIN

Front 24

Syphilis
follow-up

Back 24

clinical and serologic testing at 3 and 6 mo.
need to see 4fold decrease at 6 mo.-
if not HIV test/CSF test +retreat

Front 25

Neurosyphilis

Back 25

repeat CSF examination q6mo until titer is normal
if not decreased by 6mo. or nl at 2 years--retreat

Front 26

Syphilis and HIV disease

Back 26

repeat nontreponemal testing at 1,2,3, 6, 9 and 12 mo.
CSF eval 6mo after treatment or if you don't see 4-fold decrease by 3 months

Front 27

Congenital syphilis

Back 27

most infants borth to women with primary or secondary syphilis;
manifest 10-14 days after birth, rash copious nasal DC,

Front 28

HPV
biology

Back 28

small slowly growing double DNA virus can infect epithilial surface and mucous membranes,

Front 29

HPV "high risk types"

Back 29

contain genome sequence with oncogenic activity
(16 and 18)

Front 30

Can HPV vaccine be give with an abornmal PAP?

Back 30

YES

Front 31

Can HPV vaccine be give with visible warts?

Back 31

YES

Front 32

Can HPV vaccine be give with breastfeeding?

Back 32

YES

Front 33

Can HPV vaccine be given in pregnancy?

Back 33

Not recommended

Front 34

HPV vaccine dosing

Back 34

3 doses
2nd dose 2 months after 1st,
3rd dose 6 months afer 1st

Front 35

What strains of HPV does Gardisil prevent?

Back 35

HPV 6, 11,16, and 18

Front 36

What ages is HPV vaccine recommended for?

Back 36

9-26yrs

Front 37

Treatment options for HPV

Back 37

cryotherapy, laser therapy, surgery,
Podofilix (self-treatment),
Imiquimod (cream self-treatment)
Tricholoracetic acid (TCA only treatment available for pregnancy)

Front 38

Treatment options for HPV in pregnancy

Back 38

Tricholoracetic acid (TCA only treatment available for pregnancy)
Note: never podophyllin or 5FU