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28 Cards in this Set
- Front
- Back
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Spread of STDs besides sexual intercourse |
Touching infected genital region (esp herpes, syphilis & gonorrhea) eg oral, anal Finger spread (to self or others) 👄 region (esp herpes, syphilis & gonorrhea) eg kissing infected mouth 👁 infections (esp gonorrhea, Chlamydia & herpes) |
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Gonorrhea - etiological agent + epidemiology |
Neisseria gonorrhoaeae Major reservoir - asymptomatic carriers Pyogenic infection of urethra and uterine cervix (sexually transmitted) Increased transmission of HIV |
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Gonorrhea - transmission |
M to F - semen F to M - urethra Anal sex (rectal intercourse) Oral sex (pharyngeal intercourse) M to child ie perinatal transmission |
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Gonorrhea - virulence factors |
Pili/fimbriae (attach to urethral mucosa) Polyphosphate capsule (🛑 phagocytosis) Protein 1 aka Por (🛑 intracellular killing) Protein 2 aka Opa (tight attachment to cells) Protein 3 aka Rmp ie Reduction Modifiable (produce Abs against bactericidal activity) |
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Gonorrhea - clinical findings in M |
Acute urethritis - purulent urethral discharge Chronic urethritis - stricture Multiple discharging sinuses (Water-can perineum) Epididymitis - unilat swollen + tender testicles |
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Gonorrhea - clinical findings in F |
Cervicitis - mucopurulent/ purulent cervical discharge, easy 🩸 + (inter menstrual 🩸, dysuria, lower abd pain) Vulvovaginitis - prepubertal girls Acute infection - Endometritis, salpingitis, Bartholin abscess Chronic - Pelvic Inflammatory Disease (PID) -> ectopic 🤰 , infertility |
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Gonorrhea - clinical findings in new born |
(Non-venereal - infection via passage in birth canal) Gonococcal Ophthalmia Neonatorum —> blindness Prevention: tetra/erythro/silver nitrate in conjunctival sac of new born |
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Gonorrhea - clinical findings in both M and F |
Disseminated Gonococcal Infection (DGI) - polyarthritis, skin rash (pustular-hemorrhagic) + 🤒 Pharyngitis - orogenital sex Conjunctivitis - autoinnoculation |
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Gonorrhea - specimens for dx |
Pus Swab - Urethral (M); endocervical (F); rectum, conjunctiva, throat Synovial fluid - DGI Stuart transport media |
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Gonorrhea - lab dx tests |
Microscopy/Morphology - non motile, gram -ve, diplococci, kidney-shaped Culture - small, convex, glistening, soft, mucoid colonies on chocolate agar (5-10% CO2) Biochemistry - oxidase +ve, catalase +ve, ferments glucose w acid production NAAT - assays for direct detection in genito-urinary specimen Serology - Radio Immuno Assay or ELISA used in chronic & metastatic lesions (arthritis) in DGI |
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Gonorrhea - Antibiotic sensitivity testing on culture |
Modified Thayer Martin culture (lysed 🩸 + antibiotic selective for N gonorrhea) - useful when other bacteria is present in vaginal/rectal specimen Eg colistin- N gonorrhea & N meningitidis resistant but most saprophytic spp of N susceptible |
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Gonorrhea - rx |
Rx both partners w: Ceftriaxon Cefrofloxacin Ofloxacin + Doxy NB drug resistance to penicillin common (makes B lactamase) |
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Gonorrhea - prevention |
Safe sex - eg barrier method (Condom) Avoid multiple sexual partners Heath Ed Early detection + contact tracing |
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Syphilis - etiological agent + epidemiology |
Spirochetes - Treponema pallidum Contagious during early syphilis not late Syphilitic lesions are the portal for HIV transmission |
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Syphilis - transmission |
Direct sexual contact Trans-placentally (congenital) Sharing needles by IV drug users Accidentally - hospital personnel, lab staff +🩸 transfusion recipient |
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Syphilis - pathogenesis |
(1) Penetrates mucus surface or abraded skin (2) Travel to ln (3) disseminates in 🩸 stream (4) adheres to endothelial cells 1o lesion (end-arteritis) —> endothelial scarring —> inflamm + tissue necrosis —> fibrosis —> 1o chancre ulcer (heals but spirochetes disseminates) |
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Syphilis - virulence factors |
Outer membrane protein (adhere to host cells) Hyaluronidase (perivascular infiltration) Fibronectin (🛑 phagocytosis) |
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Syphilis - clinical findings in Primary Stage (Chancre) Syphilis |
Painless sore/ulcer (hard chancre) where spirochete entered (eg genitals, lip etc). Painless firm bilat regional lymphadenopathy (inguinal) Lasts 3 wks, contagious + heals w/o rx |
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Syphilis - clinical findings in Secondary Syphilis |
Skin rash - diffuse, w superficial scale (papulosquamous), may leave residual pigmentation Condylomata Lata - highly infectious, painless, mucosal, warty erosion in warm moist areas Mucosal lesions - highly infectious mucosal patch (slightly raised, oval, grayish white w pink base, no 🩸) w painless generalized lymphadenopathy 6wks - 6mths after 1o chancre |
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Syphilis - clinical findings in Latent Syphilis (Asymptomatic + serological test +ve) |
Early latent - 1st yr after resolution of 1o or 2o lesions Late latent - after 1st yr, non/infectious (except vertical🤰) Begins @ end of 2o syphilis and may last a lifetime |
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Syphilis - clinical findings in Late or Teritary Syphilis |
Lesions in skin, bone & visceral organs Blindness, deafness, deformity, lack or coordination, paralysis + dementia 3 types: late benign (gummatous), cardiovascular & neurosyphilis Destructive stage, 3-10yrs, non-infectious |
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Syphilis - clinical findings of Congenital Syphilis |
Mom had to be in Stage 1 or 2 Early - 2 yrs, infectious, rhinitis, hepatosplenomegaly & lymphadenopathy Late - after 2 yrs, non-infectious, interstitial keratitis & Clutton’s joint (bilat knee effusions) |
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Syphilis - prevention |
Barrier methods - eg condoms Prophylactic rx of contacts 🛑 sexual contact w infected partners |
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Syphilis - rx |
Early - 1 IM benzathine penicillin G Late - weekly infection for 3 wks Allergic - tetra or doxy |
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Syphilis - specimens for dx |
Tissue fluid from early surface lesion Blood serum (for serology) |
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Syphilis - lab dx |
Dark field microscopy of ulcer discharge - elongated, motile (3 types: rotation w midpt bending, corkscrew or flex-extension), thin, delicate spirally coiled bacilli w tapering ends Stained preparation - either Fontana’s stain (silver impregnation) or DFA- TP test Serology - either Standard tests or Specific tests |
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Syphilis - nontreponemal tests (Reagin)/ standard test |
Detects Ab against cardiolipin: VDRL - venereal disease research lab test RPR - rapid plasma reagin TRUST - Toludine red unheated serum test |
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Syphilis - treponemal tests/ Specific |
Detects Abs against specific Treponemal Ag: FTA-ABS - Fluorescent treponemal Ab absorption test used for Congenital Syphilis TPI - T pallidum immobilization test (uses live T pallidum) TPHA - T pallidum haemagglutination test |
