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Name the 4 reportable STIs in MS
- Chlamydia trachomatis - chlamydiosis
- Neisseria gonorrheoae- gonorrhea
- HIV- AIDS
- Treponema pallidum- syphilis
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Which organism is an obligate intracellular pathogen?
Chlamydia trachomatis
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Bacterial vaginosis is a change in the normal flora from a _______ dominated community to one with increased numbers of ______. Vaginal pH is ______
- lactobacillus, anaerobes
- increased
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Most common vaginal infection in women of childbearing age _____. Is it sexually transmitted?
- Bacterial vaginosis
- Not sexually transmitted
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Strong fish-like odor, abornomal vaginal discharge (white/gray), dysuria, and itching can all be symptoms of
Bacteria vaginosis (although most women are asymptomatic)
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Treatment of Bacterial vaginosis
Metronidazole, clindamycin
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Nugent score
1-10. Based on number of large Gram-P bacilli versus smaller anaerobes (G-)
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STI infection increases the risk of ____ acquisition and transmission by 2-5x
HIV
STI cure rates are lower in HIV-infected individuals (duh, weaker immune system)
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Pelvic Inflammatory Disease
Inflammation of uterus, fallopian tubes and ovaries- produces scarring tha tleads to infertility
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Inflammation of uterus, fallopian tubes, and ovaries- produces scarring that leads to infertility
Pelivic Inflammatory Disease (PID)
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Most common cause of PID
Chlamydia (trachomatis)..... (but N. gonorrheaoe als)
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24 y/o presents w/ fever, lower abdominal pain, and vaginal discharge
- PID
- Treat for appropriate STI after diagnosis of organism
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Syndrome Managment: Urethral discharge in men.
Positive if
Major STI pathogens
- Postive if urethral smear has four or more PMNs / high power field
- Neisseris and Chlamydia are the major STI pathogens (sometimes Trichomonas)
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Most common STI causes of vaginal discharge (2)
Vaginal discharge due to mucopurulent cervicitis may be (2)
Trichomonas vaginalis and Bacterial vaginosis
Neisseria or Chlamydia
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Infection of they eyelids of newborns
Caused by
- Neonatal conjunctivitis
- Caused by Neisseria or Chlamydiae
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Herpes
Primary Symphilis
ChancroidLGV
Donovanosis
- Herpes- small, painful (systemic symptoms)
- Primary Symphilis- Painless, indurated (none)
- Chancroid-erythematous, painful (none)
- LGV-Painless, small (yes)
- Donovanosis- painless, small (yes)
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Herpes
HSV-1
HSV-2
- HSV-1 (fever blisters)
- HSV-2 (genital warts)
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Can be asymptomatic, but can still transfer disease. Women more commonly show symptoms.
Genital herpes (HSV-2)
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Where does herpes replicate?
Locally in epithelial cells
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Treatment for genital herpes (HSV-2)
- No effective tx
- Antivirals (acyclovir, valaciclovir, famciclovir) reduce duration and severity of outbreaks
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Btw outbreaks, HSV-2 ascends _____ to the ____
- Peripheral sensory neurons
- dorsal root ganglia
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Most common STI worldwide
HPV
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What types of HPV cause
1) genital warts
2) cervical cancer
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2 HPV vaccines
- Gardasil: 6, 11, 16, and 18
- Cervarix: 16, 18
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3 Types of Trichomonads
- Trichomonas hominis (commensal in intestine)
- Trichomonas tenax (commensal in oral cavities)
- Trichomonas vaginalis (pathogen)
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Trichomonas vaginalis' only stage
Trophozoites
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Trophozoites (T. vaginalis) characteristics (4):
- 4 anterior flagella
- Undulating membrane
- Single nucleus
- Axostyle
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Trichomonas vaginalis is acquired by
sexual intercourse
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Strawberry cervix is associated with
T. vaginalis
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3 Symptoms of T. vaginalis
- Purulent frothy discharge
- Strawberry cervix
- Vulvar/vaginal erythema
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Diseases caused by Chlamydia trachomatis (and serotypes)
- trachoma (A,B,Ba, C) -Follicular conjunctivitis
- conjunctivitis (D-K)- Adult inclusion conjunctivitis, Neonatal conjunctivitis
- pneumonia (D-K)- Infant pneumonia, rhinitis, cough
- urogenital infections (D-K)- STD
- Reiter's Syndrome (D-K)
- LGV (L-1, L-2, L-3)- Lymphogranuloma venereum: painless initial lesion, inguinal bulbs, draining fistulas
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Diseases caused by Chlamydphila pneumoniae
Bronchitis, pneumonia (transmitted by respiratory droplets)
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Diseases caused by Chlamydophila psittaci
Psittacosi- Parrot Fever, ornithosis
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Fitz-Hugh-Curtis Syndrome
Inflammation of hte serous covering of the liver- spread from PID, women only
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Compare urethral discharges of Chlamydia trachomatis and Neisseria gonorrhea
Urethral discharge of non-gonoccocal urethritis (NGU, Chlamydia trachomatis) is more watery, less purulent, less abundant
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Chlamydia trachomatis (NGU) diagnose and treatment
- Diagnose with urinalysis or PCR
- Azithromycin or doxycycline
- Erythromycin or ampicillin in pregnancy
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Presence of mucopurulent or purulent endocervical discharge in the endocervical canal or in an endocervical swab specimen, may include easily induced cervical bleeding
Mucopurulen Cervicitis (Chlamydia trachomatis)
-Most infected women are asymptomatic
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Leading cause of infertility in women
PID (Chlamydia trachomatis)
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Spectrum of inflammatory disorders fo the female upper genital tract
Pelvic Inflammatory Disease (PID, Chlamydia trachomatis)
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Tender inguinal/femoral lymphadenopathy; perinodal inflammation and PAINFUL bubo formation
Lymphogranuloma venereum (LGV, Chlamydia trachomatis)
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LGV Tx
- Doxycycline or erythromycin (21 days)
- Drainage of infected buboes in inguinal lymph nodes
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Neisseria gonorrheoae:
Gram-P/N?
Shape?
Location?
Aerobic/Anaerobic?
- Gram-N
- Diplococcus (kidney bean)
- intracellular
- aerobic
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Disseminated infection w/ sepsis in 1-3% of infected women and a lower percentage of men. It presents with migratory arthralgias, pustular rash, suppurative arthritis (wrists, knees, ankles) and fever.
Gonococcemia (Gonorrhea complication)
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N. gonorrheoae tx
- Ceftriaxone + azithromycin or doxycycline
- Ceftriaxone or erythromcine ointment for ophthalmia neonatorum
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Treponema pallidum: Who is the host? How do you visualize it?
Humans are only natural host. Use dark field microscopy to see it (can't be grown in vitro or seen on gram stain)
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3 clinical stages of syphilis
- Primary (hard chancre, lots of spirochetes)
- Secondary (rash, condylomata lata, lots of spirochetes)
- Tertiary (gummas, no spirochetes)
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Invades mucus membranes or breaks in skin, can infect all tissues of body
Syphilis
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Hard chancre and painless indurated ulcer (teeming with spirochetes) is characteristic of
- Primary syphilis
- (if left untreated, 50% progress to secondary syphilis)
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Red maculopapular rash (palms and soles), white patches on mucus membranes (condylomata lata on genital or anal areas)
- Secondary Syphilis, lots of spirochetes
- (50% of latent cases progress to tertiary syphilis)
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Gummas (highly destructive granulomas), neuro issues, cardiovascular issues
Tertiary syphilis (lesions contain very few spirochetes), exaggerated responses due to hypersensitivity reactions
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What causes congenital syphilis, when is it transmitted?
T. pallidum after first trimester (50% of fetuses abort or are stillborn)
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50% of babies who survive transplacental transmission of T. pallidum exhibit _____
Early congential syphilis: up to age ____
Late congenital syphilis is after age ___
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Macropapular rash
Hepatosplenomegaly (anemia, jaundice)
bone involvement
pneumonia, snuffles
testicular masses
Early congenital syphilis (< 2 y/o)
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Hutchinson's triad includes? and is a sign of ?
- Hutchinson's Triad:
- Tooth deformation (H's teeth)
- Interstitial keratitis (eyes)
- 8th nerve deafness
Late congenital syphilis (>2 y/o)
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Name 3 symptoms of Late Congenital Syphilis
- Hutchin's Triad
- Saddle nose
- Bone deformations (saber shins)
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Syphilis tx
- Penicillin (no resistant T. pallidum ever found)
- Tetracycline or erythromycine for pt's allergic to penicillin
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Jarish-Herxheimer reaction
Flu-like symptoms due to mass killing of T. pallidum by antibiotic (in syphilis treatment), releases lipoproteins
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Causative agent of Chancroid?
Tx?
- Haemophilus ducreyi
- Azithromycin or ceftriaxone (alt. cipro or erythro)
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H. ducreyi:
Gram-P/N?
Shape?
Aerobic/Anaerobic?
Fastidious?
- Gram-N
- Coccobacillus
- Facultative anaerobe
- Fastidious
Causes chancroids
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Tender erythematous papule that ruptures in 2-3 days to form a painful ulcer with soft edges that has grey/yellow purulent exudate
Chancroid
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Diagnose chancroid with
Gram stain of scrapings from ulcers, bubo aspirates
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Calymmatobacterium granulomatis causes
Granuloma inguinale (Donovanosis)
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Calymmatobacterium granulomatis:
Gram-P/N?
Shape?
Location?
- Gram-N
- Coccobacillus
- Intracellular
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Small painless erythematous pusutures or subcutaneous nodules that can disseminate to other orthers (ie. liver, bone). Disease & treatment?
- Donovanosis (Granuloma inguinale)
- Tx: Azithromycine, doxycycline, erythromycine, tetracycline, TMP/SMX
Does NOT have to be transmitted sexually
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