Micro Test 3: STDs

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BrookeNH10
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186769
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Micro Test 3: STDs
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2012-12-03 10:14:37
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STDs
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STDs
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  1. Name the 4 reportable STIs in MS
    • Chlamydia trachomatis - chlamydiosis
    • Neisseria gonorrheoae- gonorrhea
    • HIV- AIDS
    • Treponema pallidum- syphilis
  2. Which organism is an obligate intracellular pathogen?
    Chlamydia trachomatis
  3. 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
  4. Most common vaginal infection in women of childbearing age _____.  Is it sexually transmitted?
    • Bacterial vaginosis
    • Not sexually transmitted
  5. Strong fish-like odor, abornomal vaginal discharge (white/gray), dysuria, and itching can all be symptoms of
    Bacteria vaginosis (although most women are asymptomatic)
  6. Treatment of Bacterial vaginosis
    Metronidazole, clindamycin
  7. Nugent score
    1-10.  Based on number of large Gram-P bacilli versus smaller anaerobes (G-)
  8. 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)
  9. Pelvic Inflammatory Disease
    Inflammation of uterus, fallopian tubes and ovaries- produces scarring tha tleads to infertility
  10. Inflammation of uterus, fallopian tubes, and ovaries- produces scarring that leads to infertility
    Pelivic Inflammatory Disease (PID)
  11. Most common cause of PID
    Chlamydia (trachomatis)..... (but N. gonorrheaoe als)
  12. 24 y/o presents w/ fever, lower abdominal pain, and vaginal discharge
    • PID
    • Treat for appropriate STI after diagnosis of organism
  13. 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)
  14. 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
  15. Infection of they eyelids of newborns
    Caused by
    • Neonatal conjunctivitis
    • Caused by Neisseria or Chlamydiae
  16. 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)
  17. Herpes
    HSV-1
    HSV-2
    • HSV-1 (fever blisters)
    • HSV-2 (genital warts)
  18. Can be asymptomatic, but can still transfer disease.  Women more commonly show symptoms.
    Genital herpes (HSV-2)
  19. Where does herpes replicate?
    Locally in epithelial cells
  20. Treatment for genital herpes (HSV-2)
    • No effective tx
    • Antivirals (acyclovir, valaciclovir, famciclovir) reduce duration and severity of outbreaks
  21. Btw outbreaks, HSV-2 ascends _____ to the ____
    • Peripheral sensory neurons
    • dorsal root ganglia
  22. Most common STI worldwide
    HPV
  23. What types of HPV cause
    1)  genital warts
    2) cervical cancer
    • 1)  6, 11
    • 2) 16, 18
  24. 2 HPV vaccines
    • Gardasil: 6, 11, 16, and 18
    • Cervarix: 16, 18
  25. 3 Types of Trichomonads
    • Trichomonas hominis (commensal in intestine)
    • Trichomonas tenax (commensal in oral cavities)
    • Trichomonas vaginalis (pathogen)
  26. Trichomonas vaginalis' only stage
    Trophozoites
  27. Trophozoites (T. vaginalis) characteristics (4):
    • 4 anterior flagella
    • Undulating membrane
    • Single nucleus
    • Axostyle
  28. Trichomonas vaginalis is acquired by
    sexual intercourse
  29. Strawberry cervix is associated with
    T. vaginalis
  30. 3 Symptoms of T. vaginalis
    • Purulent frothy discharge
    • Strawberry cervix
    • Vulvar/vaginal erythema
  31. Trichomoniasis tx
    • Metronidazole
    • Tinidazole
  32. 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
  33. Diseases caused by Chlamydphila pneumoniae
    Bronchitis, pneumonia (transmitted by respiratory droplets)
  34. Diseases caused by Chlamydophila psittaci
    Psittacosi- Parrot Fever, ornithosis
  35. Fitz-Hugh-Curtis Syndrome
    Inflammation of hte serous covering of the liver- spread from PID, women only
  36. 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
  37. Chlamydia trachomatis (NGU) diagnose and treatment
    • Diagnose with urinalysis or PCR
    • Azithromycin or doxycycline
    • Erythromycin or ampicillin in pregnancy
  38. 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
  39. Leading cause of infertility in women
    PID (Chlamydia trachomatis)
  40. Spectrum of inflammatory disorders fo the female upper genital tract
    Pelvic Inflammatory Disease (PID, Chlamydia trachomatis)
  41. Tender inguinal/femoral lymphadenopathy; perinodal inflammation and PAINFUL bubo formation
    Lymphogranuloma venereum (LGV, Chlamydia trachomatis)
  42. LGV Tx
    • Doxycycline or erythromycin (21 days)
    • Drainage of infected buboes in inguinal lymph nodes
  43. Neisseria gonorrheoae:
    Gram-P/N?
    Shape?
    Location?
    Aerobic/Anaerobic?
    • Gram-N
    • Diplococcus (kidney bean)
    • intracellular
    • aerobic
  44. 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)
  45. N. gonorrheoae tx
    • Ceftriaxone + azithromycin or doxycycline
    • Ceftriaxone or erythromcine ointment for ophthalmia neonatorum
  46. 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)
  47. 3 clinical stages of syphilis
    • Primary (hard chancre, lots of spirochetes)
    • Secondary (rash, condylomata lata, lots of spirochetes)
    • Tertiary (gummas, no spirochetes)
  48. Invades mucus membranes or breaks in skin, can infect all tissues of body
    Syphilis
  49. Hard chancre and painless indurated ulcer (teeming with spirochetes) is characteristic of
    • Primary syphilis
    • (if left untreated, 50% progress to secondary syphilis)
  50. 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)
  51. Gummas (highly destructive granulomas), neuro issues, cardiovascular issues
    Tertiary syphilis (lesions contain very few spirochetes), exaggerated responses due to hypersensitivity reactions
  52. What causes congenital syphilis, when is it transmitted?
    T. pallidum after first trimester (50% of fetuses abort or are stillborn)
  53. 50% of babies who survive transplacental transmission of T. pallidum exhibit _____
    Early congential syphilis: up to age ____
    Late congenital syphilis is after age ___
    • diverse stigmata
    • 2
    • 2
  54. Macropapular rash
    Hepatosplenomegaly (anemia, jaundice)
    bone involvement
    pneumonia, snuffles
    testicular masses
    Early congenital syphilis (< 2 y/o)
  55. 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)
  56. Name 3 symptoms of Late Congenital Syphilis
    • Hutchin's Triad
    • Saddle nose
    • Bone deformations (saber shins)
  57. Syphilis tx
    • Penicillin (no resistant T. pallidum ever found)
    • Tetracycline or erythromycine for pt's allergic to penicillin
  58. Jarish-Herxheimer reaction
    Flu-like symptoms due to mass killing of T. pallidum by antibiotic (in syphilis treatment), releases lipoproteins
  59. Causative agent of Chancroid?
    Tx?
    • Haemophilus ducreyi
    • Azithromycin or ceftriaxone (alt. cipro or erythro)
  60. H. ducreyi:
    Gram-P/N?
    Shape?
    Aerobic/Anaerobic?
    Fastidious?
    • Gram-N
    • Coccobacillus
    • Facultative anaerobe
    • Fastidious

    Causes chancroids
  61. Tender erythematous papule that ruptures in 2-3 days to form a painful ulcer with soft edges that has grey/yellow purulent exudate
    Chancroid
  62. Diagnose chancroid with
    Gram stain of scrapings from ulcers, bubo aspirates
  63. Calymmatobacterium granulomatis causes
    Granuloma inguinale (Donovanosis)
  64. Calymmatobacterium granulomatis:
    Gram-P/N?
    Shape?
    Location?
    • Gram-N
    • Coccobacillus
    • Intracellular
  65. 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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