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11/28 STD Clinical Correlation
by Dr. Lillis
56
Microbiology
Professional
11/28/2011

Additional Microbiology Flashcards

 


 

Cards

Term
Name the STDs characterized by discharges.
Definition
gonorrhea, chlamydia, nongonococcal urethritis, mucopurulent cervicitis, trichomonas vaginitis/urethritis, candidiasis
Term
Name the STDs characterized by sores.
Definition
syphilis, genital herpes
uncommon in US= lymphogranuloma venereum, chancroid (Haemophilus ducreyi), granuloma inguinale
Term
How do you treat a gonorrhea?
Definition
cefixime 400 mg orally X 1 dose OR ceftriazone 125 mg IM x 1 dose PLUS Azithromycin 1 gram orally x 1 dose (for possible chlamydia coinfection)
Term
What is the incubation period of gonorrhea in a male?
Definition
1-14 days (usually 2-5 days)
Term
What are the symptoms of gonorrhea in a man?
Definition
dysuria and urethral discharge (5% asymptomatic)
Term
How do you diagnose gonorrhea?
Definition
gram stain of urethral or cervical smear, NAAT
Term
What are complications of gonorrhea?
Definition
men= acute epididymitis, disseminated GC
women= PID, disseminated GC
Term
Where does gonorrhea infect females?
Definition
endocervical canal is the primary site but 70-90% also colonize urethra
Term
What is the incubation of gonorrhea in women?
Definition
unclear, sx usually in 10 days
Term
What are the symptoms of gonorrhea infection in women?
Definition
majority asymptomatic; may have vaginal discharge, dysuria, labial pain/swelling, abdomenal pain
Term
What causes nongonococcal urethritis?
Definition
20-40% chlamydia
15-25% mycoplasma genitalium
10-20% ureaplasma urealyticum
5-15% trichomonas vaginalis
1-4% adenovirus
1-2% herpes symplex virus
Term
What are the symptoms of nongonococcal urethritis?
Definition
mild dysuria and mucoid discharge
Term
How do you diagnose nongonococcal urethritis?
Definition
urethral smear= more than or equal to 5 PMNs (usually 15), or OI field
urine microscopic= more than or equal to 10 PMNs
Leukocyte esterase (+)
Term
What are the symptoms of mucopurulent cervicitis?
Definition
pelvic pain, vaginal d/c, dysparunia, post-coital bleeding
Term
How do you diagnose cervicitis clinically?
Definition
purulent or mucopurulent endocervical exudate visible in the endocervical canal OR yellow or green d/c visible on endocervical swab specimen OR easily induced cervical bleeding
Term
What is empiric treatment for chlamydia?
Definition
azithromycin 1 gram single dose OR doxycycline 100 mg twice daily for 7 days
Term
What is the empiric treatment for GC?
Definition
ceftriaxone 125 mg IM single dose OR cefixime 400 mg single dose
Term
What are organisms other than chlamydia and gonorrhea associated with mucopurulent cervicitis?
Definition
TV, BV, HSV, MG
Term
What percent of C. trachomatis infections are asymptomatic?
Definition
women= 80-90%
men= 70-80%
Term
What percent of N. gonorrhoeae infections in men and women are asymptomatic?
Definition
50-70% of women
20-30% of men
Term
What percent of women with GC develop PID?
Definition
10-20
Term
What are the CDC minimal criteria for PID?
Definition
uterine fundal tenderness, adnexal tenderness, or cervical motion tenderness
Term
What are the symptoms of PID?
Definition
endocervical d/c, fever, lower abdominal pain
Term
What are the complications of PID?
Definition
infertility (15-24% with 1 episode PID secondary to GC or chlamydia), 7x risk of ectopic pregnancy with 1 episode PID, chronic pelvic pain in 18%
Term
What causes acute PID?
Definition
20-40% = N. gonorrhoeae
20% = C. trachomatis
40-60% = mixed aerobes and anaerobes including mycoplasma hominis + N. gonorrhoeae
Term
Recomended outpatient treatment guidelines for PID=
Definition
ceftriaxone 250 mg IM once OR other parenteral 2rd generation cephalosporin (ceftizoxime, cefotaxime) PLUS doxycycline 100 mg orally 2 times a day for 14 days, metronidazole is optional
Term
What are you looking for on smear of pt with gonorrhea?
Definition
gram negative intracellular diplococci (GNID)
Term
What has replaced gram stain in clinic?
Definition
one step methylene blue stain
Term
What has the highest sensitivity and specificity for chlamydia endocervical specimens?
Definition
amplification
Term
T/F A negative culture, antigen detection, and gen-probe for chlamydia means the pt doesn't have chlamydia.
Definition
false, those test have high specificity but relatively low sensitivity for chlamydia
Term
What causes cervicitis?
Definition
chlamydia, gonorrhea, genital herpes
Term
What causes vaginitis?
Definition
candidiasis, trichomoniasis, bacterial vaginosis
Term
What are the microbial shifts that occur in bacterial vaginosis?
Definition
decrease in lactobacillus
100-1000 increase in G. vaginalis, anaerobes, mycoplasmas
Term
What physiologic changes are associated with bacterial vaginosis?
Definition
elevation of vaginal pH above 4.5, production of high concentrations of amines, and thin homongenous skim-milk like discharge
Term
What are possible complications of BV?
Definition
abnormal pregnancy outcome, increased risk of post-hysterectomy wound infection, PID, endometritis following elective abortion, increased risk of HIV and other STD transmission
Term
How do you diagnose bacterial vaginosis clinically?
Definition
Amsel's critera= 3 out of 4
1) vaginal pH >4.5
2) positive "whiff" test
3) more than 20% of epithelial cells are clue cell
4) characteristic vaginal d/c (homogenous skim milk-like)
Term
How do you treat bacterial vaginosis?
Definition
metronidazole orally, clindamycin cream, metronidazole gel
Term
How do you treat yeast vaginitis?
Definition
topical antifungals, gluconazole single oral dose
Term
How do you treat trichomoniasis?
Definition
metronidozole single dose or tinidazole single dose
Term
What causes painful genital ulcers?
Definition
chancroid and genital herpes simplex
Term
What causes painless genital ulcer diseases?
Definition
syphilis, lymphogranuloma venereum, granuloma inguinale
Term
How do you treat syphilis?
Definition
benzathine penicillin 2.4 million units IM X 1 dose
Term
What is the incubation period of primary syphilis?
Definition
10-90 days (average 3 weeks)
Term
Describe the syphilitic chancre.
Definition
early macule/papule erodes into clean based, painless, indurated ulcer with smooth firm borders. Unnoticed in 15-30% of patients. Resolves in 1-5 weeks and highly infectious
Term
What stage of syphilis represents hematogenous dissemination of spirochetes?
Definition
secondary
Term
How long after the chancre does secondary syphilis appear?
Definition
2-8 weeks
Term
What are the symptoms and duration of symptoms in secondary syphilis?
Definition
rash-whole body (includes palms and soles), mucous patches, condylomata lata (highly infectious), constitutional symptoms, resolves in 2-10 weeks
Term
T/F Primary infectious with genital HSV is commonly asymptomatic.
Definition
true
Term
Chancroid versus syphilitic chancre.
Definition
syphilis= induration, painless, clean base
chancroid= undetermined lesion border, painful lesion, purulent exudate
Term
Classic characteristics of genital herpes to differentiate it from other ulcerative STDs.
Definition
multiple ulcers, shallow lesions, painful lesions
Term
How sensitive/specific are "classic" signs for the diagnosis of genital ulcer disease?
Definition
low sensitivity but high specificity
Term
What is characteristic physical exam finding of lymphogranuloma venereum?
Definition
groove sign
Term
Name the syphilis serologic assays.
Definition
Reagin tests (VDRL, RPR, ART)
treponemal tests (FTA-ABS, MHA-TP)
Term
When is serologic testing for untreated syphilis most sensitive?
Definition
secondary stage for both reagin and treponemal tests (treponemal test is also very sensitive during late syphilis)
Term
How do you treat chancroid?
Definition
azithromycin, ceftriaxone
Term
How do you treat genital herpes?
Definition
acyclovir, valcyclovir, famciclovir
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