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GYN DM STIs
| Question | Answer |
|---|---|
| Multiple array of Dianostic methodologies available to test for STIs | Wet Prep, Bacterial Culture, Viral culture, Serological methods (multiple), DNA probes/PCR DNA Amplification |
| Interfering Factors during STI testing | Some Organisms (ie. N. gonorrhea) sensitive to lubricants & disinfectants, Menses may alter test results, Female douching within 24 hr collection may alter pH & decrease # of organisms recovered on wet prep or cervical culture |
| Interfering Factors during STI testing | Males voiding 1-2 hr before urethral culture washes secretions away, fecal material may contaminate a rectal culture, Specific temp, transport time, and culture medium required for certain organisms, recent abx hx |
| Labeling a sample | Need patient identifier, date, time, etc. Indicate specimen source on label (urethra, rectum, endocervix, labia minora, etc) |
| Wet Prep Directions | use nonbacteriostatic sterile cotton swab and gently rotate swab over vaginal wall (avoid cervical mucus and blood); obtain pH with narrow pH paper (3-6), Insert discharge-moistened swab into tube of 1ml saline, send to lab or examine w/scope w/in 20 min |
| Cervical Testing | refrain from douching or tub bathing 24 hr prior to culture. Remove cervical mucus with cotton swab and discard; Insert sterile swab into endocervical canal, wait 15-30sec, inoculate plate directly or place in transport media for desired test |
| Gram Stain Sample collection from the Urethra | urethra: calcium alginate tipped swab. In males, if discharge is visible, collect without inserting swab. If not, Insert swab tip 1-2 cm and rotate 3-5 sec. Females: same as males, but more shallow |
| Gram Stain Sample Collection from the cervix | Cervix cotton swab: generally not done, Some do a gram stain for clue cells (gold Standard) |
| Gold standard test for finding clue cells | Gram Stain of Cervix cells |
| Gonorrhea Culture Plating | Chocolate Agar, Thayer-Martin, or Jembec Plates at room temp, Roll swab in a "z" pattern & cross streak, incubate plates at 36C within 1 hr of collection, no refridg. |
| Gonorrhea Specimen Procedure: Anal/rectal (if anal exposure/anal sex) | Insert sterile cotton swab 2-3 cm into anal canal (beyond rectal sphincter), pressing laterally to sample anal crypts and to avoid feces. If stool contaminates swab, repeat swab is necessary. |
| Gonorrhea Specimen Procedure: Oropharyngeal Culture (if oral intercourse) | Throat swab obtained from posterior pharynx & tonsillar crypts; include areas of inflammation or exudate. MUST identify specimen is to evaluate for gonorrhea (routine throat culture is not plated to media that would recover GC). Avoid tongue, lips, cheeks |
| Gonorrhea Specimen Procedure: Urethral Culture | Ideal specimen is prior to first morning micturition, but can collect at least 1 hour post urination. Gently swab anterior urethra. perform supine if pt prone to vasovagal syncope. Urethral/prostatic massage may increase culture yield |
| Gold Standard Method for HSV | Culture; 90% sensitivity. Acceptable specimens: "unroofing" of a genital vesicular lesion is preferred for culture |
| What percentage of the US population has positive herpes antibodies on serologic testing? | 50% |
| HSV Culture: vesicle and crusted lesion | V: open Vesicle with 18-gauge needle, abrade base of lesion with cotton swab to obtain cells. C: remove crust with moist gauze, scrape base of lesion with cotton swab (avoid bldg). Both: place swab in viral transport medium immediately & refrid. if delay |
| Serology in HSV | Disadvantage: only 85% of pts with + culture have + serology. Advan: Ig titers helpful if IgM + (active, new dz) or IgG titer>1:160. Rapid results. |
| Serology in HSV notes | 4-fold rise in titer indicative of acute initial HSV infection. Recurrent infxn less likely to show dramatic increase in titer |
| Treponema pallidum is the causative agent of | Syphilis |
| Acute Syphilis presentation | : Chancre develops on skin near infection site about 3 to 6 weeks after innoculation, lasts for about 5 to 6 weeks |
| Secondary Stage Syphilis presentation | Rash (often on soles & palms) & generalized lympadenopathy, typically lasts about 3 months |
| Early vs. Late latent Syphilis | If it’s been over a year, it’s late latent. If under a year, it’s early latent. |
| Latent stage Syphilis | Disease inactivity after secondary stage, may last up to 5 years; asymptomatic & ~ 1/3 of infected pts do not progress to tertiary phase. |
| Tertiary Syphilis | End organ Manifestations, including CNS, cardiovascular and ocular |
| Detection of Treponema pallidum spirochetes | Darkfield Microscopy is diagnostic, but not definitve if negative; scope is expensive and requires experienced microscopist; not always available. It tells you how infectious pt is |
| What do non-treponemal serology tests (VDRL, RPR) detect? | they detect antibodies to reagin (lipid substance in membrane of T. pallidum; similar to phospholipids in body). Non-specific, many false positives |
| Diseases that may cause False positive RPR/VDRL | Malaria, Typhus, Leptospirosis, Cat-Scratch fever, Leprosy, Hepatitis, Mononucleosis, Periarteritis nodosa, SLE, Acute viral or bacterial infections, Lymphogranuloma venereum, Hypersensitivity rxns, recent immunizations, mycoplasmal pneumonia |
| When does a VDRL serology become positive in a Syphilis patient? | About 2 wks after inoculation; remains + during primary and secondary stages &2/3 of pts in latent & tertiary stages have + VDRL |
| Treponemal Tests | FTA (Fluorescent Treponmeal Antibodies)-Absorption Test. This is more specific and positive 4-6 wks post inoculation = definitive testing. Also MHA-TP (Microhemagglutination Test) is comprable in accuracy to FTA-Abs |
| Name the definitive Test for Syphilis | FTA-Abs. Need to wait 4-6 weeks post inoculation |
| Gonorrhea Diagnostic Methods | Gram Stain (negative intracellular dipolococci), Culture (yield is 85-95% if quality specimen), DNA by PCR Amplification (NAAT) is fast, accurate and commonly used |
| What color do Gonorrhea diplococci show up on gram stain? | pink. Gram -. |
| Co-infection with ___ is high in pt with Gonorrhea. Send specimen for both. | Chlamydia |
| Acceptable culture specimens for Gonorrhea | Cervical, Urethral, Anal & Oropharyngeal (specify suspect GC) |
| _____ is the etiologic agent of Chancroid | Haemophilus ducreyi. Occurs more in Africa, Caribbean, Asia. It is a cofactor in contracting HIV and mostly in heterosexual males with prostitute contact and no condom |
| Chancroid is most often a co-infection with1 | herpes &/or syphilis |
| Chancroid on gram stain shows up as | "SCHOOL OF FISH". |
| Most frequently occurring STD in developed countries | Chlamydia. Most prevalent in <20 yo, nulliparous, users of non-barrier contraceptive methods. Frequently associated with gonorrhea |
| ___ is truly an obligate intracellular parasite | Chlamydia |
| Test of Choice for Chlamydia | DNA amplification/PCR/NAAT: accurate and rapid results. Serologic studies and culture are antiquated |
| Federal regulations of HIV testing | Separate written informed consent or pre-test counseling is no longer required nationally, based on 2006 CDC guidelines (exception: some states legislate written consent). Patient must be informed of HIV testing |
| HIV at risk populations | MSM, bisexuaql, IVDA, transfusion, gestational exposure |
| 4 methods for diagnosis of HIV | Detect antibodies to the virus, detect viral p24 antigen, detect viral nucleic acid (NAT), culture HIV virus. By far, the most widelyused is detection of antibody to HIV |
| Most common cause of HIV false positive in low risk patient | recent immunization |
| Most common cause of HIV false negative test in high risk patient is | dusting during window period prior to seroconversion |
| A positive initial screen for HIV with an ELISA test is | a Western Blot or IFA (immunofluorescence assay) |
| What should you do if an ELISA is positive, but IFA/WB is negative? | repeat test in 3-6 months |
| TIme frame from HIV inoculation to seroconversion | 2-12 weeks. ELISA tests for antibodies to HIV, NOT viral antigens. 99% sensitive (probability that test will be reactive if a true positive) in persons infected with HIV for 12 weeks or more. 99% specific |
| _____ is based on using electrophoresis technique to separate HIV antigens derived from virus grown in culture | Western Blot |
| ____based on using electrophoresis technique to separate HIV antigens derived from virus grown in culture denatures the viral components, imparts a negative charge to the antigens, & separates them primarily on the basis of their molecular weights | Western Blot |
| Detuned testing | performing both a sensitive & a low sensitivity test; premise is that if sensitive test is pos & low sensitive test is neg, antibody titer levels are low & indicates a relatively recent infectionBenefit of very early detection |
| _____Used to assess antiviral Rx, diagnose neonatal infection, detect HIV before seroconversion & determine progression of HIV (+ early in dz then absent, but + again late in course of disease) | Antigen tests (p24) ELISA type method. Detects free antigen or bound antigen/antibody complexes |
| _____ is more indicative of Rx response than CD4 | HIV Viral Load (HIV RNA). Also used to detect transplacental transmission of HIV |
| HIV diagnosis in infants | definitive diagnosis before 6 mo old is still difficult. Tx them as if they are positive to prevent progression in the event that they are in fact positive |
| The saliva test available for rapid HIV testing | OraQuick. By law, pts must receive a "subject information packet". All positives require confirmation with standard serology (EIA & Western Blot) |
| Early infection with HIV can only be detected with | Viral load |
| Most common diagnostic method for Trichomonas | Wet Prep |
| The finding of a Donovan Body on Wright's of Giemsa's stain from smear of ulcer indicates | Granuloma inguinale caused by Calymmatobacterium granulomatis (gram negative bipolar rod encapsulated in mononuclear lymphocytes) |
| If you suspect Lymphogranuloma Venereum, which serotype of Chlamydia trachomatis are you looking for? | L1, L2, L3. Lab diagnosis is complement fixation test. This is rare in the US |
| Laboratory diagnosis of HPV | Characteristic Pap smear abnormalities, HPV High Risk DNA typing, usually associated with Pap smear (specified vs. reflex testing), Colposcopy (lesions enhanced with acetic acid) |
Created by:
ltm12