GYN DM STIs
Help!
|
|
||||
|---|---|---|---|---|---|
| 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)
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
ltm12