Microbio -10- STI/STD
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| Why is syphillis called the great imitator | symptoms are similar to many other diseases
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| Why has the syphilis rate increased so much in the last decade | surge in cases among homosexual and bisexual men
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| What is the causative organism of syphilis | treponema pallidum
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| How is syphilis trasmitted | person to person by sexual intercourse direct contact with lesions rarely spreads disease
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| What is the second most common cause of genital ulceration | Syphilis
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| What is the progression of syphilis | 4 stages primary -> secondary -> to late/tertiary and latent
neurosyphilis is seperate from the 4 stages
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| What is the initial symptom of syphilis | chancre ulcer painless nodule or ulcer at point of entry of bacterium
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| When does the chancre ulcer appear after infection | appears 10 days to 3 months post exposure
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| Where do you typically find the chancre ulcer | usually found on penis, vulva or vagina can occur on lips as well disappears in a few weeks w/o treatment
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| When would you typically not visualize the chancre ulcer with syphilis | when it is on the cervix, tongue or buccal mucosa
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| what is secondary syphilis marked by | T. Pallidum enters lymphatics and bloodstream disseminates throught the body and causes skin rash 2 to 8 weeks after exposure
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| Why do you need to be careful in touching the rash found in secondary syphilis | the lesions carry active bacteria
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| Where is the most common area to find the rash in secondary syphilis | on the palms of the hands and the soles of the feet
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| What are some other signs and symptoms of secondary syphilis that can cause it to be confused w other diseases | flulike sypmotms, mild fever, fatigue, headache, sore throat and lymphadenopathy
patchy hairloss, condyloma lata in moist groin area
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| what is the latent stage of syphilis | disease enters a stage in which it is not contagious and there are no symptoms which can last 20-30yrs. 40% will enter late or tertiary syphilis
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| What are the final results of syphilis | mental illness, blindness, other neurological problems heart disease and death
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| What joint condition can you see in tertiary syphilis | charcot joint
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| What is neurosyphilis | when bacteria invades the nervous system
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| What are some s/sx associated with neurosyphilis | headaches, stiff neck, fever, seizures, strokes if blood vessels are involved.
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| Why is neurosyphilis viewed seperately from normal syphilis | neurosyphilis is harder to treat
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| how do you dx syphilis | recognize s/sx
microscopic identification of syphilis bacteria
blood tests
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| What type of microscopic technique will you use to identify syphilisq | darkfield microscopy
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| What blood test is done for syphilis | RPR, rapid plasma reagin
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| What is the confirmatory test for RPR | fluorescent treponemal antibody absorption or T. Palladium hemaglutination assay
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| Why most you perform a lumbar puncture on latent or late phase syphilis patients | need to check for neurosyphilis
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| What is the tx for syphilis | use IM penicillin or other antibiotic in case of PCN allergy
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| What is the followup protocol for syphilis treatment | serological tests should be repeated at 6,12 and 24 months to ensure tx was succesful
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| How can you prevent syphilis | avoid contact with sores and body fluids of infected persons
use condoms during sex
test and treat in early pregnancy to avoid neonatal syphilis
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| What will occur 25% of the time in a pregnant women infected w/ syphilis | They will miscarry, have stillbirth or neonatal death
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| What other STI will you test for in patients w/ syphilis infection | HIV
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| What is the organism that causes gonorrhea | neisseria gonorrhoeae
gram negative diplococci found only in humans
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| what is the incubation period for gonorrhea | 2-5 days in males and 10 days in females
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| Do you get immunity from having gonorrhea before | no protection from previous infections and there is no vaccine available
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| What is the second most commonly reported notifiable disease in the US | Gonorrhea
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| what coinfection do you see with gonorrhea | C. Trachomatis
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| What are the clinical presentations of gonorrhea | purulent discharge for cervix/vagina or urethra
vaginal itching, burning & irritation
severe dysuria, urgency
cervicitis-inflammed, swollen, friable
urinary frequency
pharyngitis
anal GC
conjunctivitis
85% of infected females are asymptomatic
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| How do you dx gonorrhea | Gram STain of discharge
Thayer Martin Medium Culture-gold standard
DNA hybridization
Nucleic acid amplification assays-expensive
serologic tests-expensive not clinically sig.
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| What are the tx guidlines for gonorrhea | use appropriate antibiotic treat for concomitant chlamydia, treat sexual partners. Have them abstain from sex for 7 days test for other STIs
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| Do you need to do followup testing w/ gonorhhea | no but rescreening in 2-3 months is beneficial (chance of reinfection)
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| what is the new form of gonorrhea that is becoming more prevalent | quinolone resistant N. Gonorrhoeae
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| What can hapen in untreated gonorrhea in pregnancy | preterm labor/delivery and premature rupture of membranes
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| what is the most reported infectious disease in the US | chlamydia
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| what is the pathogen that causes chlamydia | chlamydia Trachomatis
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| What are sequelae in women with chlamydia | PID, ectopic pregnancy and infertility
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| Why is chlymdia infection infection rate so high | often infection is asymptomatic
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| What else can chalmydia cause when you get perinatal transmission from mother to child or person to person transmission with flies as a vector | blindness
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| What is lymphogranuloma venereum | chronic lymphadenitis of femoral or inguinal nodes caused by a serotype of chlamydia
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| How do you dx chlamydia | women- urine or endocervix/vaginal swab
men- urine or urethral swab
rectal infections by rectal swab
culture, direct immunoflourescence, EIA, nucleic acid hybridization test or NAATs
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| What should you test for when a patient tests + for chlamydia | test for other STIs
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| What patient education will you give to someone with chlamydia | no sex for 7 days after 1 time treatment or until finishing 7 day treatment
no sex until partners are treated as well
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