Understanding Sexually Transmitted Infections (STIs)
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Questions and Answers

What is a characteristic of primary syphilis?

  • Presence of genital discharge
  • Inflammation of the urethra
  • Presence of hard chancre (correct)
  • Multiple sexual partners involvement

    • Which of the following STIs is caused by Chlamydia trachomatis?

  • Gonorrhea
  • Lymphogranuloma venereum (correct)
  • Syphilis
  • Granuloma inguinale

    • What is the typical duration for a hard chancre to heal in primary syphilis?

  • 6 to 8 weeks
  • 4 to 6 weeks (correct)
  • 2 to 4 weeks
  • 8 to 10 weeks

    • Which of the following is NOT a mode of transmission for syphilis?

    <p>Airborne particles (A)</p> Signup and view all the answers

    What type of lesions are primarily associated with primary syphilis?

    <p>Hard chancre (A)</p> Signup and view all the answers

    Which of the following conditions is characterized by genital discharge?

    <p>Non-gonococcal urethritis (D)</p> Signup and view all the answers

    What population is experiencing an increased prevalence of syphilis cases?

    <p>Intravenous drug users (C)</p> Signup and view all the answers

    Which of the following is NOT a type or stage of syphilis?

    <p>Chronic syphilis (D)</p> Signup and view all the answers

    Which of the following is NOT a symptom associated with congenital syphilis?

    <p>Purulent vaginal discharge (A)</p> Signup and view all the answers

    What is the principle behind VDRL and RPR tests for syphilis?

    <p>Patient's production of anti-cardiolipin antibodies (B)</p> Signup and view all the answers

    Which antibiotic is primarily used for treating primary and secondary syphilis?

    <p>Benzathine penicillin (C)</p> Signup and view all the answers

    What is a complication associated with gonorrhea in males?

    <p>Epididymitis (B)</p> Signup and view all the answers

    Which of the following conditions can result from an ascending infection of Neisseria gonorrhoeae in females?

    <p>Endometritis (A)</p> Signup and view all the answers

    What characteristic distinguishes Neisseria gonorrhoeae from other bacteria?

    <p>Resistance to intracellular killing (D)</p> Signup and view all the answers

    Which of the following is a symptom of Neisseria gonorrhoeae infection in females?

    <p>Purulent vaginal discharge (A)</p> Signup and view all the answers

    What is a feature of quaternary syphilis in patients with AIDS?

    <p>Aggressive form of neurosyphilis (A)</p> Signup and view all the answers

    What bacterium is responsible for causing hard chancre?

    <p>Treponema pallidum (D)</p> Signup and view all the answers

    Which statement is true about soft chancre?

    <p>It has a purulent exudate. (A)</p> Signup and view all the answers

    What characterizes secondary syphilis?

    <p>Non-itchy rash on the trunk and extremities (D)</p> Signup and view all the answers

    What does latent syphilis signify?

    <p>Serologic proof of infection without signs or symptoms (A)</p> Signup and view all the answers

    What is a symptom of tertiary syphilis?

    <p>Formation of gumma (C)</p> Signup and view all the answers

    Which type of syphilis can relapse to secondary syphilis?

    <p>Early latent syphilis (C)</p> Signup and view all the answers

    What can occur with congenital syphilis?

    <p>Stillbirth (C)</p> Signup and view all the answers

    What condition is often associated with neurosyphilis?

    <p>Loss of mental functions (C)</p> Signup and view all the answers

    What is a potential complication of a Neisseria gonorrhoeae infection in females?

    <p>Pelvic Peritonitis (B)</p> Signup and view all the answers

    Which condition can result from neonatal conjunctivitis caused by Neisseria gonorrhoeae?

    <p>Corneal scarring (D)</p> Signup and view all the answers

    What type of specimen is commonly used for the diagnosis of Neisseria gonorrhoeae?

    <p>Urethral swab (A)</p> Signup and view all the answers

    Which selective media is used for culturing Neisseria gonorrhoeae?

    <p>Thayer-Martin medium (A)</p> Signup and view all the answers

    What is one treatment option for penicillinase-producing Neisseria gonorrhoeae infections?

    <p>Ciprofloxacin (C)</p> Signup and view all the answers

    Which of the following serovars of Chlamydia trachomatis is associated with lymphogranuloma venereum?

    <p>L1, L2, L3 (C)</p> Signup and view all the answers

    What is the most common bacterial sexually transmitted infection?

    <p>Non-gonococcal urethritis (B)</p> Signup and view all the answers

    Which immune-mediated condition is associated with Chlamydia trachomatis infections?

    <p>Reiter’s syndrome (D)</p> Signup and view all the answers

    Which diagnostic method is primarily used for Chlamydial infections?

    <p>Cell Cultures (A)</p> Signup and view all the answers

    What is a common symptom of trichomoniasis in females?

    <p>Redness or soreness of genitals (A)</p> Signup and view all the answers

    Which of the following is a significant complication that can arise from untreated trichomoniasis?

    <p>Transmission of HIV (B)</p> Signup and view all the answers

    Which serovar of Chlamydia trachomatis is associated with lymphogranuloma venereum?

    <p>L1 - L3 (B)</p> Signup and view all the answers

    What is a notable characteristic of the vaginal discharge associated with trichomoniasis?

    <p>Thin with a fishy smell (C)</p> Signup and view all the answers

    Which of the following treatments is used for vaginal candidiasis?

    <p>Clotrimazole vaginal pessaries (C)</p> Signup and view all the answers

    What is the role of NAATs in the diagnosis of Chlamydial infections?

    <p>To amplify nucleic acids for detection (D)</p> Signup and view all the answers

    What is a prominent predisposing factor for genital herpes?

    <p>Pregnancy (D)</p> Signup and view all the answers

    Flashcards

    Sexually Transmitted Infections (STIs)

    Illnesses spread through sexual contact.

    Syphilis

    A STI caused by Treponema pallidum with stages from primary to tertiary.

    Primary Syphilis

    The first stage of syphilis, characterized by a painless sore (chancre).

    Chancre

    A painless sore, often on genitals, that's a symptom of primary syphilis.

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    Bacterial STIs with Genital Ulceration

    Certain STIs affecting genitals with sores (ulcers).

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    Bacterial STIs with Genital Discharge

    STIs causing abnormal fluid release from genitals.

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    Gonorrhea

    A bacterial STI, also known as gonorrheal urethritis.

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    Transmission of Syphilis

    Spread through sexual contact, transplacentally (to babies), and blood.

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    Hard Chancre

    Painless, non-exudative sore caused by Treponema pallidum, with a raised edge and depressed center.

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    Soft Chancre

    Painful, purulent sore caused by Haemophilus ducreyi, with a soft depressed edge and raised center.

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    Secondary Syphilis

    A skin rash that appears 6-8 weeks after primary infection, characterized by a symmetrical reddish-pink maculopapular rash on the trunk and extremities. It's highly contagious.

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    Tertiary Syphilis

    Serious late-stage syphilis with various organ damage, appearing 1-10 years after the initial infection.

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    Congenital Syphilis(Early)

    Syphilis transmitted from mother to child during pregnancy, leading to various complications and potentially still birth.

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    Latent Syphilis

    Syphilis infection with no symptoms, but detectable by serological tests.

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    Gummatous Syphilis

    Tertiary syphilis marked by soft, rubbery tumor-like balls (gummas) forming in various organs, particularly skin, liver and nervous system.

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    Neurosyphilis

    Tertiary syphilis affecting the nervous system, leading to dementia, hallucinations, and impaired physical functions.

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    Congenital Syphilis

    Syphilis passed from a mother to her child during pregnancy.

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    Late Syphilis Symptoms

    Characteristics like prominent frontal bones, saddle nose, and specific joint and tooth issues.

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    Syphilis Diagnosis Methods

    Uses dark-field and fluorescent microscopy, and serologic tests (like VDRL and RPR) to identify syphilis.

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    Syphilis Treatment

    Typically treated with penicillin, though alternative antibiotics might be used.

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    Gonorrhea Symptoms (Male)

    Commonly presents with painful urination and a pus-like discharge from the penis.

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    Gonorrhea Symptoms (Female)

    Can be asymptomatic but can include vaginal discharge, and potentially, ascending infections (PID).

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    Gonorrhea Pathogenesis

    Gonorrhea attaches and invades urogenital cells, resisting intracellular killing mechanisms to spread.

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    Gonorrhea Common Sites

    Infection can be found in the urethra, endocervix, rectum, pharynx, and eyes (conjunctivitis).

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    Neisseria gonorrhoeae complications (female)

    Infections like tubo-ovarian abscess, ectopic pregnancy, infertility, pelvic peritonitis, and Fitz-Hugh-Curtis syndrome (perihepatitis) can arise from Neisseria gonorrhoeae.

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    Neonatal Gonorrheal Conjunctivitis

    Infection of a newborn's eye, acquired during birth from an infected mother.

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    Disseminated N. gonorrhoeae infection

    The spread of N. gonorrhoeae throughout the body, affecting multiple systems and causing symptoms like bacteremia, septic arthritis, tenosynovitis, and dermatitis.

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    N. gonorrhoeae diagnostic specimens

    Samples like endocervical swabs, urethral swabs, and eye swabs are collected for diagnosis.

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    N. gonorrhoeae staining characteristic

    Gram-negative intracellular diplococci are the characteristic findings when staining samples under a microscope.

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    N. gonorrhoeae culture media

    Selective media like Thayer-Martin (chocolate agar with antibiotics) is used to grow specific bacteria, including N. gonorrhoeae.

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    Chlamydia trachomatis serovars D-K implications

    Causes non-gonococcal urethritis (NGU), a common STI often asymptomatic, and can lead to pelvic inflammatory disease (PID) in women.

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    Treatment of N. gonorrhoeae resistance

    Antibiotics like spectinomycin, 3rd-generation cephalosporins (ceftriaxone, cefotaxime), and ciprofloxacin are used to treat N. gonorrhoeae, noting some are now resistant to penicillin.

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    Chlamydia Serovars

    Different strains of Chlamydia trachomatis categorized by their genetic characteristics and associated diseases. Examples include D-K serovars and L1-L3 serovars.

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    Chlamydial Infections Diagnosis: Cell Cultures

    A method to diagnose chlamydial infections by growing the bacteria in a lab using specific cell types, such as chicken embryonic cells or HeLa cells.

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    Chlamydial Infections Diagnosis: NAATs

    Nucleic Acid Amplification Tests (NAATs), such as PCR, are highly sensitive methods used to detect chlamydial DNA, even in small amounts.

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    Herpes Genitalis

    A sexually transmitted infection (STI) characterized by painful blisters and sores in the genital area, caused by the herpes simplex virus (HSV). HSV-2 is the most common cause.

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    Trichomonas vaginalis

    A microscopic, single-celled parasite responsible for trichomoniasis, a common sexually transmitted infection (STI) affecting the vagina.

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    Trichomoniasis Symptoms in Women

    Symptoms of trichomoniasis in women include: itching, burning, vaginal discharge (clear, white, yellowish, greenish), and discomfort when urinating.

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    Untreated Trichomoniasis Risks

    Leaving trichomoniasis untreated can lead to serious complications, including increased risk of HIV transmission and potential complications during pregnancy.

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    Curable Trichomoniasis

    Trichomoniasis is a curable infection through appropriate treatments, usually with medications prescribed by a healthcare professional.

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    Study Notes

    Sexually Transmitted Infections (STIs)

    • STIs, also known as venereal diseases (VDs), are illnesses with a high chance of transmission through sexual activity.
    • Bacterial STIs can be categorized into those with genital ulceration and those with genital discharge.

    Bacterial STIs with Genital Ulceration

    • Syphilis: Caused by Treponema pallidum, characterized by a painless chancre at the site of infection.
    • Chancroid: Caused by Haemophilus ducreyi, resulting in a painful chancre.
    • Lymphogranuloma venereum (LGV): Caused by Chlamydia trachomatis strains L1, L2, and L3, leading to regional lymph node swelling.
    • Granuloma inguinale (Donovanosis): Caused by Klebsiella granulomatis, resulting in a painless genital ulcer.

    Bacterial STIs with Genital Discharge

    • Gonorrhea (Gonococcal urethritis): Caused by Neisseria gonorrhoeae, often asymptomatic in females and typically causing painful urination and discharge in males.
    • Non-gonococcal urethritis: Caused by Chlamydia trachomatis, Mycoplasma genitalium, or Mycoplasma hominis, commonly asymptomatic.

    Syphilis

    • A prevalent sexually transmitted infection, particularly in developing nations like Caribbean and sub-Saharan Africa and Southeast Asia.
    • Increasing reported cases are linked to intravenous drug use, indiscriminate sex, and multiple sexual partners.
    • Transmission pathways include sexual contact, transplacental transmission (congenital syphilis), blood transfusion, and direct inoculation to the skin.

    Syphilis: Pathogenesis

    • Spirochetes penetrate through mucosal membranes and skin abrasions.
    • Primary lesions develop at the site of infection, characterized by mononuclear leukocytes, macrophages, and lymphocytes.
    • Focal endarteritis and periarteritis occur.

    Types and Stages of Syphilis

    • Primary syphilis
    • Secondary syphilis
    • Latent syphilis
    • Tertiary syphilis
    • Quaternary syphilis
    • Congenital syphilis

    Primary Syphilis

    • Appears 10-90 days after infection (average 21 days).
    • Characterized by a hard chancre, a firm, painless sore at the site of infection.
    • Usually heals spontaneously within 4 to 6 weeks.
    • Often associated with local lymphadenopathy.

    Secondary Syphilis

    • Typical symptoms develop 6-8 weeks post-primary infection.
    • Characterized by symmetrical, reddish-pink non-itchy skin rash, typically on the trunk and extremities.
    • Condylomata lata (flat-topped, painless growths) can appear.

    Secondary Syphilis: Additional Manifestations

    • Mucosal patches—snail track ulcers
    • Generalized lymphadenopathy
    • Fever, sore throat, or weight loss

    Latent Syphilis

    • Characterized by a lack of symptoms despite ongoing infection.
    • Can be early or more than two years after the infection.

    Tertiary Syphilis

    • Manifests after a period of latency, typically one to ten years after initial infection.
    • Characterized by the formation of gummas, soft, rubbery, tumor-like balls of granulomas affecting skin, liver, blood vessels, nervous system, and skeleton.
    • Cardiovascular syphilis: Aortic aneurysm and aortic regurgitation.
    • Neurosyphilis: Loss of mental function (dementia, hallucinations), impaired physical functions.

    Congenital Syphilis

    • Early symptoms: Stillbirth, hepatosplenomegaly, jaundice, anemia.
    • Late symptoms: Prominent frontal bones, depression of the nasal bridge (saddle nose), Clutton joints (arthritis of both knees), Hutchinson incisors, and anterior tibial bowing (saber shin).

    Quaternary Syphilis

    • This stage is less frequently discussed and usually associated with HIV-related syphilis cases.
    • Characterized by an aggressive form of neurosyphilis including necrotizing encephalitis.

    Diagnosis of Syphilis

    • Microscopy (dark-field microscopy): Examining samples from chancres or condylomata lata helps to identify Treponema pallidum bacteria.
    • Serologic tests: Non-treponemal tests (screening tests) such as VDRL, and Rapid Plasma Reagin (RPR), ELISA, help to determine antibodies presence.

    Treatment of Syphilis

    • Penicillin is the standard treatment, adjusted for different stages and/or patient-specific factors.
    • Other antibiotics (e.g., azithromycin, tetracycline) can be used as alternatives.

    Neisseria gonorrhoeae Infections (Gonorrhea)

    • A sexually transmitted infection.
    • Usually symptomatic in males but often asymptomatic in females.
    • Key clinical symptoms for males are dysuria and purulent urethral discharge.
    • In females, symptoms include localized infection, purulent vaginal discharge, vulvovaginitis, endocervicitis, and abscess formation in Bartholin's gland.
    • Ascending infection leads to endometritis, salpingitis, and pelvic inflammatory disease (PID).
    • Complications in females can include tubo-ovarian abscess, ectopic pregnancy, and infertility.

    Neisseria gonorrhoeae Diagnosis

    • Specimens include endocervical swabs, urethral swabs, and eye swabs.
    • Using Gram staining techniques, gram-negative intracellular diplococci can be identified.
    • Cultures are conducted using selective media such as Thayer-Martin medium.

    Neisseria gonorrhoeae Treatment

    • Treatments include spectinomycin, third-generation cephalosporins (ceftriaxone, cefotaxime), and ciprofloxacin.
    • It is recommended to treat concomitant STDs, such as chlamydia, with appropriate antibiotics.

    Chlamydia trachomatis

    • Most common bacterial STI.
    • Usually asymptomatic.
    • Common clinical presentations are dysuria, urethral discharge, and pelvic inflammatory disease (PID) in women.
    • May lead to infertility if left untreated.

    Chlamydia trachomatis (D-K) Diagnosis

    • Cell cultures using chicken embryo cells, HeLa cells, or McCoy cells enables identification.
    • NAATS (Nucleic Acid Amplification Tests) and ELISA (Enzyme-Linked Immunosorbent Assay) are used for molecular diagnosis and detection of antigens.
    • Serology (anti-chlamydial antibodies) can be used, but not helpful for acute infections.

    Herpes Genitalis

    • A sexually transmitted infection.
    • Characterized by painful genital vesicles (blisters) and sores.
    • Can be caused by HSV-2 (more common) or HSV-1.
    • Primary infection presents as painful, erythematous blisters in the genital region that develop within two days to two weeks of exposure.
    • Recurrences manifest as grouped vesicular lesions preceding by a prodrome of pain, itching, tingling, burning, or paresthesia.
    • 50% of cases are subclinical, but the presence of viral shedding can lead to the transmission of the infection.
    • Neonatal herpes occurs when the virus is transmitted to a newborn during childbirth through infected genital secretions, resulting in high mortality.

    Diagnosis of Herpes Genitalis

    • Tzanck smear: Smearing specimens taken from the base of the lesions, stained with Giemsa or Pap stains, helps to identify multinucleated giant cells typical of herpes.
    • Direct fluorescent antibody testing.
    • Serologic assays: Used to identify antibodies in recurrent infections.
    • Viral Culture.

    Herpes Genitalis Treatment

    • Antiviral drugs (e.g., acyclovir, valacyclovir, famciclovir) are prescribed to manage episodic outbreaks and prevent recurrence, especially effective in primary infections.

    Candidiasis

    • Candida infections are caused by various Candida yeast species, with C. albicans being the most significant.
    • Infections can be acute, subacute, or chronic.
    • Candida is commonly found as a commensal organism in oral cavities, GI tracts, vaginas, and skin.
    • C. albicans itself is not a skin commensal, while other Candida species might be.
    • Predisposing factors that may lead to candidiasis include pregnancy, trauma, immunodeficiency, endocrine issues such as diabetes mellitus, thyroid dysfunction, adrenal insufficiency (Addison’s disease), and hematological conditions like leukemia, low white blood cell count, and lymphoma.
    • Iatrogenic factors include massive steroid use, antibiotics, and cytogenic drugs/radiotherapy, along with catheters and contraceptive pills.
    • Vaginal candidiasis (vaginal thrush) are characterized by >50% vaginal discharge, predisposing factors such as pregnancy, diabetes, and oral contraceptive pills, acidic vaginal environment suppression of normal vaginal flora, facilitating Candida growth.
    • Infections affecting the mouth or body can manifest as oedematous, red, itchy vaginal walls with a pseudomembrane, thick creamy vaginal discharge in females, or vesicular eruptions in the penis in men.

    Trichomoniasis

    • Caused by Trichomonas vaginalis, a flagellated anaerobic protozoan parasite.
    • The most common pathogenic protozoan infection in industrialized countries is associated with itching, burning, redness, or soreness of the genitals.
    • Vaginal discharge can change in consistency, volume, and color, often featuring a fishy odor.
    • Left untreated, trichomoniasis can cause severe health problems, particularly in those with co-existing HIV infections.
    • Treatment involves antibiotics, typically azithromycin.

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