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Questions and Answers
What is a characteristic of primary syphilis?
What is a characteristic of primary syphilis?
Which of the following STIs is caused by Chlamydia trachomatis?
Which of the following STIs is caused by Chlamydia trachomatis?
What is the typical duration for a hard chancre to heal in primary syphilis?
What is the typical duration for a hard chancre to heal in primary syphilis?
Which of the following is NOT a mode of transmission for syphilis?
Which of the following is NOT a mode of transmission for syphilis?
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What type of lesions are primarily associated with primary syphilis?
What type of lesions are primarily associated with primary syphilis?
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Which of the following conditions is characterized by genital discharge?
Which of the following conditions is characterized by genital discharge?
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What population is experiencing an increased prevalence of syphilis cases?
What population is experiencing an increased prevalence of syphilis cases?
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Which of the following is NOT a type or stage of syphilis?
Which of the following is NOT a type or stage of syphilis?
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Which of the following is NOT a symptom associated with congenital syphilis?
Which of the following is NOT a symptom associated with congenital syphilis?
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What is the principle behind VDRL and RPR tests for syphilis?
What is the principle behind VDRL and RPR tests for syphilis?
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Which antibiotic is primarily used for treating primary and secondary syphilis?
Which antibiotic is primarily used for treating primary and secondary syphilis?
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What is a complication associated with gonorrhea in males?
What is a complication associated with gonorrhea in males?
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Which of the following conditions can result from an ascending infection of Neisseria gonorrhoeae in females?
Which of the following conditions can result from an ascending infection of Neisseria gonorrhoeae in females?
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What characteristic distinguishes Neisseria gonorrhoeae from other bacteria?
What characteristic distinguishes Neisseria gonorrhoeae from other bacteria?
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Which of the following is a symptom of Neisseria gonorrhoeae infection in females?
Which of the following is a symptom of Neisseria gonorrhoeae infection in females?
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What is a feature of quaternary syphilis in patients with AIDS?
What is a feature of quaternary syphilis in patients with AIDS?
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What bacterium is responsible for causing hard chancre?
What bacterium is responsible for causing hard chancre?
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Which statement is true about soft chancre?
Which statement is true about soft chancre?
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What characterizes secondary syphilis?
What characterizes secondary syphilis?
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What does latent syphilis signify?
What does latent syphilis signify?
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What is a symptom of tertiary syphilis?
What is a symptom of tertiary syphilis?
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Which type of syphilis can relapse to secondary syphilis?
Which type of syphilis can relapse to secondary syphilis?
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What can occur with congenital syphilis?
What can occur with congenital syphilis?
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What condition is often associated with neurosyphilis?
What condition is often associated with neurosyphilis?
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What is a potential complication of a Neisseria gonorrhoeae infection in females?
What is a potential complication of a Neisseria gonorrhoeae infection in females?
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Which condition can result from neonatal conjunctivitis caused by Neisseria gonorrhoeae?
Which condition can result from neonatal conjunctivitis caused by Neisseria gonorrhoeae?
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What type of specimen is commonly used for the diagnosis of Neisseria gonorrhoeae?
What type of specimen is commonly used for the diagnosis of Neisseria gonorrhoeae?
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Which selective media is used for culturing Neisseria gonorrhoeae?
Which selective media is used for culturing Neisseria gonorrhoeae?
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What is one treatment option for penicillinase-producing Neisseria gonorrhoeae infections?
What is one treatment option for penicillinase-producing Neisseria gonorrhoeae infections?
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Which of the following serovars of Chlamydia trachomatis is associated with lymphogranuloma venereum?
Which of the following serovars of Chlamydia trachomatis is associated with lymphogranuloma venereum?
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What is the most common bacterial sexually transmitted infection?
What is the most common bacterial sexually transmitted infection?
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Which immune-mediated condition is associated with Chlamydia trachomatis infections?
Which immune-mediated condition is associated with Chlamydia trachomatis infections?
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Which diagnostic method is primarily used for Chlamydial infections?
Which diagnostic method is primarily used for Chlamydial infections?
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What is a common symptom of trichomoniasis in females?
What is a common symptom of trichomoniasis in females?
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Which of the following is a significant complication that can arise from untreated trichomoniasis?
Which of the following is a significant complication that can arise from untreated trichomoniasis?
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Which serovar of Chlamydia trachomatis is associated with lymphogranuloma venereum?
Which serovar of Chlamydia trachomatis is associated with lymphogranuloma venereum?
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What is a notable characteristic of the vaginal discharge associated with trichomoniasis?
What is a notable characteristic of the vaginal discharge associated with trichomoniasis?
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Which of the following treatments is used for vaginal candidiasis?
Which of the following treatments is used for vaginal candidiasis?
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What is the role of NAATs in the diagnosis of Chlamydial infections?
What is the role of NAATs in the diagnosis of Chlamydial infections?
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What is a prominent predisposing factor for genital herpes?
What is a prominent predisposing factor for genital herpes?
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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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Description
This quiz covers crucial information about sexually transmitted infections, particularly focusing on bacterial STIs. It categorizes STIs into those causing genital ulceration and those causing genital discharge, detailing specific infections, their causes, and symptoms. Test your knowledge on these significant health issues and learn how to identify them.