NU 545 Pathophysiology Unit 3 Study
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NU 545 Pathophysiology Unit 3 Study
Guide Assured Success Guaranteed
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What is an STI? (affect more than 20 million Americans per year, and 1/2 are younger
than 25 years. Hidden epidemic. - ANSWER-STI: is the general term for any disease
that can be spread by intimate and/or sexual contact.
Includes systemic diseases such as hepatitis and tuberculosis
Is prevalent in all socioeconomic and racial or ethnic groups
Individuals who have unprotected nonmonogamous sex have the greatest risk for STI
exposure and infection.
Types of sexually transmitted urogenital infections - ANSWER-Bacterial -(gonorrhea-
syphilis-chancroid-granuloma inguinale-bacterial vaginosis)
Viral
Protozoal
Parasitic
Fungal
Gonorrhea (Bacterial infection) - ANSWER-Disseminated gonococcal infection (DGI)
•Rare systemic complication brought about by the spread of infection through the
bloodstream
•Life-threatening condition causing a generalized rash and severe joint pain
Perihepatitis
•Spread of N. gonorrhoeae to the liver
Ophthalmia neonatorum
•Gonococcal eye infection in an infant from an infected mother (most states require
prophylactic opthalmic antibiotics to prevent gonococcal eye infection. Topical
antibiotics may not be effective in eliminating neonatal infection and systemic tx. is
indicated for all newborns with known exposure. (onset of symptoms 1-12 days)
Newborns may also develop gonorrheal rhinitis.
Gonnorhea (Bacterial infection) - ANSWER-Is caused by Neisseria gonorrhoeae.
Transmission generally requires the contact of epithelial surfaces such as vaginal, oral,
or anal intercourse, and infection in the adults can be in the vagina, rectum, oropharynx,
and the urethra.
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Pregnant woman can pass gonorrhea to her fetus through infected cervical and vaginal
secretions, and a mother can pass it to her newborn child. Following vertical
transmission, the newborn eyes can be infected and result in blindness if untreated.
Humans are the only natural hosts.
Presence of pili helps N. gonorrhoeae attach to the epithelial cells of mucous
membranes.
Why is treatment for gonorrhea becoming more difficult? - ANSWER-because of rapidly
developing resistance to antibiotics. CDC and WHO advise dual drug treatment to treat
the infection and staunch increasing resistance.
Antibiotic resistance is most common in those who frequently have oral and anal
intercourse (men with men) CDC says gonorrhea likely to become resistant to all
antibiotics in the near future.
Common sites/complications of gonorrhea (Bacterial infection) - ANSWER-
•Endocervical canal (inner portion of the cervix): most common site for women
•Urethra
•Skene and/or Bartholin glands
•Urethra or rectum: most common site for men
Complications:
•Pelvic inflammatory disease (PID)
•Sterility
•Disseminated infection
Clinical manifestations of gonorrhea (Bacterial infection) - ANSWER-•Men: sudden
onset of painful urination or purulent penile discharge, or both (within a week from
infection)
•Women (within 10 days of exposure or 1-2 days after the next period. More than half
are asymptomatic
Symptoms often do not appear until they have spread to the upper reproductive tract
(uterus, fallopian/uterine tubes, and ovaries)
Dysuria (difficult/painful urination)
Increased vaginal discharge, increased flow or dysmenorrhea, dyspareunia (painful sex)
, lower abdominal and/or pelvic pain
Fever; mucopurulent discharge from the cervical os
treatment for gonorrhea (Bacterial infection) - ANSWER-•Antibiotic (ceftriaxone)
•Multidrug administration to reduce resistance
•Resistant to many antibiotics
•Treatment of partners
•Avoidance of sex until infection resolved, then usage of condoms
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What is syphilis? (Bacterial infection) - ANSWER-On the increase from men having sex
with men
Treponema pallidum (anaerobic spirochete)
•Is a corkscrew-shaped, anaerobic bacterium that cannot be cultured in vitro (grow in
human organ or tissue only)
•Infects any body tissue
•Becomes a systemic disease shortly after infection
Maternal-fetal transmission can occur as early as 9 weeks' gestation.
Tests
•Darkfield microscopy and serologic testing
Where is the bacteria from syphillis present? (Bacterial infection) - ANSWER-exudate
from moist mucosal or cutaneous lesions, the spirochete is usually transmitted to others
during the first few years of infection.
Why does untreated early syphilis result in perinatal death (40-70%) during pregnancy?
(Bacterial infection) - ANSWER-Because the spirochete can cross the placental
membrane to infect the fetus. However, simple tx with penicillin is 98% effective at
preventing vertical transmission (from mother to baby during the period immediately
before and after birth) .
Therefore, all pregnant women should be screened at their first prenatal visit, and
women at risk should be screened again in the 3rd trimester and at the time of delivery.
The course of untreated syphilis consists of 4 stages:
Stage 1 Primary (usually painless, round, and hard sores)
Secondary
Latent
Tertiary - ANSWER-Primary syphilis: local invasion
Treponema pallidum multiplies in epithelium producing granulomatous tissue reaction
(chancre)
From 12 days to 12 weeks after exposure
Average duration: 3 weeks
Granulomatous tissue reaction: hard chancre (eroded, painless, firm, and indurated
[hard] ulcer)
Microorganisms drain with the lymphatic fluid
Firm, enlarged, and nontender regional lymph nodes
Stage 2, secondary syphilis - ANSWER-Secondary syphilis: systemic disease: blood-
borne bacteria spread to all major organs. There is a period in which the immune
system can suppress the infection. Even without treatment, spontaneous resolution of
the skin lesions occurs and the individual enters the latent stages of infection.
systemic manifestations:
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Develops 6 weeks after the first appearance of the chancre
Low-grade fever, malaise, sore throat, hoarseness
Anorexia, generalized adenopathy, headache, joint pain, and skin or mucous membrane
lesions or rashes
Condylomata lata (a raised growth on the skin resembling a wart typically in the genital
region)
Stage 3, Latent syphilis - ANSWER-Latent syphilis: May be subdivided into early and
late stages; however serologic studies show that syphilis is present, but there are no
clinical manifestation. Transmission remains possible at this phase.
Duration: as short as 1 year or as long as a lifetime
Divided into early and late stages
Medical evidence of the infection; asymptomatic individual
Stage 4, Tertiary syphilis - ANSWER-Tertiary syphilis: Is the most severe stage,
involving significant morbidity and mortality . The pathogenesis of syphilitics
manifestations at this phase remain unclear. The destructive skin, bone, and soft
lesions (called gummas) of tertiary syphilis probably are caused by a severe
hypersensitivity reactions to the microorganisms. Within the cardiovascular system,
infection with T. Pallidum may cause aneurysms, heart valve insufficiencies, and heart
failure.
Appearing after the latent stage
Most severe stage
Formation of gummas: destructive skin, bone, and soft tissue lesions
Destructive systemic manifestations
Neurosyphilis: tabes dorsalis (loss of coordination of movement general paresis
(muscular weakness)
Congenital Syphilis - ANSWER-Congenital
caused by the passage of spirochete across the plasma membrane to affect any or all
fetal tissues. The infection can cause fetal death or growth abnormalities, including
changes in fetal bones, teeth and neurologic system. Affected Newborns can have
growth abnormalities, rashes, hepatosplenomegaly, jaundice, CNS involvement
including blindness and deafness. A classically reported late manifestation of congenital
syphilis is notched incisors. While now rare, this stigma is used in historical studies of
syphilis.
•Vasculitis, necrosis, fibrosis, and distribution of Treponema pallidum throughout the
tissues
•Early and late stages
Tests
