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59 Cards in this Set
- Front
- Back
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Describe the clinical manifestations and potential complications of infections with
Chlamydia trachomatis Neisseria gonorrhoeae Gardnerella vaginalis Trichomonas vaginalis Candida albicans |
Learning Objectives
diagnosis treatment prevention pathogenesis epidemiologic |
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Infectious causes of cervicitis
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Infectious causes: Chlamydia trachomatis and Neisseria gonorrhoeae
Trichomoniasis and genital herpes less frequent causes |
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Infectious causes of Urethritis
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N. gonorrhoeae and C. trachomatis
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Symptoms of urethritis
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discharge of mucopurulent or purulent material, dysuria, or urethral pruritis
Asymptomatic infections are common. |
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symptoms of cervicitis
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Abnormal vaginal discharge and intermenstrual vaginal bleeding (e.g., after sexual intercourse).
May also be asymptomatic |
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Chlamydia trachomatis
Obligate intracellular pathogens Exist as elementary and ___ bodies |
reticulate
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metabolically inactive, infectious form of c trachomatis
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Elementary bodies-
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- metabolically active, non-infectious form of c trachomatis
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Reticulate bodies
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What are the Two biological variants (biovars) based on the type of host cells they infect of c trachomatis?
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Trachoma Biovar- infects non-ciliated mucosal epithelial cells and conjuntival cells
Causes urogenital infections, neonatal infections and trachoma Lymphogranuloma venereum Biovar- infects macrophages Causes Lymphogranuloma venereum |
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Trachoma Transmitted from person to person on _____
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hands
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Urogenital _____ infection is the most frequently reported infectious disease in the US
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Chlamydia
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When Chlamydia infects the eye, it is called what?
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Trachoma
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What are the "-itis" problems associated with chlamydia?
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Urethritis
Cervicitis Endometritis Pelvic inflammatory disease (salpingitis) |
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List racial groups in the order of highest rate of chlamydia infection
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Black
American Indian/Alaskan natives Hispanic Asian/pacific islander White |
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Urogenital Chlamydia infection is more commonly reported in individuals age _____
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15-24
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Specimens for diagnosis of C. trachomatis
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Women - urine or endocervix or vagina swab
Men -urine specimen Rectal C. trachomatis infections (receptive anal intercourse)- rectal swab specimen |
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most sensitive tests for C. trachomatis?
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NAATs are the most sensitive tests
Other options: Culture (must be grown in cells) Direct immunofluorescence (DFA) Enzyme immunoassay (EIA) Nucleic acid hybridization tests |
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Treatment of Urogenital Infections With C. trachomatis
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Azithromycin
Doxycycline Alternatives: Erythromycin Ofloxacin and Levofloxacin |
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Sex partners should be tested and treated if they had sexual contact with patient during the ____ days preceding onset of symptoms or diagnosis of chlamydia in the patient
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60
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Neisseria gonorrhoeae: how's it spread?
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sexually
perinatally |
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"Itises" caused by Neisseria gonorrhoeae
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Men- urethritis, proctitis, pharyngitis
Women- cervicitis, urethritis, proctitis, pharyngitis |
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Who is most likely to have noticeable symptoms early (men or women) with Neisserai gonorrhoeae?
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men
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most common cause of septic arthritis in sexually active young adults.
What about everyone else (overall most common cause)? |
N. gonorrhoeae
S. aureus |
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How do N. gonorrhoeae Attach to and penetrate of mucosal cells
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Pilin
Pili that facilitate attachment to epithelial cells Opa proteins Mediate strong adherence to epithelial cells; gives N. gonorrhoeae colonies an opaque appearance |
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_____ protein promotes N. gono survival within neutrophil phagosomes
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Porin
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________ similar to LPS- incites inflammation leading to purulent discharge and other clinical manifestations of infection
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Liopoligosaccharide (LOS)
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List the racial groups in order of gono rates
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black
AI/AN Hispanic White Asian/PI |
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Diagnostic Methods for N. gonorrhoeae
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NAAT (most sensitive )
Nucleic acid hybridization ((DNA probe test, molecular probe test). C and S gram stain ELISA, EIA |
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agar for C and S of gono
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Thayer Martin
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when use gram stain for gono diagnosis?
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Diagnostic only for male urethral specimen
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Treatment of N. gonorrhoeae
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DOC for uncomplicated infections is cephalosporins cephtriaxone or cefixime
CDC recommendations April 2007: Ceftriaxone IM single dose OR Cefixime single dose suspension PLUS****TREATMENT FOR CHLAMYDIA IF CHLAMYDIAL INFECTION IS NOT RULED OUT |
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Treatment of Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum
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Cephalosporins
Quinolones TREATMENT ALSO FOR CHLAMYDIA IF NOT RULED OUT |
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Treatment of Disseminated Gonococcal Infection (DGI)
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Hospitalization
Ceftriaxone Cefixime Ciprofloxacin, Ofloxacin or Levofloxacin C. trachomatis |
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Vulvovaginitis symptoms
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vaginal discharge and/ or vulvar itching and irritation, and a vaginal odor might be present.
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most common causes of Vulvovaginitis
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Bacterial Vaginitis (most common)
Anaerobic microorganisms, mycoplasmas, and Gardnerella vaginalis |
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other causes of Vulvovaginitis
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Candida albicans
Trichomonas vaginalis |
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Vulvovaginitis Results from replacement of the normal vaginal _________ sp. in with high concentrations of anaerobic bacteria (e.g., Prevotella sp. and Mobiluncus sp.), Gardnerella vaginalis, and/or Mycoplasma hominis
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Lactobacillus
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What's the most prevalent cause of vaginal discharge or malodor
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bacterial vaginitis
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describe the vaginal discharge of bacterial vaginitis
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gray, thin, and homogeneous
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predisposing factors of bacterial vaginitis
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Recent antibiotic use
Decreased estrogen production of the host Wearing an intrauterine device (IUD) Douching Sexual activity new sexual partner(s) |
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Facultatively anaerobic gram-variable rod Related to Haemophilus sp
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Gardnerella vaginalis
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Diagnosis of Bacterial Vaginosis
Diagnosed by clinical criteria or Gram stain. Clinical criteria require three of the following: (what?) |
homogeneous, thin, white discharge that smoothly coats the vaginal walls
presence of clue cells on microscopic examination of gram stain pH of vaginal fluid >4.5 a fishy odor of vaginal discharge |
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Bacteria-coated epithelial cells in vaginal discharge are ____ cells
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clue
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Complications of Bacterial Vaginitis
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Endometritis
PID Cellulitis |
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Treatment of BV
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Metronidazole
Clindamycin |
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Vulvovaginal Candidiasis (VVC) is caused by what?
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C. albicans; occasionally caused by other Candida sp.
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Vulvovaginal Candidiasis (VVC) symptoms
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Pruritus is the most common symptom
Thick, odorless, white vaginal discharge (with an appearance similar to cottage cheese) vulvar burning, dyspareunia, and burning sensation with urination |
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Candida species that are normal vaginal flora
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(C albicans, C tropicalis, and C glabrata)
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Risk factors for candida spp overgrowth
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oral contraceptive use
diabetes HIV or other immunocompromised states chronic antibiotic use pregnancy. young age at first intercourse increased frequency of intercourse receptive oral sex |
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what is the Second most common cause of vaginitis?
75% of women will have at least one episode 40%–45% will have two or more episodes |
Vulvovaginal Candidiasis (VVC)
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VVC can be classified as either ____ or _____
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uncomplicated or complicated
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What type of VVC?
Recurrent or Severe Nonalbicans candidiasis Occurs in women with uncontrolled diabetes, debilitation, or immunosuppression, or those who are pregnant |
Complicated
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WHat type of VCC?
Sporadic or infrequent Mild-to-moderate symptoms Typically due to Candida albicans Occurs in immune competent women |
uncomplicated
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Definitive Diagnosis of VCC
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Wet preparation (saline, 10% KOH)
Gram stain of vaginal discharge Both demonstrates yeasts or pseudohyphae |
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Treatment of VVC
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OTC Intravaginal Agents Butoconazole
Clotrimazole Miconazole Tioconazole Oral Agent: Fluconazole |
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Trichomoniasis is caused by what
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protozoan Trichomonas vaginalis
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Symptoms of women with tricho
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Women
Foul-smelling, frothy vaginal discharge Vulvar irritation Severe pruritis Swollen labia minora and the vagina due to inflammation and constant scratching Painful sexual intercourse Some women have minimal or no symptoms. |
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symptoms of men with tricho
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May be asymptomatic or may be associated with nongonococcal urethritis (NGU)
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Treatment of Trichomoniasis
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Metronidazole
OR Tinidazole |
