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39 Cards in this Set
- Front
- Back
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4 types of urethritis/cervicitis syndromes
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gonorrhea
chlamydia nongonococcal urethritis (males) mucopurulent cervicitis (females) |
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Sx of urethritis?
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discharge, dysuria, PMN's
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how to tell gonorrhea urethritis vs nongonococcal (NGU) ?
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gram stain, negative diplococci intracellularly -> gonorrhea
not seen, NGU |
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Sx of cervicitis?
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mucopurulent vaginal discharge
cervical friability (bleed easily) vaginal discharge |
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difference of gram stain of female cervicitis vs male urethritis?
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female less sensitive and specific due to other vaginal bacteria
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characteristics of gonorrhea
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Neisseria gonorrhoeae
non motile gram negative diplococcus oxidase positive, rapid division aerobic growth, requires CO2 enriched atmosphere on chocolate agar media |
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gonococcus evades host immune response via?
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antigenic variability of pili
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3 outer membrane proteins of gonococcus? their fxn?
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Opa, Por, LOS
facilitate cell invasion and evasion of host immune system |
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pathogenesis of gonococcus?
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pili and opa mediate attachment to host cells
endocytosis w/ associated loss of cilia in adjacent cells organisms penetrate host epithelium to submucosa host immune response. inflammation, pus antigenic variation inhibits host immune clearance humans sole host survive briefly outside mucosal contact required for infection. incubation ~7days |
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urethritis can progress to?
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epididymitis
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cervicitis can lead to?
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frank salpingitis, PID
fitz-hugh curtis syndrome long term infertility, ectopic pregnancy, chronic pelvic pain |
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color of gonococcal urethritis discharge? chlamydia discharge?
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gonococcus - yellow green
chlamydia - milkish |
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non genital tract gonococcal infections?
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pharyngitis
rectal infection/proctitis disseminated gonococcal infection - dermatitis (pustules), arthritis (small joints), bacteremia ophthalmia neonatorum/conjunctivitis (vertical transmission) |
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Tx of gonococcus?
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ceftriaxone
30% co infected w/ chlamydia so treat for both infections |
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characteristics of chlamydia?
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chlamydia trachomatis
obligate intracellular bacteria 3 species: trachomatis: urethritis, cervicitis, conjunctivitis pneumoniae: respiratory infections psittaci: respiratory infections antigenically complex w/ multiple serovars genus specific LPS antigen and psecies specific antigens in major outer membrane protein |
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pathogenesis of chlamydia
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infectious particle is elementary body
EBs attach to and invade host cells through receptor mediated endocytosis lysosomal fusion inhibited EBs coalesce into reticulate bodies (RB) Rbs divide by binary fission RBs revert to EBs, and released |
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clinical presentation of nongoconoccal urethritis, mucopurulent cervicitis?
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like gonorrhea
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most cases of nongonococcal urethritis and mucopurulent cervicitis caused by chlamydia?
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no. other pathogens including mycoplasma, ureaplasma, trichomonas, anaerobes
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other clinical manifestations of chlamydial infection?
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lymphogranuloma venereum
ophthalmia neonatorum neonatal pneumonia |
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Tx of chlamydia?
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macrolide (azithro, erythro)
fluoroquinolone doxycycline screen for GC but don't treat empirically |
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3 vaginitis/vaginosis syndromes?
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bacterial vaginosis
trichmoniasis (only this is STD) vulvovaginal candidiasis |
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bacteria normally present at high livels in vagina?
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lactobacillus
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role of lactobacillus in vagina?
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ferment glucose to lactic acid
produces hydrogen peroxide protects against bacterial overgrowth protects against other cervical pathogens including GC, Ct, and HIV |
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what things disrupt normal vaginal ecology?
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antibiotics
douching multiple sex partners STD defective lactobacilli |
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difference between vaginitis and vaginosis?
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vaginitis - inflammatory response of the vagina. presence of WBC
vaginosis - noninflammatory, absence of WBC. decreased lactobacillus, increased anaerobes |
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presentation of vaginosis?
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thin homogeneous discharge
elevated vaginal pH >4.5 fish like odor on addition of KOH presence of "clue cells" |
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agent of trichomoniasis?
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parasite: trichomonas vaginalis
motile, seen on wet mount slightly larger than WBC |
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strawberry cervix in what disease?
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trichomoniasis
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agent of vulvovaginal candidiasis?
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candida albicans
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Sx of vulvovaginal candidiasis?
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thick, white cottage cheese like discharge
pruritis vulvar edema, erythema low vaginal pH <4.5 (compared to trich or bacterial vaginosis) |
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Tx of bacterial vaginosis?
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metronidazole
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tx of trichomoniasis?
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metronidazole
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tx of vulvovaginal candidiasis?
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OTC antifungal cream (triazoles) or azole agent
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2 agents of exophytic STDs
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HPV
molluscum contagiosum |
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HPV strain that causes warts?
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6,11
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GPV strain that causes cervical dysplasia and cancer?
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16,18. others can do it too
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gardasil covers which HPV strains?
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6,11, 16,18
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presentation of molluscum contagiosum?
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common pox virus
smooth, domed lesions |
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2 ectoparasitic infestations?
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public lice
phthirus pubis - crab louse. causes external itching. seen w/ naked eye scabies sarcoptes scabei - mite, burrows intoskin, causes itching and tracks |
