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59 Cards in this Set

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What tissue in the body is affected by gonorrhea?
columnar and transitional epithelium
Epidemiology of gonorrhea?
2nd most common reportable infectious dz in US
most common in young sexually active person
highest prev in unmarried person of low SES and education
Microbiologic characteristics of n. gonorrhea?
gram negative diplococci
dies on drying or cooling, rarely transmitted by fomites
5-10% CO2 for growth in lab
ferments only glucose (other Neisseriae ferment glucose and maltose)
Which strains of N. gonorrhea are most virulent? Why?
Those with pili
They mediate attacment to columnar epi cells on mucosal surface
Prevent ingestion/killing by PMN
Prevents opsonization by AB
What mediates cellular invasion in gonorrhea?
AB against gonorrhea?
adhesins
produced following infection, but doesn't provide effective immunity b/c of the many antigenic variants,
IgA proteases cleave IgA made by mucosal cells
What plays the biggest role in protecting against gonorrhea?
terminal components of complement (6,7,8)
CLincal presentation of gonorrhea in males?
Females?
urethritis, dysuria, 5-10% asymptomatic
urethritis and/or cervical discharge, asymptomatic in 30-80%
What are extragenital syndromes of gonorrhea?
proctitis
pharyngitis
progressive pelivc infection (prostatitis, epididimitis, PID)
disseminated infection
Clinical features of progressive gonorrhea infection in pelvis of males?
pain and tenderness from prostatitis and epidiymitis i
urethral stenosis --> obstruction and sterility
Progressive gonorrhea infection in pelvis of woman?
PID (--> endometritis, salpingitis, oophoritis) esp around time of menses
fever, chills, lower abdomainl and pelvic pain
Who is mroe likely to get a disseminated gonococcal infection? what are the features?
women (9:1)
gonococcemia (w fever, chills, polyarthralgia, tenosynovitis, and skin lesions) and gonococcal arthritis
skin lesions on extremities
Features of gonococcal arthritis?
blood cultures negative
no skin lesions
usually large monoarticular joints
pain, red, swollen, tender
Describe gonococcal conjunctivitis?
mostly in neonates
infected during vaginal delivery, prevent with topical Ab at birth
ocassionally seen in adults and older children
How to make a lab diagnosis of gonorrhea?
in males with urethrtis, PMN with organism
in females, less reliable b/c of saprophytic Neisseria
what type of agar is needed to culture N. gonorrhea? How to grow them?
chocolate agar with antibiotics, incubate in 5-10% CO2
what is another way to diagnose gonorrhea w/o culture?
molecular probes
tx for PID from gonorrhea?
broad spectrum AB
give parenterally or orally
Rates of transmission of gonorrhea?
50-67% of female contact of men wiht GC (15-20% get PID)
20-33% of male contacts of women with GC get infected
What is nongonococcal urethritis?
syndrome similar to GC urethritis, only men can get this
females are dx'd with acute urethral syndrome
Etiologic agents of NGU?
chlamydia trachomatis
ureaplama urelyticum
mycoplasm genitalium
What is the most common CDC reportable infection?
NGU
Clinical manifestations of NGU?
Urethral exudates +/- dysuria
sx are less severe than GC
dishcarge less purulent, fewer PMN's
some pts are asymptomatic
Lab dx of NGU?
gram stain of urethral exudate (PMNs but no GNID)
culture available, but not done
can use molecular probes and amplification tests
Treatment of NGU?
azithromycin
doxycycline
Infectious agent for syphilis?
Treponema pallidum
Micro of Treponema pallidum?
thin, motile spirochete
corkscrew-like motility
can't grow in culture, requires animal passage
pathogenesis of syphilis (how is it spread? how does infection occur? how does body respond?)
transmission by sexual contact, transplaental and blood transfusion
infection occurs when organism penetrates mucous membranes or abraded skin then enters lymphatics and disseminates
CMI and humoral response occurs
Primary syphilis sx?
chancre
single, painless indurated raised wiht cartilagenous consistency
located at site of innoculation
often with regional lymphadenopathy
incubation period of primary syphilis?
3-90 days, mean 21
How is primary syphilis confirmed?
dark field microscopic exam
chancres resolve in 10-14 days wiht no therapy
Sx of secondary syphilis?
highly varied manifestations
begins 2-8 wks after appearance of chancre
flu-like illness with fever, malaise, lympadenopathy
mucous patches (gray, shallow, irregular ulcerations of mucous membranes)
dx of 2ndary syphilis?
dark field exam of mucous membrane lesions
serology
types of skin lesions in 2ndary syphilis?
location?
macular or papular rashes
scaly erythematous lesions
spares palms and soles
condyloma lata (genital areas at mucocutaneous jxns) they are loaded with spirochetes and are highly contagious
Stages of syphilis?
latent (no sx, si, just + serology)
tertiary (late); may involve CV and CNS, or can be asymptomatic
Sx of neurosyphilis?
menigovascular (seizures/strokes)
parenchymal (cognitive abnormalities, mental status changes, general paresis, optic atrophy, tabes dorsalis)
what is tabes dorsalis?
ataxia
peripheral neuropathy
CV involvement of syphilis?
Aortitis
Aortic aneurysm
Cutaneous components of tertiary syphilis?
ulcerating gumma
nodular lesions
Sx of congenital syphilis?
saddle-nose deformity
Hitchinson's teeth
when can congenital syphilis be prevented?
prevent with screening
if mom is treated in 1st half of pregnancy, can prevent
Explain process of darkfield microscopy?
scrape lesion
examine by wet prep
use darkfield microscope
What types of serological tests are used to dx syphilis?
nonspecific reagin tests
specific anti-treponemal AB tests
what are the nonspecific reagin tests?
How do they work?
usefulness of these tests?
VDRL, RRR, ART
directed against lipid Ag that results from interactions of host tissues with T. pallidum or for T. pallidum itself
Good sensitivity, limited specificity (false + in IVDU, elderly, collagen-vascular dz, HCV)
usefulness of specific anti=treponemal Ab tests?
more sensitive and specific, more $$
not cost effective if low risk
false + common in SLE, and other treponemal dz
False - in early primary syphilis
Treatment of syphilis?
for primary, secondary, and latent, single dose of penicillin or doxycylcine if allergy
for late: 2.4 MU benzathine penicillin IM x3 doses

check serology at 3,6,12 months to document efficacy of treatment
What is a chancroid?
soft chancre
painful, soft ulcer with buboes (swelling of LN) in groin
usually mutliple, tender, with shaggy border
acute, localized process w/o systemic sx
what is agent of chancroid? microbio of the organism?
H. ducreyi (gram - bacillis)
must differentiate from syphilis (- darkfield and syphilis serologies)
rarely clutured, unless you can get material from bubo
treatment of chancroid?
azithromycin or ceftriaxone
what is lymphogranuloma venereum? Organism?
chronic lymphadenitis from chlamydia trachomatis
clinical features of lymphogranuloma venereum?
large tender inguinal LN, fever, chills, joint pain, HA
skin over LN purplish
enlarge LN on both sides of inguinal liganment (= Groove sign)
some MSM and women may present with priamry anorectal infection (diarrhea, tenesmus, bloody or mucopurulent discharge)
complication of lymphogranuloma
males: elephantiasis of penis
females: rectal strictures (aso MSM), vaginal fistula
Dx of lymphogranuloma venereum
serology gives highest yield
cutlures less sensitive
Rx for lymphogranuloma venereum
doxycycline
Which herpesviurs is the most common for genital herpes?
HSV2 >> HSV1
clinical presentation of genital herpes?
painful vesiculopustular lesions
in males: on penis, rectum, perianal in MSM
female: vulva, introitus, vagina, cervix, perianal
can extend to groin and legs
lesions can coalesce
intial vesicle unroofs, crusts and heals
how long do herpes incidents last? how often do they recur?
7-10 d
3-5 d
Dx of genital HSV?
observation
can do cell culture, probes or PCR
management of HSV?
acyclovir and analogs effective, not curitave
how to manage women wiht HSV?
C section recommended since fetus at risk of neonatal HSV and shdeeing is intermittent and asymptomatic