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38 Cards in this Set

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What is pelvic inflammatory disease?
STD complication only experienced by women

Infertility, Chronic Pelvic Pain, Ectopic Pregnancy
what is meant by mucopurulent discharge
smelly discharge with WBCs
An 18 y/o white women woke up in the morning to find her left knee was hot, swollen, and very painful. She could not walk to work and a friend offered her a ride to the clinic. While she was waiting and filling out a questionnaire, she realized that her right hand was stiff and it was hard to hold the pen tightly. She also remembered a burning sensation when she urinated.

A history taken by the medical student revealed that she had 3 male sexual partners during the last month, one of whom was new. She had never had a swollen joint before. However, she had a history of sexually transmitted disease (chlamydia the previous summer).
Physical exam revealed a tender knee joint which yielded a purulent synovial fluid on aspiration. The fluid had 80,000 WBC’s/mm3. She had a cervical discharge that on Gram stain showed Gram-negative diplococci within the poly’s. Cultures on the synovial fluid were negative. What is she likely diagnosed with
Neisseria gonorrhoeae
What are the characteristics of Neisseria? (gram -/+, shape, requirement, oxidase +/-)
Gram Negative diplococci

Coffee bean shape

requires CO2 to grow

Oxidase positive (aerobic)
if something grows on a cysteine trypticase agar what is it?
For the following, please list if they grow on nutrient agar, ferment glucose, and ferment maltose:

N. gonnorhoeae
N. meningitidis
Moraxella catarrhalis
grow on nutrient agar, ferment glucose, and ferment maltose

N. gonnorhoeae: (-); (+); (-)
N. meningitidis: (-); (+); (+)
Moraxella catarrhalis: (+); (-); (-)
with respect to gonorrhoea who is more likely to have it, M/F?

the following is the clinical presentation of what?

Purulent discharge
Neisseria Gonorrhoeae
What is the major virulence factor of Neisseria Gonorrhoeae?


note: Antigenic variation of pilin types is frequent due to many silent (nonfunctional) loci that recombine with a pilin promoter
Describe the outer membrane proteins I,II, and III i...what disease are these associated with?
they are virulence factors for GONORRHEA

OMP I - functions as a porin (Por) protein with OMP III → resists serum killing

OMP II - opacity (Opa) protein (renders colonies less translucent) absent in strains that cause disseminated gonococcal infections

OMP III – reduction-modifiable (Rm) proteins stimulate antibodies that binds IgG and interferes with intracellular killing

Neisseria gonorrhoeae has a capsule that plays a role in its virulence

what leads to the creamy discharge seen in n. gonorrhoeae?
Invade the mucous membranes (nonciliated columnar epi’s) → acute suppuration (creamy discharge)

Damage due to brisk inflammatory response → clinical symptoms of dysuria and discharge

Gram stain is sufficient for diagnosis of gonorrhoeae in both Males and Females

it is good for males

but for females you need to culture
Tx for gonorrhoeae?
A 25-year-old male, Mr. C, saw a physician with a complaint of purulent discharge from his penis. The diagnosis of gonorrhea was made and he was given ceftriaxone (3rd generation cephalosporin) by intramuscular injection. He improved initially but over the last 3 days he noticed a milder but persistent urethral discharge and pain on urination. Worried that he may not have been cured, he went to a Sexually Transmitted Disease Clinic for evaluation. He reported having no sexual intercourse since his last visit. His latest sexual partner, Ms. G, accompanied him to the clinic, although she had no complaints of pain, vaginal irritation, or discharge.
Mr. C had a small amount of clear urethral discharge.
Ms. G was found to have a greenish discharge emanating from her cervical os. Her cervix was inflamed and bled easily when a swab was used to remove adherent secretions.
Gram stains of both Mr. C and Ms. G revealed numerous neutrophils but no evidence of Gram-negative diplococci.

What is the likely cause of this infection?
Chlamydia can exist in 2 forms, what are they?
Elementary body: Infectious

Reticulate body: nonifectious (growing)
What serotypes of chlamydia trachomatis causes classic chlamydia (including: Nongonococcal urethritis, Reiter’s syndrome, proctitis, mucopurulent cervicitis, salpingitis, neonatal conjunctivitis, infant pneumonia)
Pathogenesis of Chlamydia?
Chlamydia attach to cells and become phagocytized

Avoid lysosomal fusion

Change from nonreplicating elementary bodies to metabolically active reticulate bodies****

Replicate and develop into elementary bodies (infectious)

Leave host cell → lysing it in process

Initiate new infection
a pt has recently moved the middle east and presents with blindness. It appears that keratoconjunctivitis has developed and progressed to conjunctival and corneal scarring, which lead to the blindness... What was the cause of this?
Chlamydia trachomatis A,B,or C Serotype


DOC: tetracyclines or Sulfonamides
10-40% of women with untreated chlamydial or gonococcal cervicitis develop what?
pelvic inflammatory disease (PID) particularly in teens due to ectopy

15-25% of women with PID become infertile
Risk of tubal pregnancy > 8X after PID
Cause spontaneous abortions, stillbirths, premature delivery, low birth weight and permanently disabling infant infections
What is cervical ectopy? why is it important?

Ectopy also makes the cervix more susceptible to Chlamydial and gonorrheal infections as well as to HIV infections. (common in teens, will normally regress)

growth of cervical tissue into the vagina
Clinical features: initial symptoms may be ulcer on the genitalia → suppurative inquinal adenitis → lymphatic obstruction and rectal strictures

what does this pt have? serotype?
pt has Lymphogranuloma venereum

due to C. trachomatis (L1, L2, and L3)

other sx (from the web):
Drainage through the skin from lymph nodes in groin

Blood or pus from the rectum (blood in the stools)

Painful bowel movements (tenesmus)

Swelling of the labia
pt presents with a vaginal pH > 5 with the release of amine-like odor. Clue cells are present in the gram stain...what is this? species that cause it
Bacterial Vaginosis

Gardnerella vaginals; Mobiluncus sp (curved anaerobic gram neg rod)

part of normal flora, not acquired sexually, do not need to treat partner
Malodorous, frothy discharge associated with burning, itching and chafing.
Diffuse vaginal erythema ...what is this? cause?

Trichomonas vaginalis
sores followed by rash should make you think?

--treponema pallidum
pt presents with a single painless ulcer on the genitalia....

--treponema pallidum

enter through microabrasion
in a man with syphilis, which is infective, the chancre or the rash?
after the rash, what can long term untreated syphilis lead to? 3

CV syphilis

Neural Syphilis
what stage of syphilis is this?

Usually a single chancre develops after ~3 weeks
Chancre appears at the site where Treponema entered the body
Chancre last about a month
Primary Syphilis
what stage of syphilis is this:

Skin rash is characteristic
Skin lesions are infectious
Rash will resolve with or without treatment
About 1/3 will cure spontaneously
Secondary syphilis
what stage of syphilis is this:

Gummas develop in skin or other tissues, characterized by granuloma formation (cellular hypersensitivity reaction)
Tertiary Syphilis

Treponema pallidum cannot be grown in culture
What anti-body will be positive in 99% of syphilis pts?
Wasserman Ab

in RPR
What is the confirmatory test for syphilis?

FTA-absorption test
to diagnose neurosyphilis, what must you do?
must do VDRL test with cerebral spinal fluid
Tx for Syphilis?
Pen G
soft chancre = ?

painful or painless?
Haemophilus ducreyi


bleeds easy
Itchy, reddish papules in the webs of the fingers, arm pits, and genital region...