175 - Gonorrhea, Mycoplasma, and Vaginosis (INCOMPLETE) Flashcards
Gram-negative, aerobic coccus-shaped bacterium found in pairs
Visualized intracellularly, located within PMN leukocytes
Neiserria gonorrhea
Gonococcal infections were termed _____ in the 16th century in Europe
“The clap”
Before the advent of antibiotic, _____ were used to treat gonorrhea
Silver preparations including silver nitrate and silver proteinate
The prevalence of gonorrhea will be slightly higher in
Women
Incubation period of gonorrhea in men
Typically from 2-8 days
Most gonorrhea infections in men are symptomatic by _____ after exposure
2 weeks
Most common manifestation of gonococcal infection in men
Urethritis
Entire distal penis becoming swollen in gonorrhea
Bull head clap
Epididymitis is more commonly caused by
Chlamydia trachomatis or by combined infection with N. gonorrhea
_____% of women infected with N. gonorrhea are asymptomatic
50
Y/N: Vaginitis does not occur except in prepubertal girls and postmenopausal women because the vaginal epithelium of sexually mature women does not support the growth of N. gonorrhea
Yes
Manifestation of gonococcal infection manifesting in those who practice unprotected anoreceptive intercours
Proctitis
Gonococcal proctitis is most common in
MSM
Classic triad of disseminated gonococcal infection
Dermatitis
Migratory polyarthritis
Tenosynovitis
Disseminated gonococcal infection occurs in _____%
0.5-3
Skin findings of disseminated gonococcal infection
Small- to medium-sized macules or, most typically, hemorrhagic vesicopustules on an erythematous base located on palms and soles or on the trunk and elsewhere on the extremities
Term to describe the cutaneous lesions of DGI
Gun metal gray
Y/N: On the palms and soles, DGI lesions may be tender, but in other sites, they tend to be both nonpruritic and painless
Yes
Histologic findings of cutaneous lesions of DGI
Perivascular neutrophilia, dermal vasculitis, and epidermal neutrophil infiltration
Symptoms of PID tend to occur or worsen at the time of
Menses
Inflammation of the liver capsule associated with GU tract infection
Fitz-Hugh-Curtis syndrome
Whereas true septic arthritis caused by gonorrhea is more typically (monoarticular or pauciarticular/polyarticular), (monoarticular or pauciarticular/polyarticular) disease is most often associated with active bacteremia
Monoarticular or pauciarticular
Polyarticular
Gonococcal meningitis tends to be (more/less) severe than meningococcal meningitis
Less
Gonococcal endocarditis represents a rare complication of disseminated disease, affecting _____% of those with disseminated gonococcus
1-2
Serious complication that often fails antimicrobial therapy and requires surgical interventions
Gonococcal endocarditis
Neonates may acquire N. gonorrhea during passage through the birth canal from contact with infected secretions
Characterized by profuse, purulent ocular discharge and can lead to severe corneal perforation of scarring
Ophthalmia neonatorum
Prophylactic use of _____ for prevention of ophthalmia neonatorum
Silver nitrate drops
Erythromycin, or tetracycline ophthalmic ointment
Pharyngeal or genital gonococcal infection in children is often a sign of
Sexual abuse
Released by N. gonorrhea during periods of rapid growth and contributes to its pathogenesis in disseminated infection
Lipooligosaccharide endotoxin
Y/N: Humans are the only natural hosts of N. gonorrhea
Yes
Because of high specificity (>99%) and sensitivity (>95%), _____ that demonstrates PMN leukocytes with intracellular gram-negative diplococci can be considered diagnostic for infection with N. gonorrhea in symptomatic men
Gram stain of a urethral specimen
Y/N: A negative Gram stain result can be considered sufficient for ruling out gonococcal infection in asymptomatic men at high risk for infection
No - cannot be considered
Y/N: In contrast to urethral Gram stains, the sensitivity of Gram stain in endocervical swabs is less than 35% and should not be used as a screening tool in women
Yes
_____ specimens are never recommended for diagnostic purposes because the _____ mucosa resists gonococcal invasion
Vagina
Vaginal
Has been the “gold standard” diagnostic test for years in the diagnosis of gonorrhea
Bacterial culture
Culture of N. gonorrhea can be performed on _____ medium
Modified Thayer-Martin
Provide more rapid diagnosis
Highly sensitive and specific and may be able to detect even the presence of one organism
Nucleic acid amplification tests
Diagnosis via any nonculture method does not allow for
Antibiotic sensitivity testing
Y/N: Previously treated gonococcal infection reduces the risk of reinfection
No - does not reduce the risk
First-line treatment of patients with N. gonorrhea
Combination of ceftriaxone and azithromycin
Ceftriaxone 250 mg IM single dose plus
Azithromycin 1 g PO single dose
About _____% of people with gonococcal infection are coinfected with Chlamydia
10-30
Recommended regimen for DGI affecting the joints
Ceftriaxone 1 g IM/IV every 24 hours for 7 days plus
Azithromycin 1 g PO single dose
Treatment for gonococcal meningitis and endocarditis
Ceftriaxone 1-2 g IV every 12-24 hours for 10-14 plays plus
Azithromycin 1 g PO single dose
Treatment for gonococcal infection in neonates
Ceftriaxone 25-50 mg/kg/day IV/IM in a single daily dose for 7 days or 10-14 days if meningitis is documented or
Cefotaxime 25mg/kg IV/IM every 12 hours for 7 days, or for 10-14 days if meningitis is documented
Treatment of partners of _____ patients diagnosed with gonorrhea empirically is as or more effective that the traditional reliance on referral, testing, and as-needed treatment. No studies have evaluated empiric treatment of gonorrhea (or chlamydia) in _____
Female or heterosexual male
MSM
The CDC currently recommends _____ screening of men who engage in receptive anal intercourse, all sexually active women younger than 25 years old, any woman with a new sex partner, multiple sex partners, or a sex partner with a known STI. Other at-risk populations include those who are not in monogamous relationships, have a current or past history of STIs, or who exchange sex for money or drugs
Yearly
Smallest free-living, self-replicating bacteria
Developed by degenerative evolution from lactobacilli
Mycoplasma
Mycoplasma (have/lack) a cell wall
Lack
Mycoplasma routinely colonize the _____ tracts of humans
Respiratory
Urogenital
Referred to as the genital mycoplasmal organisms
Mycoplasma spp
other Ureaplasma spp
Most common strains of Mycoplasma
Mycoplasma hominis
Mycoplasma genitalium
Rates of colonization with Mycoplasma tend to be lower in _____, except in the setting of HIV coinfection
Men
Y/N: The detection of M. hominis in a urethral smear is irrelevant to NGU because it is thought to be a commensal organism with low virulence
Yes
Most common cutaneous disease in men with mycoplasma infection
Urethritis
Most common cutaneous disease in men with mycoplasma infection
Cervicitis
Y/N: There is a clear relationship between genital mycoplasma and epididymitis or prostatitis
No - no clear relationship
The abundance of _____ to metabolize predisposes Ureaplasma spp to the urinary tract
Urea
Y/N: All genital mycoplasmas multiply as parasites because they are unable to complete various metabolic reactions
Yes
Required for growth of Mycoplasma and is taken from the epithelial cell
Cholesterol
Y/N: Mycoplasma spp tend to migrate away from mucosal surfaces
No - tend to remain localized to mucosal surfaces
Mycoplasmas are slow-growing organisms, and culture can take up to _____ to speciate
6 months
M. hominis and U. urealyticum can be cultured on special media, which is enriched with _____ as a nutrient source
Horse serum
Preferred method of testing for Mycoplasma
NAAT
Preferred specimen to submit when the reference laboratory plans to use NAAT for Mycoplasma
First-voided urine
FDA-approved diagnostic laboratory test for detection of Mycoplasma spp
None
Y/N: Gram stain will not detect Mycoplasma spp
Yes
Because Mycoplasma spp lack a cell wall, they are inherently resistant to _____ antibiotics because these drugs target cell wall synthesis
Beta-lactam
Cephalosporin
Treatment for mycoplasma urethritis
Azithromycin 1 g PO single dose or
Azithromycin 500 mg PO on day 1 + 250 mg PO for 4 days or
Moxifloxacin 400 mg/day for 7-14 days
In macrolide-resistant mycoplasma infection, consider a course of _____ and retesting of patients 3 to 4 weeks after therapy completion to assess for clearance
Oral moxifloxacin
If M. genitalium is isolated or if the patient does not respond to treatment on standard PID regimens, the CDC recommends consideration of treatment with
Moxifloxacin 400 mg/day for 14 days
Y/N: The CDC does not currently recommend routine screening for mycoplasma infection
Yes
Chlamydia primarily affects the mucous membranes of the
Ophthalmic, genitourinary, and respiratory systems
Most frequently reported STI
Chlamydia trachomatis
Most common manifestation of C. trachomatis infections
Urogenital infections
Most common site of C. trachomatis infection in men
Urethra
Most common site of C. trachomatis infection in women
Urethra
Cervix
The discharge in (chlamydia/gonococcal) urethritis is more purulent and profuse
Gonococcal
Y/N: In urethritis, there is considerable clinical overlap, and neither the nature of the discharge nor the severity of accompanying dysuria can be reliably used to make a specific diagnosis
Yes
Most common causes of epididymitis in male patients younger than 35 years of age
C. trachomatis
N. gonorrhea
Y/N: The majority of women with urogenital C. trachomatis infections are symptomatic
No - asymptomatic
Neonatal conjunctivitis or ophthalmia neonatorum may result from
Gonorrhea or chlamydia infections
Ophthalmia neonatorum typically presents _____ after birth and is characterized by a purulent ocular discharge with erythema and swelling of the eyelids
1-2 weeks
Neonatal chlamydial pneumonia typically presents within _____ of birth and is characterized by nasal symptoms, tachypnea, and cough
8 weeks
The cough of neonatal chlamydial pneumonia is _____ in nature
Staccato
Y/N: Wheezing is typically absent in neonatal chlamydial pneumonia
Yes
In neonatal chlamydial pneumonia, peripheral _____ may be observed, and patients may be prone to developing _____ later in life
Eosinophilia
Asthma
Individuals with the histocompatibility marker _____ are at increased risk of developing reactive arthritis
HLA-B27
Nonmotile, gram-negative, obligate intracellular bacteria that replicates within human cells
C. trachomatis
Two-phase life cycle of C. trachomatis
Elementary body
Reticulate body
Infectious form of C. trachomatis
Elementary body
Enters the host epithelial cell via endocytosis, resulting in the formation of a chlamydial inclusion
Elementary body
C. trachomatis serovar: chronic conjunctivitis and trachoma
A through C
C. trachomatis serovar: urogenital infections
D through K
C. trachomatis serovar: lymphogranuloma venereum
L1 through L3
C. trachomatis symptoms occur _____ after exposure
1-3 weeks
Preferred method of testing for C. trachomatis
Approved by the FDA for the diagnosis of urogenital infections caused by C. trachomatis
NAAT
Most sensitive test available and as specific as culture for diagnosing C. trachomatis infection
NAAT
Y/N: NAATs are not FDA approved for the diagnosis of infection at rectal and oropharyngeal sites for infections caused by C. trachomatis
Yes
NAATs only detect the DNA or RNA of chlamydial species and may remain positive up to _____ after treatment
3 weeks
First-line treatment of chlamydial infections
Doxycycline 100 mg twice daily for 7 days
Azithromycin single 1-g dose
Most common vaginal infection in women ages 15-44 years
Bacterial vaginosis
Protective against development of BV
Hormonal contraception
In BV, there is a decrease in the population of _____ species
Lactobacilli
Large rod-shaped organisms that help maintain the acidic pH of healthy vaginas and inhibit other anaerobic microorganisms
Lactobacilli
The number of asymptomatic BV infection is as high as _____%
84
White or gray vaginal discharge and fishy odor, especially after contact with alkaline semen during intercourse
Milky, homogenous vaginal coating may be seen adherent to the vaginal wall
Bacterial vaginosis
Criteria for diagnosing BV
Amsel criteria
Components of the Amsel criteria
- Profuse milky vaginal discharge
- A positive whiff test result (presence of a fishy odor when secretions are exposed to 10% or 20% potassium hydroxide)
- A vaginal fluid pH greater than 4.5
- Presence of clue cells greater than 20% on microscopic examination
According to the Amsel criteria for diagnosing BV, _____ of the four findings must be present
Three
Squamous epithelial cells covered by coccobacilli that give the cytoplasm a ground-glass appearance and obscure the crisp margins of the cell, leaving ragged borders
Clue cells
Most reliable indicator of BV
Presence of clue cells representing at least 20% of epithelial cells
Method involving the use of gram staining to distinguish between the normal bacterial flora of gram-negative rods and lactobacillli from the gram-negative morphotypes seen in BV
Nugent method
Because of the variety of bacterial species, _____ is not a reliable diagnostic test for BV
Nugent method
Y/N: There are reports of cases of BV that may resolve on their own without therapy
Yes
Treatment in asymptomatic BV is not necessary in
Women who are not pregnant
Sometimes used for BV mainly to help with repopulation of normal lactobacilli to prevent recurrence
Probiotics
