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TCM (microbio) > 2_ Sexually transmitted Disease and Virus. > Flashcards

2_ Sexually transmitted Disease and Virus. Flashcards

1
Q

What is the morphology of the treponema​ organism?

A
  1. Poorly staining G(-) spirochete (helical spiral) that is best seen with silver impregnation.
  2. Virulence: no specific virulence factors
  3. Metabolism: Glycosaminoglycans (potentially host-derived) and high lipid content. Require pH 7.2-7.4, temperature of 30-37 C and microaerophilic environment.
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2
Q

What mechanisms can treponema​ use to evade and infect hosts?

A
  1. Poorly staining G(-) spirochete (helical spiral) that is best seen with silver impregnation.
  2. Virulence: no specific virulence factors
  3. Metabolism: Glycosaminoglycans (potentially host-derived) and high lipid content. Require pH 7.2-7.4, temperature of 30-37 C and microaerophilic environment.
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3
Q

The treponema would require what type of environment to allow them to thrive?

A
  1. Poorly staining G(-) spirochete (helical spiral) that is best seen with silver impregnation.
  2. Virulence: no specific virulence factors
  3. Metabolism: Glycosaminoglycans (potentially host-derived) and high lipid content. Require pH 7.2-7.4, temperature of 30-37 C and microaerophilic environment.
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4
Q

What pathogen is sexually transmitted and capable of causing lymphoplasmacytic vasculitis and granulomas?

A
  1. treponema pallidum pallidum
  2. Cause syphilis
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5
Q

The treponema pallidum pallidum pathogen is G(-) pathogen with silver impregnation staining. What is the disease process induced by this organism?

A
  1. Lymphoplasmacytic vasculitis
  2. Granuloma
  3. Syphilis
    1. mostly painless, evolving disease with 3 stages.
    2. 10-90 incubation period with hard chancre on genitals.
    3. 2-24 weeks later can develop into disseminating rashes and infectious condyloma lata (secondary syphilis).
    4. tertiary develops years later with appearance of gumma
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6
Q

Describe the infantile form of congenital syphilis.

A

Symptoms common within 2 yr of life. Variable based on specific organism.

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7
Q

Describe the tardive form of congenital syphilis.

A

Symptoms appear after the age of two with Hutchinsons triad (interstitial keratitis, notched incisors, sensorineural hearing loss)

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8
Q

Hutchinson triad is commonly seen at what age, from what pathophysiology, and what are the three symptoms?

A
  1. Seen after age 2.
  2. Seen in congenital syphilis, after age two.
  3. Interstitial keratitis, Notched incisors, Sensorineural hearing loss (CN VIII)
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9
Q

What are the typical diagnostic test for treponema pallidum pallidum?​

A
  1. Anticadriolipin serology or VDRL
  2. Direct treponemal antibody test
  3. Darkfield/fluorescent antibody
  4. Wasserman test: was used, but pt developed antibodies to anticardiolipin producing false-positives.
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10
Q

True/False:

Treponema can be grown in vitro.

A

False, they are not able to be grown in vitro.

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11
Q

What are the treatments for all treponema infections?

A

Benzathine, penicillin G intravenous injection.

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12
Q

WHat pathogen appears as gram negative “coffee bean” diplococci?

A

Neisseria

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13
Q

What are the important virulence factors that Neisseria organisms contain?

A
  1. Fimbrie: aid in attachment.
  2. Porin A/B: proinvasive, antigenic. Used for serological testing.
  3. Opa Proteins: facilitate adherence and invasion.
  4. LPS endotoxin: damages ciliated epithelial cells in fallopian tubes.
  5. Extracellular proteases: Cleaves the proline-threonine bond in IgA.
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14
Q

What is the role of fimbriae?

A

Aid in attachment to plasma membrane. Seen in Neisseria

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15
Q

What is the role of Porin A or Porin B?

A

A pro-invasive, antigenic virulence factor used for some serological testing. Found in Neisseria​ organisms.

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16
Q

What is the role of Opa proteins?

A

Increase the adherence and invasion of pathogens. Seen in Neisseria organisms.

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17
Q

What is the role of LPS endotoxin?

A

The endotoxin is released to damage the ciliated epithelial cells of fallopian tubes. Utilized by Neisseria organism.

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18
Q

For which Neisseria are humans the only host?

A

Neisseria gonorrhoeae

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19
Q

What are the common themes seen with a N. gonorrhoeae infection?

A
  1. RElatively painless
  2. age group 15-29
  3. Men have urethral exudate.
  4. Female are infected in cervix with minimal symptoms; some develop PID.
  5. Lead to pharyngeal and anorectal infections.
  6. Cause sepsis with C5-C9 deficient.
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20
Q

A 27 y/o male presents to clinic with purulent urethral discharge anal itching and pain (proctitis). What is most likely the cause of his symptoms?

A

Neisseria gonorrhoeae infection. Potential to lead to C5-C9 deficiency.

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21
Q

What diagnostic test could be run to test the presence of N. gonorrhoeae?

A
  1. Urethral exudate Gram negative inctracellular diplococci.
  2. nucleic acid hybridization test.
  3. Thayer-Martin VCN lysed RBC media in order to culture.
  4. PCR
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22
Q

What are the recommended treatments for N. gonorrhoeae infection?

A
  1. Ceftriaxone with axithromycin or doxycycline.
  2. penicillin and quinolones are no longer used due to resistance development.
  3. use of condoms.
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23
Q

What would the chlamydia look like under microscopy?

A

Coccoid to short rod, gram negative intracellular bacteria.

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24
Q

What are common group characteristics of chlamydia?

A
  1. Coccoid, gram-negative intracellular bacteria.
  2. Obligate intracellular parasite.
  3. Contain infectious elementary bodies that internalized by host cells.
  4. Reticulate (initial) bodies are the replicative form.
  5. unable to form ATP, must use ATP/ADP translocator to steal host’s
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25
Q

Of the chlamydia group, what is the sexually transmitted pathogen?

A

​C. trachomatis

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26
Q

What are the diseases that C. trichomatis serovars D-K are able to cause?

A
  1. Serovars D-K:
    1. nongonococcal urethritis, epididymitis, cervicitis, pharyngitis, salpingitis, endometriosis, PID, inclusion conjunctivitis.
  2. Serovars L1-L3:
    1. lymphogranuloma venereum (common in men where early detection leading to small painless papule or pustule.
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27
Q

What is the pathophysiology of the C. trachomatis​ serovar L1-L3?

A
  1. Serovar L1-L3:
    1. Lymphogranuloma venereum with early infection/detection leading to small painless papule or pustule with tender lymph.
  2. Serovar D-K:
    1. nongonococcal urethritis, epididymitis, cervicitis, pharyngitis, salpingitis, endometriosis, PID.
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28
Q

What diagnostic testing can be used to detect C. trachomatis infection?

A

Nucleic amplification testing. Pap smear identification. Cell culture.

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29
Q

What are the preventative methods to prevent C. trachomatis infection?

A

Antibiotics (vary with presentation), condoms, avoid bird handling.

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30
Q

What is the morphology of the Haemophilus group?

A

gram negative coccobacilli.

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31
Q

What is a Gram-negative coccobacilli, non-motile, facultative anaerobe. Using capsule and LPS endotoxin as virulence factors?

A

Haemophilus

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32
Q

What are the virulence factors of Haemophilus pathogens?

A

Capsule

LPS Endotoxin

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33
Q

Can Haemophils cause a sexually transmitted disease, and if so what?

A

Yes, leads to painful soft chancre and lymphadenitis with infection of H. ducreyi.

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34
Q

What should be found on physical exam with suspected H. ducreyi infection?

A

Painful soft chancre (chancroid) and lymphadenitis.

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35
Q

What are the morphological characteristics of Klebsiella type organisms?

A

Non motile, facultative anaerobic Gram negative bacilli.

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36
Q

What are the most common virulence factors that all Klebsiella should possess?

A

Capsule and LPS endotoxin.

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37
Q

Which of the Klebsiella pathogen is transmitted sexually?

A

Klebsiella granulomatis

38
Q

What should Klebsiella granulomatis look like under microscopy?

A

Non-motile, facultative anaerobic Gram-negative bacilli.

39
Q

What pathogen is responsible for a painless genital ulcer that can ultimately lead to scarring with lymphatic blockage?

A

Klebsiella granulomatis. The disease would be Donovanosis (granuloma inguinale)

40
Q

What are the physical characteristics of the Mycoplasmataceae organisms?

A

Non-motile, facultative anaerobic lacking cell walls

41
Q

What has sterol cell membrane that could have originated from Gram positive?

A

mycoplasmataceae.

42
Q

What are the sexually transmitted mycoplasms pathogens?

A
  1. M. genitalium
  2. M. hominis
  3. Ureaplasma urealyticum
43
Q

What pathogens can cause non-gonococcal urethritis, cervicitis, and PID?

A
  1. C. trachomatis
  2. M. genitalium
  3. M. hominis
  4. Ureaplasma urealyticum
44
Q

What class are small gram variable, coccobacilli. Non-motile, facultative anaerobic with no specific virulence factors?

A

Gardnerella pathogens.

45
Q

Which gardnerella pathogen is sexually transmitted?

A

​Gardnerella vaginalis

46
Q

What is the cause of bacterial vaginosis?

A

reduced number of lactobacilli allowing for increase of anaerobic bacteria.

47
Q

Patient presents with what is bacterial vaginsosis. What pathogen would you most likely to find associated with her diagnosis?

A
  1. Gardnerella vaginalis ( located with clue cells.)​
48
Q

What type of history should you suspect for using as a diagnosis for Gardnerella vaginalis?

A
  • thin vaginal discharge
  • “Fishy” vaginal odor
  • Burning with urination
  • Asymptomatic
  • Associate with high number of sexually active partners.
49
Q

What morphology should you see on examination of herpesvirus?

A

dsDNA with large enveloping.

50
Q

What are unique group characteristics to herpesvirus?

A
  • dsDNA
  • produce intracellular inclusion and multinucleated giant cells.
  • Capable of latency and leads to recurrent infections (during immunocompromised periods)
51
Q

What are the common sexually transmitted forms of herpesvirus?

A

HSV-1

HSV-2

52
Q

Which herpesvirus contain intranuclear acidophilic Cowdry type A inclusions?

A

HSV-1

HSV-2

53
Q

Describe the disease of HSV-2

A
  1. Genital herpes: blistering of skin and mucosal regions
  2. Neonatal herpes: local or disseminated and lack of treatment leads to death
  3. Whitlows: erythematous lesion on toes or nail cuticles.
  4. Herpetic meningitis or encephalitis.

**transmitted by sexual contact or during vaginal delivery; increase HIV risk infection**

54
Q

Describe HSV-2 genital localization.

A
  • Genital herpes: blistering of skin and mucosal regions
  • Neonatal herpes: local or disseminated and lack of treatment leads to death
  • Whitlows: erythematous lesion on toes or nail cuticles.
  • Herpetic meningitis or encephalitis.

**transmitted by sexual contact or during vaginal delivery; increase HIV risk infection**

55
Q

A mother with Herpes refuses to have C-section and wants to have a vaginal delivery. What risk is she exposing her unborn fetus to?

A
  • Genital herpes: blistering of skin and mucosal regions
  • Neonatal herpes: local or disseminated and lack of treatment leads to death
  • Whitlows: erythematous lesion on toes or nail cuticles.
  • Herpetic meningitis or encephalitis.

**transmitted by sexual contact or during vaginal delivery; increase HIV risk infection**

56
Q

A patient presents with bizarre lesion on his toes, and his nail cuticles. He has a history of multiple unprotected encounters with multiple individuals. Screening with PCR, immunostaining, or cytology would most likely reveal what?

A
  • Genital herpes: blistering of skin and mucosal regions
  • Neonatal herpes: local or disseminated and lack of treatment leads to death
  • Whitlows: erythematous lesion on toes or nail cuticles.
  • Herpetic meningitis or encephalitis.

**transmitted by sexual contact or during vaginal delivery; increase HIV risk infection**

57
Q

The concern for catching and treating HSV-2, is two-fold. One is to prevent subsequent infections to other individuals. What is the second?

A
  • Genital herpes: blistering of skin and mucosal regions
  • Neonatal herpes: local or disseminated and lack of treatment leads to death
  • Whitlows: erythematous lesion on toes or nail cuticles.
  • Herpetic meningitis or encephalitis.

**transmitted by sexual contact or during vaginal delivery; increase HIV risk infection**

58
Q

What are commonly seen with HSV-1 infections?

A
  • Genital herpes: blistering of skin with mucosal lesions
  • Herpes labialis: cold sores
  • Gingivostomatitis: oropharyngeal blistering in kids
  • Fatal sporadic encephalitis: #1 cause of viral encephalitis in US

**salivary transmission**

59
Q

What is responsible for the #1 source of viral encephalitis in the US?

A

HSV-1

60
Q

What is the morphology of the papillomaviridae organisms?

A
  • circular dsDNA
  • Contain trophic for epithelial cells of the skin and mucus membranes.
61
Q

What organism is sexually transmitted within the papillomaviridae organism?

A

Human papillomavirus.

62
Q

What is the pathophysiology of the HPV infection process?

A
  1. Oncogenic transforming virus that genome is incorporated into the host genome.
  2. They produce intranuclear and cytoplasmic inclusions.
  3. The viral E6 inhibits the p53 protein and viral E7 inhibits pRB protein.
  4. allowing for rapid uncontrolled cell growth (cancer)
63
Q

What are common disease associated with HPV infection?

A
  1. Verrucae (skin warts)
  2. Condyloma (genital warts)
  3. Papilloma (cervical, anal, pahyrngeal CA)
64
Q

Which are considered the high risk HPV and what are they associated with?

A
  • Types 16, 18
  • Cause most cancers and high grade dysplasias
65
Q

Which are considered the low risk HPV types and what are they associated with?

A
  • Types 6, 11
  • associated with condyloma and oropharyngeal papilloma.
66
Q

What is the morphology of Retroviridae?

A

+ssRNA, enveloped.

Allos integration in the the host DNA, with reverse transcriptase

67
Q

What are the associated sexually transmitted pathogens of retroviridae group

A

HIV-1, HIV-2

68
Q

How are HIV spread?

A

Any type of fluid/fluid contact or pregnancy. Allows for HIV to attach to CD4 receptors and CCR5 and CXCR4 co-receptors.

69
Q

What are common symptoms you will see with a HIV-1 infection?

A
  1. lymphadenopathy
  2. fever
  3. weight loss
  4. malaise
  5. AIDS
  6. AIDS dementia: similar to alzheimer but has HIV infection of brain.
  7. Wasting syndrome.
70
Q

What are you likely to see with HIV-2 infection?

A
  1. Lymphadenopathy
  2. fever
  3. weight loss
  4. malaise
  5. AIDS
  6. AIDS dementia
  7. Wasting syndrome.

HIV-2 mostly localized to West Africa.

71
Q

What testing could be performed to verify HIV contamination?

A
  • Serology for HIV antibodies (ELISA)
  • Western Blot (antibodies against the viral protein)
  • PCR
72
Q

What are different types of retrovirals used for HIV treatment?

A
  1. nucleoside/nucleotide analogues
  2. nonnucleoside reverse transcriptase inhibitors.
  3. protease inhibitors
  4. fusion inhibitors
  5. chemokine coreceptor antagonists.
  6. integrase inhibitors.
73
Q

What is morphologically characteristic of poxviridae?

A

dsDNA with envelope. Normally replicate in the cytoplasm.

74
Q

What is the sexually transmitted pathogen within the Poxviridae group?

A
  1. Molluscum contagiosum virus
    1. contain huge intracytoplasmic inclusion bodies (molluscum bodies)
75
Q

Describe the length, and localization of the Molluscum contagiosum virus.

A

Self limited viral disease. Spread by direct contact, seen in young children and adults. Note 0.2-0.4cm umbilicated nodules on the face, trunk, and anogenital regions.

76
Q

What is the morphology of the Flaviviridae?

A

+ssRNA, enveloped. Vector-borne

77
Q

What is the sexually transmitted organism within the Flaviviridae group?

A
  1. Zika Virus:
    1. spread by Aedes mosquito, also transplacentally, and via sexual intercourse months after infection.
78
Q

How is the Zika virus most often spread?

A
  1. Aedes mosquito bite
  2. Sexual intercourse (up to months after infection occurred)
  3. transplacentally.
79
Q

The Zika virus, if infected, can lead to what later effects?

A
  1. Guillain-Barre Syndrome (ascending paralysis)
  2. Congenital malformation
    1. microcephaly, lissencephaly, hearing loss, ocular malformation.
80
Q

What is the morphology of trichomonas?

A

Flagellated unicellular protozoan with corkscrew motility

81
Q

What is the common trichomonas related sexually transmitted pathogen?

A

Trichomonas vaginalis

82
Q

Trichomonas vaginalis leads to infection as a flagellated unicellular protozoan using corkscrew motility. What disease will be caused?

A

Trichomoniasis: urethritis in males, vaginitis in females.

  • Watery yellow-green purulent vaginal fluid with malodor
  • Vaginal irritation and painful intercourse.
  • Asymptomatic.
  • Males exhibit burning on urination and ejaculation.
83
Q

You suspect trichomoniasis in your male patient due to what symptoms?

A

Urethritis, with burning on urination and with ejaculation

84
Q

You suspect trichomoniasis in your female patient due to what?

A
  • watery, yellow-green purulent fluid discharge.
  • malodor
  • vaginal irritation, with intercourse.
85
Q

What is Anoplura?

A

The sucking lice. Typically 1-2mm round body insect. Motile via 6 legs.

86
Q

What anoplura (sucking lice) can be sexually transmitted?

A
  • Phthirus pubis
    • found on pubic hair of sexually active people.
    • Leads to:
      • pediculosis pubis (crabs) with itching, nits, rash, and moving lice.
87
Q

What type of disease is caused by Phthirus pubis?

A

Pediculosis pubis (crabs)

associated with rash, moving lice, nits.

88
Q

What is the morphology of mites?

A

Round arachnid (8 legs) that are sexually transmitted

89
Q

Which type of mite is commonly sexually transmitted?

A

​Sarcoptes scabiei

90
Q

Describe an infection based on the Sarcoptes scabiei.

A
  • Microscopic superficial skin pathogen
  • Scabies with burrows in the superficial epidermis and itchy rash of wrists, dorsal foot, and genitalia.

TCM (microbio) (7 decks)

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