3: Gonorrhea and Chlamydia

Question 1

Which are relationships between N. gonorrhoeae bacteriology and pathogenesis?

A. No growth on maltose – No beer-borne transmission

B. Sensitive to dehydration & cold – sexual transmission

C. Gram(-) LOS – local inflammation

D. Flagellar motility – spread up the reproductive tract

E. IgA protease – Bacteria easily colonize mucosal surfaces

Answer 1

B. Sensitive to dehydration & cold – sexual transmission

C. Gram(-) LOS – local inflammation

E. IgA protease – Bacteria easily colonize mucosal surfaces

Question 2

The following are important SIMILARITIES between N. meningitidis and N. gonorrhoeae:

_____ protease as a virulence factor

Septic _____ as a complication

Growth on _____ medium

Answer 2

The following are important SIMILARITIES between N. meningitidis and N. gonorrhoeae:

IgA protease as a virulence factor

Septic arthritis as a complication

Growth on Thayer-Martin medium

*SInce gonorrhoeae does not have a capsule you cannot vaccinate, but N. Meningitidis does so it does have a vaccine.

Question 3

The advantages to Chlamydia of having two different forms are (EBs = elementary bodies, RBs = reticulate bodies):

_____ s are tiny and rugged – great for hopping from host to host

_____ s are large and complex – great for efficiently producing progeny

_____ s are too compact to efficiently reproduce; _____ s are too delicate to survive outside a host cell

Answer 3

The advantages to Chlamydia of having two different forms are (EBs = elementary bodies, RBs = reticulate bodies):

EBs are tiny and rugged – great for hopping from host to host

RBs are large and complex – great for efficiently producing progeny

EBs are too compact to efficiently reproduce; RBs are too delicate to survive outside a host cell

Question 4

What’s the difference between a C. trachomatis infection leading to Lymphogranuloma Venereum versus one that leads to regular genital chlamydia?

Answer 4

The serovar of C. trachomatis that does the infecting

Question 5

A patient to whom you prescribed doxycycline for a Chlamydia infection a month ago is back with a recurrence of symptoms. What happened?

Answer 5

Reinfection from her untreated partner: counsel simultaneous treatment

Question 6

N. gonorrhoeae Virulence factors: _____ protease, pili, LOS, Porins, Opa

Answer 6

N. gonorrhoeae Virulence factors: IgA protease, pili, LOS, Porins, Opa

Question 7

N. gonorrhoeae = gram(_____) _____ cocci, _____/facultative, human-restricted, oxidase-_____, catalase-_____

Answer 7

N. gonorrhoeae = gram(-) diplococci, aerobic/facultative, human-restricted, oxidase-positive, catalase-positive

Question 8

N. gonorrhoeae Growth _____ on blood agar and overgrown by normal flora on nonselective media: use Thayer-Martin if _____ flora (genital, nasopharyngeal), _____ if normally-sterile (CSF, blood)

Answer 8

N. gonorrhoeae Growth inhibited on blood agar and overgrown by normal flora on nonselective media: use Thayer-Martin if normal flora (genital, nasopharyngeal), chocolate if normally-sterile (CSF, blood)

Question 9

N. gonorrhoeae: Host defends with IgG-enhanced complement and PMNs, usually contains gonococcus. Complement _____ predisposes to complications.

Answer 9

N. gonorrhoeae: Host defends with IgG-enhanced complement and PMNs, usually contains gonococcus. Complement deficiency predisposes to complications.

Question 10

N. gonorrhoeae: Asymptomatic/Untreated gonococcus in women leads to _____

Answer 10

N. gonorrhoeae: Asymptomatic/Untreated gonococcus in women leads to PID (pelvic inflammatory disease)

Question 11

N. gonorrhoeae Other serious complications follow bacteremia: DGI, _____ arthritis, meningitis, endo _____

Answer 11

N. gonorrhoeae Other serious complications follow bacteremia: DGI, septic arthritis, meningitis, endocarditis

DGI = Disseminated infection

Question 12

N. gonorrhoeae Neonates must be protected by _____ eye ointment

Answer 12

N. gonorrhoeae Neonates must be protected by prophylactic eye ointment

*Neonatal conjunctivitis: prophylactic application of erythromycin ointment or silver nitrate to eyes shortly after birth

Question 13

N. gonorrhoeae Test with _____ and _____ stain of appropriate samples; DNA testing available

Answer 13

N. gonorrhoeae Test with culture and gram stain of appropriate samples; DNA testing available

Question 14

_____ are effective protection against N. gonorrhoeae when used correctly

Answer 14

Condoms are effective protection against N. gonorrhoeae when used correctly

Question 15

Treat N. gonorrhoeae with _____, _____, admit if complications

Answer 15

Treat N. gonorrhoeae with ceftriaxone, cefotaxime, admit if complications

Question 16

Chlamydia trachomatis is a small, _____ intracellular bacterium (so must use drugs that penetrate the human cell membrane).

Answer 16

Chlamydia trachomatis is a small, obligate intracellular bacterium (so must use drugs that penetrate the human cell membrane).

Question 17

Chlamydia replicate in a unique manner beginning with tiny, infectious, rugged, _____ bodies which “unpack” into _____ bodies after infection.

Answer 17

Chlamydia replicate in a unique manner beginning with tiny, infectious, rugged, elementary bodies which “unpack” into reticulate bodies after infection.

Question 18

Chlamydia Reticulate bodies form intracellular _____ that are visible on microscopy; within the inclusions they multiply by _____ fission, forming new reticulate bodies and later new elementary bodies.

Answer 18

Chlamydia Reticulate bodies form intracellular inclusions that are visible on microscopy; within the inclusions they multiply by binary fission, forming new reticulate bodies and later new elementary bodies.

Question 19

Chlamydia’s Unusual life cycle complicates research; one known virulence factor is _____ used for entry & establishing inclusion body.

Answer 19

Chlamydia’s Unusual life cycle complicates research; one known virulence factor is T3SS used for entry & establishing inclusion body.

Question 20

_____ causes Lymphogranuloma Venereum, blinding trachoma, and pneumonia (Unit 4) in addition to urogenital “chlamydia”

Answer 20

C. trachomatis causes Lymphogranuloma Venereum, blinding trachoma, and pneumonia (Unit 4) in addition to urogenital “chlamydia”

Question 21

Chlamydia Treatment can often be initiated based on _____ findings, additional diagnostics are available and may be desired in various situations (tissue culture for C. trachomatis in _____ victims).

Answer 21

Chlamydia Treatment can often be initiated based on physical findings, additional diagnostics are available and may be desired in various situations (tissue culture for C. trachomatis in rape victims).

Question 22

Treat Chlamydia with _____ EXCEPT for pregnant/pediatric/allergic patients, who get _____ or other alternatives. Patients who get alternatives may need follow-up testing and retreatment.

Answer 22

Treat Chlamydia with tetracyclines (doxycycline) EXCEPT for pregnant/pediatric/allergic patients, who get erythromycin or other alternatives. Patients who get alternatives may need follow-up testing and retreatment.

Question 23

_____ are effective protection vs Chlamydia when used correctly.

Answer 23

Condoms are effective protection vs Chlamydia when used correctly.

Question 24

Immune complement is important in Neisseria infections because

A.  It always contains the infection at the local site

B.  It often clears  N. gonorrhoeae infections before symptoms can develop

C.  Individuals with complement deficiencies are at higher risk of complications from Neisseria infections

D.  N. gonorrhoeae pili are necessary to defend against it

Answer 24

C. Individuals with complement deficiencies are at higher risk of complications from Neisseria infections

Question 25

Your new lab tech never successfully cultures Neisseria from endocervical samples, but can grow it fine from septic joint fluid, CSF, or blood. What’s going on?

The lab is contaminated with Neisseria-killing fungus

He’s culturing the samples on blood agar

He’s culturing the samples on nonselective chocolate agar

He’s faking his lab reports

Answer 25

He’s culturing the samples on nonselective chocolate agar

Question 26

3) What is Most Unusual about the replication of Chlamydia?

A.  Chlamydia replicates within human host cells

B.  Chlamydia requires ATP as an energy source

C.  Chlamydia forms two morphs: reticulate and elementary bodies

D.  Chlamydia cannot replicate in the presence of doxycycline

Answer 26

C. Chlamydia forms two morphs: reticulate and elementary bodies

Question 27

4) Why does urogenital Chlamydia infection remain so prevalent, now that it can be cured by a relatively cheap antibiotic?

A.  Asymptomatic infections form a reservoir

B.  People still don’t use condoms

C.  A treated patient can be reinfected by his/her untreated partner

D.  All of the above

Answer 27

D. All of the above

Question 28

Chlamydia & N. gonorrhoeae can both cause _____ disease in women.

Answer 28

Chlamydia & N. gonorrhoeae can both cause pelvic inflammitory disease in women.