bacterial sexually transmitted infections

Question 1

chlamydia
what is unique about it?
what bacteria causes it?
what does it cause?

Answer 1

special: classified as bacteria BUT replicate ONLY within cells as it can’t make it’s own ATP and lack peptidoglycan (but have gram - like envelope-can’t detect with gram stain)
caused by- chlamydia trachomatis
cause- genital infections and conjunctivitis, infant pneumonia, trachoma (roughing of inner surface of eyelids), lymphogranuloma venereum

Question 2

what are the life stages of chlamydia and chlamydophila

Answer 2

elementary bodies- infectious form-rigid cell wall for extracellular survival
reticulate form- replicative form-has fragile cell wall and is intracellular

Question 3

what’s the main form of chlamydia found to cause disease

Answer 3

chlamydia trachomatis

Question 4

what are biovars and what are the two associated with c. trachomatis

Answer 4

• biovars are forms of c/ trachomatis that have different biochemistry
• trachoma( urogenital problems) and LGV (most invasive

Question 5

what are c. trachomatis tropisms

Answer 5

-nonciliated columnar cuboidal and transitional epithelial cells like urogenital and conjunctival places

Question 6

pathogenesis of chlamydia

Answer 6

-c. trachomatis causes destruction of epithelia and proinflammatory cytokine response that can, without treatment, lead to fibrosis and infertility

Question 7

what do these serovars cause?
a, b, Ba, and C -
D-K-
L1, L2, L2a, L2b, L3-

Answer 7

a, b, Ba, and C -trachoma
D-K- urogenital tract disease
L1, L2, L2a, L2b, L3- lymphogranuloma venereum

Question 8

what is trachoma caused by and how is it transmitted?

Answer 8

• c. trachomatis
• it is a chronic conjunctivitis that is transmitted eye-to-eye by droplets, hands, clothing, and flies (especially where there’s a shortage of water or numerous flies present)
• leading cause of preventable blindness in the world

Question 9

what is a tell-tail sign of adult conjunctivitis? neonatal?

Answer 9

adult- mucopurulent discharge, keratitis, corneal infiltrates
neonatal- incubate up to 12 days post birth and then have swelling of eyelids and discharge

Question 10

what are symptoms of chlamydia in men vs women

Answer 10

men

• most are symptomatic
• mucopurulent discharge
• dysuria
• epidymitis, prostatitis and may progress reiter syndrome- urethritis, conjunctivitis, polyarthritis (CUP)

women

• often asymptomatic- reservoir
• mucopurulent discharge
• pelvic inflammatory disease- inflam of reproductive organs
• abdominal pain
• can cause scarring and sterility or ectopic pregnancy

Question 11

reiter syndrome

Answer 11

cup
conjunctivitis, urethritis, polyarthritis
in men with chlamydia
-caused by prolonged chlamydia

Question 12

lymphogranuloma vernereum (LGV)

Answer 12

• caused by serovars L1-3 of chlamydia trachomatis
• invasive
• prevalent in Africa, asia, south America- recently traveled sexually active individual
• patient presents with lesion that is painless
• get swelling and inflammation of lymph nodes that drain the site of initial infection = called INGUINAL LYMPHADENOPATHY
• nodes can become supurative and rupture forming fistulas
• proctitis can also result

Question 13

diagnosis and treatment of c. trachomatis

Answer 13

• diagnosis-
  scraping of cervix or urethra or conjunctiva
  1) stain with IODINE -identifies GLYCOGEN IN RETICULAR BODIES
  -also see cytoplasmic inclusions of elementary bodies and reticular bodies
  2) can also immunoflores elementary bodies with elisa
  *3) PCR nucleic acid amplification test from urine or urethral discharge are considered test of choice

Question 14

treatment for c trachomatis

Answer 14

doxcyline and macrolides

Question 15

prevention for c trachomatis

Answer 15

• control re-infection- infections doesn’t confer immunity

- safe sex, early detection and treatment of symptomatic patients with their sex partners

Question 16

would you prescribe a beta lactam to a chlamydia pt?

Answer 16

no because c. trachomatis does not have peptidoglycan

Question 17

how do macrolides and doxycline work

Answer 17

inhibit protein synthesis

Question 18

type of bacteria that causes gonorrhea and it’s features

Answer 18

-Neisseria gonorrhoeae
-gram negative, anaerobic, free living, diplococci
catalase pos
non spore forming
looks like kidney bean

Question 19

how do you tell the difference between N. meningitides and n. gonorrhoeae

Answer 19

• can’t distinguish under microscope
• see how they react to sugars and look at sites of primary infection
• N. meningitides ferments maltose and N gonorrhoeae does NOT
• N gonnorrhoeae doesn’t have a capsule

Question 20

what type of virulence factors does N. gonorrhoeae have?

Answer 20

• PILIN (ATTACHMENT)
• porin- promotes intracellular survival
• opa protein that attaches to surface of eurkaryotic cells
• LOS- LIPOLIGOSACCHARIDE- LIKE LPS IN GONORRHEA
• IgA protease
• BETA LACTAMASE

Question 21

LOS- lipooligosaccharide

Answer 21

• LOS changes the way it looks to allow it to escape immune defense

Question 22

when is a patient more at risk for dissemated infections of N. gonnorhoeae

Answer 22

when the patient has deficiencies in late components of complement c5b-9 (membrane attack complex)

Question 23

pathogenesis of gonorrhea

Answer 23

• gonococci attach to mucosal cells (via pili, porB or opa)
• penetrate cells and multiply
• pass thru cells to subepithelial space where infection is established -usually cervix for women
• LOS stimulates inflammation- chemokines and TNF alpha (proinflammatory cytokine) which is responsible for symptoms

Question 24

symptoms of gonorrhea

Answer 24

• MUCOPURULENT DISCHARGE at involved site, urethra, epididymis, cervix, anus
• DYSURIA after 2-5 days
• most men have acute symptoms/women can be asymptomatic
• men- epididymitis, prostatitis, periurethral abscesses
• women- salpingitis (inflame of fallopian tubes), tubovarian absesses, PID (pelvic inflammatory disease)
• pharyngitis, conjunctivitis in neonates obtained during birth

Question 25

why do we get a mucopurulent discharge in gonorrhea pt

Answer 25

• because cause an inflammatory response and neutrophils are the first to the site of infection and they actively phagocytose the bacteria and we see their white color there and that white stuff is filled with bacteria

Question 26

what occurs in disseminated infections

Answer 26

• septicemia and infection of skin and joints

- suppurative arthritis in wrists, knees, ankles, grey, pustular rash on erythramatic base but not on head or trunk

Question 27

Diagnosis of gonorrhoeae

Answer 27

• direct smear to find gram (-), bean shaped diplococci (multilobular) in neutrophils (INTRACELLULAR)!!!!!!!! -ACURATE IN MEN/ NOT WOMEN DUE TO NORMAL BIOTA
• culture-scrapings of urethra/cervix.rectal or throat swabs- fastitious chocolate agar
• nucleic acid amplification (PCR)

Question 28

if put thru a maltose fermentation/oxidation test, would n. gonorrhoea support infection?

Answer 28

no

Question 29

how do you diagnose a chlamydia infection

Answer 29

-culture of urethral scraping with cells followed by staining

Question 30

treatement of n. gonorrhoeae

Answer 30

-ceftriaxone plus doxycycline or erythromycin (presumed with chlamydia)

Question 31

a deficiency in what would result in increased susceptibility to gonnorhea infections

Answer 31

CD8- problem with (complement) c5b-9 makes patients more susceptible to Neisseria infections