Bacterial STDs Flashcards
Members of Chlamydia are obligate _________
intracellular (can’t make own ATP)
The Chlamydia ________ body is the form that enters host mucosal cells
Elementary body
E=entry
The Chlamydia ________ body is the form that replicates intracellulary by fission
Reticulate body
R=replicate
The Chlamydial species that causes a STD is also a cause of _______ arthritis
reactive
Chlamydia trachomatis
The #1 cause of nongonococcal urethritis, PID, and reactive arthritis lacks what in its cell wall?
Muramic acid
What serotypes of Chlamydia trachomatis are associated with vag/penis/neonatal conjunctivitis + pneumonia?
serotypes D thru K
dick!
Chlamydia is to ______ arthritis as N. gonorrhoeae is to ___________ arthritis
reactive (Reiter’s syndrome)
septic
Discharge coming from chlamydial infections is ________
watery
Pt presents with painful urination, sore joints, and conjunctivitis. What is the DOC?
Azithromycin
The DOC for Chlamydia STD infections has what MOA?
blocks translocation of protein synthesis
binds 50S (domain V of 23S)
Pelvic inflammatory disease (PID) often presents how?
purulent cervical discharge Chandalier sign (cervical motion tenderness) salpingitis/endometritis/hydrosalpinx
PID is a huge risk for what?
ectopic pregnancy
When PID leads to infection of the liver CAPSULE and surrounding peritoneum, what’s it called?
Fitz-Hugh-Curtis syndrome
Pt presents with purulent cervical discharge and cervical motion tenderness. She also now has RUQ pain, liver enzymes normal. What are the 2 most likely organisms?
Chlamydia trachmatis #1
Neisseria gonorrhoeae #2
both cause PID, which leads to FHC syndrome
What is the buzzword for the adhesions of the parietal peritoneum to the liver in Fitz-Hugh-Curtis syndrome?
violin string adhesions
What are the differences in presentation with gonorrhea and chlamydia?
Gonorrhea is:
purulent YELLOW discharge (hi volume)
shorter incubation
more dysuria
Gonococci ferment _______, while meningococci ferment ________
just Glucose
Glucose AND Maltose
Gonococci ______ polysaccharide capsule, meningococci _________ polysaccharide capsule
do NOT have a
do have a
Gonococci on gram stain are _________ and found where?
G- diplococci
within PMNs
Compare the gram stain of gonococci vs Chlamydia.
gonococci: lil G- diplococci inside PMNs
Chlamydia: nothing! (no muramic acid in wall)
Ureaplasma is treated with?
Erythromycin
An organism grows on Thayer Martin Agar. How does it gram stain, and its oxidase?
G- diplococci (gonococcal)
Oxidase +
Why is penicillin used for meningococcal infections but not gonococcal infections?
Gonococci commonly have a BETA-LACTAMASE
What mechanism allows gonococci to keep evading a good immune response against it?
rapid Ag variation of Pili
specifically Opa proteins
What’s the most common bacterial STD?
Chlamydia
Pt has yellow dick discharge. Cultures reveal G - diplococci inside PMNs. What is the DOC?
Ceftriaxone
The DOC for gonococcal infections inhibits bacterial?
this inhibits CROSSLINKING in bacteria
(aka inhibits TRANSPEPTIDATION)
via binding to PBP
What causes painful genital ulcers?
HSV
Chancroid
What causes painless genital ulcers?
Syphilis Lymphogranuloma venereum (Chlamydia L1-3) granuloma inguinale (Klebesiella granulomatis)
What typically presents with multiple genital ulcers?
HSV
Chancroid
Granuloma inguinale (K. granulomatis)
What typically presents with single genital ulcers?
syphilis
LGV
Primary syphilis presents as what?
PAINLESS chancre (well circum; clear base, no exudate)
painless local LAD
Pt presents with a dark brown body rash, and patches of hair loss. The causative organism uses what to move?
Axial filaments (aka endoflagellum)
Condylomata lata commonly are found in _______ syphilis and look?
secondary syphilis
grayish, soft, fleshy papules (genital/anal/oral)
A patient with known syphilis presents with malaise, sore throat, myalgia, and generalized LAD. What other symptoms will be present?
copper body rash
moth eaten alopecia
condylomata lata
(secondary=systemic)
After secondary syphilis, what are the 2 pathways of infection?
Latency (early1 yr duration) Tertiary syphilis (waning of immunity)
The sceening test used during primary and secondary syphilis is reactive with?
beef cardiolipin (VDRL test)
What are some causes of false positives in the syphilis screening test?
Viruses (mono, hepatitis)
Drugs
Rheumatic fever
Lupus, Leprosy
In order to confirm syphilis, a _______ must be done after the VDRL
FTA-ABS (fluorescent Ab, specific for syphilis)
What are the lesions where syphilis spirochetes can be obtained?
chancre, copper rash, condylomata, rhinitis (neonate)
NOT from gumma usually
If tertiary syphilis is suspected, the _____ is sampled for a VDRL
spinal fluid
Describe the areas commonly invaded by syphilis during the tertiary phase
CNS (posterior column, brain parenchyma, eye)
Aorta
General paresis in tertiary syphilis can be described as _______, which means it has invaded where?
invaded brain parenchyma
change in cognition (personality, memory, irritability, headache, carelessness, sz, delusions)
Pt presents with ataxia. When he’s asked to close his eyes with feet together, he can’t stand straight. He also complains of shooting pains to his legs. Where is his infection located?
tertiary syphilis in the posterior column
Tabes dorsalis (degeneration, demyelination)
pt has +Romberg test
Describe Argyll Robertson pupils.
CONSTRICTS with accomodation (focus close)
NO REACTION to light
Progressive degeneration of weight bearing joints (most often the FOOT) in tertiary syphilis is called what?
Charcot joints
Charcot joints are seen in what disorders?
Syphilis (tertiary)
DM, alcoholic neuropathy, CP
How are the deep tendon reflexes in tabes dorsalis?
reduced
Syphilis is to condylomata __________ as HPV is to condylomata _________
lata
accuminata
What area of the aorta is destroyed by Syphilis, which can lead to aortic aneurysm?
vaso vasorum destruction
may calcify aortic arch, cause valve probs, aneurysm
Pt receieves treatment for syphilis, what is a characteristic side effect seen in tx with spirochetes?
Jarisch-Herxheimer reaction
LPS released from organism, causes hi temp, lo BP, joint pain, rigors
DOC for syphilis?
Penicillin G
What are chronic benign lesions seen in the CNS of syphilis patients?
Gummas (usually no organisms)
Gummas are characterized by what type of histology?
granuloma (epithelioid histiocytes/Macroph; surrounded by giant cells, surrounded by lymphocytes)
_______ cells secrete ________, which converts macrophages to histiocytes and giant cells.
Th1 cells
secrete IFN-gamma
Pt presents with PAINFUL ulcers on his penis, and tender inguinal LAD. What growth requirements does the causative organism have?
Factor X (heme) ONLY
Haemophilus ducreyi (oxidase +)
Haemophilus species must grow on blood agar that’s been _________; unless its in the presence of _______
lysed (aka chocolate agar)
Staph aureus (satellite effect)
Chancroid is to _________ as chancre is to penicillin G
Ceftriaxone
Chlamydia trachomatis (D-K) is to chlamydia as Chlamydia trachomatis (L1-3) is to ?
Lymphogranuloma venereum
L1, L2, and L3 serotypes of Chlamydia trachomatis typically cause an infection of the ________
lymphatics (usually INGUINAL)
A patient presents with a SINGLE PAINLESS dick ulcer, and has INGUINAL LAD that is TENDER. Where is the pt most likely from?
prob Africa/Asia/South America
if US=think NYC
Groove sign is linear LAD superior and inferior to the inguinal ligament. It is characteristic of what organism?
Chlamydia trachomatis (L1-3)
Bubo formation is seen in what infections?
bubonic plague
gonorrhea
chlamydia
et al
Treatment for L1-3 Chlamydia?
doxycycline
Bleeding, beefy red, granulomatous ulcers in a pt from Papua New Guinea?
Klebsiella granulomatis (granuloma inguinale)
What is the histologic buzzword for Klebsiella granulomatis infection?
Donovan body (intracellular PMN/plasma cell inclusion)
Due to the high risk of Chlamydial transmission to the infant, we put ________ on all newborn’s eyes
Erythromycin
