Bacterial Urethritis/Cervicitis Flashcards
Cause 60-80% of all urethritis/cervicitis
Ct. GC, and ureaplasma
Mycoplasma
UreaPLASMA
2 Major sx of GC, Ct, ureaplasma infx
Dysuria and discharge
2 consequences of subclinical STD infection
Sequelae, transmission
1 reportable infection in the US
Ct
Your patient has gram - diplococci on gram stain of penile discharge. What else should you look for?
Intracellular inclusions = Ct, which will be present in 50% of GC infections
3 sequelae of GC/Ct infection in female
PID
Ectopic pregnancy
Sterility
Newborn infection caused by GC and Ct
Conjunctivitis (neonatorum ophthalmia)
Newborn infection caused by Ct but not GC
Pneumonia
Nuclear inclusion body
Herpes (Tzank cells)
Cytoplasmic inclusion body
Ct
Where does Chlamydia replicate?
Membrane-bound vacuoles (inclusion bodies) in the cytoplasm of mucosal epithelial cells
Describe the biphasic lifecycle of Ct.
- Elementary body (EB) - attachment and entry; metabolically inert but infectious
- Reticulate body (RB) - replicates inside inclusion bodies
How is Ct grown in the lab?
Tissue culture (cannot be grown on artificial medium like agar plates)
Which form of Ct is infectious?
EB (think: it must be extracellular to be transmitted)
Which form of Ct are we looking at when we view the characteristic cytoplasmic inclusion bodies under the microscope?
RB (this is the form that replicates, which takes place in inclusion bodies)
Primary virulence factor of Ct
Ability to cause inflammation
Productive Ct infection
Epithelial cell lysis and EBs released to nearby cells/for sexual transmission
Which class of antibiotics is ineffective against Ct and why?
B-lactams - Ct is intracellular
N. gonorrhoeae vs. N. meninigiditis
GC - no capsule
Meninigiditis - encapsulated
Primary virulence factor of N. gonorrhoeae
LPS
also produces an IgA1ase
Which GC structures undergo antigenic variation and how often can this occur?
Pili and other outer membrane attachment proteins
Can occur multiple times per infection
How do GC and Ct cause damage to host cells?
Inflammatory response
What is the mechanism of antigenic variation in GC?
Silent peptide-encoding locus without a promoter is switched into an expression locus with a promoter
Tropism of Ct
Restricted to mucosal epithelial cells
Can GC or Ct disseminate?
GC (remember Ct is restricted to mucosal epithelial cells)
A patient presents with a penile discharge and says “it hurts when I pee.” His PCP prescribed him PCN which cleared the infection. Which agent was the cause of his urethritis?
GC (Ct and ureaplasma are not susceptible to beta-lactams)
When is a ureaplasma infection particularly worrisome?
Pregnancy - associated with poor birth outcomes
Why is ureaplasma infection possibly underdiagnosed?
Specific lab diagnosis is rarely accomplished
Beta-lactams should only be used to treat which etiology of urethritis/cervicitis?
GC
Ct = IC; ureaplama = no cell wall
Upper genital tract complications of GC, Ct, ureaplasma
Salpingitis, PID, epididymitis, perihepatitis Fitz-Hugh-Curtis syndrome
Upper genital tract complication mostly caused by GC
Prostatitis
GC/Ct complication most prevalent in MSM
Rectal infection
Complications caused by GC only
Pharyngitis, disseminated infx, prostatitis
Is neonatorum conjunctivitis more commonly caused by GC or Ct?
Ct - silver nitrate gel prophylaxis for GC
Complications caused by Ct only
Infant pneumonia
Reiter’s syndrome
Reactive, non-septic arthritis following GC, Ct, or bacterial enterocolitis infections
How does GC/Ct conjunctivitis occur in a person with genital infection?
Autoinoculation
Manifestations of GC dissemination
Fever, sepsis, rash, aseptic arthritis, endocarditis, meningitis
Most common symptom of male urethritis
Dysuria (frequency is less common)
Sx of GC urethritis
PURULENT D/C, dysuria, may have frequency, itching of distal urethra
Sx of chlamydial urethritis
MILKY D/C, dysuria, may have frequency, distal urethral itching
Fever present in pt with urethritis
Upper genital tract likely involved
Inguinal lymphadenopathy
NOT urethritis!!
think syphilis if nonpainful, LGV if painful
Source of discharge in cervicitis
Endocervix
Sx of PID
Cervical motion tenderness, adnexal tenderness, lower abd pain, fever
Components of PID
Endometritis, salpingitis, tubo-ovarian abscess, &/or pelvic peritonitis
Complications of PID
Sterility, ectopic pregnancy, chronic pelvic pain
PID damage worse: GC or Ct?
Ct
PID symptoms less prominent: GC or Ct?
Ct
2 month old with conjunctivitis and tachypnea
Think Chlamydial pneumonia
Cough in Chlamydial pneumonia
Repetitive staccato cough
wheezing is rare!
Xray findings of Chlamydial pneumonia
Bilateral infiltrates with hyperinflation
WBC pattern in Chlamydial pneumonia
Peripheral eosinophilia
High risk population for GC and Ct
Sexually active patients, especially with multiple partners
Inner city residents
AA
15-24 yo
Annual incidence of Ct vs. GC
Ct = 3 million GC = 1 million
Although subclinical infections are common for both GC and Ct, ___ tends to be especially associated with subclinical infections.
Ct
Diagnostic options for GC
- Thayer Martin culture
- Gram stain
- Oxidase test
- NAAT
Gold standard for GC diagnosis
Thayer Martin culture
Gold standard for Ct diagnosis
NAAT of urine or exudate
Diagnostic options for Ct
- NAAT of urine or exudate
- Tissue culture (can’t be grown on medium)
- RADT
Describe Thayer Martin medium
Chocolate agar (lysed RBCs) containing vanc to kill G+, nystatin to kill fungi, and colistin to kill G+ except N. gonorrheae or meninigiditis
Gram stain shows polys with G- diplococci
GC
Gram stain shows polys but no G- cocci
Non-GC urethritis (most likely Ct)
Can Ct be gram stained?
No!
Most common diagnostic method for GC?
NAAT (but culture is gold standard)
Most common diagnostic method for Ct?
NAAT (also the gold standard)
A patient presents with mucopurulent discharge from the cervix. First step in management?
Workup for GC/Ct (NAAT)
Only consider BV, trich, HSV, or HPV if other sx present (like odor, vesicles, warts, etc) or in event of treatment failure
DOC for GC
Single IM injection of ceftriaxone
DOC for Ct in non-pregnant adolescents and adults
1 dose azithromycin OR 10 day course of doxy
Who cannot receive doxy?
Preggos, infants, children (remember chelation and discoloration of teeth, bones)
Silver nitrate gel is used for:
Preventing neonatorum ophthalmia due to GC (not very effective for Ct)
DOC for preggos, infants, young children with Ct
Erythromycin
Not recommended for use in GC due to high resistance rates
Fluoroquinolones
Name 3 STDs for which the sexual partner requires treatment
- GC
- Ct
- Trich
Incidence trend of GC vs Ct
GC decreasing, Ct increasing
Sx of LGV
Inguinal lymphadenopathy, suppuration of lymph nodes, ulceration at site of entry
High risk demographic for LGV
MSM (but rare in US)
Trachoma
Non-ST Ct; leading cause of infectious blindness
spread by direct contact or by fomites
A patient with vision loss discovered to be secondary to a chlamydial infection asks about the risk of passing Ct to her partner as they do not use any forms of contraception. You tell her:
Different Ct strains cause trachoma than cause urethritis/cervicitis, so minimize partner’s risk of direct contact with the infected eye(s) but sexual transmission not a concern
