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Repro Images + Micro > Bacterial Urethritis/Cervicitis > Flashcards

Bacterial Urethritis/Cervicitis Flashcards

1
Q

Cause 60-80% of all urethritis/cervicitis

A

Ct. GC, and ureaplasma

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2
Q

Mycoplasma

A

UreaPLASMA

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3
Q

2 Major sx of GC, Ct, ureaplasma infx

A

Dysuria and discharge

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4
Q

2 consequences of subclinical STD infection

A

Sequelae, transmission

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5
Q

1 reportable infection in the US

A

Ct

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6
Q

Your patient has gram - diplococci on gram stain of penile discharge. What else should you look for?

A

Intracellular inclusions = Ct, which will be present in 50% of GC infections

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7
Q

3 sequelae of GC/Ct infection in female

A

PID
Ectopic pregnancy
Sterility

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8
Q

Newborn infection caused by GC and Ct

A

Conjunctivitis (neonatorum ophthalmia)

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9
Q

Newborn infection caused by Ct but not GC

A

Pneumonia

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10
Q

Nuclear inclusion body

A

Herpes (Tzank cells)

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11
Q

Cytoplasmic inclusion body

A

Ct

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12
Q

Where does Chlamydia replicate?

A

Membrane-bound vacuoles (inclusion bodies) in the cytoplasm of mucosal epithelial cells

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13
Q

Describe the biphasic lifecycle of Ct.

A
  1. Elementary body (EB) - attachment and entry; metabolically inert but infectious
  2. Reticulate body (RB) - replicates inside inclusion bodies
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14
Q

How is Ct grown in the lab?

A

Tissue culture (cannot be grown on artificial medium like agar plates)

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15
Q

Which form of Ct is infectious?

A

EB (think: it must be extracellular to be transmitted)

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16
Q

Which form of Ct are we looking at when we view the characteristic cytoplasmic inclusion bodies under the microscope?

A

RB (this is the form that replicates, which takes place in inclusion bodies)

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17
Q

Primary virulence factor of Ct

A

Ability to cause inflammation

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18
Q

Productive Ct infection

A

Epithelial cell lysis and EBs released to nearby cells/for sexual transmission

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19
Q

Which class of antibiotics is ineffective against Ct and why?

A

B-lactams - Ct is intracellular

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20
Q

N. gonorrhoeae vs. N. meninigiditis

A

GC - no capsule

Meninigiditis - encapsulated

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21
Q

Primary virulence factor of N. gonorrhoeae

A

LPS

also produces an IgA1ase

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22
Q

Which GC structures undergo antigenic variation and how often can this occur?

A

Pili and other outer membrane attachment proteins

Can occur multiple times per infection

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23
Q

How do GC and Ct cause damage to host cells?

A

Inflammatory response

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24
Q

What is the mechanism of antigenic variation in GC?

A

Silent peptide-encoding locus without a promoter is switched into an expression locus with a promoter

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25
Q

Tropism of Ct

A

Restricted to mucosal epithelial cells

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26
Q

Can GC or Ct disseminate?

A

GC (remember Ct is restricted to mucosal epithelial cells)

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27
Q

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?

A

GC (Ct and ureaplasma are not susceptible to beta-lactams)

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28
Q

When is a ureaplasma infection particularly worrisome?

A

Pregnancy - associated with poor birth outcomes

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29
Q

Why is ureaplasma infection possibly underdiagnosed?

A

Specific lab diagnosis is rarely accomplished

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30
Q

Beta-lactams should only be used to treat which etiology of urethritis/cervicitis?

A

GC

Ct = IC; ureaplama = no cell wall

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31
Q

Upper genital tract complications of GC, Ct, ureaplasma

A

Salpingitis, PID, epididymitis, perihepatitis Fitz-Hugh-Curtis syndrome

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32
Q

Upper genital tract complication mostly caused by GC

A

Prostatitis

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33
Q

GC/Ct complication most prevalent in MSM

A

Rectal infection

34
Q

Complications caused by GC only

A

Pharyngitis, disseminated infx, prostatitis

35
Q

Is neonatorum conjunctivitis more commonly caused by GC or Ct?

A

Ct - silver nitrate gel prophylaxis for GC

36
Q

Complications caused by Ct only

A

Infant pneumonia

37
Q

Reiter’s syndrome

A

Reactive, non-septic arthritis following GC, Ct, or bacterial enterocolitis infections

38
Q

How does GC/Ct conjunctivitis occur in a person with genital infection?

A

Autoinoculation

39
Q

Manifestations of GC dissemination

A

Fever, sepsis, rash, aseptic arthritis, endocarditis, meningitis

40
Q

Most common symptom of male urethritis

A

Dysuria (frequency is less common)

41
Q

Sx of GC urethritis

A

PURULENT D/C, dysuria, may have frequency, itching of distal urethra

42
Q

Sx of chlamydial urethritis

A

MILKY D/C, dysuria, may have frequency, distal urethral itching

43
Q

Fever present in pt with urethritis

A

Upper genital tract likely involved

44
Q

Inguinal lymphadenopathy

A

NOT urethritis!!

think syphilis if nonpainful, LGV if painful

45
Q

Source of discharge in cervicitis

A

Endocervix

46
Q

Sx of PID

A

Cervical motion tenderness, adnexal tenderness, lower abd pain, fever

47
Q

Components of PID

A

Endometritis, salpingitis, tubo-ovarian abscess, &/or pelvic peritonitis

48
Q

Complications of PID

A

Sterility, ectopic pregnancy, chronic pelvic pain

49
Q

PID damage worse: GC or Ct?

A

Ct

50
Q

PID symptoms less prominent: GC or Ct?

A

Ct

51
Q

2 month old with conjunctivitis and tachypnea

A

Think Chlamydial pneumonia

52
Q

Cough in Chlamydial pneumonia

A

Repetitive staccato cough

wheezing is rare!

53
Q

Xray findings of Chlamydial pneumonia

A

Bilateral infiltrates with hyperinflation

54
Q

WBC pattern in Chlamydial pneumonia

A

Peripheral eosinophilia

55
Q

High risk population for GC and Ct

A

Sexually active patients, especially with multiple partners
Inner city residents
AA
15-24 yo

56
Q

Annual incidence of Ct vs. GC

A 
Ct = 3 million
GC = 1 million
57
Q

Although subclinical infections are common for both GC and Ct, ___ tends to be especially associated with subclinical infections.

A

Ct

58
Q

Diagnostic options for GC

A
  1. Thayer Martin culture
  2. Gram stain
  3. Oxidase test
  4. NAAT
59
Q

Gold standard for GC diagnosis

A

Thayer Martin culture

60
Q

Gold standard for Ct diagnosis

A

NAAT of urine or exudate

61
Q

Diagnostic options for Ct

A
  1. NAAT of urine or exudate
  2. Tissue culture (can’t be grown on medium)
  3. RADT
62
Q

Describe Thayer Martin medium

A

Chocolate agar (lysed RBCs) containing vanc to kill G+, nystatin to kill fungi, and colistin to kill G+ except N. gonorrheae or meninigiditis

63
Q

Gram stain shows polys with G- diplococci

A

GC

64
Q

Gram stain shows polys but no G- cocci

A

Non-GC urethritis (most likely Ct)

65
Q

Can Ct be gram stained?

A

No!

66
Q

Most common diagnostic method for GC?

A

NAAT (but culture is gold standard)

67
Q

Most common diagnostic method for Ct?

A

NAAT (also the gold standard)

68
Q

A patient presents with mucopurulent discharge from the cervix. First step in management?

A

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

69
Q

DOC for GC

A

Single IM injection of ceftriaxone

70
Q

DOC for Ct in non-pregnant adolescents and adults

A

1 dose azithromycin OR 10 day course of doxy

71
Q

Who cannot receive doxy?

A

Preggos, infants, children (remember chelation and discoloration of teeth, bones)

72
Q

Silver nitrate gel is used for:

A

Preventing neonatorum ophthalmia due to GC (not very effective for Ct)

73
Q

DOC for preggos, infants, young children with Ct

A

Erythromycin

74
Q

Not recommended for use in GC due to high resistance rates

A

Fluoroquinolones

75
Q

Name 3 STDs for which the sexual partner requires treatment

A
  1. GC
  2. Ct
  3. Trich
76
Q

Incidence trend of GC vs Ct

A

GC decreasing, Ct increasing

77
Q

Sx of LGV

A

Inguinal lymphadenopathy, suppuration of lymph nodes, ulceration at site of entry

78
Q

High risk demographic for LGV

A

MSM (but rare in US)

79
Q

Trachoma

A

Non-ST Ct; leading cause of infectious blindness

spread by direct contact or by fomites

80
Q

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:

A

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

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