Bacterial Urethritis/Cervicitis

Question 1

Cause 60-80% of all urethritis/cervicitis

Answer 1

Ct. GC, and ureaplasma

Question 2

Mycoplasma

Answer 2

UreaPLASMA

Question 3

2 Major sx of GC, Ct, ureaplasma infx

Answer 3

Dysuria and discharge

Question 4

2 consequences of subclinical STD infection

Answer 4

Sequelae, transmission

Question 5

1 reportable infection in the US

Answer 5

Ct

Question 6

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

Answer 6

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

Question 7

3 sequelae of GC/Ct infection in female

Answer 7

PID
Ectopic pregnancy
Sterility

Question 8

Newborn infection caused by GC and Ct

Answer 8

Conjunctivitis (neonatorum ophthalmia)

Question 9

Newborn infection caused by Ct but not GC

Answer 9

Pneumonia

Question 10

Nuclear inclusion body

Answer 10

Herpes (Tzank cells)

Question 11

Cytoplasmic inclusion body

Answer 11

Ct

Question 12

Where does Chlamydia replicate?

Answer 12

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

Question 13

Describe the biphasic lifecycle of Ct.

Answer 13

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

Question 14

How is Ct grown in the lab?

Answer 14

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

Question 15

Which form of Ct is infectious?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

Primary virulence factor of Ct

Answer 17

Ability to cause inflammation

Question 18

Productive Ct infection

Answer 18

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

Question 19

Which class of antibiotics is ineffective against Ct and why?

Answer 19

B-lactams - Ct is intracellular

Question 20

N. gonorrhoeae vs. N. meninigiditis

Answer 20

GC - no capsule

Meninigiditis - encapsulated

Question 21

Primary virulence factor of N. gonorrhoeae

Answer 21

LPS

also produces an IgA1ase

Question 22

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

Answer 22

Pili and other outer membrane attachment proteins

Can occur multiple times per infection

Question 23

How do GC and Ct cause damage to host cells?

Answer 23

Inflammatory response

Question 24

What is the mechanism of antigenic variation in GC?

Answer 24

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

Question 25

Tropism of Ct

Answer 25

Restricted to mucosal epithelial cells

Question 26

Can GC or Ct disseminate?

Answer 26

GC (remember Ct is restricted to mucosal epithelial cells)

Question 27

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?

Answer 27

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

Question 28

When is a ureaplasma infection particularly worrisome?

Answer 28

Pregnancy - associated with poor birth outcomes

Question 29

Why is ureaplasma infection possibly underdiagnosed?

Answer 29

Specific lab diagnosis is rarely accomplished

Question 30

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

Answer 30

GC | Ct = IC; ureaplama = no cell wall

Question 31

Upper genital tract complications of GC, Ct, ureaplasma

Answer 31

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

Question 32

Upper genital tract complication mostly caused by GC

Answer 32

Prostatitis

Question 33

GC/Ct complication most prevalent in MSM

Answer 33

Rectal infection

Question 34

Complications caused by GC only

Answer 34

Pharyngitis, disseminated infx, prostatitis

Question 35

Is neonatorum conjunctivitis more commonly caused by GC or Ct?

Answer 35

Ct - silver nitrate gel prophylaxis for GC

Question 36

Complications caused by Ct only

Answer 36

Infant pneumonia

Question 37

Reiter's syndrome

Answer 37

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

Question 38

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

Answer 38

Autoinoculation

Question 39

Manifestations of GC dissemination

Answer 39

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

Question 40

Most common symptom of male urethritis

Answer 40

Dysuria (frequency is less common)

Question 41

Sx of GC urethritis

Answer 41

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

Question 42

Sx of chlamydial urethritis

Answer 42

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

Question 43

Fever present in pt with urethritis

Answer 43

Upper genital tract likely involved

Question 44

Inguinal lymphadenopathy

Answer 44

NOT urethritis!! | think syphilis if nonpainful, LGV if painful

Question 45

Source of discharge in cervicitis

Answer 45

Endocervix

Question 46

Sx of PID

Answer 46

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

Question 47

Components of PID

Answer 47

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

Question 48

Complications of PID

Answer 48

Sterility, ectopic pregnancy, chronic pelvic pain

Question 49

PID damage worse: GC or Ct?

Answer 49

Ct

Question 50

PID symptoms less prominent: GC or Ct?

Answer 50

Ct

Question 51

2 month old with conjunctivitis and tachypnea

Answer 51

Think Chlamydial pneumonia

Question 52

Cough in Chlamydial pneumonia

Answer 52

Repetitive staccato cough | wheezing is rare!

Question 53

Xray findings of Chlamydial pneumonia

Answer 53

Bilateral infiltrates with hyperinflation

Question 54

WBC pattern in Chlamydial pneumonia

Answer 54

Peripheral eosinophilia

Question 55

High risk population for GC and Ct

Answer 55

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

Question 56

Annual incidence of Ct vs. GC

Answer 56

``` Ct = 3 million GC = 1 million ```

Question 57

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

Answer 57

Ct

Question 58

Diagnostic options for GC

Answer 58

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

Question 59

Gold standard for GC diagnosis

Answer 59

Thayer Martin culture

Question 60

Gold standard for Ct diagnosis

Answer 60

NAAT of urine or exudate

Question 61

Diagnostic options for Ct

Answer 61

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

Question 62

Describe Thayer Martin medium

Answer 62

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

Question 63

Gram stain shows polys with G- diplococci

Answer 63

GC

Question 64

Gram stain shows polys but no G- cocci

Answer 64

Non-GC urethritis (most likely Ct)

Question 65

Can Ct be gram stained?

Answer 65

No!

Question 66

Most common diagnostic method for GC?

Answer 66

NAAT (but culture is gold standard)

Question 67

Most common diagnostic method for Ct?

Answer 67

NAAT (also the gold standard)

Question 68

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

Answer 68

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

Question 69

DOC for GC

Answer 69

Single IM injection of ceftriaxone

Question 70

DOC for Ct in non-pregnant adolescents and adults

Answer 70

1 dose azithromycin OR 10 day course of doxy

Question 71

Who cannot receive doxy?

Answer 71

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

Question 72

Silver nitrate gel is used for:

Answer 72

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

Question 73

DOC for preggos, infants, young children with Ct

Answer 73

Erythromycin

Question 74

Not recommended for use in GC due to high resistance rates

Answer 74

Fluoroquinolones

Question 75

Name 3 STDs for which the sexual partner requires treatment

Answer 75

1. GC 2. Ct 3. Trich

Question 76

Incidence trend of GC vs Ct

Answer 76

GC decreasing, Ct increasing

Question 77

Sx of LGV

Answer 77

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

Question 78

High risk demographic for LGV

Answer 78

MSM (but rare in US)

Question 79

Trachoma

Answer 79

Non-ST Ct; leading cause of infectious blindness | spread by direct contact or by fomites

Question 80

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:

Answer 80

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