Bacterial urethritis/Cervicitis and Sequelee

Question 1

Primary symptoms of Chlamydia trachomatis(Ct) and Neisseria gonorrhoeae(GC)?

Answer 1

Dysuria and penile/vaginal exudation

Question 2

What is the laboratory dx for Ct and GC?

Answer 2

Nucleic acid amplification tests (NAATs) on urine or exudates

Question 3

What cures a Ct or GC infection?

Answer 3

Proper dx and antibx tx

Question 4

Are subclinical/unapparent infections common?

Answer 4

Yes

Question 5

What happens when a Ct or GC infection goes untreated?

Answer 5

Pts are subject to serious sequelae and will continue to spread the infection to sexual contacts

Question 6

What is the most serious sequela for Ct and GC?

Answer 6

Pelvic inflammatory disease (PID) –> lead to sterility and ectopic pregnancy

Question 7

Are multiple episodes of Ct and GC rare?

Answer 7

No –> they are common

Question 8

What is the main problem with GC or Ct in pregnancy?

Answer 8

The baby can be infected during birth leading to conjunctivitis (Ct and GC) and/or pneumonia (Ct)

Question 9

What is Ct?

Answer 9

An obligate intracellular parasite - gram negative bacterium that is deficient in peptidoglycan

Question 10

What is the development cycle of Ct?

Answer 10

A small, metabolically inert but infectious elementary body and a larger dividing form reticulate body that grows within a membrane-bound vacuole(inclusion body) in the cytoplasm of mucosal epithelial cells.

Question 11

What antibx is ineffective and why?

Answer 11

Beta-lactam antibxs – Ct resides in an isosmotic intracellular environment

Question 12

What is the primary virulence factor for Ct?

Answer 12

Ability to cause inflammation

Question 13

Does GC have a capsule?

Answer 13

No

Question 14

What is shed during infections? What does it do?

Answer 14

LPS (lipoligosaccharide) –> invokes an inflammatory response

Question 15

Which STD undergoes antigenic variation?

Answer 15

GC

Question 16

How is antigenic variation achieved?

Answer 16

Two mechanisms involving the pili
1. Result of insertion of parts of various SILENT peptide-encoding loci (PilS) with no promoter into an EXPRESSION locus (PilE) with a promoter, resulting in hugre variety of antigens. This mutation can occur multiple times during the course of a single infection.

Question 17

What are GCs considered? Implications?

Answer 17

Extracellular Parasites - killed when phagocytosed by PMNs`

Question 18

How does urethritis present in men?

Answer 18

GC: purulent penile discharge
Ct: a less purulent, milky discharge
Dysuria (burning, frequency less common)

Question 19

How does cervicitis present?

Answer 19

GC: purulent endocervix discharge
Ct: a less purulent, milky discharge
Dysuria (burning, frequency less common)

Question 20

What is PID?

Answer 20

An inflammatory process involving a variable combination of endmetritis, salpingitits, tubo-ovarian abcess, and pelvic peritonitis

Question 21

How does PID present?

Answer 21

Dull to severe lower abdominal pain
Signs and symptoms of cervicitis
Adnexal tenderness
Cervical motion tenderness
Fever
IS VERY SERIOUS

Question 22

With what bacteria will disseminated infections occur? Presentation?

Answer 22

GC - fever, rash, septic arthritis

Question 23

With which bacteria will infant pneumonia occur? Presentation

Answer 23

Ct

• Vertical rather than horizontal transmission
• Afebrile
• Repetitive staccato cough with tachypnea
• Hyperinflation with bilateral infiltrates on a chest radiograph
• Wheezing is rare
• Peripheral eosinophilia may be present
• Concurrent or history of conjunctivitis suggests Chlamydia but does not always precede infant pneumonia
• Serum IgM lvls raised

Question 24

High risk populations for GC or Ct?

Answer 24

Anyone having sex - especially with multiple partners
Inner city residents - incidence higher in AAs
Age grp 15-24 yrs accts for the vast majority of reported infections

Question 25

Gram Stain on penile exudate: Gram negative cocci in PMNs, what is the dx?

Answer 25

GC

Question 26

Gram stain on penile exudate: PMNs but no cocci seen, what is the dx?

Answer 26

Non-gonorrheal urethritis (most likely Ct)

Question 27

For which sex is a gram stain best?

Answer 27

Males and not very accurate in females

Question 28

Can a gram stain detect Ct?

Answer 28

No

Question 29

What is the Thayer-Martin medium?

Answer 29

Rich chocolate blood agar with antibxs to inhibit normal flora

• Vancomysin (Anti Gram +)
• Nystatin (Anti-Fungal)
• Colistin (Anti-Gram - except for GC or N. men.)

Question 30

How is GC presumptively ided?

Answer 30

Growth on T-M, Gram Stain (Gram - diplococcus), Oxidase positive test (<— KNOW THIS)

Question 31

What is the most common dx tool for GC or Ct?

Answer 31

NAAT on urine or cervical/urethral exudates

Question 32

Best choice of tx for GC?

Answer 32

Single IM injection of ceftriaxone

Question 33

DOC for Ct?

Answer 33

Azithromycin or Doxycycline