Bacterial urethritis/Cervicitis and Sequelee Flashcards
Primary symptoms of Chlamydia trachomatis(Ct) and Neisseria gonorrhoeae(GC)?
Dysuria and penile/vaginal exudation
What is the laboratory dx for Ct and GC?
Nucleic acid amplification tests (NAATs) on urine or exudates
What cures a Ct or GC infection?
Proper dx and antibx tx
Are subclinical/unapparent infections common?
Yes
What happens when a Ct or GC infection goes untreated?
Pts are subject to serious sequelae and will continue to spread the infection to sexual contacts
What is the most serious sequela for Ct and GC?
Pelvic inflammatory disease (PID) –> lead to sterility and ectopic pregnancy
Are multiple episodes of Ct and GC rare?
No –> they are common
What is the main problem with GC or Ct in pregnancy?
The baby can be infected during birth leading to conjunctivitis (Ct and GC) and/or pneumonia (Ct)
What is Ct?
An obligate intracellular parasite - gram negative bacterium that is deficient in peptidoglycan
What is the development cycle of Ct?
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.
What antibx is ineffective and why?
Beta-lactam antibxs – Ct resides in an isosmotic intracellular environment
What is the primary virulence factor for Ct?
Ability to cause inflammation
Does GC have a capsule?
No
What is shed during infections? What does it do?
LPS (lipoligosaccharide) –> invokes an inflammatory response
Which STD undergoes antigenic variation?
GC
How is antigenic variation achieved?
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.
What are GCs considered? Implications?
Extracellular Parasites - killed when phagocytosed by PMNs`
How does urethritis present in men?
GC: purulent penile discharge
Ct: a less purulent, milky discharge
Dysuria (burning, frequency less common)
How does cervicitis present?
GC: purulent endocervix discharge
Ct: a less purulent, milky discharge
Dysuria (burning, frequency less common)
What is PID?
An inflammatory process involving a variable combination of endmetritis, salpingitits, tubo-ovarian abcess, and pelvic peritonitis
How does PID present?
Dull to severe lower abdominal pain Signs and symptoms of cervicitis Adnexal tenderness Cervical motion tenderness Fever IS VERY SERIOUS
With what bacteria will disseminated infections occur? Presentation?
GC - fever, rash, septic arthritis
With which bacteria will infant pneumonia occur? Presentation
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
High risk populations for GC or Ct?
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
Gram Stain on penile exudate: Gram negative cocci in PMNs, what is the dx?
GC
Gram stain on penile exudate: PMNs but no cocci seen, what is the dx?
Non-gonorrheal urethritis (most likely Ct)
For which sex is a gram stain best?
Males and not very accurate in females
Can a gram stain detect Ct?
No
What is the Thayer-Martin medium?
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.)
How is GC presumptively ided?
Growth on T-M, Gram Stain (Gram - diplococcus), Oxidase positive test (<— KNOW THIS)
What is the most common dx tool for GC or Ct?
NAAT on urine or cervical/urethral exudates
Best choice of tx for GC?
Single IM injection of ceftriaxone
DOC for Ct?
Azithromycin or Doxycycline
