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Repro Micro > Bacterial Urethritis/Cervicitis and Sequalae > Flashcards

Bacterial Urethritis/Cervicitis and Sequalae Flashcards

1
Q

What 3 bugs account for 60-80% of the cases of STIs with primary symptoms of dysuria and penile/vaginal exudation?

A

Chlamydia trachomatis (Ct), Neisseria gonorrhoaea (gonococcus or GC), and Ureaplasma urelyticum

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2
Q

How is Lab Dx of Ct or GC usually made?

A

NAATs on urine or exudates for Ct and GC

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3
Q

How are Ct and GC treated? What is common with them? and what does this mean for patients?

A

Proper diagnosis and antibiotics; subclinical/unapparent infections are common; they spread infections to sexual contacts

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4
Q

What is the most serious sequelae of Ct and GC?

A

Lower genital tract infections that spread to the upper genital tract which leads to pelfic inflammatory dz and lead to sterility and ectopic pregnancy

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5
Q

Can the newborn be infected during birth with Ct and GC?

A

Yes, resulting in conjunctivitis and or pneumonia (Ct)

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6
Q

Are multiple episodes of Ct and GC common?

A

Yes

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7
Q

Is infection with multiple STDs at the same time common?

A

Yes

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8
Q

If someone is infected with GC, what are the chances they are also infected with Ct?

A

50%

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9
Q

What kind of parasite is Ct?

A

Obligate intracellular (gram negative bacterium that is deficient in peptidoglycan) that can be grown in tissue culture but not artificial medium

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10
Q

What is the developmental cycle of Ct?

A

It is a distinctive intracellular developmental cycle that consists of two alternating forms: A small, metabolically inert but infectious elementary body (EB) and a larger dividing reticulate body (RB)

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11
Q

Where does the RB of Ct grow?

A

Within a membrane-bound vacuole (inclusion body) in the cytoplasm of mucosal epithelial cells

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12
Q

In a productive Ct infection, what happens to the host cell?

A

It dies by lysis which releases EBs to infect nearby cells or to be sexually transmitted to a new host

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13
Q

Because Ct reside in an isosmotic intracellular environment, what class of drugs are ineffective?

A

B-lactam antibiotics

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14
Q

What is the primary virulence factor of Ct (besides the ability to grow inside eukaryotic cells)?

A

Their ability to cause inflammation

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15
Q

Does GC have a capsule?

A

No capsule

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16
Q

What is shed during GC infections?

A

LPS, it invokes an inflammatory response

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17
Q

What is achieved by at least two mechanisms involving pili and their outer membrane surface proteins in GC?

A

Antigenic variation

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18
Q

What is the pilus variation a result of?

A

Insertion of parts of various silent peptide-encoding loci into an expression locus which results in huge variety of antigens; can occur multiple times during course of single infections

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19
Q

Are GCs extracellular parasites?

A

Yes, they are killed when phagocytksed by PMNs

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20
Q

What do GCs secrete?

A

An IgA1ase

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21
Q

Do Ct or GC invoke a protective immune response?

A

No, people do not become resistant

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22
Q

Where is Ct limited to?

A

Mucosal epitheliim (no dissemination to blood/lymph) while GC can sometimes disseminate (septicemia and rash)

23
Q

Does Ureaplasma have a cell wall?

A

No, they lack a cell wall

24
Q

Is ureaplasma susceptible to any B-lactams?

A

No

25
Q

What are the uncomplicated lower genital tract infections caused by GC and Ct?

A

Cervicitis, urethritis

26
Q

What are the upper genital tract complications of GC and Ct?

A

Salpingitis and PID, epididymitis, perihepatitis fitz-hugh-curtis syndrome, prostatitis (Gc onle?)

27
Q

What are some diseases of other sites from GC and Ct? (Just writing the bolded terms here)

A

Pharyngitis (oral sex, GC), Conjunctivitis in the newborn, Infant pneumonia (1-4 mo, Ct), Disseminated (GC, sepsis w/ rash)

28
Q

What is Urethritis/Cervicitis?

A

Asymptomatic/inapparent/subclinical infections common in men and women

29
Q

What are the symptoms of Urethritis in men?

A

GC: Purulent penile discharge, Ct: less purulent, milky discharge, Dysuria for both

30
Q

What are the symptoms for Cervicitis?

A

Similar to men except discharge is from the endocervix

31
Q

What is PID?

A

An inflammatory process involving a variable combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis

32
Q

What are the symptoms of PID?

A

Dull to severe lower abdominal pain, Sx/Signs of cervicitis may be present, adnexal tenderness, cervical motion tenderness, and fever

33
Q

What are the serious complications of PID?

A

Often requires hospitalization, tubo-ovarian abscesses possible, may result in sterility, can lead to ectopic pregnancy, can result in chronic pelvic pain

34
Q

What are the symptoms of a disseminated GC infections?

A

Fever, Rash (often on fingers or toes and feet), Septic arthritis

35
Q

When does infant pneumonia (Ct) occur?

A

1-4 months postpartum

36
Q

What are the symptoms of Infant pneumonia?

A

Repetitive staccato cough with tachypnea, wheezing is rare

37
Q

What is the most important part about transmission/epidemiology?

A

Inapparent infections are common, many people are infected but do not know it (Ct especially)

38
Q

What is gram stained for bacterial STDs?

A

Penile exudates

39
Q

If a G- cocci is seen on gram stain, what is presumptive Dx?

A

GC

40
Q

If poly but no cocci are seen on gram stain, what is Dx?

A

Non-GC urethritis (most likely CT)

41
Q

What can’t a gram stain detect?

A

Ct

42
Q

Unless Ct is excluded by a test, what must be done?

A

Patient w/ GC must be treated for GC and Ct

43
Q

What medium can GC be grown on?

A

Thayer-Martin medium, which is a rich chocolate blood agar w/ Abs to inhibit normal flora

44
Q

What is GC presumptively identified by?

A

Growth on T-M, G stain (gram neg diplococcus), oxidase positive test

45
Q

What is the most common Dx by (on urine or cervical/urethral exudates) for GC and Ct?

A

NAAT, Gold standart for Ct

46
Q

What does a rapid antigen detection test detect?

A

Ct directly in exudates

47
Q

What is the best treatment option for GC?

A

Single IM injection of ceftriaxone, but resistance is increasing

48
Q

Why can’t fluoroquinolones be used anymore?

A

Resistance has developed

49
Q

What is the DOC for Ct?

A

Azithromycin (2nd DOC Doxy = CI’d in infants, young children, and pregnant women; Erythro for newborns, infants, and pregnant women)

50
Q

How do you prevent Ophthalmia neonatorum?

A

Silver nitrate/topical Abx in eyes of newborn for GC, silver nitrate/abx in eyes does not work for Ct so it does not prevent Ct infant pnuemo

51
Q

Compare the levels of GC and Ct in the US?

A

GC has been declining over the past 10 years but still shows a significant health problem, level of Ct increasing

52
Q

What is another Ct STD?

A

Lymphogranuloma venereum (LGV); swollen lymph nodes, supparation of lymph nodes, ulceration at site of entry, rare in US but need to be aware of LGV

53
Q

What is a non-STD Ct infection?

A

Trachoma, a significant potentially blinding chronic Dz

Repro Micro (6 decks)

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