Bacterial Urethritis/Cervicitis and Sequalae Flashcards
What 3 bugs account for 60-80% of the cases of STIs with primary symptoms of dysuria and penile/vaginal exudation?
Chlamydia trachomatis (Ct), Neisseria gonorrhoaea (gonococcus or GC), and Ureaplasma urelyticum
How is Lab Dx of Ct or GC usually made?
NAATs on urine or exudates for Ct and GC
How are Ct and GC treated? What is common with them? and what does this mean for patients?
Proper diagnosis and antibiotics; subclinical/unapparent infections are common; they spread infections to sexual contacts
What is the most serious sequelae of Ct and GC?
Lower genital tract infections that spread to the upper genital tract which leads to pelfic inflammatory dz and lead to sterility and ectopic pregnancy
Can the newborn be infected during birth with Ct and GC?
Yes, resulting in conjunctivitis and or pneumonia (Ct)
Are multiple episodes of Ct and GC common?
Yes
Is infection with multiple STDs at the same time common?
Yes
If someone is infected with GC, what are the chances they are also infected with Ct?
50%
What kind of parasite is Ct?
Obligate intracellular (gram negative bacterium that is deficient in peptidoglycan) that can be grown in tissue culture but not artificial medium
What is the developmental cycle of Ct?
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)
Where does the RB of Ct grow?
Within a membrane-bound vacuole (inclusion body) in the cytoplasm of mucosal epithelial cells
In a productive Ct infection, what happens to the host cell?
It dies by lysis which releases EBs to infect nearby cells or to be sexually transmitted to a new host
Because Ct reside in an isosmotic intracellular environment, what class of drugs are ineffective?
B-lactam antibiotics
What is the primary virulence factor of Ct (besides the ability to grow inside eukaryotic cells)?
Their ability to cause inflammation
Does GC have a capsule?
No capsule
What is shed during GC infections?
LPS, it invokes an inflammatory response
What is achieved by at least two mechanisms involving pili and their outer membrane surface proteins in GC?
Antigenic variation
What is the pilus variation a result of?
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
Are GCs extracellular parasites?
Yes, they are killed when phagocytksed by PMNs
What do GCs secrete?
An IgA1ase
Do Ct or GC invoke a protective immune response?
No, people do not become resistant
Where is Ct limited to?
Mucosal epitheliim (no dissemination to blood/lymph) while GC can sometimes disseminate (septicemia and rash)
Does Ureaplasma have a cell wall?
No, they lack a cell wall
Is ureaplasma susceptible to any B-lactams?
No
What are the uncomplicated lower genital tract infections caused by GC and Ct?
Cervicitis, urethritis
What are the upper genital tract complications of GC and Ct?
Salpingitis and PID, epididymitis, perihepatitis fitz-hugh-curtis syndrome, prostatitis (Gc onle?)
What are some diseases of other sites from GC and Ct? (Just writing the bolded terms here)
Pharyngitis (oral sex, GC), Conjunctivitis in the newborn, Infant pneumonia (1-4 mo, Ct), Disseminated (GC, sepsis w/ rash)
What is Urethritis/Cervicitis?
Asymptomatic/inapparent/subclinical infections common in men and women
What are the symptoms of Urethritis in men?
GC: Purulent penile discharge, Ct: less purulent, milky discharge, Dysuria for both
What are the symptoms for Cervicitis?
Similar to men except discharge is from the endocervix
What is PID?
An inflammatory process involving a variable combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis
What are the symptoms of PID?
Dull to severe lower abdominal pain, Sx/Signs of cervicitis may be present, adnexal tenderness, cervical motion tenderness, and fever
What are the serious complications of PID?
Often requires hospitalization, tubo-ovarian abscesses possible, may result in sterility, can lead to ectopic pregnancy, can result in chronic pelvic pain
What are the symptoms of a disseminated GC infections?
Fever, Rash (often on fingers or toes and feet), Septic arthritis
When does infant pneumonia (Ct) occur?
1-4 months postpartum
What are the symptoms of Infant pneumonia?
Repetitive staccato cough with tachypnea, wheezing is rare
What is the most important part about transmission/epidemiology?
Inapparent infections are common, many people are infected but do not know it (Ct especially)
What is gram stained for bacterial STDs?
Penile exudates
If a G- cocci is seen on gram stain, what is presumptive Dx?
GC
If poly but no cocci are seen on gram stain, what is Dx?
Non-GC urethritis (most likely CT)
What can’t a gram stain detect?
Ct
Unless Ct is excluded by a test, what must be done?
Patient w/ GC must be treated for GC and Ct
What medium can GC be grown on?
Thayer-Martin medium, which is a rich chocolate blood agar w/ Abs to inhibit normal flora
What is GC presumptively identified by?
Growth on T-M, G stain (gram neg diplococcus), oxidase positive test
What is the most common Dx by (on urine or cervical/urethral exudates) for GC and Ct?
NAAT, Gold standart for Ct
What does a rapid antigen detection test detect?
Ct directly in exudates
What is the best treatment option for GC?
Single IM injection of ceftriaxone, but resistance is increasing
Why can’t fluoroquinolones be used anymore?
Resistance has developed
What is the DOC for Ct?
Azithromycin (2nd DOC Doxy = CI’d in infants, young children, and pregnant women; Erythro for newborns, infants, and pregnant women)
How do you prevent Ophthalmia neonatorum?
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
Compare the levels of GC and Ct in the US?
GC has been declining over the past 10 years but still shows a significant health problem, level of Ct increasing
What is another Ct STD?
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
What is a non-STD Ct infection?
Trachoma, a significant potentially blinding chronic Dz
