Cervical infections Flashcards
what infections cause cervicitis, and what is it?
inflammation of the lower part of the uterus
-most commonly caused by chlamydia and gonorrhea
- -adolescent girls have a lot of columnar epithelium so they are very susceptible
- women often transmit to men because they don’t realize they have it (unlike trichomoniasis, there isn’t much of a discharge)
how many species of gonorrhea?
(2 - both are part of our normal flora)
Neisseria gonorrhoeae
Neisseria meningitidis
Does gonorrhea gram stain?
YES. gram (-). diplococci
lots of the organism is visible and PMNs
Neisseria characteristics
- Capnophilic (likes CO2) - wont survive outside of incubator
- oxidase positive
N. gonorroheae
-Chocolate agar but not blood agar
N. meningitidis
-Both chocolate agar and blood agar
Which sugars can each species oxidize?
Oxidize sugars to acid
N. gonorrhoeae – glucose only
N. meningitidis – glucose + maltose
Virulence factors that N. Gonorrhea uses?
-its surface is covered with Pili - used for attachment to columnar epithelial cells (protects against phagocytosis
the pili can change (antigenic variation) and therefore escape detection by the immune system (porin B both species)
- the bacteria needs Iron for growth and metabolism, this is why its only seen in humans
- do have the endotoxin but its LOS (oligosaccharide). Lipid A (remember elicits an immune response (a heavy and inflammatory one) - can totally destroy the fallopian tube and lead to sterility
what is the epidemiology of gonorrhea?
higher incidence in the US than most other developing countries
blacks, inner city, people with multiple sex partners
trending down and equal for men and women, except
men sexing men is treading up
complication of gonorrhea
acute urethritis proctitis pharyngitis ophthalmia neonatorum (new born's eyes!) acute cervicitis or vulvovaginitis
Who is the more likely reservoir males or females?
females because they can be asymptomatic (silent partner)
gonorrhea characteristics
purulent (mucopurulent in females), yellow, creamy discharge (thicker/puss like)
(not watery like BV, because in this case we do have lots of PMNs/WBCs - immune response)
-two to eight day incubation
-burning and frequent urination
(females also have fever and abdominal pain)
gonorrhea complications
- both males and females could end up with permanent sterility (females could have ectopic pregnancy)
- its rare but the infection could move into the blood stream, that’s bad, meningitis, skin lesins
A young adult presents with arthritis?
this is strange, usually its the elderly presenting? Why are his joints inflamed?
purulent arthritis (invasion of a joint by an infectious agent) is a potential complication of gonorrhea
How could we diagnose gonorrhea?
in males all you need is a positive gram stain (unless the sample is NOT taken from the urethra)
BUT in females a positive gram stain could be normal flora, so you need to culture and ID (unless the sample is taken from the urethra, we know its not supposed to be there, so we don’t need to culture)
- only grows on chocolate agar!! remember needs the CO2 environment
- the best method is to use the nucleic acid amplification assay because this can test for gonorrhea and chlamydia
Chlamydia signs and symptoms
its still a mucopurulent discharge (but its less thick than gonorrhea)
- dysuria
- vaginal pruritis (itchy)
- can induce bleeding just by touching walls of cervix
Diagnosing Chlamydia
- on the gram stain only see PMNs, dont see the bacteria because its obligate intracellular
- for confirmation you can use a nucleic acid probe followed by amplification
