E6 Flashcards
What is the most common bacterial STI in the US?
Chlamydia
What serotypes of chlamydia are responsible for trachoma?
ABC
What serotypes of chlamydia are responsible for ocular and genital infections?
D-K
What serotypes of chlamydia are responsible for lymphogranuloma venereum?
L1-L3
What is the classificiation of chlamydia trachomatis?
gram -, obligate intracellular cocci
What is the pathology of chlamydia?
Reticulate and elementary bodies
- tropism for epithelium of mucous membranes
- disease caused by destroying cells causing release of proinflammatory cytokines
What is the leading cause of preventable blindness?
Eye trachoma
What does adult and neonate chlamydial inclusion characterize as?
mucopurulent discharge
What are the characteristics of male urogential chlamydia?
- most symptomatic
- urtheritis: dysuria, and mucopurulent discharge
- complications: epididymitis and prostatiists, Reiter syndrome
What are the characteristics of female urogential chlamydia?
- 80% asymptomatic
- mucopurulent discharge
- pelvic inflammatory disease= fibrosis = sterility and ectopic pregnancy
What is lymphogranuloma venereum?
chlamydia starts off as primary painless papule with inflammation and swelling of lymph nodes that can rupture and cause fistulas
How is chlamydia diagnosed?
- culture with iodine shows reticulate bodies
- ELISA shows elementary bodies
- nucleic acid amplification from urine
How is LGV chlamydia treated?
doxycycline for 21 days
How is ocular/genital chlamydia treated?
Azithromycin or doxycyline for 7 days
How is newborn chlamydia treated?
Erythromycin for 10-14 days
Does infection confer immunity with chlamydia?
No, safe sex practices needed
What are the classifications of neisseria gonorrhea?
Gram -, aerobic diplococci, oxidase +, catalase +, nonspore forming, non maltose oxidizing
When is gonorrhea common?
Persons with C5-C8 or membrane attack complex issues
Does infection confer immunity with gonorrhea?
No, safe sex practices needed
What are the three pathological aspects of gonorrhea?
Pilin = attachment Porin = survival LOS = endotoxin
What is the pathogenisis of gonorrhea?
- Attach to cells with pili, enter and multiply
- Pass through to subendothelial space
- LOS stimulates TNF-a for inflammation
What are the characteristics of normal gonorrhea?
Mucopurulent dischrage, and dysuria
-pharyngitis with genital
What are the complications of gonorrhea?
Men: rare, epididymitis and prostatitis
Women: abcess and inferitility
What are the characteristics of disseminated gonorrhea?
Septicemia and infection of skin and joints, pustular rash and purulent arthritis
- large grey necrotic ulcer with erythemus base
- purulent conjunctivitis = newborn with vaginal delivery
- anorectal in MSM
- perihepatitis (Fitz-Hugh-Curtis)
How is gonorrhea diagnosed?
- smear with gram - bean diplococci neutrophils (4+ men, 2+ women)
- culture if appropriate
- NAAT combined test with chlamydia
How is gonorrhea treated?
ceftriaxone and doxicycline/azithromycin (treat chlamydia presume gonorrhea)
How is neonate gonorrhea treated?
Prophylaxis with erythromycin
How is occular gonorrhea treated?
Ceftriaxone
What is the classification of T pallidium (syphilis)?
gram negative sphirochete, mobile, microaerophilic, sensitive to heat and disinfectant
What is characteristic of primary syphilis?
-1+painless indurated skin lesion at entry with inflammation that lasts weeks to 2 months
What is characteristic of secondary syphilis?
Flu-like symptoms, prominant skin lesions over body as well as raised condyloma lata at skin folds
What is characteristic of latent syphilis?
Asymptomatic continued transmissable infection
What is characteristic of tertiary or late syphilis?
diffuse and chronic destruction of tissues
-gummas
What is congential syphilis?
- newborns born with rhinitis and maculopapular rash
- teeth and bone malformation, blindness, deafness, cardiovascular issue
What is ocular syphilis?
any eye structure infected that can result in permanent damage
How is syphilis diagnosed?
- nontreponemal test: measure Ab to cardolipin RPR, and VDRL
- treponemal: Ab to t palidium
How is syphilis treated?
penicillin or doxycycline/azithromycin for allergic
What are the symptoms for urthertitis in males?
- blood in urine and semen
- burning with urination
- polyuria
- itching and tenderness
What are the symptoms of urethritis in women?
- abd and pelvic pain
- burn with urination
- fever and chills
What are the most common non-gonoccocal urethritis?
most = chlamydia
-m. genitalium and u. urealyticum
What must be kept in mind when treating non-gonococcal urethritis?
Resistant to penicillin, cephalosporin, vancomysin
What are the characteristics of m. gentialium and u. urealyticum?
sterol in membrane
-smallest free living with no cell wall
What does mycoplasma hominis resemble?
Fried egg
What is used to treat m. genitalium?
resistant to doxcycline/azithromycin
what is used to treat men with non-gonococcal urethritis?
- doxcycline
- recurrent - azithromycin or quinolones
What disease is associated with haemophilis ducreyi?
Chancroid
What classifications is haemophilis ducreyi?
gram negative, pleomorphic coccobacilius, facultative anaerobe
What is the characteristic of chancroid?
Painful papule with erythemous base 5-7 days post exposure
How is chancroid diagnosed?
1+ painful ulcers, No T palidum, positive lymphadenopathy, and negative HSV
How is chancroid treated?
Macrolide azithromycin or erythromycin
What bacteria is associated with Donovanosis/Granuloma inguinale?
Klebsiella granulomatis
What are the classifications of Klebsiella granulomatis?
gram negative encapsulated intracellular
What are the characteristics of Donovanosis?
primary lesions painless and wart-like but bleed easily
-significant gential damage if untreated
How is Donovanosis diagnosed?
Rule out other, Donovan bodies in specimen
How is Donovanosis treated?
Prolonged tetracycline, sulfamethoxazole, gentamicin, ciproflaxacin, or erythromycin
What should be done about genital ulcers?
- all tested for syphilis, herpes, or ducreyi
- treat with suspected before labs return
What is bacterial vaginosis?
overgrwoth of anaerobic species and reduction of lactobacillus
What are the symptoms of bacterial vaginosis?
Discharge, odor, pain, burning, itching
How is bacterial vaginosis diagnosed?
- Amsel: grey/white discharge clue cells, fishy odor with KOH4.5
- Nugent: based on ratio of lactobacillus, G vaginalis, and mobiliunus (7-10 =BV)
What are the complications of bacterial vaginosis?
- increased susceptibility to hIV and passing it
- increased infection post-surgery
- preterm deliver, miscarriage, and infection after delivery
- increased susceptibility to STD
How is bacterial vaginosis treated?
- anaerobe/parasite = metronidazole
- gram+/anaerobe = clindomycin
What is vulvovaginal candidiasis?
common fungal infection with candida albicans in women of childbearing age
What are the classical symptoms of vulvovaginal candidiasis?
thick, odorless, white vaginal discharge
What is uncomplicated versus complicated vulvovaginal candidiasis?
uncomp: sporadic, infrequent in otherwise healthy individ
comp: recurrent or severe or non-albicans or pt has uncontrolled diabetes, debilitation, or immunosuppression
What are the characteristics of candida albicans
- frequent after antibiotics
- immunocompromised - esophagitic disseminated
What are the classifications of candida?
oval yeast-like that produce buds and pseudohyphae and hyphae
-germ tubes
What are the risk factors for vulvovaginal candidiasis?
local or generalized immunosuppression: oral contraceptive, pregnancy, diabetes, corticosteroids, HIV infection, antibiotics
How is vulvovaginal candidiasis diagnosed?
culture iwth 10% KOH = hyphae and budding
What is the treatment for Vulvovaginal candidiasis?
- 1-3 day topical azole = uncomplicated
- 7-14 day topical or 2 fluoconazole = complicated
What is the most common curable STD?
Trichomonas
What are the symptoms of female trichomonas?
- asymptomatic or scant watery discharge
- severe vaginitis, with dysuria and yellow-green frothy foul smelling discharge
What are the symptoms of male trichomonas?
Asymptomatic carriers
What are the classifications of trichomonas?
small pear protozoa (motile) with axostyle for attachment (only trophozoite)
What is the pathogenisis of trichomonas?
- destructionof epithlail, netrophilial influx and petechial hemorrages
- no clinically significant immunity so possible reinfection
How is trichomonas diagnosed?
swimming T vaginalis in exudate, asymptomatic PAP smear
How is trichomonas treated?
Metronidazole for both partners
What is the infecting bacteria with toxic shock syndrome?
S. aureus
What are the classifications of S aureus?
gram + cocci, catalase +, coagulase +
What is TSST-1?
heat and proteolytic resistant exotoxin of s aureus
How does TSST-1 function?
-can penetrate mucosal barrier and is responsible for systemic effects
-superantigen stimulate T cell activation and release of cytokines
-macrophage release IL-1B (fever), and TNF-a (shock)
t cell release IL-2 and IFN-g
What are the symptoms of toxic shock syndrome?
diarrhea, ill-feeling, fever and chills, nausea and vomiting
How is TSS diagnosed?
must have all major symptoms and 3 minor
How is TSS treated?
remove tampon, supportive measure, stop tampon use
-beta lactamase resistant penicillin or vancomycin
What are the classifications of the HIV virus?
ssRNA, reverse transcriptase polymerase
- nucleocapsid with p24 capsid protein
- envelope with gp41 (fusion) and gp120 (attachment)
What is the concentration of CD4+ cells associated with AIDS?
<200uL
Where is HIV-1 found?
predominant worldwide and in the US
Where is HIV-2 found?
W. Africa, less likely to progress to AIDS
What are the steps of the HIV lifecycle?
- Attachement: gp120 binds CD4 on T lymphocyte, monocyte, and macrophage cuasing conformational change in gp120 so can bind CCR5 or CXCR4
- Fusion: gp41 mediates b/w viral envelope and plasma membrane
- Reverse transcription: produce linear dsDNA, most error prone of all retroviruses = rapid evolution = need for multidrug treatment
- Integration: dsDNA moves into nucleus where viral integrase causes incorporation =provirus
- genome replication
- Trasncription
- Budding: at lipid rafts
- Maturation: protease cleaves gags to ensure infectivity of virion
What types of drugs are used to inhibit HIV at entrance?
- chemokine receptor antagonist that bind coreceptor and prevent binding with gp120 (maraviroc)
- fusion inhibitor bind gp41 and prevent conformational change
What types of drugs are used to inhibit HIV reverse transcriptase?
- NRTI: incorporate n growing DNA chain during provirus synthesis and cause chain termination (Azidothymidine)
- NNRTI: bind to reverse transcriptase and inhibit (Nevirapine)
What type of drugs are used to inhibit HIV integration?
integrase inhibitor: block DNA entrance to cell (Raltegravir)
What type of drugs are used to inhibit HIV protease?
Protease inhibitor: protease inhibition causes immature and defective HIV (squinavir)