Exam #6: Review Flashcards
List the important characteristics of the Chlamydiaceae family.
Lack peptidoglycan
Stain weakly Gram (-)
Contain LPS with weak endotoxin activity
What does C. trachomatis have a tropism for?
Nonciliated, columnar, cuboidal, & transitional epithelial cells of the:
- Urethra
- Endocervix
- Endometrium
- Fallopian tubes
- Anorectum
- Respiratory tree
- Conjunctiva
What is trachoma?
Chronic inflammatory/ granulomatous process of the eye leading to:
- Corneal ulceration
- Scarring
- Pannus formation (abnormal layer of granulation tissue)
- Blindness
What is adult inclusion conjunctivitis?
Acute conjunctivitis seen in sexually active adults that is characterized by:
- Mucopurulent discharge
- Dermatitis
- Corneal infiltrates
- Corneal vascularization (chronic disease)
What are the symptoms of C. trachomatis infections in men & women? What is the important difference?
Men=
- Dysuria
- Mucopurulent discharge
Women= MOST ASYMPTOMATIC carriers
- PID
What are the complications of C. trachomatis infection in men?
1) Epididymidis
2) Prostatitis
3) Reiter Syndrome
What is Reiter Syndrome?
1) Urethritis
2) Conjunctivitis
3) Polyarthritis
4) Mucocutaneous lesions
What are the symptoms of LGV?
Small, painless ulcers that swell
Painful inguinal lymph nodes that ulcerate
How is C. trachomatis diagnosed?
*After obtaining a SCRAPING of the location:
1) Giemsa stain
2) Iodine for reticulate bodies
3) Immunoflourescence of elementary bodies
and
4) NAAT, which is the gold standard
List six virulence factors associated with N. gonorrhoeae. What is unique about some of these virulence factors?
1) Pilin= attachment
2) Por protein= promotes intracellular survival
3) Opa protein= attachment
4) LOS= endotoxin (stimulates TNF-alpha & chemokine response)
*These undergo antigenic variation
5) IgA protease
6) B-Lactamase
What complications can be seen in N. gonorrhoeae infection in men & women? (Note disseminated gonorrhoeae)
Men=
- Epididymidis
- Prostatitis
- Periuretheral abscess
Women=
- Salpingitis
- Tubovarian abscess
- PID
What are the symptoms of disseminated N. gonorrhoeae?
Septicemia
Gonococcal arthritis
Pustular rash
*Leading cause of purulent arthritis in adults
How is N. gonorrhoeae diagnosed?
1) Direct smear= Gram negative bean-shaped diplococcus in neutrophils
2) Culture and growth from uretheral or cervical scrapings
3) NAAT
How is N. gonorrhoeae treated?
Ceftriaxone + prophylactic Chlamydia treatment i.e. azithromycin or doxycycline
What are the characteristics of Treponema pallidum?
Thin Gram (-) spirochete
Motile
Microaerophilic
How is sphyilis diagnosed?
Dark field microscopy
Direct fluorescence
Serology
(Treponemal & Non-teponemal- cardiolipin)
What are the symptoms of secondary syphilis?
Secondary syphilis= systemic syphilis
- Flu-like syndrome
- Prominent desquamating lesion on palms of hands & soles of the feet
- Condylomata lata
What are symptoms of tertiary syphilis?
- Gummas
- Diffuse chronic inflammation
- Can affect any tissue/ organ
What are the symptoms of congenital syphilis?
Chronic rhinitis lead to saddle nose Hutchinson malformation (teeth) Bone malformation Blind & Dead Cardiovascular syphilis
What are the most common causes of NGU? List the characteristics of these organisms.
Mcoplasma genitalium ("fried-egg" morphology)- No doxy
Ureaplasma urealyticum
- NO cell wall
- Not stained
- Pleomorphic
- Membrane contains sterols
How is Chancroid treated?
Macrolides
What causes Donovanosis?
Klebsiella granulomatis
What are the symptoms of Donovanosis?
Hard, ulcerated, and painless lesion that bleeds easily & has a tendency to cause significant genital damage
How is Donovanosis diagnosed?
Donovan bodies
List the characteristics of Lactobacillus. What is unique about where it can grow?
Gram (+) rod
Microaerophilic or anaerobic
Cannot grow in urine; thus, it DOES NOT cause UTI
What are the risk factors for bacterial vaginosis?
- Oral sex
- WSW
- Sex during menses
- New or multiple sex partners
- Smoking
- IUD
What are the four amsel criteria for bacterial vaginosis diagnosis?
1) Discharge (white-gray)
2) Clue cells
3) Whiff test
4) pH greater than 4.5
Remember, “I don’t have a clue why I smell fish in the vagina garden”
What are the complications of bacterial vaginosis?
1) Increased STD & HIV risk
2) Increased STD & HIV transmission risk
3) Increased development of post-surgical infections
4) Increased risk of pregnancy complications
How is bacterial vaginosis treated?
Oral metronidazole
Clindamycin
What increased the risk for vulvovaginal candidiasis?
- Antibiotic administration*
- Systemic corticosteroids
- Oral contraceptives
- Pregnancy
- DM
- HIV infection
How is candidia albicans diagnosed?
- Microscopic examination with 10% KOH
- Growth & culture on “Nickerson medium”
- Germ tube test
What are the symptoms of Trichomoniasis?
Vaginitis
Ictching
Burning
Dysuria
“Yellow-green, frothy, foul-smelling discharge”
What is another hallmark finding of Trichomonas vaginalis?
Strawberry cervix
This is due to epithelial cell descturction in the GU tract that leads to neutrophil influx & petechial hemorrhage
What are the presenting symptoms of TSS?
Malaise Fever Nausea Vomiting Diarrhea
Erythroderma
How is TSS treated?
1) Remove tampon
2) Supportive therapy (shock)
3) Beta-Lactamse resistance PCN or vancomycin
What are the symptoms of prostatitis?
Lower back pain
Perirectal pain
Testicular pain
What are some of the risk factors for developing a UTI?
Sexual intercourse Catheterization (CA-UTI) BPH DM Pregnancy
What bacteria most commonly cause community acquired UTI?
UPEC
S. saprophyticus
What bacteria are hospital acquired UTIs associated with?
Klebsiella
Proteus mirabilis
Pseudomonas aeruginosa
What are serologic makers of enterobacteriaceae?
O, H, & K antigens
O= LPS K= capsular H= flagella
What virulence factors are associated with enterobacteriaceae?
Endotoxin (LPS)
Antimicrobial resistance
What virulence factors are associated with UPEC?
Adhesin
Hemolysin
LPS/ Endotoxin
Type I pili (mannose)
P-pili (“sugar”)
What virulence factor is associated with Proteus mirabilis? What is the clinical implication?
Urease
Urease–> alkanization of the urine that can cause precipitation of organic & inorganic compounds i.e. leading to renal stones
How is a Proteus UTI treated?
TMP-SMX
How is pseudomonas aeruginosa diagnosed?
Blue-green cyan pigment
How is pseudomonas UTI treated?
Multiple antibiotics
What risk factors are associated with enterococsus UTI?
Hospitalization
Treatment with broad spectrum antibiotics
What infections are associated with enterococcus aside from UTI?
Peritonitis
Endocarditis
How is uncomplicated cystitis treated?
TMP-SMX
How is pyelonephritis treated?
Depends whether the causative organism if Gram positive or Gram negative.
Gram positive= Amoxicillin
Gram negative= Fluoroquinolones
What are the requirements for treating asymptomatic asymptomatic bacteriuria? How is it treated?
1) Pregnant women
2) Prior urologic surgery
3) Renal transplant
- Amoxicillin
- Cephalexin
- Nitrofurantoin
What are the symptoms of acute HIV infection?
3-6 weeks post-infection there will be a mononucelosis-like syndrome with:
Fever Malaise Arthralgia Lymphadenopathy Sore throat Rash
What are common HIV associated infections & what causes them?
Oral Hairy Leukoplakia= EBV
Pneumonia= Pneumocytis jevori & Mycobacterium Tuberculosis
Trursh= candidia albicans
CMV retinitis= CMV
Neoplasm= kopasi’s sacrcoma, B-cell lymphoma
Diarrhea= cryptosporidium & isopsera belli
List the classes of antiretroviral drugs.
- Attachment inhibitors= chemokine receptor antagonists (gp120)
- Fusion inhibitors= gp41
- Reverse transcriptase inhibitors
Nuceloside
Non-nucleoside - Integrase inhibitors
- Protease inhibitors
What is the current standard of care for ARV therapy?
2x NTRIs +
1) NNRTI
2) II
3) PI
What are the symptoms of HSV genital infection?
Genital lesion
Fever
Inguinal lymadenopathy
Malaise
How does the lesion seen with HSV appear?
The lesion progresses from macules to papules, vesicles, pustules, & ulcers
List the characteristics of HSV.
Herpesvirus family
Enveloped
dsDNA
HSV-2 is most common
What are the three presentations of Neonatal Herpes Infection?
1) Localization to skin, eyes, & mouth
2) Encephalitis
3) Disseminated infection
How is HSV diagnosed?
Clinical appearance
Tzanck smear
PCR
Immunohistochemistry to detect antigens
Generally, how is HSV infection treated based on different regions that can be infected?
Oral= NOT Eye= topical antiviral Neonatal= IV antiviral Genital= oral antiviral (long term if recurrent)
List the characteristics of HPV.
Papovirus family
dsDNA
non-enveloped
What is the medical term for genital warts?
Condyloma acumanitum
What are the descriptive features of genital warts?
Hyperkerototic
Firm
Expohilic papules
What serotypes of HPV cause Plantar Warts?
1 & 4
Which HPV serotypes have the highest association with cancer?
HPV 16 & 18
How is HPV diagnosed?
Main tool for diagnosis is the Pap smear; cells are removed during pelvic examination & placed directly onto glass slide with fixative
- Mild dysplasia involving lower 1/3 of epithelial= cervical intraepithelial neoplasia I (CINI)
- Dysplasia of the entire epithelium= carcinoma in situ (CIN3)
- Dyplasia + breach of the basal membrane= invasive squamous cell carcinoma
How is HPV treated?
Low grade lesions=
- Cauterization
- Cryotherapy
- CO2 laser therapy
- Loop excision
Advanced (carcinoma in situ +)=
- Hysterectomy
+/- radiation and/or chemotherapy
