Genital Flashcards
Mention STDs with systemic effects
HIV, HLTV, HBV, CMV
Some STDs if left untreated cause….
PID & infertility in women
…..&……cause urethral discharge & PID
N.gonorrhea & C.trachomatis D-K
Vaginal discharge is caused by……..
Candida albicans & Gardnella vaginalis
Genital herpes is mostly caused by………
HSV-2
List complications of genital herpes
Recurrence, aseptic meningitis, neonatal infection if genital herpes affects pregnant women
The duagnostic specimen for genital herpes is……
Vesicular fluid, scraping of ulcer base
Treatment of genital herpes is…..
Acyclovir
Treponema pallidum is inactivated by……
mild heat 60deg, cold, most disinfectants
Describe MOT of syphilis
Mainly by sexual contact but also direct contact but no through fomites. Also transplacentally. Rarely by blood transfusion
GR:
1-Evasion of immune response by treponema pallidum
2-Immunity to syphilis is incomplete
- Due to unique stucture of treponemal outer membrane
- Since specific Abs do not stop progression of disease
Mention Abs produced in response to syphilis
- Reagin (heterophil or non-specific) antibodies: a mixture of IgM & IgG against widely distributed antigens in normal tissues as cardiolipid, appear 2-3 wks after infection
- Specific antitreponemal Abs
Describe mainfestations of 1ry syphilis
Multiply at inoculation site & form local painless hard chancre on genitalia in 2-10 wks. Bilateral Regional lymphadenopathy. 1ry lesions disappear heal spontaneously within 3-6 wks. It is communicable.
Describe mainfestations of 2ry syphilis
- Most commonly affect skin & mucus membranes in the form of warty or macular lesions. Moist leisons on genitalia are called condyloma containing organism (highly infectious)
- Constitutional symptoms
- Pharyngitis, menintis, nephritis, hepatitis.
- Serology is highly +ve
- 1/3 heal without treatment, 1/3 have latent syphilis, 1/3 disease progress to tertiary
Describe mainfestations of 3ry syphilis
It is slowly progressive, destructive inflammatory disease that may affect any organ may occur after decades in untreated individuals. Tertiary syphilis is chct by appearance of chronic granulomas (gumma) in skin, skeleton, CNS, CVS). Few spirochaetes are found in lesions
Mention diagnostic specimen for direct methods in syphilis
List methods of examination
Freshly collected exudates from chancre in 1ry stage or condyloma in 2ry stage
Methods: Fontana-stained preparation, unstained preparation examined by dark field microscope, direct immunofluorescence
T.pallidum can be propagated by inoculation on……
Rabit testis
Mention uses of standart tests fir syphilis
- Screening as they are cheap & simple (in 1ry & 2ry)
- Monitor efficacy if therapy as their titer dec with specific ttt
Mention flocculation tests for syphilis diagnosis & explain each
A) Venereal disease research lab test: Ag added to patient heat inactivated serum, +ve cases are visualized microscpoically
B) Rapid plasma reagin test: Ag contains carbon to enable reaction to be visuallized by nakes eye. Doesn’t require heat inactivation
GR:
1. False +ve
2. False -ve
In non-specifuc tests for syphilis
- Non treponemal infectious diseases, collagen & vascular diseases
- Prozone phenomenon & tertiary syphilis
Specific Abs for syphilis apear…….& remain for…..
2-3 wks after infection
Life
The test used as confirmation after screening is……., while……..is replacing flocculation for screening purposed.
Fluorescent treponemal Ab test
EIA
…….is used for ttt of syphilis while……is used in penicillin-allergic, non-pregnant patient
Penicillin G
Doxycycline
……..can follow ttt of 2ry syphilis
Jarisch-Herxheimer reaction
Chancroid is caused by……which requires…..for growth
H.ducreyi
X factor
Describe manifestations of chancroid
Chct by soft painful genital ulcers called soft chancre. Tender unilateral lymphadenopathy is also found. A chancroid ulcer may block the opening of urethra, causing pain during urination. Most common symptom in women
Ttt of chancroid is…….
Azithromycin or IM ceftriaxone
Mention causative agent & C/P of lymphgranukoma venereum
C. trachomatis L1-L3
The disease is chct by painless genital papule or ulcer followed by enlarged painful inguinal LNs which ulcerate & discharge pus into sinuses
Lymphgranuloma venereum is ttt by…..
Doxycycline (erythromycin in pregnant women & children)
Chlamydia grow on…..
Yold sac of chick embryo or tissue culture
Describe pathogenesis of Chlamydia trachomatis (D-K) genital infection
Enters body through scrapes or cuts & infects cells lining mucus membranes. Typically, the lesion at a site of infection is small painless & heals rapidly. Clinical manifestations of chlamydial infection result from destruction of infected cells & inflammatory response this destruction stimulates. Reinfection in the same site or a similar strain triggers a vigorous immune response that can result in sexual dysfunction.
List causative agents of genital warts & the features of each
Their MOT is….
- Human papilloma virus: small, non-enveloped icosahedral viruses containing circular dsDNA
- Molluscum contagiosum: brick-shaped, enveloped dsDNA belongs to Poxviridae
Sexual or indirect contact
HPVs induce…….., & some integrate into genome & produce…..that can trigger cancer
Epithelial cell proliferation
E6 & E7 proteins
MCV lesions may heal spontaneously within…..
2-6 wks
Describe prevention of HPV
- A recombinant vaccine having 4 types of HPV, 6&11 cause genital warts, 16&18 cause carcinoma
- A recombinant vaccine but contains only 16&18. Cervarix contains an adjuvant called AS04 that thereby enhances Ab production
Describe manifestations of vaginal candidiasis
Irritation, pruritis & vaginal discharge is often curd like. This may be accompanied by urethritis & dysuria & may present as a UTI.
Candida multiplication within vagina takes place when…….&…….
More alkaline than usual or if normal bacterial populations are reduced by Abx
Bacterial vaginosis causative agent is……
Gardnerella vaginalis (it is polymicrobial)
Describe manifestions of bacterial vaginosis
- The vaginal discharge is thin & greyish & has a pleasant odour often describes as “fishy”
- Some itching & irritation of the vaginal opening may also occur
- Up to 50% of women with bacteria vaginosis report no symptoms
Diagnostic Specimen for bacterial vaginosis is……..
Vaginal exudates or swab (high vaginal or endocervical)
Explain the following tests for bacterial vaginosis:
1. Amine or Whiff test
2. Saline wet film
- Addition of a drop of 10% KOH on vaginal secretion produces a fishy odor
- Examined by high power lens shows chct “clue cells”
Ttt of bacterial vaginosis is……., & candidiasis is…..
Metronidazole
Oral fluconazole or vaginally adminstered miconazole or butoconazole
Most common causative agents of cervicitis are……..
C.trachomatis & N.gonorrhea
PID causes inc risk of…….
Ectopic pregnancy & sterility
Mention causative agents of prostatitis
- Enterobacteriacae & pseudomonas
- N.gonorrhea & C.trachomatis
Bacterial causeing urethritis include……while viral is caused by……
N.gonorrheae, C.trachomatis, Ureaplasma urealyticum
HSV & CMV
List virulence factors of N.gonorrhea
- Lipoligosaccharides (endotoxin)
- Pili: undergo marked antigenic variation
- Outer membrane proteins (play a role in attachment)
- IgA1 proteases
- B-lactamases (plasmid mediated)
Mention symptoms of disseminated gonococcal infection
Septic arthritis, fever, septic skin lesions on extermities & may end in septic shock
Mention diseases caused by N.gonorrhea which are NOT sexually transmitted
- Ophthalmia neonatorum due to passage in infected birth canal. Routine prevention by topical erythromycin
- Vulvovaginitis due to poor hygeine in young girls
- Gonococcak conjunctivitis due to autoinfection
Mention diagnostic specimen of gonococcal inefction
- In males: urethral exudates or morning drop in chonic cases
- In females: urethral & endocervical samples (a high vaginal swab is not suitable)
- Disseminated: blood, swab from skin lesion, pus aspirated from a joint
Describe role of direct demonsatration in diagnosis of gonorrhea
In males with acute urethritis microscopic exam of gram-stained film is diagnostic
In females & chronic cases positive culture is needed
Mention media for growth of Neisseria & suitable conditions
Thayer martin medium (for contaminated samples)
Heated blood agar (for sterile)
5-10% CO2, 37deg, 24-48 hrs
Mention biochemical tests for Neisseria
Oxidase +ve & ferment glucose with production of acid only
GR: Serology is not suitable for gonorrhea
Due to high variability of gonococcal antigens
Describe treatment of gonorrhea
Third generation cephalosporins are 1st line therapy. Alternative is spectinomycin in allergic patients. Tetracyclines are indicated for eradication of associated C.trachomatis.
