Genital Ulcers/PID

Question 1

Genital herpes

Answer 1

Genital Ulcers
• enveloped, icosahedral 
• DS DNA 
• replicates in nucleus
• *HSV-2 (~90% genital herpes), HSV-1
• HSV-1 ↑’ing
- causes vesicular lesions in genital area + sexual history
Lab
- * causes Chancroid=soft chancre
Labs
- *Tzanck test

Question 2

Haemophilus ducreyi

Answer 2

Genital Ulcers
- small Gr- coccobacillus
- strict human pathogen
- no known animal, environmental reservoir
- facultative anaerobe
- extremely infectious
Labs
- fastidious
- chocolate agar + humidity +CO2
- *culture is gold standard
Virulence
- cytotoxin
- pili
- LOS

Question 3

Treponema pallidum

Answer 3

Genital Ulcers
• Gr-, spiral or corkscrew shaped
• human reservoir
• microaerophilic to anaerobic
• extremely labile
• very motile
- *causes syphilis
Labs
- darkfield or immunofluorescence microscopy
Virulence
- axial filaments
- hyaluronidase
- hemolysins
Primary Syphilis 
- *highly infectious, hard, painless chancre
- regional, rubbery lymphadenitis
- *spirochetes disseminate!
Secondary Syphilis
- *highly infx
- initial chancre
- *skin rash
- *condyloma lata
- can become latent
Tertiary (late) syphilis
- *only noncontagious form
- 3 forms:
  - gummatous
  - CV
  - neurosyphilis

Question 4

Lymphogranuloma venereum (LGV)

Answer 4

Genital Ulcers
• causes particular *Chlamydia trachomatis serovars
• mostly men who have sex w/ men
• *predominantly disease of lymphatic tissue
Diagnosis
- granulomatous lesions tend to ulcerate, destroying skin and subcutaneous tissue

Question 5

Klebsiella granulomatis

Answer 5

Genital Ulcers
- causes *granuloma inguinale
- Gr- rod, capsule, nonmotile
- normal microbiota GI
Labs
- fastidious
- CO2, egg yolk
e)	w/in inflammatory foci found mainly intracellularly in *macrophages
   - *Donovan bodies= Klebsiella granulomatis w/in macrophages

Question 6

Human Papilloma Virus (HPV)

Answer 6

HPV
• Naked, icosahedral
• Circular dsDNA
• Replicates in nucleus
• *Papillomavirus- *cervical (99%), *anal (80%), vaginal, vulvar, penile, oral carcinoma
o Dependent on host cell transcription and replication machinery
• Strictly epitheliotropic, w/ tropism for mucosal or cutaneous epithelium
• Difficult to grow in tissue culture in vitro
- Types 6, 11=genital warts=condylomata acuminata
- Range from smooth, flattened papules to a *verrucous (warty/rough), papilliform appearance
- in pregnancy, *cauliflower-like lesions
- *Types 16,18=cervical cancer
Diagnosis
- *DNA probes, PCR of cervical swabs and tissue specimens (molecular methods) (gold standard)
Malignant Transformers
- early HPV genes implicate *E6, E7
- *pRb (cellular *retinoblastoma proten–> tumor suppressor)
- *p53 (norm induces apoptosis)

Question 7

Actinomyces israelii

Answer 7

PID
• Gr+ *filamentous bacillus
- *normal microbiota oropharynx, intest., GU
• anaerobic to facultative to microaerophilic
– *non-acid fast
– fastidious (and slow)
- capnophilic
- *“sulfur granules” in pus
- *yellow-orange, hard
– characteristic *‘molar tooth colonies’ –> following *tooth extraction
Transmission Sx
- causes PID through ass. w/ IUDs
• causes *Actinomycosis
- chronic suppurative granulomatous lesions → form abscesses connected by sinus tracts → may open to skin
• *pelvic - hallmark is tendency to spread w/out regard to anatomical barriers