Gonorrhea and Chlamydia

Question 1

Scientific name for Gonorrhea?

Answer 1

Neisseria gonorrhoeae

Question 2

Scientific name for Chlamydia?

Answer 2

Chlamydia trachomatis

Question 3

Bacteriology of N. gonorrhoeae?

Answer 3

Diplococci, oxidase positive, Gram (-), LOS endotoxin, Chocolate agar culture, not encapsulated

Question 4

Is gonorrhoeae cleared from the body spontaneously?

Answer 4

No. Cleared by complement from bloodstream, restrict infection to local sites. Complement deficiencies predispose for complications (bacteremia)

Question 5

Gonorrhoeae drug resistance?

Answer 5

Plasmid-borne antibiotic resistance more common. Cephlasporin resistance

Question 6

Transmission of gonorrhoea?

Answer 6

Sexually or congenital (birth). Single exposure contraction.

Question 7

How does gonorrhoeae present in neonates?

Answer 7

Purulent conjunctivitis (uni/bilateral), eye pain, redness, discharge. Permanent blindness if untreated.

Pharyngeal, respiratory, rectal, or disseminated possible.

Question 8

How does gonorrhoeae present in men?

Answer 8

Symptomatic. Anterior urethritis, dysuria, purulent discharge, unilateral epididymitis

Question 9

How does gonorrhoeae present in women?

Answer 9

Possibly asymptomatic. Cervicitis, PID, sterility, ectopic pregnancy

Question 10

Gonorrhoeae virulence factors?

Answer 10

IgA protease, pili attachment, Opa proteins, Porin A/B serum resistance (anti-complement)

Question 11

Common secondary infection assoc. with gonorrhoeae?

Answer 11

Pelvic inflammatory disease (PID). Cervical infection spreads to fallopian tubes (pain, infertility, ectopic pregnancy risk).

Dysuria, tenderness, abdominal pain, vaginal discharge, intermenstrual bleeding

Question 12

Symptoms that men and women can share?

Answer 12

genital tract, anorectal, pharyngeal, eye infections

Question 13

What is Fitz-Hugh-Curtis syndrome?

Answer 13

Assoc. with gonorrhoeae and chlamydia.

Infection jumps from fallopian tube to liver capsule –> Acute perihepatitis.

Imaging may show thickened fallop. tubes or abscess

Question 14

Pt with significant STI risk factors, presents with unexplained knee inflammation/pain, but no urogenital symptoms. What are you thinking?

Answer 14

Disseminated infection (DGI) of gonorrhoeae.

Can present with arthritis (jt pain), dermatitis (skin pustules), asymmetric tenosynovitis w. wrist/ankles pain, moderate fever, septic asymmetric arthritis (knee most common).

Question 15

What are some rare sequelae of gonorrhoeae infection?

Answer 15

GONOCOCCAL meningitis: use spinal tap

ENDOCARDITIS: More common in men, aortic valve = common site, subacute fever/chills/sweats/malaise, chest pain and cough

Question 16

How do you diagnose gonorrhoeae in men?

Answer 16

Urine and exudate testing: PMNs indicate urethritis, gram (-) diplococci seen in microscopy.

If negative, obtain urethral swab. Culture on chocolate agar (Thayer-martin). Colonies test gram (-), oxidase (+), and diplococci. Most sensitive and specific test.

Question 17

How do you diagnose gonorrhoeae in women?

Answer 17

Endocervical smear, culture on chocolate agar (Thayer-martin)

Question 18

Diagnosing disseminating infection (DGI)?

Answer 18

Swab, gram stain, culture mucosal surfaces and fluid draws.

Sample normally-sterile sites (blood, jt fluid) and culture on choco. agar.

Question 19

How does N. meningitidis differ from N. gonorrhoeae?

Answer 19

Only meningococci ferment maltose

Question 20

How is gonorrhoeae treated? Is concurrent infection possible? Treatment?

Answer 20

Rx: Ceftriaxone, cefixime. If penicillin allergy, cephalosporin. Be aware of resistance).

Septic joints: aspiration

Concurrent chlamydia infection often: Add azithromycin or doxycycline.

Question 21

Treating gonorrhoeae in neonates.

Answer 21

Application of erythromycin ointment or silver nitrate to eyes post-birth.

Question 22

Prevention of gonorrhoeae in adults?

Answer 22

Condoms, informing of sexual partners, expedited partner treatment

Question 23

What makes chlamydia replication so specialized?

Answer 23

Involves ELEMENTARY and RETICULATE bodies (forms).

ELEMENTARY body (infectious, metabolically inactive) attaches to cell surface (lung and mucousal epithelium). and is endocytosed. T3SS activated.

Endosome reorganized in RETICULATE body (non-infectious, metabolically active). Replication within endosome via binary fission. Forms Inclusion granule (EBs + RBs). Reverse endocytosis of microbes,48 hrs post-infect.

Question 24

Immunological response to chlamydia?

Answer 24

Symptomatic inflammatory cascade (swelling, discharge). No clearance of infection. No immune memory; reinfection possible.

Question 25

Different serovars of chlamydia are responsible for which diseases?

Answer 25

A, B, Ba, C: Blinding trachoma L1-L3: lymphogranuloma venereum D-K: genital tract infections

Question 26

What distinguishes chlamydia infection in men vs. women?

Answer 26

Men often asymptomatic. Disease reservoirs. Recurrent infections in women usually due to reinfection by undiagnosed male partner.

Question 27

Common symptoms of chlamydia infection.

Answer 27

Local mucosal inflammation and discharge. Urethritis, cervicitis, vaginitis.

Question 28

Link between chlamydia and HIV?

Answer 28

Chlamydia infection increases risk of HIV infection through open sores.

Question 29

Dangers of chlamydia during pregnancy?

Answer 29

Can be transmitted to infant during delivery

Question 30

Risk factors for chlamydia.

Answer 30

Non-barrier contraception use, <19 y/o, multiple sex partners, single, poor

Question 31

Potentially dangerous sequelae of chlamydia infection

Answer 31

PID. Cervical infection spreads to fallopian tubes (pain, infertility, ectopic pregnancy risk). Dysuria, tenderness, abdominal pain, vaginal discharge, intermenstrual bleeding REITER SYNDROME (aka reactive arthritis): Immune response. Conjunctivitis, urethritis, arthritis ("Can't see, can't pee, can't climb a tree"). Treat with NSAIDs. 2 years for resolution.

Question 32

How do you physically diagnose chlamydia in women?

Answer 32

Endocervical bleeding, mucopurulent endocervical discharge, intermenstrual bleeding, dysuria, abdominal pain

Question 33

How do you physically diagnose chlamydia in men?

Answer 33

Usually asymptomatic, but can present with urethral discharge, urinary frequency/urgency, dysuria, scrotal pain/tenderness, perineal fullness

Question 34

Diagnosing chlamydia through labs.

Answer 34

A. Cytologic diagnosis: microscopy will show inclusion bodies B. Cell culture: Grows well in many cell lines C. Chlamydia rRNA detection: Hybridization with DNA probe D. ELISA and PCR of urine/exudate possible

Question 35

Treatment of chlamydia

Answer 35

Intracellular microbe. Need intracellular drugs. Primary: doxycycline (NOT for preggos) and azithromycin Secondary: Erythromycin and amoxicillin (Need fw-up testing) Treat partner also