Gonorrhea/Chalmydia

Question 1

gonorrhoeae pathogenesis

Answer 1

transmitted sexually or at birth. in a neonate it will show as conjunctivitis. males are usually symptomatic, with anterior urethritis. females are often asymptomatic, with cervicitis. genital infections most common, but can infect the butt

Question 2

virulence factors of gonorrhoeae

Answer 2

IgA protease clears IgA from mucosal surfaces to facilitate conlonization. Pili attach to columnar and transitional epithelium of mucosal surfaces, and are antiphagocytic. Opa proteins enhance cell adherence and entry. Porin A and B channels in outer membrane allow cell entry. LOS induces local inflammatory response.

Question 3

pelvic inflammatory disease

Answer 3

spread of cervical infection to fallopian tubes, creating pain, risks of infertility, and ectopic pregnancies.

Question 4

disseminated gonococcal infection

Answer 4

can occur. certain strains are more likely to disseminate. virulence factor is serum resistance, including Porin A in the cell wall. more common in women. asymptomatic infection, menses, pregnancy, and complement C6-C9 deficiency can predispose this.

Question 5

gonorrhoeae diagnosis: exam

Answer 5

extremely contagious. symptoms develop within 10 days of infection. men show with urethritis, dysuria, purulent discharge, sometimes epididymitis unilaterally.
women show with purulent vaginal discharge, cervicitis, pelvic inflamm disease

both show co-infection of pharynx, rectum, and eye. all appear as irritated/destroyed tissue with discharge

Question 6

fitz-hugh-curtis syndrome

Answer 6

bacteria jump from fallopian tube to liver capsule, leading to acute perihepatitis.

Question 7

Disseminated infection signs

Answer 7

often lack urogenital symptoms. arthritis, dermatitis, joint pain and skin pustules. asymmetric tenosynovitis with pain in wrists and ankles. moderate fever. progression to septic asymmetric arthritis (usually the knee)

Question 8

rare occurrences in gonorrhoeae

Answer 8

gonococcal meningitis, endocarditis. endocarditis is more common in men, and the aortic valve is the most common site.

Question 9

gonorrhoeae diagnosis for males

Answer 9

try urine and exudate testing. gram stain: PMNs indicate urethritis, gram - intracellular diplococci indicate gonorrhea. Nucleic acid amplification tests give the best sensitivity and specificity. If repeat tests are needed, do a urethral swab. gram stain will be same, culture on chocolate agar with drugs (Thayer martin plate). test colonies for gram negative oxidase positive

Question 10

gonorrhoeae diagnosis for females

Answer 10

endocervical smear and wipe off exudate first. do nucleic acid tests, and if needed, culture on thayer martin

Question 11

disseminated gonococcal infection diagnosis

Answer 11

swab, gram stain, and culture all available mucosal surfaces and fluid draws. samples from sterile sites can be cultured on chocolate agar. can do immunofluorescence on pustule samples.

Question 12

how to differentiate between gonorrhoeae and meningitidis

Answer 12

only meningococci ferment maltose. can also use immunofluorescence.

Question 13

gonorrhoeae treatment

Answer 13

begin promptly. ceftriaxone or cefixime. if allergic to penicillin, use cephalosporin but watch for resistance. add azithromycin or doxycycline because chlamydia also co-infects. apsirate the septic joints. follow up in 3 months unless in a resistant area. admit to hospital if pregnant, PID, DGI, endocarditis, meningitis, purulent joint infection

Question 14

gonorrhoeae prevention

Answer 14

neonatal conjunctivitis: prophylactic application of erythromucin ointment or silver nitrate to eyes after birth. Use condoms, treat people promptly. report incidence to local health authority. expedited partner treatment can be warranted in some cases (scripts without exam)

Question 15

chlamydia replication

Answer 15

two cell types: elementary bodies and reticulate bodies. elementary body attaches to surface of cell. endocytosis occurs, and EB reorganizes into reticulate body in endosome. the RB replicates and are then reorganizes to EB. The inclusion granule then contains both RB and EB, some bacteria cause cell to lyse, and others exocytosis to get out

Question 16

elementary bodies

Answer 16

small, infections, rigid outer membrane, rugged. bind to receptors on epithelium of lung or mucus membrane and initiate infection

Question 17

reticulate bodies

Answer 17

non-infectious intracellular form. metabolically active, replicating, synthesize its own DNA, RNA and proteins, but uses host ATP. fragile gram - membrane. inclusions accumulate 100-500 progeny before release

Question 18

immune response to chlamydia

Answer 18

inflammatory cascade causes some of the symptoms (swelling and discharge) but usually fails to either clear the infection or prevent reinfection. no useful immune memory, meaning reinfection is common

Question 19

organisms for urogenital chlamydia

Answer 19

c. trachomatis. 18 serovars: A, B, Ba, and C are binding trachoma. L1-L3 are lymphogranuloma venereum, and D-K are genital tract infections

Question 20

blinding trachoma

Answer 20

infectious eye disease. leading cause of preventable blindness. spread by secretions- direct and fomites. untreated eyelids turn inward, causing the eyelashes to scratch the cornea.

Question 21

lymphogranuloma venereum

Answer 21

endemic in south and central america. small, painless ulcer proceeds to swollen, painful lymph nodes. symptoms are caused by bacterial replication in the mononuclear phagocytes of the local lymph nodes. aspiration of buboes and fistulas may speed healing.

Question 22

genital chlamydia

Answer 22

often asymptomatic, particularly in male reservoirs. most commonly local mucosal inflammation and discharge. urethritis or urethritis/vaginitis/cervicitis. infection increases risk of acquiring HIV. pregnant women infected with chlamydia can pass infection to infants during delivery.

Question 23

genital chlamydia risk factors

Answer 23

nonbarrier contraceptive use, multiple sexual partners, single marital status, age less than 19, socioeconomic disempowerment

Question 24

chlamydia -> pelvic inflamm disease

Answer 24

leading cause of PID and infertility in women. creates risk of chronic pain and ectopic pregnancy

Question 25

reiter syndrome

Answer 25

reactive arthritis. secondary to an immune mediated response. conjunctivitis + urethritis + arthritis. 80% of affected patients are human leucocyte antigen B27 positive. treated with NSAIDs, may take 2 years to resolve

Question 26

genital chlamydia diagnosis exam

Answer 26

women may be asymptomatic, easily induced endocervical bleeding, mucopurulent endocervical discharge, intermenstrual bleeding, dysuria, abdominal pain.

men have urethral discharge, urinary frequency/urgency, dysuria, scrotal pain/tenderness, and perineal fullness

Question 27

urogenital chlamydia lab tests

Answer 27

test for co-incident chlamydia in all STD patients. NAAT or cell culture. NAAT gives best reliable results. C. trachomatis grows easily in a variety of cell lines, culture works fine if no NAAT. cytologic diagnosis for infant ocular trachoma. cell sample is stained by giemsa or IF.

Question 28

urogenital chlamydia treatment

Answer 28

antibiotic must be intracellular. doxycycline or azithromycin. Doxycycline is contraindicated in pregnant or patients younger than 9. second choice are erythromycin and aomxicillin. can be hidden behind gonococcal infections. reinfection is common. treat partner also

Question 29

N. gonorrhoeae bacteriology

Answer 29

like meningitidis: diplococci, human restricted, oxidase positive, cleared from bloodstream by immune complement, growth in vitro inhibited by trace metals and fatty acids (Chocolate agar not blood agar), gram negative. is a lipooligosaccharide (lower molecular weight)

unlike meningitidis: not encapsulated, hundreds of serotypes, even more sensitive to dehydration/cold, plasmid-borne antibiotic resistance more common