Gonorrhea/Chalmydia Flashcards
gonorrhoeae pathogenesis
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
virulence factors of gonorrhoeae
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.
pelvic inflammatory disease
spread of cervical infection to fallopian tubes, creating pain, risks of infertility, and ectopic pregnancies.
disseminated gonococcal infection
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.
gonorrhoeae diagnosis: exam
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
fitz-hugh-curtis syndrome
bacteria jump from fallopian tube to liver capsule, leading to acute perihepatitis.
Disseminated infection signs
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)
rare occurrences in gonorrhoeae
gonococcal meningitis, endocarditis. endocarditis is more common in men, and the aortic valve is the most common site.
gonorrhoeae diagnosis for males
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
gonorrhoeae diagnosis for females
endocervical smear and wipe off exudate first. do nucleic acid tests, and if needed, culture on thayer martin
disseminated gonococcal infection diagnosis
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.
how to differentiate between gonorrhoeae and meningitidis
only meningococci ferment maltose. can also use immunofluorescence.
gonorrhoeae treatment
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
gonorrhoeae prevention
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)
chlamydia replication
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
elementary bodies
small, infections, rigid outer membrane, rugged. bind to receptors on epithelium of lung or mucus membrane and initiate infection
reticulate bodies
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
immune response to chlamydia
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
organisms for urogenital chlamydia
c. trachomatis. 18 serovars: A, B, Ba, and C are binding trachoma. L1-L3 are lymphogranuloma venereum, and D-K are genital tract infections
blinding trachoma
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.
lymphogranuloma venereum
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.
genital chlamydia
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.
genital chlamydia risk factors
nonbarrier contraceptive use, multiple sexual partners, single marital status, age less than 19, socioeconomic disempowerment
chlamydia -> pelvic inflamm disease
leading cause of PID and infertility in women. creates risk of chronic pain and ectopic pregnancy
