Gynecological and Pregnancy Infections Part 3 (Staudinger) Flashcards
Genital herpes clinical presentation
primary: fever, headache, dysuria, painful-stinging itchy genital sores
later (recurrent): in sacral ganglia, ruptures and ulcerated vesicles, no systemic symptoms
Genital herpes pathology
DNA virus; lifelong infection (in nerve root - typically the sacral ganglia); can be transmitted vertically; three M’s - Molding, multi nucleation and margination
The three M’s associated with genital herpes
Molding (nuclei confirm to shape of adjacent nuclei)
Multi-nucleation (multiple nuclei)
Margination (clearing or glass-like nuclei)
HSV I
orofacial involvement
HSV II
genital involvement
Genital herpes treatment
Acyclovir OR Famciclovir OR Valacyclovir; inhibits DNA synthesis by binding thymidine kinase; most effective if started within 72 hours
Acyclovir Resistance
decreased or absent production of viral thymidine kinase that present acyclovir from reaching the activated triphosphate state
Syphilis
Primary: painless chancre before 6 weeks
Secondary: condyloma lata, macular red rash (palms and soles) after 6 weeks
Tertiary: gummatous lesions and can cause thoracic aortic aneurysm 6 years later
Neurosyphilis
tabes dosalis - involves posterior columns or dorsal roots of spinal cord - loss of position and vibration
Argyll Robertson pupils - involves mid brain - pupils do not react to light
Syphilis pathogen
treponema pallidum; spiral corkscrew spirochete, highly motile; historical will show lymphoplasmacytic infiltrate with numerous plasma cells
Histology of tertiary syphilis
large areas of necrosis with palisaded histiocytes and plasma cells
Syphilis diagnosis
Screening test: RPR (rapid plasma reagin)
Specific test: FTA-ABs (treponema antibody test)
Direct: PCR for syphilis DNA (most common)
Treatment for syphilis
Benzathine penicillin - safe for pregnancy (allergy then, Doxycycline)
Neurosyphilis/Ocular syphilis: Penicillin G or penicillin G AND probenecid
Chancroid
pathogen Haemophilus ducreyi; gram neg rod; rare; occurs in developing nations; painful ulcers; multiple; inguinal lymphadenopathy; do NOT confuse with chancre of syphilis - rule out through syphilis testing
Lymphogranuloma venereum
pathogen Chlamydia trachomatis L1, L2, and L3 (different from the cause of cervicitis); occurs in tropical locations; painless genital ulcer; buboes (common in men)
Granuloma inguinale
pathogen Klebsiella granulomatosis; biopsy shows “Donovan bodies”; occurs in India, Caribbean, Southern Africa; painless friable/beefy red lesions; NOT associated with lymphadenopathy; treat with azithromycin
“Donovan bodies” on histo
pathogen Klebsiella granulomatosis causes Granuloma inguinale; painless friable/beefy red lesions; NOT associated with lymphadenopathy; treat with azithromycin
Toxic Shock Syndrome (TSS)
staph aureus infection; rapid onset fever, diffuse erythematous macular rash that involves palms and soles (sunburn-like)
Staphylococcus aureus
gram positive, catalase positive, coagulase positive; grape-like clusters; main organism in TSS; TSST-1 crosslinks T cells and macrophages and induce release of cytokines
MOA of Staphylococcus aureus in TSS
TSST-1 acts as superanitgen by binding directly to the MHC class II molecules on macrophages and crosslinks to T cell receptors; cross linking activates both macrophages and T cells and causes massive release of cytokines undoing clinical symptoms: hypotension, fever and shock
Treatment of TSS
all are cell wall synthesis inhibitors:
Vancomycin (Glycopeptide) - drug of last resort
Piperacillin/Tazobactam (Penicillin plus B lactamase inhibitor)
Cefepime (4th generation cephalosporin)
Meropenem (Carbapenems)
Imipenem/Cilastatin (Carbapenem plus DHP 1 inhibitor - renal enzyme)
