Gynecological and Pregnancy Related Infections Part 3 Flashcards
focused exam of primary outbreak of gential herpes
primary outbreak is more severe than recurrent ones
bilateral scattered small shallow vesciles that are painful and bilateral lymphadenopathy with systemic symptoms
recurrent genital herpes
unilateral vesicles that can rupture and ulcerate, usually no systemic symptoms
all herpes vesicles can rupture and ulcerate, this is unilateral that is the difference
in herpes there is often associated ________-
lymphadenopathy
recurrent herpes infections are common due to the fact that the virus remains latent in the ?
sacral ganglia
herpes simplex is a double stranded _ virus that has lifelong peristency in the _
DNA
nerve root
HSV I involvement
orofacial
HSV II involvement
genital involvement
herpes can be transmitted to the infant via
vertical transmission
herpes cytology shows?
molding, multinucleation, margination
molding- nuclei conform the the shape of other nuclei
multinucleation- multiple nuclei form
margination- glass like quality of the nuclei due to viral particles present
genital herpes treatment specifically target?
DNA synthesis
Acyclovir (only one that can be given IV)
Famciclovir
Valacyclovir
for treatment of genital herpes it is most effective if started within _ hrs.
72
72 hrs from onset of lesions
MOA of acyclovir
it is adminsitered as a prodrug and targets herpes virus specific thymidine kinase and cellular kinases phosphoyrlate in order for it to be incorporated into viral DNA and stops the lengthening of DNA strands
how does viral herpes gain resistance to acylcovir?
there is a decreased production of thymidine kinase which prevents acyclovir from reaching its triphosphate active state and cannot be incorpoprated into viral DNA to stop synthesis
primary symphilis presentation
bump that is now a open wound and is painless with mild inguinal lymphadenopathy (later stage)
primary syphilis develops a _ chancre 6 weeks after contact
painless
_ weeks after a primary infection of syphilis what secondary syphilis presents and shows what
6 weeks
condyloma lata wart like lesion on the palms and soles (macular rash)
the macular rash in syphilis is on the palms and soles what other processes involve the palms and soles
rocky mountain spotted fever and toxic shock syndrome
secondary syphillis usually resolves in 2 months and will remain latent until becoming reactivated and forming tertiarry syphillis when?
6-40 years later
tertiary syphillis is characterized by involvement throughout the body and widespread _ formation
gumma
what are gummas?
lesions that involve skin, bones, soft tissue and other organs they show spirochete organisms with a area of central necrosis, paslama cells and histiocytes
tertirary syphillis can also cause _ with involvement of the vasa vasorum (small vessel that feeds the aorta)
thoracic aorta aneurysm/dilation
if tertiary syphillis involves the porerior columns of dorsal roots of the spinal cord there is loss of?
this is known as tabes doraslis
loss of position and vibration sense below the level of the lesion
patient will often fall with their eyes closed and fee together
if tertiary syphilis involves the midprain what happens
the pupils do not react to light but constrict in focusing with near object(argyll robertson pupils)
sphyillis is caused by?
microbiology
treponema pallidum which is a corckscrew spirocete with spinning motility
a key feature in both primary and secondary syphillis is the presence of?
plasma and lymphocytic infiltrarte termed lymphoplasmacytic infiltrate on histology
how do gummas in tertirary symphillis present hsitologically ?
they present with large areas of necrosis with histiocytes and plasma cells
what stain shows the spirochetal symphilis bacteria
silver stain
what are the nontrepnemal screening tests
VDRL, RPR, TRUST
nonspecific tests that checks the antibodies (screening test)
in syphilis _ is typically utilized to make the diagnosis
serology
after a nonspecific test more specific treponemal diagonostic tests check for antibodies against specific antigens: what are these tests?
FTA-ABS
if you have a direct tissue sample of syphillis you can use what to test it?
4 of them
PCR (most used- definitve and checks for DNA of syphillis)
Darkfield microscopy
fluroescent antibody testing
silver stain
treatment for syphillis (primary/early/secondary/latent)
benzathine penicilin or doxycyline if allergic to penicillin
want to target treponema pallidum
neurpsyphilis/ocular syphilis (tertiary) is treated with?
aqueous crystalline penicillin G
procain penicillin G and probenaecid
what is benzathine penicillin
2 penicillin G molecules that react with diphenyethylene diamine that is given IM and contains a beta lactam ring
safe during pregnancy
what does benzzathine penicillin cover
bacteria coverage
gram positive bacterio like beat hemolytic strep
gram negative bacteria like trepnema pallidum ( in syphillis)
side effects of bezathine penicillin/ beta lactam antibiotics
allergic reactions and analphylactic shock
also penicillins and cephalosporins
benzathine penicillin can cause a rare reaction when used to treat sphyillis which is termed?
Jarisch-herxheimer
a chancroid is usually seen where?
location
in resource poor areas (africa, subsaharan, latin america)
chancroid present with
multiple painful genital ulcers and inguinal lymphadenopathy
chancroid is caused by?
gram negative bacillus haemophilus ducreyi
is testing available for chancroid?
no, but rule out HSV and syphillis
how do we treat chancroid
azithromycin, certriacoine, ciprofloxacin, erythromycin
lymphogranuloma venerum (LGV) is found where
location
tropical/subtropical locations
LGV presentation
one painless geninital ulcer that heals but then develops buboes which are painful unilateral inguinal lymphadenopathy
more common in men than women due to lymphatic drainage differences
lymphogranuloma venerum is caused by
chlamydia trachomatic L1, L2, L3 serovars
a gram negative intracellular bacteria that relies on host ATP
treatment of LVG
normal vs pregant
normal - doxycline
pregnant- macrolides (azithromycin)
granuloma inguinale is found?
location
in india, papua new guinae, caribbean
granuloma inguinale presentation
painless nodule that slowly enlarges that are beefy red can ulcerate and do NOT HAVE LYMPHADENOPETHY
granuloma inguinale is caused by?
gram negative rod klebsiella granulomatosis
biopsy of granuloma inguinale shows
donovan bodes which are collections of bacilli in cytoplasma of macrophages, monocytes, or histiocytes
treatment of granuloma inguinale
azithromycin
azithromycin is?
a macrolide, 50s subuint inhibitor that inhibits protein synthesis
what are the macrolides?
erythromycin, azithromycin, clarithromycin
toxic shock syndrome is characterized by the rapid onset of?
fever, erythematous rash on palms and soles, desquamation of skin 2 weeks after rash apperance, hypotension + systemic involvement indicationg shock
TSS is caused by
staph aureus
can ocurr with MSSA and MRSA
usually in mentrual cases but doesnt have to be (high absorbent tampons)
staph aureus is a ?
microbiology
gram positive, catalase positive, coagulase positive coccous that is found in clusters
what is catalase
a enxyme that breaks down hydrogen peroxide
what is coagulase
an enzyme that acitvates the formarion of a fibrin clot to help protect the baceria
what are the virulence factors of staph aureus?
hyalurinidase (destroys CT)
staphylokinase (destroys clot)
lipase (destroys fat)
staph aureus produces TSS by releasing what
toxic shock syndrome toxin 1 (TSST-1)
what is the mechanism of action of TSST-1?
it acts as a super antigen to crosslink T cells and macrophages this binding releases cytokines that give systemic features like hypotension and fever (shock)
how do we treat TSS
remove the foregin body or infection by surgical debriedment, care for the shock symptoms, and start empiric antibiotics
what is the glycopeptide that is used to treat TSS
vancomycin
vancomycin is used in TSS if the infection is _
suspected to have MRSA (methicillin resistant )
what is the MOA of vancomycin?
it inhibits cell wall synthesis of bacateria by creating unstable cross links
how has bacteria become vancomycin resistant ?
the resistant strains change from D-ala:D-Ala to D-ala:D-Lac/Ser
what is a B-lactamase enxyme
this is an enxyme produced by some bacteria than give them resistance to Antibiotics like penacinllinase which helps it to degrade betalactam rings
bacteria that produce extended spectrum b-lactamases are _ strains
multi drug resistant strains
how do beta lactamase inhibitors work
they work by extending B-lactam spectrum of antibiotic activity to prevent resistant from betalactamases.
what combination drug of betalactam is used to treat TSS
Piperacillin and Tazobactam (zosyn)
given IV, covers both gram positive and gram negative can be used to treat PID
what cephalosporin can be used to treat TSS
Cefepime
4th generation, covers gram negative and gram positive, cell wall synthesis inhibitors
cefepime when treating TSS is a fron tline agent when infection is with _
enterobacteriacea
what carbapenems are used to treat TSS
meropenem and imipenem/clistatin
beta lactam antibiocs that are cell wall synthesis inhibitors
meropenem has what side effects and resistance arise because?
side effects: clostridium difficile and allergic reactions
resistance: mutations in penicillin binding proteins
is imepenem/cilastatin active against MRSA?
no
imipenem is rapidly degraded by?
renal enzyme dehydropeptidase (DHP1)
imipenem is coadmisnistered with?
cilastatin which is a DHP1 inhibitor and it prevents inactivation of imipenem
