L10 Sexually Transmitted Infections

Question 1

What are the risks and potential complications of neonatal gonorrhea, and how can it impact the health of newborns?

Answer 1

Neonatal gonorrhea poses risks such as severe eye infections leading to potential blindness and respiratory infections such as pneumonia and sepsis.

Question 2

Discuss the issue of antibiotic resistance in Neisseria gonorrhoeae, including surveillance programs and first-line treatments.

Answer 2

Antibiotic resistance in Neisseria gonorrhoeae is monitored through programs like Gonococcal Resistance to Antimicrobial Surveillance Programme (GRASP), threatening first-line treatments like ceftriaxone and azithromycin.

Question 3

Provide an overview of Chlamydia trachomatis, including its unique characteristics and lifecycle within host cells.

Answer 3

Chlamydia trachomatis is an obligate intracellular bacterium with a small genome, lacking cell walls, and exhibiting two forms: elementary bodies (EBs) and reticulate bodies (RBs).

Question 4

What are the clinical manifestations of Chlamydia trachomatis infection, and how do they differ between men and women?

Answer 4

Clinical manifestations of Chlamydia trachomatis include urethritis, cervicitis, soreness, dysuria, urethral discharge, post-coital bleeding, and ascending infections that can lead to pelvic inflammatory disease.

Question 5

How is Chlamydia trachomatis diagnosed, and what are the treatment options recommended by the British Association for Sexual Health & HIV (BASHH)?

Answer 5

Chlamydia trachomatis is diagnosed using nucleic acid amplification tests (NAATs) and is treated with antibiotics like doxycycline or azithromycin.

Question 6

Describe the stages of syphilis, including primary, secondary, and tertiary syphilis, and the associated symptoms.

Answer 6

Syphilis stages include primary (chancre), secondary (rash, sore throat, headache), and tertiary (disfiguring lesions, cardiovascular involvement, neurosyphilis).

Question 7

What are the key points highlighted in the PHE Report 2019 regarding syphilis, and what trends are observed in the data?

Answer 7

The PHE Report 2019 on syphilis highlights increasing cases, particularly in females and congenital syphilis.

Question 8

How did the COVID-19 pandemic impact the delivery of sexual health services and the diagnosis of sexually transmitted infections in England in 2020?

Answer 8

The COVID-19 pandemic disrupted sexual health services, resulting in decreased STI testing and diagnoses in 2020.

Question 9

Provide an overview of human papillomavirus (HPV), including its structure, associated conditions, and role in cancer development.

Answer 9

Human papillomavirus (HPV) is a DNA virus causing benign growths like warts and increasing the risk of cancer, primarily transmitted through close contact.

Question 10

Discuss the HPV vaccine program in the UK, including its target population, cost-effectiveness, and potential benefits.

Answer 10

The HPV vaccine program in the UK targets girls and aims to prevent cervical cancer and other HPV-related cancers.

Question 11

Summarize the key takeaways from the workshop regarding public health initiatives, STI surveillance, and the importance of prevention strategies.

Answer 11

Public health initiatives, surveillance programs, and prevention strategies play crucial roles in addressing sexually transmitted infections and promoting sexual health.

Question 12

Why is the genital tract considered a potential portal of entry for microbes, and what are the potential consequences of microbial transmission through genital secretions?

Answer 12

direct exposure to external environments during sexual activity.
Consequences of microbial transmission through genital secretions include the development of STIs

Question 13

Describe the flora found in the male genital tract and how colonising or infecting organisms can ascend to sterile locations.

Answer 13

a complex flora, including bacteria like Staphylococcus, Streptococcus, and various anaerobes.
Colonising organisms can ascend from the urethra to sterile locations
- upper urethra, prostate, and epididymis.

can lead to conditions such as
-urethritis, prostatitis, and epididymitis.

Question 14

What is the optimal sample for investigating STIs in females, and why is it preferred?

Answer 14

endocervical swab.
preferred because Neisseria gonorrhoeae, for example, does not survive well outside of the endocervical epithelium,
therefore - ideal site for sample collection to detect the presence of pathogens.

Question 15

Provide a brief overview of Neisseria gonorrhoeae, including its Gram stain, morphology, and key structural features.

Answer 15

Gram-negative diplococci
appears as diplococci under microscopy.

possesses key structural features such as type IV pili for initial attachment to epithelial cells, polysaccharide capsules, and lipooligosaccharide (LOS) in its cell wall,

lipid A endotoxin. - potent stimulator of the immune system and inflammatory response
– triggers release of pro-inflam cytokines such as IL-1, IL-6 and TNFa
– chronic inflammation can proliferate the infection, exacerbating tissue damage
- may lead to fever, septic shock, and organ failure

Question 16

What are the differences in the likelihood of infection and symptoms between men and women exposed to Neisseria gonorrhoeae?

Answer 16

Men have a lower likelihood of infection from a single sexual encounter (20%) compared to women (50%).
Men experience symptomatic infections with acute inflammation, dysuria, and purulent discharge,
women are often asymptomatic or may experience symptoms such as cervicitis, vaginal discharge, and pelvic pain.

Question 17

Explain the process of infection by Neisseria gonorrhoeae, including its mechanisms of attachment, evasion of immune responses, and potential sites of colonization within the male and female genital tracts.

Answer 17

Neisseria gonorrhoeae initiates infection by attaching to epithelial cells via type IV pili, stimulating pro-inflammatory cytokines and chemokines, recruiting immune cells like macrophages and neutrophils, and surviving within these cells. It can ascend within the male and female genital tracts, potentially colonizing sites such as the urethra, cervix, fallopian tubes, and abdominal organs.

Question 18

How does the complex flora of the female genital tract contribute to vulnerability to pathogens, and what are the potential consequences of pathogen ascension to various anatomical structures?

Answer 18

The complex flora of the female genital tract, including bacteria like Lactobacillus species, can contribute to vulnerability to pathogens by:
- maintaining a delicate balance that, when disrupted, can allow pathogenic microbes to proliferate.
- Ascension of pathogens to various anatomical structures such as the endometrium, fallopian tubes, and abdominal organs can lead to infections like PID, ectopic pregnancy, and infertility.

Question 19

How does Neisseria gonorrhoeae modulate macrophages, and what are the consequences of these modifications?

Answer 19

escaping the phagosome
inhibiting apoptosis/autophagy
modulating cytokine production,
modulating iron production,
and reducing T cell proliferation

Question 20

Describe the pathophysiology of damage caused by Neisseria gonorrhoeae infection in both men and women, including the effects on epithelial cells and potential complications.

Answer 20

damage to epithelial cells, loss of ciliated cells, fallopian tube scarring, occlusion of the oviduct, adhesions leading to chronic pelvic pain, urethritis, systemic dissemination, and potentially ascending infections.

Question 21

what are ascending infections?

Answer 21

when pathogens such as Neisseria gonorrhoeae,
spread from the lower genital tract to the upper reproductive organs,
such as the uterus, fallopian tubes, and ovaries, in females

Question 22

What host factors contribute to susceptibility to genital tract infections?

Answer 22

Host factors such as:
compromised immune function,
hormonal changes,
sexual behaviors,
and genetic predispositions

alter the body’s ability to defend against pathogens or maintain a healthy microbial balance.
contributing to susceptibility to genital tract infections

Question 23

Describe the diagnostic methods used for investigating STIs, including sample collection, laboratory techniques, and specific media used for culturing pathogens.

Answer 23

sample collection via swabs or urine,
laboratory techniques:
- nucleic acid amplification tests (NAATs)
= detecting microbial DNA or RNA,
- culturing on media
= to confirm their presence and identify antibiotic susceptibility patterns.

Question 24

Provide examples of media used in diagnosing STIs and explain their compositions and purposes.

Answer 24

GC VCAT (gonococcal culture medium) and CNA media (Columbia agar with selective antibiotics). GC VCAT is designed to culture fastidious organisms like Neisseria gonorrhoeae, while CNA media is selective for Gram-positive cocci such as staphylococci and streptococci.

Question 25

What results would indicate the presence of Neisseria gonorrhoeae in diagnostic testing, and how are such results interpreted?

Answer 25

growth of colonies on specific media like GC VCAT plates. Such results are interpreted as positive for N. gonorrhoeae infection, warranting further confirmation and treatment.