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DERS (reproductive) > L41- Urogenital Infections III > Flashcards

L41- Urogenital Infections III Flashcards

1
Q

Treponema pallidum, briefly describe the progression of disease

A

(syphilis)
Primary (weeks after): chancre on genitals

Secondary (wks - mos): flu-like syndrome + copper rash + condylomata lata

Tertiary (15-20yrs): diffuse chronic inflammation, CNS, CVS involvement

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2
Q

describe the relationship between T. pallidum and pregnancy

A

(congenital syphilis)
-crosses uterine/placental membranes

  • MOST cases –> spontaneous, septic abortion
  • occasional live-birth –> infants with active infection, usually teratogenic effects seen
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3
Q

list three distinguishing features of late-stage congenital syphilis

A
  • Stromal Haze due to interstitial keratitis
  • Saddle Nose
  • Hutchinson’s teeth
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4
Q

Syphilis pathogenesis:

  • (1) is usually required first, then (2) can occur
  • (3) can precipitate perivascular infiltration (‘spreading factor’)
  • coating of (4) protects T. pallidum from phagocytosis
A

1- adherence via outer membrane proteins

2- tissue destruction / lesions => immune response

3- hyaluronidase

4- fibronectin

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5
Q

Primary Syphilis:

  • (1) route of entry
  • (2) replication occurs
  • (3) results and (4) is the final stage
A

1- enters subepithelial tissues via skin breach (sexual transmission)

2- slow / fastidious: doesn’t tolerate wide-range of environmental conditions

3- endarteritis, granulomas

4- lesions heal –> bacterial dissemination via LNs, blood (latency is poorly understood)

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6
Q

(1) occurs before the beginning of secondary syphilis, and then (2) may be trigger symptoms. Tertiary syphilis involves (3) to occur.

A

1- immune system evasion (poorly understood)

2- inflammatory response

3- diffuse chronic inflammation, damage to CNS

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7
Q

________ is the main definitive diagnosis of early syphilis

A

(direct microsopy) dark-field examination of exudate from skin lesions (primary)

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8
Q

Hemophilus ducreyi key microbial features

A
  • Gram- anaerobic rod (maybe coccobacilli)
  • fastidious
  • pleomorphic shape

-obligate human pathogen

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9
Q

Hemophilus ducreyi:

  • (1) is main presentation
  • (2) predominant geographic areas
  • (3) risk is increased
A

1- chancroid: painful soft ulcer

2- tropics (Africa, Asia, Latin America — sporadic in N. America)

3- HIV transmission

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10
Q

list some signs and symptoms of Hemophilus ducreyi infections

A
  • painful genital ulcer / penile chancre
  • (men) inguinal bubo (LN enlargement) along w/ penile ulceration

-(women) chancroid ulcer on posterior vaginal wall –> spontaneous rupture of L inguinal bubo in 25% cases

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11
Q

describe the key factors of Hemophilus ducreyi pathogenesis

A

-extracellular pathogen resisting phagocytosis

Virulence factors:

  • outer membrane serum resistance protein
  • Toxins: i) CDT (cytolethal distending toxin) + ii) hemolysin => tissue destruction
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12
Q

describe the difficulty of diagnosing H. ducreyi

A

Other DDx: syphilis, HSV1/2 (frequently co-infections); 30-50% cases, Dx is based on ulcer appearance

  • culture requires special usually unavailable agars and not 100% sensitive:
  • Gonococcal agar case w/ 2% bovine Hb + 5% fetal calf serum
  • Mueller Hinton agar (heated horse blood)

-Ag detection, serology, amplification (PCR, ect) is not easily available and accurate

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13
Q

Chancroid:

  • (soft/hard) chancre, (mildly/firmly) indurated, (mild/moderate) erythema
  • pain-(less/ful)
  • (5) on microscopic observation
  • (6) required for Dx
A 
1- soft
2- mildly indurated
3- moderate erythema
4- very painful (+/- superinfection)
5- Gram stain
6- culture
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14
Q

Syphilus:

  • (soft/hard) chancre, (mildly/firmly) indurated, (mild/moderate) erythema
  • (pain/-less)
  • (5) on microscopic observation
  • (6) required for Dx
A 
1- hard
2- firmly indurated
3- mild erythema
4- painless (unless secondary infection)
5/6- darkfield examination
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15
Q

______ are considered the less common STI pathogens

A
  • mycoplasma genitalium

- Klebsiella granulomatis

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16
Q

Mycoplasma, Ureaplasma:

  • (1) key microbial traits
  • (2) general Sxs
A

1- very small free living bacteria, lack cell wall, obligate intracellular

2:

  • symptomless
  • Sxs: discharge, dysuria/burning, frequency, urgency, pain
17
Q

Mycoplasma genitalium infects (1) to cause (2)

A

1- GUT

2- non-gonococcal urethritis

18
Q

Ureaplasma urealyticum infects (1) to cause (2)

A

1:

  • respiratory tract
  • GUT

2:

  • non-gonococcal urethritis
  • pyelonephritis
  • spontaneous abortion
  • premature birth
19
Q

Mycoplasma genitalium mainly cause NGU:

  • (1) number of species
  • (2) is main feature, causing bacteria to have (3) shape
  • (4) describe outer membrane
A

1- >16
2- mollicutes (soft skin) = lack of cell wall
3- pleomorphic
4- triple layer w/ sterol (external membrane) –> serum/cholesterol must be added to growth media

20
Q

Klebsiella granulomatis = _____:

  • family
  • main characteristic
  • main microbial features
A

= granuloma inguinale
-Enterobacteria family

-**Donovan bodies = intracellular inclusions in macrophages

  • encapsulated
  • Gram-
  • pleomorphic / ‘safety-pin’ appearance
  • fastidious (difficult to culture on standard media)
21
Q

Klebsiella granulomatis:

  • (1) main geographic area
  • (2) Sxs
A

1- Tropics, Subtropics

2- painless, expanding, supporative lesion —- tend to bleed easily = ‘beefy red’

22
Q

describe the spectrum of HPV infections

A

low risk HPV = Condyloma Acuminata

high risk HPV = cervical dysplasia or cervical cancer

23
Q

sites of HPV infections (descending order)

A 
cervix
anus
vagina
penis
vulva
oropharynx
oral cavity
24
Q

Both low risk and high risk HPV infections often present with (1). (2) is the other presentation with a (3) long incubation period. (4) is the result if (2) remains untreated.

A

1- asymptomatic

2- anogenital warts

3- wks to mos to yrs

4- regression of wart size and number

25
Q

genital warts = _______

A

condylomata acuminata

26
Q

Anogenital warts:

  • (1) are the most common causes
  • (2) are the most affected groups (men and women)
A

1- HPV6, HPV11 (90% of anogenital warts)

2:
Women: 20-24 y/o
Men: 25-29 y/o

27
Q

in addition to anus and genitals, HPV can infect (1) and eventually can (2); note- (3) is the most common type

A

1- throat (oropharynx + oral cavity; oral sex transmission)`

2- throaat cancer (higher risk than smoking or alcohol)

3- HPV16 (72% cancers)

28
Q

HPV:

  • (1) genome
  • infects (2) cells
  • low risk HPV => (3)
  • high-risk HPV => (4)
A

1- circular dsDNA (8kB)
2- epithelial cells

3- genital warts
4- premalignant lesions = CIN / cancer

29
Q

HPV infections cause (1) of viral genome and the overexpression of (2) and (3), include targets. (4) are the HPV capsid proteins.

A

1- episomal / integration of viral DNA

2- E6 –> p53
3- E7 –> RB
4- L1, L2

30
Q

describe HPV Dx

A

1) genital warts –> dx by visual inspection

2) cervical cell changes –> routine PAPs or HPV testing/typing

31
Q

list the main HPV strains with vaccine and age group given to

A

(Gardasil)
HPV- 16, 18 (high risk) + 6, 11 (low-risk)
-now added HPV- 31, 33, 45, 52, 58

Given to ages 9-26 y/o (for test, but actually up to 45 y/o)

32
Q

describe the additional testing for Syphilis Dx

A

1st: Non-treponemal screening test
- beef heart / bovine Cardiolipin: reactive, weak reactive, minimally weak reactive, non-reactive
- RPR (rapid plasma reagin) test

2nd (if pos): treponemal test = TP-particle agglutination (TP-PA)

DERS (reproductive) (14 decks)

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