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ER II Exam I > Lecture 7: Infections of the Lower Genital Tract > Flashcards

Lecture 7: Infections of the Lower Genital Tract Flashcards

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1
Q

HSV-2 infection in the neonate may be mild, but more commonly what course does it follow and what’s affected?

A
  • More commonly is fulminating
  • Generalized LAD, splenomegaly, and necrotic foci throught the lungs, liver, adrenals and CNS
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2
Q

With STD can cause cervical dysplasia and cancer; as well as vuvlvar cancer in females?

A

HPV

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3
Q

Lymphogranuloma venereum is caused by what organism?

A

Chalmydia trachomatis

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4
Q

HPV and herpes virus are associated with what type of inflammatory response?

A

Cytopathic-cytoproliferative reactions

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5
Q

What is the major infectious cause of corneal blindness in the United States?

A

HSV-1

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6
Q

What is the major cause of fatal sporadic encephalitis in the US?

A

HSV-1

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7
Q

Infection by which organism increases the risk of HIV transmission by 4-fold and increases the risk of HIV acquisition by 2-3 fold?

A

HSV-2

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8
Q

Which congenital infection may resemble erythroblastosis fetalis; infants w/ intra-uterine growth retardation, jaundice, hepatosplenomegaly, anemia, thrombocytopenia and encephalitis?

A

CMV –> Cytomegalic inclusion disease

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9
Q

L. monocytogenes infection during pregnancy can lead to what complications?

A

Amnionitis —> abortion, stillbirth, or neonatal sepsis

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10
Q

Which infection in neonates involves the formation of pyogenic granulomas distributed over the whole body; what organism is responsible?

A
  • Granulomatosis infantiseptica
  • Listeria monocytogenes
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11
Q

Finding of gram-positive, most intracellular bacilli in CSF is virtually diagnostic for which organism?

A

Listeria monocytogenes

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12
Q

Infants born with L. monocytogenes sepsis often have what clinical finding and what will be seen in the placenta?

A
  • Papular red rash over the extremities (Granulomatosis infantiseptica)
  • Listerial abscesses can be seen in the placenta
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13
Q

Untreated N. gonorrheae infection in a woman can lead to pelvic inflammatory disease which may can what 2 complications?

A
  • Ectopic pregnancy
  • Inferitility
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14
Q

Neonatal N. gonorrheae infection causes what?

A

Conjunctivitis which may lead to blindness

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15
Q

Which organism is responsible for causing chancroid (soft chancre) in both males and females; what is its morphology and gram stain?

A

Haemophilus ducreyi = Gram negative coccobacillus

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16
Q

Where is Haemophilus ducreyi seen most commonly?

A
  • Tropical and subtropical areas
  • Most common cause of genital ulcers in Africa and SE Asia
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17
Q

Who is Haemophilus ducreyi most commonly seen in?

A

People of lower socioeconomic status and men who have frequent sex with prostitutes

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18
Q

Where do most ulcers associated w/ H. ducreyi develop in females; are they painful or painless?

A

Vagina or periurethral area; PAINFUL erythematous papule

*Haemophilusducreyi(it’s so painful, you “do cry”)

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19
Q

How does the ulcer of H. ducreyi differ from that of syphillis; what is seen morphologically at the base of the ulcer?

A
  • Ulcer is NOT indurated, and multiple lesions may occur
  • Base of ulcer is covered by shaggy, yellow-gray exudate
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20
Q

What is seen in 50% of patients with H. ducreyi within 1-2 weeks following primary infection?

A

Regional LN’s become large and tender

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21
Q

Microscopically how does the ulcer of chancroid (H. ducreyi) appear?

A

Superficial zone of neutrophilic debris + fibrin w/ underlying zone of granulation tissue containing areas of necrosis and thrombosed vessels

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22
Q

Which organism is associated with granuloma inguinale (donovanosis) in both males and females; what is its gram stain and morphology?

A

Klebsiella granulomatis = Encapsulated,gramnegativecoccobacillus

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23
Q

Which organism endemic in rural areas of some developing countries can lead to extensive scarring, often assoc. w/ lymphatic obstruction and lymphedema (elephantitis) of the external genitalia?

A

Klebsiella granulomatis (aka donovanosis)

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24
Q

How does the lesion of granuloma inguinale begin and how does it progress over time?

A
  • Raised papular lesion on moist stratified squamous epithelium of genitalia
  • Eventually ulcerates and develops abundant granulation tissue, manifesting grossly as a protuberant, soft, PAINLESS mass
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25
Q

Which cause of genital ulcers if left untreated is sometimes associated with urethral, vulvar and anal strictures?

A

Klebsiella granulomatis

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26
Q

What is one major difference about the pathogenesis of H. ducreyi and K. granulomatis?

A
  • H. ducreyi often has regional LN involvement; become large and tender
  • K. granulomatis typically spares the regional LN’s
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27
Q

Which stain of a culture can be useful in identifying K. granulomatis; what is characteristically seen?

A
  • Giemsa-stain shows minute, encapsulated coccobacilli (Donovan bodies) inside macrophages
  • Silver stains may also be used
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28
Q

What is the microaerophilic spirochete that causes syphillis?

A

T. pallidum

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29
Q

What is the gram stain and unique shape of spirochetes?

A

Flagellated, gram negative, slender corkscrew-shaped (or spiral)

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30
Q

T. pallidum is too slender to be gram stained so what is used for visualization?

A

Silver stain and immunofluorescence techniques

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31
Q

Which pathological process is characteristic of all stages of syphillis?

A

Proliferative endarteritis of small vessels w/ surrounding plasma cell-rich infiltrate

32
Q

Primary syphillis occurs about 3 weeks after infection and is characterized by what?

A

Single, firm, nontender, raised, red lesion (hard chancre) at site of treponemal invasion of the penis, cervix, vaginal wall, or anus

33
Q

2-10 weeks after untreated primary syphilis the pt enters second stage of syphillis which is characterized by what?

A
  • Palmar rash (palms or soles of feet) that may be maculopapular, scaly, or pustular
  • Moist areas of skin i.e., anogenital region, inner thighs and axillae may have condyloma lata = broad-based, elevated plaques
  • Mild fever + LAD + malaise + weight loss = common
  • Asymptomatic neurosyphillis may develop
34
Q

How long is the typical latent period between secondary syphillis and tertiary syphillis?

A

5+ years

35
Q

What are the main manifestations of tertiary syphillis that may occur alone or in combination?

A
  • Cardiovascular syphillis
  • Neurosyphillis
  • Benign tertiary syphillis (aka gummas)
36
Q

What is the most common clinical manifestation of tertiary syphillis and what is seen?

A
  • Cardiovascular syphillis
  • Aortitis —> progressive dilation of aortic root and arch, which may cause aortic valve insufficiency and aneurysms of prox. aorta
37
Q

What is the characteristic finding of benign tertiary syphillis and what are the signs/sx’s?

A
  • Gummas in bone, skin, and mucous membranes of upper airway and mouth = nodular lesions
  • Skeletal involvement causes pain, tenderness, and swelling + pathologic fractures
  • Skin/mucous membranes w/ nodular or, rarely, destructive, ulcerative lesions
38
Q

What are the clinical manifestations of infantile syphillis?

A
  • Nasal discharge and congestion (snuffles) in first few months of life
  • Desquamating or bullous rash –> sloughing skin, particularly of the hands and feet and around the mouth + anus
  • Hepatomegaly and skeletal abnormalities = common
39
Q

What is seen on histological examination of a gumma associated with tertiary syphillis?

A

Centers of coagulated, necrotic material and margins composed of plump, palisading macrophages and fibroblasts surrounded by large numbers of mononuclear leukocytes, mainly plasma cells

40
Q

The later manifestations of congenital syphillis inculde what distinct triad?

A
  • Interstital keratitis
  • Hutchinson teeth
  • CN VIII deafness
41
Q

Syphillitic osteochondritis and periostitis affect all bones, but lesions of which 2 areas are most distinct and what is classically seen?

A
  • Nose –> destruction of vomer causes collapse of bridge, later on saddle-nose deformity
  • Legs –> periostitis of the tibia leads to excessive new bone growth on anterior surfaces and anterior bowing, or SABER SHIN
42
Q

What is the gram stain and special feature of Chlamydia trachomatis?

A

Small gram-negative, obligate intracellular parasite

43
Q

What are the 2 forms that Chlamydia trachomatis exists in during its life cycle and characteristic of each?

A
  • Elementary body = infectious, metabolically inactive form, which is taken up by the host cell
  • Reitculate body = metabolically active form, uses host ATP and AA’s to replicate
44
Q

Lymphogranuloma venereum caused by which serotypes of C. trachomatis?

A

L serotype (L1-L3)

45
Q

Lymphogranuloma venereum is endemic where?

A

Parts of Asia, African, the Caribbean region, and S. America

46
Q

Characteristics of the genital ulcers and LAD seen in lymphogranuloma venereum?

A

PAINLESS genital ulcers, PAINFUL LAD (i.e., buboes)

47
Q

Urethritis causes by C. trachomatis is characterized by what?

A

Mucopurulent discharge containing predominance of neutrophils

48
Q

What is the characteristic morphology of the lesions and regional LN’s involvement in lymphogranuloma venereum?

A
  • Mixed granulomatous and neutrophilic inflammatory response
  • Regional LAD within 30 days, granulomatous rxn assoc. w irregular shaped foci of necrosis containing neutrophils (stellate abscesses)
  • Over time extensive fibrosis + local lymphatic obstruction + lymphedema + strictures
49
Q

Candida vaginitis is common in which settings?

A

Women who are diabetic, pregnant, or on oral contraceptives

50
Q

Which sign’s and sx’s are common to Candida vaginitis?

A

Intense itching, erythema, swelling and a thick, curdlike discharge (“cottage cheese-like”)

51
Q

What is the characteristic morphology of Candida?

A

Pseudohyphae and budding yeast

52
Q

How is the diagnosis of Candida vaginitis made; which stain and what’s seen?

A

Pseudospores or filamentous fungal hyphae in wet KOH mounts of discharge or on pap smear

53
Q

How do the lesions of HSV-2 on genital mucosa appear early on and describe their progression; cervical and vaginal lesions present with what?

A
  • Red papules —> vesicles —> painful coalescent ulcers
  • Cervical or vaginal lesions present w/ severe purulent discharge and pelvic pain
54
Q

Smears of the inflammatory exudate of HSV-2 show what characteristic cytopathic changes?

A

Multinucleated squamous cells containing eosinophilic to basophilic viral inclusions w/ “ground-glass” appearance

55
Q

Detection of anti-HSV antibodies in the serum is indicative of what?

A

Recurrent/latent infection

56
Q

Which type of Molluscum contagiosum virus is most often sexually transmitted?

A

MCV-2

57
Q

What family of viruses is Molluscum contagiosum; what is unique about its replication?

A
  • Poxvirus; dsDNA and linear virus
  • ONLY DNA virus to replicate in the cytoplasm
58
Q

What is the characteristic appearance of the papules seen w/ Molluscum contagiosum infection?

A
  • Pearly, dome-shaped w/ dimpled umbilicated center
  • Central waxy core contains cells w/ cytoplasmic viral inclusion bodies
59
Q

What is the morphology of Trichomonas vaginalis?

A

Large, flagellated ovoid protozoan

60
Q

What are the common presenting signs and sx’s of Trichomonas vaginalis?

A
  • Yellow-green, foul-smelling, frothy vaginal discharge
  • Vulvovaginal discomfort + dysuria
  • Dyspareunia (painful intercourse)
61
Q

Which STI is associated with a fiery-red vaginal and cervical mucosa, with marked dilation of cervical mucosal vessels resulting in the characteristic “strawberry cervix” appearance?

A

Trichomonas vaginalis

62
Q

Diagnosis of Trichomonas vaginalis is made how; use what stain?

A

Motile trophozoites in methylene blue wet mount, present w/ corkscrew motility

63
Q

What is the gram-stain and shape of Gardnerella vaginalis?

A

Pleomorphic, Gram-variable bacillus

64
Q

What is the typical presentation of Gardnerella vaginalis?

A

Present w/ thin, green-GRAY, vaginal discharge w/ fishy smell

65
Q

What will a pap smear of pt with Gardnerella vaginalis show?

A

Superficial and intermediate squamous cells covered with shaggy coatin of coccobacilli (clue cells)

66
Q

Which test for Gardnerella vaginalis will enhance the fishy odor?

A

Amine whiff test: mix discharge w/ 10% KOH

67
Q

Pelvic inflammatory disease arising after spontaneous/induced abortions and normal or abnormal deliveries are referred to as what; most commonly caused by what organisms?

A
  • Puerperal infections
  • Typically polymicrobial: staphylococci, streptococci, coliforms, and Clostridium perfringens
68
Q

How does PID causes by gonococcal infections differ from that caused by staphylococcis, streptococci, and other puerperal invaders; which is more often assoc. w/ bacteremia?

A
  • Gonococcal shows marked acute inflammation of mucosal surfaces; spread upward to involve fallopian tubes and tubo-ovarian region
  • Puerperal invaders have less mucosal involvement and more inflammation of deeper layers; spread via lymph and veins; bacteremia is a more frequent complication
69
Q

What are the common signs/sx’s of PID?

A
  • Pelvic pain + adnexal tenderness
  • Fever
  • Purulent cervical discharge
70
Q

Which part of the female genital tract is usually spared in Gonococcal infections?

A

Endometrium

71
Q

What are the acute vs. chronic complications which may arise from PID?

A
  • Acute = peritonitis and bacteremia —-> endocarditis, meningitis, and suppurative arthritis
  • Chronic = infertility and tubal obstruction, ectopic preg., pelvic pain, and intestinal obstruction
72
Q

Which infection is associated with strikingly enlarged cells and intranuclear basophilic “owl eye” inclusions?

A

CMV

73
Q

Lesions of genital HSV infection develop 3-7 days after transmission and are often accompanied with what systemic sx’s?

A

Fever + malaise + tender inguinal LAD

74
Q

What is the gravest consequence of HSV infection?

A

Transmission to the neonate during birth (active and primary/initial infection) is assoc. w/ high mortality rate

75
Q

What is a rare complication of PID that occurs almost exlusively in women?

A

Fitz-High Curtis Syndrome

ER II Exam I (26 decks)

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