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CAM202 > MICROBIOLOGY > Flashcards

MICROBIOLOGY Flashcards

1
Q

What are the common microbial causes of cervicitis?

A
  1. Chlamydia trachomatis
  2. Neisseria Gonorrhoea
  3. HSV
  4. Trichomonas vaginalis (protozoa)
  5. Anaerobes

Mark also indicates that Mycoplasma Genitalium can cause this, but it isn’t as common (STI Lecture 2).

1-3 most common causes. Remainder not as common.

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2
Q

Describe the common clinical presentation of cervicitis, and include associated symptoms

A
  1. Discharge (usually mucopurulent from endocervix)
  2. Inflamed & oedematous ectropion

Commonly associated with:

  1. Co-exiting urethral infection
  2. History of dysuria
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3
Q

Where do you collect specimens to diagnose cervicitis, and what technique do you use to diagnose it?

A

Always take a sample of the discharge
Swab high vagina (next to ectropion on cervix), endocervical) and a first pass urine.

Analyse all using PCR are most organisims don’t culture.

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4
Q

What are the common microbial causes of urethritis?

A

Gonococcus
Chlamydia trachomatis

The following are gaining importance:
Ureaplasma urealyticum
Mycoplasma hominis
Trichomonis vaginalis (protozoa)
HSV
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5
Q

Describe the common clinical presentation of urethritis, and include associated symptoms

A

Urethral inflammation
In males also meatal inflammation
Dysuria
Discharge

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6
Q

What are the differential diagnosis for someone presenting with urethral discharge & dysuria?

A

Urethritis, Cystitis or ureter infection

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7
Q

What are the important aspects of clinical history and specimen collection for a patient suspected of having gonococcal urethritis?

A

Need to take a good history of exposure - eg oral/anal sex as often these areas can also be infected, not just urethra, but are asymptomatic.

Swab urethra, +/- anorectal/pharyngeal areas depending on history of risky behaviour.

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8
Q

What is pelvic inflammatory disease (PID)?

A 
Inflammation & infection of the upper genital tract in females, typically including:
Endometrium
Ovaries
Fallopian tubes
Surrounding structures
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9
Q

What are clinical signs & symptoms of PID?

A 
Adnexal tenderness
Cervical motion tenderness
Lower abdomen discomfort/tenderness/rebound/guarding
Vaginal discharge
Bleeding
Dyspareunia (pain during intercourse)
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10
Q

What are the complications of PID?

A

20% infertility
20% chronic pelvic pain
10% ectopic pregnancy

Increase the chance/risk of complication, the more times you have PID.

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11
Q

Common causative agents/mechanisms by which PID is acquired?

A 
SEXUAL ACQUISITION
Chlamydia trachomatis (+/- gonorrhoea). Usually polymicrobial which makes treatment protracted and complex.

NON-SEXUAL ACQUISITION
Mechanical disruption to cervix (eg insertion of IUCD, delivery, surgery, pregnancy, termination) can increase risk, as these can disturb normal flora of vagina and increase susceptibility.

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12
Q

What is the characteristic appearance of Gonorrhoea under the light microscope?

A

Gram negative diplococci within the neutrophil cytoplasm.

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13
Q

What is the characteristic appearance of Gonorrhoea under the light microscope?

A

Gram negative diplococci within the neutrophil cytoplasm.

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14
Q

On which media is Gonorrhoea grown, and why?

A

Gonorrhoea is very fastitidious (difficult to culture) so is often grown on chocolate agar or Thayer-Martin agar (enriched media).

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15
Q

What is Thayer-Martin agar/media, and what is it used for? Why?

A

It is chocolate agar + antibiotics and used to culture Gonorrhoea (which is fastitidious). It is used to suppress ‘normal’ flora overgrowth, so that if gonorrhoea is present it will grow preferentially.

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16
Q

Is Gonorrhoea more common in males or females? What percentage of each, which infected, will be symptomatic?

A

Gonorrhoea occurs equally in males and females.

50% of females are symptomatic, while almost all males are symptomatic.

Carrier state does depend on anatomical location of infection - anorectal area and pharyngeal infections are normally asymptomatic.

17
Q

What are the risk factors for getting gonorrhoea

A 
Low socio-economic status
Urban area
Unmarried
MSM
Ethinicity
Drug use
Prostitution
Hx of STDs
Hormonal contraception
Unprotected intercourse (>80% chance for single exposure for a female, 20% chance for a single exposure for a male, 80% for multiple exposures for male)  --> much higher transmission rate from penis --> vagina
18
Q

What are the common clinical manifestations of Gonorrhoea in males?

A

Urethritis (with mucopurulent discharge 90-95%)
Dysuria
Ascending infection (10%) - includes epididymitis (one teste inflamed), prostatitis, urethral stricture or periurethral abscess (common).
5% may be asymptomatic.

19
Q

How long is Gonorrhoeal incubation in males before clinical manifestation? And how long in females?

A

Males: 2-7 days after exposure
Females: 8-10 days after exposure

20
Q

What are the common clinical manifestations of Gonorrhoea in females?

A

Urethritis (70-90%)
Cervicitis (25-68%)
Bartholins Glands infected (30%) normally these aren’t visible, but when infected they are.
Ascending infection (10-20%) including PID associated with salpingitis, endometritus, tubo-ovarian abscess.
Abnormal intra-menstrual bleeds
Abdominal/pelvic pain
50% asymptomatic

21
Q

Clinical manifestations of Gonorrhoea (not just urogenitcal tract infections)

A
  1. Urogenital tract infections
  2. Gonococcaemia (septicaemia)
  3. Disseminated infections of skin & joints (males more than females, 1-3%). Includes the pustular rash which necrosis, suppurative arthritis etc.
  4. Pharyngitis (asymptomatic often)
  5. Purulent conjunctivitis of the newborn
    Many other syndromes.
22
Q

How is Gonorrhoea diagnosed?

A

First pass urine & swabs of site of infection (ensure Rayon or Dacron swabs used). Cultured on Thayer-Martin, PCR used to identify.

23
Q

Public health implications of Gonorrhoea?

A

Reportable STD.
Must do contact tracting.
Follow up testing to ensure success of treatment.

24
Q

Chlamydia is an obligate intracellular organism and has a biphasic life cycle. Explain what this means.

A

Obligate intracellular - can’t replicate/survive without using the host energy/ATP source.
Elementary body - the extracellular form which infects eukaryotic cells.
Reticular body - the intracellular form which replicates.

25
Q

Which Chlamydia trachomatis serovars are responsible for urogenital tract disease?

A

Trachoma serovars D-K (A-C responsible for trachoma)

26
Q

Which Chlamydia trachomatis serovars are responsible for urogenital tract disease?

A

Trachoma serovars D-K (A-C responsible for trachoma)

27
Q

In which population is chlamydia most prevalent?

A

Females aged 15-25 (greater incidence in females to males)

28
Q

Is Chlamydia mostly symptomatic or asymptomatic in females?

A

Asymptomatic (80%).

29
Q

Is Chlamydia mostly symptomatic or asymptomatic in females?

A

Asymptomatic (80%).

30
Q

Chlamydia associated cervicitis (females) and urethritis (Both) is associated with discharge. Describe it.

A

Mucupurulent, usually thinner and less copious than gonorrhoea. Yellow/green in colour usually.

31
Q

Chlamydia associated cervicitis (females) and urethritis (Both) is associated with discharge. Describe it.

A

Mucupurulent, usually thinner and less copius than gonorrhoea. Yellow/green in colour usually.

32
Q

Lymphgranuloma venereum is a manifestation of chlamydia. Describe the course of presentation.

A

STAGE 1: 1-4 weeks post infection. Painless lesion (papule or ulcer) develops on site of infection eg penis, scrotum, vagina etc. Can be confused wtih Syphilis.

STAGE 2: 1-4 weeks post infection. Infection travels to the lymph nodes. Lymph nodes become infected and inflamed/swollen. Very painful. Can give rise to fluctuant buboes that enlarge and rupture.

Systemic symptons include:
Fever Chills Headache arthralgia myalgia

33
Q

How to diagnose Chlamydia?

A

PCR

CAM202 (7 decks)

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