(Mostly) Sexually Transmitted Diseases Flashcards
Treponema pallidum is commonly referred to as…
Syphilis
Describe the structure of Treponema pallidum
Long, thin spirochete
- Unseen in light microscope, seen by silver stain
What type of microscope can view Treponema pallidum?
Dark Field Microscope
What surrounds every Treponema pallidum cell?
Glycosaminoglycan sheath
How is Treponema pallidum made motile?
Endoflagella within the periplasm (3 per end)
What is unique about Treponema pallidum’s envelope?
No LPS
Cardiolipin in membrane
Does Treponema pallidum have many outer membrane proteins? Significance of this knowledge?
Few OM proteins
Makes it hard for immune system to find it and make Abs
Method used to culture Treponema pallidum?
None. So far unculturable in lab
Grown in rabbit testes instead
Oxygen metabolism of Treponema pallidum?
Microaerophilic
What is a chancre?
Defined, Unpainful papule at site of infection
Describe the symptoms common to Primary Treponema pallidum infection.
Ulcerated, Chancre, Regional LN swelling
Heals spontaneously, but organisms remain in blood
Describe the clinical presentation of secondary Treponema pallidum infection.
Red macular/macropapular rash anywhere
Condylomas in mount areas
What is unique about the red macular/macropapular rash of Treponema pallidum?
One of few to appear on soles and palms
What is a condyloma?
Raised, White, wart-like papule (seen in Treponema pallidum)
Difference between the early and late latent period?
Early – Within a year of secondary
Late – 1-20+ years
What is tertiary Treponema pallidum response?
Lesions of tissues through body caused by immune response
Why can’t you culture a tertiary Treponema pallidum response?
Treponema pallidum hasn’t been able to be cultured so far
Even if it could, its only immune response at this point, not the actual bacteria
Important causes of vertically transmitted disease
Toxoplasma Other -- HIV, Coxsackie, Chicken Pox, etc. Rubella Cytamegalovieus HErpes Syphilis
Clinical presentation of tertiary Treponema pallidum response?
Gummas Bones: porous, bendable, fragile Heart: aorta swells, ruptures liver CNS
Two manifectstions of Treponema pallidum in the CNS
Brain – General paresis
Spine – tabes dorsalis
Significance of Treponema pallidum in pregnant women?
20% abortion or stillbirth
80% have congenital defects
Primary defects associated with Treponema pallidum transmission in utero? (Name the group name)
Hutchison’s triad
What does Hutchison’s Triad entail?
Blindness
VIII Nerve Deafness
Hutchison’s Teeth
What are Hutchison’s Teeth?
Double pointed incisors
What organisms can carry Treponema pallidum?
Only humans
How is Treponema pallidum transmitted?
Exclusively STD
How long are infected individuals contagious with Treponema pallidum?
3-5 years
What population is seeing the most rapid increases in Treponema pallidum diagnosis?
Over 50
Two groups that should always be tested for Treponema pallidum
High-Risk Populations
After any stillbirth
Describe the infectivity and molecular mechanism of Treponema pallidum infection.
Highly infectious
Hyaluronidase facilitates spread/invasion of tissues + Rapid Motility
How is Treponema pallidum controlled (in a public health-y kind of way)?
Finding, Testing Sexual Contacts
How is Treponema pallidum diagnosed?
Look for spirochetes in chancres
Serologic Tests for Treponema pallidum
What do indirect tests look for? Direct tests?
Antibodies
the Organism
Descrive the Treponema pallidum indirect test.
Add Cardiolipin to patient’s serum
If + Reagin will cause it to clump
Many false positives
What is Reagin
IgM+IgA
What occurs in a direct Fluorescent Treponema Antibody test?
Sandwich assay for Treponema pallidum epitopes
How is early Treponema pallidum typically treated?
How is latent Treponema pallidum typically treated?
1 dose Penicillin G
3 doses Peni. for latent
Why does tertiary Treponema pallidum require much greater levels of penicillin?
You have to get through the Blood Brain Barrier
Describe the structure Neisseria gonorrhea.
G-
Coffee Bean Shape
Diplococcus
How is Neisseria gonorrhea cultured?
Best with selective media (vanco, colistin)
Also gros on MTM or chocolate blood
What oxygen metabolism does Neisseria gonorrhea use?
Aerobic, but likes 5% CO2
Describe the genetic setup on Neisseria gonorrhea
2 identical diploid chromosomes
NEVER heterozygous
Neisseria gonorrhea invades _______
Mucus membranes of UGT, Rectum, Eye, Throat
In either gender, Neisseria gonorrhea tends to present with… (4)
Urethritis
Proctitis
Pharyngitis
Arthritis
Unique Neisseria gonorrhea manifestations in women (5)
Vaginitis
Salphingitis
Pelvis Inflammatory Disease
Peritonitis
Major cause of infertility in women
How does Neisseria gonorrhea manifest in neonates?
Conjunctivitis
How is Neisseria gonorrhea spread?
Human STD
Neisseria gonorrhea is commonly associated with ______ co-infection. So What?
Chlamydia
Treat for both (presumed coinfection)
Why is Neisseria gonorrhea so widely spread?
Asymptomatic Carriers
How is Neisseria gonorrhea diagnosed?
Males – Gram stain of urethral drip
Females – Culture of cervical/vaginal swab
Unique components of Neisseria gonorrhea attachment?
- Pilus cassette switching avoids immune response
- Opa protein has a great deal of antigenic variation caused by slippage of DNA repeats
In females, Opas change during…
Menstrual Cycle
Three proteins involved in Neisseria gonorrhea evasion
Por
Rmp
IgA Protease
What is Por protein in Neisseria gonorrhea?
Outer membrane porin
Prevents phagolysosome fusion in host
What is Rmp in Neisseria gonorrhea?
Host Abs bind to it, prevents Ab binding to Por and LOS
Significance of IgA protease in Neisseria gonorrhea?
Stops IgA’s bacteriocidal, complement activating activity
What two components of Neisseria gonorrhea mediate toxicity?
LOS
PG released from autolysins at low temp/alk. pH
What does Fbp protein in Neisseria gonorrhea do?
Scavenges Fe from human lactoferrin and transferrin
Neisseria gonorrhea secretes blebs with ____ inside
PG
Why is Neisseria gonorrhea hard to drug?
Resistance is acquired very easily
What do you do for patients with Pan-resistant Neisseria gonorrhea.
Say a prayer or something - they’re keeping their Neisseria gonorrhea
How do you typically treat Neisseria gonorrhea?
Cephtriaxone or cefixime
plus doxycycline/erythromycin for chlamydia
How is newborn Neisseria gonorrhea treated?
Tetracycline drops
You’ve cured your Neisseria gonorrhea patient! Good job! What do you need to make sure not to forget?
Treat everyone they doinked
How is Neisseria meningitidis spread?
Respiratory Droplets
NOT an STD. Here because Med School is dumb
Describe the structure of Neisseria meningitidis.
G-
Coffee bean shapes
Diplococcus
Polysachharide capsule
How many types of Neisseria meningitidis are there?
Name the top 5.
About 12
A, B, C, Y, W-135
Blood related presentation of Neisseria meningitidis?
Meningococcemia
Purpura and Petechial Hemorrhages
- Caused by toxic effects of LOS, soluble PG
Non-blood clinical presentation of Neisseria meningitidis?
15% involvement of meninges
Acute Headache, Vomiting, Stiff Neck
Sometime neurological symptoms, coma, and death
In CNS cases of Neisseria meningitidis, what two findings might you expect?
PMNL in CSF
Purulent exudate of PMNL and Nm surrounding brain
What is meningococcal septicemia?
DIC and Circulatory Collapse
_____ modification with ______ disrupts microcolony. This is what allows Neisseria meningitidis to spread from the respiratory tract.
Pilin
Phosphatidylglycerol
Name a couple placed most prone to have an Neisseria meningitidis outbreak
College dorm, Military barracks
Most epidemics of Neisseria meningitidis are due to…
Specific Capsular Antigen Types
Pathogenesis of Neisseria meningitidis is most similar to…
Gonococcus
Unique pathogenesis of Neisseria meningitidis?
Antiphagocytic Polysaccharide Capsule
Special Pili for BBB endothelial cells
Bonus Adhesins in OM
How does the antiphagocytic polysaccharide capsule work?
Antigen B is sialyted
More disguised than others
Why do we care that Neisseria meningitidis has BBB attaching pili?
The proteins recruit proteins away from junction complexes, depleting cell jxns, making barrier porous
Can Neisseria meningitidis be vaccinated for? How?
Currently there are vaccines for all types
Menvo + BEXSERO or Trumenba
How is Neisseria meningitidis treated?
3rd gen. Cephalosporin
Why are Rifampin and 3rd gen ceph. used prophylactically?
They can cross the BBB whenever they want
Why might you prescribe Vancomycin for Neisseria meningitidis, even though it can’t penetrate BBB?
If the BBB is damaged/porous it can cross.
If a different, G+, bacteria causes meningitis, its helpful
How does Moraxella catarrhalis tend to present?
Opportunistic sinusitis, bronchitis, pneumonia
Otitis media in children
Moraxella catarrhalis tends to exacerbate what other disease in adults?
COPD
Top three causes of otitis media?
S. Pneu
H. flu
Moraxella catarrhalis
How do you treat Moraxella catarrhalis?
3rd generation Ceph. OR Cipro
OR not at all
Physical characteristics of Chlamydia trachomatis
Like G- Envelope
Small genome
Cell wall without MurNAc
How must Chlamydia trachomatis grow?
Obligate intracellular parasite
How is Chlamydia trachomatis often grown in the lab?
embryonated chicken eggs
McCoy cells in monolayer tissue cultures
Mouse Brains
Two forms of Chlamydia trachomatis?
Elementary Bodies
Reticulate Bodies
Describe Elementary Bodies in Chlamydia trachomatis.
Infective Form
0.3uM diameter
Tough S-S membrane
Describe Reticulate bodies in Chlamydia trachomatis.
Replicative Form
1.0uM diameter
Fragile SH HS
Does Chlamydia trachomatis tend to manifest as chronic or acute?
Chronic
Five ways that Chlamydia trachomatis infection may present in the clinic
Trachoma Inclusion Conjunctivitis Neonatal Pneumonia Chlamydia Latent Infection
How does a person get a Trachoma (Chlamydia trachomatis)?
Infection from birth from infected birth canal
Infection in early childhood by contact/mechanical vector
How does Trachoma (Chlamydia trachomatis) present clinically?
- Mucopurulent discharge, Pannus formation, cornea obstruction
- Irritation from pannus+eyelashes+other bac –> blindness
How do people get inclusion conjunctivitis from Chlamydia trachomatis? How does it present clinically?
Mostly neonates (infected birth) and adults (self-inoculation) Less severe trachoma, maybe respiratory complications
Presentation of Neonatal pneumonia via Chlamydia trachomatis? When should you suspect?
Shortness of breath, no Fever
If symptoms occur with inclusion conjunctivities
Chlamydia trachomatis patients tend to also be infected with ________
Gonorrhea
Symptoms of Chlamydia (Chlamydia trachomatis) in males
Non-gonococcal urethritis
Epididymitis
Prostatis
Symptoms of Chlamydia (Chlamydia trachomatis) in females
Urethritis
Cervicitis
Salphingitis
PID
Long term significance of salphingitis in Chlamydia and Gonorrhea?
Common cause of infertility from fallopian rupture
Symptoms of a latent infection with Chlamydia trachomatis.
Small abscess
Inguinal Buboes form sometime thereafter
If chronic, can cause fibrous lymphatic restrictions or bowel obs.
How are the buboes seen in latent Chlamydia trachomatis differentiated from plague?
Chlamydia trachomatis buboes are never in cervical lymph nodes
The STD form of Chlamydia trachomatis is most common in…
NA, SA, Eur
Trachoma Chlamydia trachomatis is most common where?
Asia/Africa
Hot, Dry places with poor access to clean water
_________ is a leading cause of infectious blindness in the world.
Trachoma Chlamydia trachomatis
Why would you treat both localizations of Chlamydia trachomatis infection at the same time in a patient?
They can cross-infect
Pathogenesis of Chlamydia trachomatis?
- Elementary bodies bind host receptor, induce endocytosis
- Chlamydia prevent phagolysosome fusion
- Induce cytokines (IL-1) and cause inflammation
- Remain for long periods without killing host
Why are vaccines against Chlamydia trachomatis ineffective?
Intracellular location of pathogen
_____ is the key to control. This is accomplished by ___.
Screening.
PCR
How is Chlamydia trachomatis treated?
Azithromycin
Tetracycline and macrolides may also work
Drastic measures to prevent Trichiasis Chlamydia trachomatis corneal keratinization include….
Surgery
Epilation (pulling out lashes)
You’re awesome! You just cured your patients Chlamydia trachomatis! Now, just don’t forget to…
Identify and treat all of their sexual conacts
Expedited partner therapy if necessary
How does Chlamydia pneumoniae tend to present clinically?
Mild URT disease
Possibly progressing to mycoplasma-like pneumonia
Chlamydia pneumoniae may be associated with what other major diseases?
Atherosclerosis
Asthma
Stroke
Late-Onset Alzheimers
How to treat Chlamydia pneumoniae?
Usually Untreated
Tetracycline might help
Chlamydia psittaci is also known as..
Parrot Fever
How does Chlamydia psittaci tend to present in the clinic?
Acute, Severe Pneumonia and Sepsis
Patchy, well-defined lung involvement
How is Chlamydia psittaci transmitted?
Contact with psittacine birds (esp. bites or feces)
How is Chlamydia psittaci controlled and treated?
Quarantine of Imported Birds
Tetracycline
