Non viral STI Flashcards
What is Chlamydia
-Anaerobic, obligate intracellular bacteria that infect columnar, or transitional epithelial cells in resp tract, rectum or urogental tract
-cant make amino acids to replicate or metabolize substances for energy - NEEDS TO USE HOST AND AA
2 forms
Elementary Body - nonreplicating and infectious form , transmission form human to human or bird to human
Replicating body - non infectious form in cell cytoplasm, replicates new EBs
Early - Convert EB into RB
Midcycle - Replication of RBs
Late - Convert RB into EB
What are the 3 serovars of chlamydia that infect humans
C-K C. trachomatis - gential infections - SEXUALLY TRANS
C. pneumoniae - lgv - SEXUALLY TRANS
SEVAR 1 C. psittacci - c ABORTIS causes still birth/abortion - inhaled from cows and sheep- in birds too pneumonia
Chlamydia trachomatis UROGENITAL INFECTIONS
causes mainly
-urethritis, cervicitis or rectal infections
-asymp
untreated infection can ascends from cervix and causes PID = infertility and ectopic pregnancy
in men organism ascends from urethra causing epididymitis and prostatitis
Lymphogranuloma venereum(LGV)
what are the stages
servars l1-l3
-replicates in mononuclear WBC and goes to lymphatic system from break in skin
primary stage - painless genital ulcer where the org entered- heals fast
secondary stage - goes from genital to lymph nodes, become buboes > pus filled painful > starts to leak
3rd - lymph vessel stricture/obstruction , swelling and more sores
if untreated
-in men: enlarged genitals since they have been obstructed
-in women PID
-in both, can become arthritis (Reiters syndrome), large liver and encephalitis, pneumonia
C. trachomatis SPECIMEN COLLECTION
-Swab of the urethra, throat, eyes or rectum
-endocervical scraping of columnar epithelial cells or combo endocervix/ urethral swab
-Cotton, Dacron and calcium alginate swabs with plastic or wire shafts
-wood shafts are toxic to CLAP
-cytobrush is best - vigorous scraping of cells because the cells are intracellular
mucous for gono first then scrap
TRANSPORT MEDIA FOR Chlamydia SWABS
2SP- CLAP SPECIFIC or UTM as transport media
-UTM for virus, mycoplasma or ureaplasma
-sucrose and protein for stabilization and nutrition
-sucrose is cyroprotectant
-AB or antifungal to kill other bacteria or fungus
-Buffer to maintain neutral pH
-Phenol red pH indicator = yellow acidic= bacterial overgrowth
-place in fridge until time for transport
-For long delays >48hrs freeze at -700C
Chlamydia trachomatis SPECIMENS COLLECTED FOR NAAT
-combo for both Chlamydia & Gonorhoeae
-on urine , endocervix, urethral, rectal & throat swabs
-urine for men
-females is endocervical swab followed secondly by urine
-transport media should best for what is testing the sample
-solution releases rRNA target and protects it from degradation
TESTS TO DIAGNOSE CHLAMYDIA
Cell cultures
Cell culture
DFA or Special Histological Stains
EIA
Nucleic Acid Amplification Test (NAAT)
Cell cultures are rarely done since they are too specialized, take too much time and need cell lines
-**
TESTS TO DIAGNOSE CHLAMYDIA
DFA or Special Histological Stains
-roll swab over slide
-add fluorescin labled monoclonal AB to outer membrane protein that is specific to C tracho
-or to LPS protein which is found in all Clap spp. This test is less specific due to cross reactions
TESTS TO DIAGNOSE CHLAMYDIA
ELISA
-AB to LPS labeled with enzyme
-if AG is present itll bind + substrate = color change
-must do confirmatory tests as other bacteria have same LPS
TESTS TO DIAGNOSE CHLAMYDIA
NAAT
Nucleic acid Amplification Test
-quick
-specific
- for clap and gono
-detect RNA or DNA targets
Mycoplasma & Ureaplasma
-smallest prokaryotes
-lack a cell wall so can’t gram stain and are resistant to Beta lactam antibiotics
Species that cause genital tract infections:
Mycoplasma hominis, Mycoplasma genitalium & Ureaplasma urealyticum
-can be NF
-can cause UTI, urethritis , PID, BV, sterility in men
-urogenital infections so it can be passed from mom to baby or sexually
Diagnostic testing
M. hominis or U. urealyticum: culture or PCR
M. genitalium not cultured, too hard to grow –PCR only
sent to PHL
Mycoplasma genitalium TESTING
not cultured only PCR is done
-no PCR at PHL so its sent to National Micro lab in Winnipeg if 3 of the following are met:
-symptomatic or recurring/persistent urethritis, cervicitis or PID
-Neg for C tracho and N gono
-After approval by med micro at PHO
urogentical swabs are frozen or refrigerated in UTM until shipped
M. hominis & U. urealyticum CULTURE what specimen are needed
Only M. hominis & U. urealyticum can be cultured*
-in men - urethral swab THEN urine
-in women - endocervical or vaginal swab THEN urine
-swabs are better than urine because orgs are cell related
-Dacron, rayon, or nylon swabs with plastic shafts –wood shafts toxic
-swabs in UTM
-urine in fridge for upto 48 hours
-swabs in UTM in fridge upto 48 hours
-freeze if delay >48hrs
how do you know if you have M. hominis & U. urealyticum
-Facultative anaerobes - both require cholesterol to maintain cell membrane
-hominis needs arginine
-urealyticum needs urea
-agar has yeast, protein, serum + AB
-arginine, urea, and magnesium sulphate
-UU produces urease which combines with mag sulphate and turns the colonies brown/black
-media is incubated for 5 - 7 days 35
C in 5-10% CO2 or ANO2
-put specimen in a SP4 orange broth with, glucose, arginine, urea & phenol red - Check daily for 5 days for color change
-Yellow color due to glucose use=Mycoplasma other than M. hominis
Red color due urea or arginine use = UU or M. hominis - sub to agar plates A7 or A8
-invert plates and examine under 10x
mycoplasma looks like fried egg
uu looks like irregular shaped brown/black colonies
Actinomyces israelii
-part of Actinomycetes group of organisms - is beaded, branching GPB
-ANO2 & NOT acid fast
NF in throat, intestine, and urogentical tract
-causes Actinomycosis- facial/dental, abdominal
-In reproductive tract, associated with PID from IUD use - tail of IUD colonized with organism, enters uterus due to trauma because the IUD breaks the mucous in cervix
Specimen
-abscess pus, yellow sulfur granules
-IUD - gram , scrap or put whole IUD in Thio , incubate O2 35 for 3 weeks
-can do PCR
Haemophilus influenzae UROGENITAL TRACT INFECTIONS
causes
specimen type
lab testing
causes - non gonococcal urethritis in men
-in women UGT infections and bartholin abscess, can pass from mom to baby
-swab or bartholins abscess aspirate , endometrium, Fallopian Tube or urethral swab in men
Lab testing
Morph- sll grey transclu on Choc wont grow on BA without staph
-Gram- smll gnb , on gncb
X & V
X factor: hemin, V factor: NAD
Haemophilus ducreyiCHANCROID
transmission
virulence factor
type of lesion produced
complications
transmission -sex NOT NF
virulence factor- capsule, pili, toxins involved in attachement and penetration of host cells
type of lesion produced - chancroid - soft edges, exudative
complications
if untreated = buboes or loss of genital tissue
-if you have open chancroid you are vulnerable to other STI
Haemophilus ducreyi LAB TESTING
samples for culture
incubation
sample for PCR
sample for culture
-Swab of genital ulcer exudate or bubo aspirate
-Dacron or cotton swab in Amies
-Needle and syringe for aspirate in sterile tube
-Aspirate kept at 4 0 C, freeze at -70 if delay and ship on dry ice
Incubation
5-10% CO2 - 35C with high humidity - may take up to 7 days to grow
Specimens For PCR
Place swab or aspirate specimen in dry sterile tube keep at 4 0 C, freeze at -70 if delay and ship on dry ice
Tan-yellow dry colonies can be pushed across plate
-gncb - school of fish
OX - pos
X factor only
MALDI
DFA to detect LOS AG - only at ref labs
PCR
Treponema pallidum SYPHILIS
caused by ?
transmission
caused by
Treponema pallidum subspecies pallidum
**Not all Treponema spp. are pathogenic
ANA, thin, corkscrew, motile
-GN but hard to stain
-cant survive long outside body they cant make their own metabolic products so they replicate slowly
-invasive and are able to evading immune system
Transmission
-sexually or mom to baby
-TORCHS org in pregnant women screen
Toxoplasmosis, Rubella Cytomegalovirus, Herpes simplex, HIV & Syphilis
Syphilis DISEASE PROCESS
stages
Primary - genital variations
-painless, non exudative lesions - HARD EDGE chancre on gentials or mouth -goes away in 3-6 wks
-NOT CURED STILL INFECTIOUS
Stages - not reproductive related
-2ndary - contagious
brown small rash on palms and soles of feet
Latent- contagious
-asymp - only diagnosed by serolgy
3ry - NOT contagious
-neurological problems
-gumma formation
-tissue destruction
SPECIMENS FOR SYPHILIS
Fluid collected from chancres
-from 1ry or 2ndary source - fluid is extremely contagious
-put on slide
-use for WP, DFA, or histo staining
-dont let it dry if youre doing darkfield or wet mount
Tissue biopfy/CSF
-histo, DFA
Blood serum/CSF
-for serology
cant culture syphilis on routine media needs mammal cells for growth
Syphilis DIRECT MICROSCOPY SCREENING TESTS
darkfield
DARKFIELD
-lesion fluid as WP with dark field
-IDing treponema on morphology and motility of spirochete
-cant diff between patho and non patho treponemes
Direct Fluorescence
-detects AG by using AB specific to ANY PATHOGENIC T PALLADIUM
BOTH must be confirmed with serology because neither differentiates T. pallidum subspecies pallidum from any other Treponema
Syphilis SEROLOGY-NON TREPONEMAL SCREENING TESTS
detection of Reagin Ab’s
-ABs to lipids like cardiolipin that are released when the host cell gets damaged in Syphilis, Leprosy, Malaria, TB or Measles
-positive is NOT specific for syphilis
-Cadiolipins can be released by any treponeme whether its pathogenic or not
NON SPECIFIC SCREENING TEST
positive must be confirmed
Venereal Disease Research Laboratory (VDRL) test
-uses mixture of lipids - Reagin which clump when pt serum or csf has AB to cardiolipin
Rapid Plasma Reagin (RPR) test:
Same as VDRL except uses cardiolipin antigen coated in charcoal
