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Clinical Pathology > Pathogenesis of HIV and major STIs > Flashcards

Pathogenesis of HIV and major STIs Flashcards

1
Q

What is the difference between STI and STD?

A

Both transmitted through sexual contact

Disease = evidence of disease symptoms (infection could be asymptomatic!)

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2
Q

What are genital infectious disease?

A

Disease not necessarily acquired by sexual contact but act can precipitate it

Examples inc commensal vaginal flora/GI flora

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3
Q

What are the main bacteria associated with STIs?

A

N gonorrhoea
Chlamydia trachomatis
Ureaplasma
Mycoplasma

T pallidum - syphillis

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4
Q

What does phthirus pubis cause?

A

Crabs

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5
Q

What does sarcoptes scabiei cause?

A

Scabies

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6
Q

What are the predominant sites of infection/disease?

A

Local e.g. T vaginalis, C trochomatis, HSV, HPV, N gonorrhoeae

Mixed - syphillis

Other sites - HIV, Hep B

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7
Q

Other than sexual contact i.e. M-F, oral, M-M, F-F; how else can STIs be spread?

A

Vertical transmission - mother to baby

e.g. conjunctivitis/keratinits

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8
Q

What is the risk of infection/acquisition mainly related to?

A

Number of sexual partners (without barriers/contraception)

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9
Q

What type of bacteria is Neisseria gonorrhoea?

A

-Gram negative, -Diplococcus (looks like a pair of hairy balls) “clap”

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10
Q

What are the characteristics of N gonorrhoeae?

A
  • Intracellular pathogen - pathocytosed and multiplies intracellularly
  • Pili on surface - attaches to surface mucosal membranes (mainly cuboidal/columnar epithelium)
  • Cell envelope
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11
Q

Where can gonorrhoea infect/effect?

A

Genital urethral tract
Rectum
Pharynx

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12
Q

How does gonorrhoea present?

A

Majority of women = asymptomatic

Urethral discharge

Dysuria

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13
Q

What are the complications of gonorrhoea (local and distant)?

A
  • Epididymitis
  • Prostatitis
  • Pelvic inflammatory disease
  • Fitz-Hugh curtis syndrome (perihepititis)

-Disseminated gonococcal infection - causes arthritis, meningitis

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14
Q

What can N gonorrhoea cause in pregnancy?

A
  • Spontaneous abortion,
  • premature labour,
  • conjunctivitis (ophthalmia neonatorum - blindness if not treated!!)
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15
Q

How is gonorrhoea diagnosed?

A
  • Urethral swab
  • Culture
  • Nucleic acid amplification test e.g. PCR
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16
Q

What is the treatment for gonorrhoea?

A

Cephlasporins eg. cefixime (oral), ceftriaxone (IV)

Azithromycin

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17
Q

What is the cause for non-gonococcal urethritis? (NGU)

A

Chlamydia

Ureaplasma urealyticum

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18
Q

What type of bacterium is chlamydia trachomatis? In what two forms does it exist?

A

Obligate intracellular pathogen

Extracellular infective - elementary body

Intracellular replicative - reticular body

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19
Q

What cells does chlamydia trachomatis target?

A

Squamocolumnar epithelium

Females - cervix, upper genital tract

Males/females - urethra, rectum, conjunctiva

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20
Q

How does chlaymdia infection present?

A

Osten asymptomatic (females more)

Urethritis

Cervicitis - strawberry cervix

Dysuria/frequency (painful, burning pee!)

21
Q

What are the complications of chlamydia?

A
  • Pelvic inflammatory disease - cause of infertility
  • Conjunctivitis
  • Epididymitis
  • Tubal infertility
  • Infant pneumonia
22
Q

How is chlamydia diagnosed?

A

NAAT (i.e. PCR)

23
Q

What is the treatment for chlamydia?

A

Azithromycin

Doxycycline

24
Q

What is the main cause of genital warts?

A

HPV 6 and 11

HP 16 and 18 = cervical cancer

25
Q

What is the treatment for genital warts?

A

Cervarix (16, 18)
Gardasil (HPV 6, 11, 16, 18)
- burn/freeze/cut

26
Q

What type of virus is the herpes simplex virus> Which one (type 1 or 2) causes genital herpes>

A

Double stranded DNA

Type 2 - genital hypes

27
Q

What are the classical symptoms of genital herpes?

A 
Pain
Itching
Dysuria
Vaginal/urethral discharge
Vesicles/ulcers - shedding (Spread)

CAN REACTIVATE

28
Q

What is the treatment for genital herpes?

A

Acyclovir

29
Q

What is the complications of Herpes?

A

Meningitis

Encephalitis

30
Q

How is genital herpes diagnosed?

A

Clinical, PCR (HSV 1 or 2), histology

31
Q

What bacteria caused syphilis? What type of bacteria is it?

A

treponema pallidum

Spiralchaete (looks like a SPIRAL)

Cannot be grown/cultured in lab

32
Q

How does it cause its symptoms and signs?

A

Penetrate intact mucosal membranes or abraded skin

Disseminates through lymph and blood quickly

Thereafter, causes symptoms and signs

33
Q

What does the primary stage of syphillis consist of?
Time
Pathology
Symptoms

A

Incubation
3-90 days
First chancre - site of inoculation, heals spontaneously within 3-6 weeks
Asymptomatic

34
Q

What does the secondary stage of syphillis consist of?
Time
Pathology
Symptoms

A

VERY INFECTIOUS
-6-8 weeks after primary
infection
-Rash - trunk, limb, soles, palms
-Condylomata lata - papules under armpits/genital regions
- Malaise, fever, weight loss
- CNS involvement - headache, meningism (rare)

35
Q

What does the latent/teriary stage of syphillis consist of?
Time
Pathology
Symptoms

A

Spontaneous resolution after 3-12 weeks (latent = no clinical manifestation)

Tertiary - >2yrs
Gummas - non-specific granulomas (organs) - chronic inflammation

Cardiovascular - aortic regurg/aneurysms

Neuro - seizures, hemiplegia, mania/pyschoses/personality change, ataxic wide based gait

Argyll Robertson pupils - constrict to accommodation but not light

36
Q

Can Syphillis cross the placenta and cause infection?

A

Yes - presents with snuffles/hepatosplenomegaly initially then saddle nose, frontal bosses, dental abnormalities later

37
Q

What is the treatment for syphillis?

A

penecillin

38
Q

What causes trichomoniasis? What is its characteristics?

A

Trichomoniasis vaginalis

Protozoan, lacks mitochondria

Humans only host

39
Q

What are the clinical characteristics of trichomoniasis? How is it diagnosed?

A

FROTHY GREEN VAGINAL DISCHARGE (mmmm…)

Microscopy/culture

40
Q

How is trichomoniasis treated?

A

Metronidazole

41
Q

What is bacterial (anaerobic) vaginosis caused by?

A

Reduced vaginal lactobacilli

Increased gardnerella vaginalis and anaerobes

42
Q

What is the characteristics of bacterial (anaerobic) vaginosis?

A

Watery discharge
Fishy odour
pH >4.5

43
Q

What are the treatment for bacterial vaginosis?

A

Metronidazole

44
Q

What is the cause for thrush? How is it transmitted?

A

Candida (usually albicans)

Sex, broad spectrum antibiotics, diabetes (poorly controlled, oral contraceptives)

45
Q

What is thrush characterised by

A

Vaginal, vulval and penile erythema (redness)

Itchiness

Thick discharge

46
Q

How is thrush diagnosed and treated?

A

Clinical diagnosis/culture

Treated with clotrimazole/fluconazole

47
Q

What is HIV marked by?

A

Loss of CD4 lymphocytes

48
Q

What are the characteristics of HIV?

A

Retrovirus - possesses reverse transcriptase

RNA dependent DNA polymerase

49
Q

What HIV glycoprotein interacts with cell CD4 receptor and CCR5?

A

p120

Clinical Pathology (50 decks)

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