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Pathology > Repro-End: STDs > Flashcards

Repro-End: STDs Flashcards

1
Q
  • Urethritis
  • Gram-negative Diplococci in PMNs in Urethral exudate
A

Neisseria gonorrhoeae

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2
Q
  • Urethritis
  • Clear Discharge
  • Asymptomatic in Women
  • Unilateral Scrotal pain in Men
  • Culture negative
  • Inclusion bodies
A

Chlamydia trachomatis

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3
Q
  • Urethritis
  • Urease Positive
  • No cell wall
A

Ureaplasma urealyticum

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4
Q
  • Cervicitis
  • Friable, Inflamed Cervix w/ Mucopurulent Discharge
  • Gram negative Diplococci
  • Probes and Culture used to distinguish
A

Neisseria gonorrhoeae

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5
Q
  • Cervicitis
  • Friable, Inflamed Cervix w/ Mucopurulent discharge
  • Non-staining Obligate Intracellular parasite
  • Probes or Culture used to Distinguish
A

Chlamydia trachomatis

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6
Q
  • Pelvic Inflammatory Disease (PID)
  • Adnexal tenderness
  • Bleeding
  • Deep Dypareunia
  • Vaginal discharge
  • Fever
  • Tenderness from Cervical Movement
  • Possible Inflammatory Mass on Bimanual exam
  • Onset often follows Menses
A
  • Neisseria gonorrhoeae
  • Chlamydia trachomatis
  • Or BOTH
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7
Q
  • Genital Lesions
  • Non-indurated
  • Painful papule
  • Suppurative w/ Adenopathy
  • Slow to Heal
A

Haemophilus ducreyi

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8
Q
  • Genital elephantitis
  • Initial papule heals
  • Lymph nodes enlarge and Develop Fistulas
A

Chlamydia trachomatis (L1-L3)

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9
Q
  • Obligate Intracellular Parasite
  • Elementary body
  • Infective form: Extracellular Elementary Body (Enfectious) –> Transforms into Reticulate body
  • Metaboically active replicating Reticulate body
  • -> Replicates by Fission
  • Not seen on Gram stain
  • Cannot make ATP
  • Cell wall lacks Muramic acid
A

Chlamydiaceae trachomatis

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10
Q
  • Smallest free-living Bacteria (Extracellular)
  • Makes Normal ATP
  • Sterols in membrane
  • Requires Cholesterol for in vitro Culture
  • “Fried-egg” colonies on Eaton’s media
  • Does not have Peptidoglycan in Cell Envelope
A

Mycoplasmataceae

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11
Q
  • Sexually active patient or Neonate
    • Adult: Urethritis, Cervicitis, PID, Inclusion conjunctivitis –> Infertility
    • Neonate: Inclusion conjunctivitis, Pneumonia (Staccato cough)
  • Immigrant from Africa / Asia
  • Genital Lymphadenopathy
  • Cytoplasmic Inclusion bodies in Scrapings on Giemsa or Fluorescent Antibody smear
A

Chlamydia trachomatis

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12
Q
  • Prevalent in Africa / Asia / South America
  • Swollen lymph nodes –> Genital Elephantitis
  • Tertiary: Ulcers, Fistulas
A

Lymphogranuloma venereum (L1-L3)

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13
Q
  • Follicular conjuctivitis
  • -> Conjunctival scarring and Inturned eyelashes
  • -> Corneal scarring
  • -> Preventable Infectious Blindness (A, B, Ba, C)
A

Chlamydia trachomatis

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14
Q

What Rx do you use to treat Chlamydia trachomatis?

A

Doxycycline or Azithromycin

Erythromycin in Infected Mothers
to prevent Neonatal disease

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15
Q
  • Urease positive
  • Non-Gram staining
  • Alkaline Urine
  • Adult Patient w/ Urethritis, Prostatitis, Renal calculi
A

Ureaplasma urealyticum

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16
Q

What do you use to treat Ureaplasma urealyticum?

A

Erythromycin or Tetracycline

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17
Q
  • Gram negative in PMNs
  • Kidney Bean shaped Diplococci w/ Flattened sides
  • Thayer-Martin medium
  • Oxidase positive
  • Maltose not fermented
  • No Capsule
A

Neisseria gonorrhoeae

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18
Q
  • Sexually active pt.
  • Urethral / Vaginal discharge (Leukorhea)
  • Possible Arthritis
  • Neonatal Ophthalmia (Neonatal Conjuctivitis)
  • Gram Negative - Diplococcus in Neutrophils
A

Neisseria gonorrhoeae

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19
Q
  • Male: Urethritis, Proctitis
  • Female: Endocervicitis, PID (contiguous spread), Arthritis, Proctitis - Mucopurulent discharge (cervicitis/urethritis)
  • Infants: Opthalmia (rapidly leads to Blindness if untreated)
A

Neisseria gonorrhoeae

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20
Q

What is the (1) treatment for Neisseria gonorrhoeae?

A

Ceftriaxone (gonorrhoeae)

w/ Azithromycin or Doxycycline (chlamidya)

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21
Q
  • Gram negative
  • Pleomorphic rod
  • Req’s Enriched media of Factor X (hemin) and Factor V (NAD) for growth on Nutrient or Blood agar
  • 10% CO2
  • “Satellite” phenomenon w/ S. aureus in Blood agar
A

Haemophilus ducreyi

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22
Q
  • Enlarged lymph nodes
  • Genital Ulcers
  • PAINFUL Chancre “Chancroid”
  • Slow to Heal w/out Treatment
  • Open Lesions increase transmission of HIV
A

Haemophilus ducreyi

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23
Q

How do you treat Haemophilus ducreyi?

A
  • Azithromycin
  • Ceftriaxone
  • Ciprofloxacin
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24
Q
  • Spirochetes: Spiral w/ Axial Filament (Endoflagellum)
    • Axial Filaments
    • Endoglagella
    • Periplasmic flagella
  • Gram negative
  • Obligate pathogen (but NOT intracellular)
  • Poorly visible - Thin spirochete - Cannot Culture
  • Endotoxin-like Lipids
A

Treponema pallidum

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25
Q
  • Nontender “Painless” Genital Chancre full of Spirochetes
  • Clean, Indurated edge
  • Contagious
  • Heals spontaneously 3 - 6 weeks
A

Primary Stage - Treponema pallidum

(10 days to 3 months after exposure)

Dx: Dark-field or Fluorescent microscopy of Lesion
50% pts will be negative by nonspecific serology

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26
Q
  • Maculopapular - “Copper colored” Rash
  • Diffuse
  • Includes Palms and Soles (Infectious)
  • Patchy Alopecia (Scalp, Beard, Facial Hair)
  • Condylomata lata: Flat, Wartlike perianal and
  • *Mucous “Patches” membrane lesions**
  • -> Highly Infectious
A

Secondary Stage - Treponema pallidum

(1 to 3 months)

Dx: Serology Non-specific and Specific

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27
Q
  • Gummas in CNS (Granulamatous Lesion w/in CNS)
  • Cardiovascular system issues
  • Aortic aneurysms (Aortitis)
  • CNS Inflammation
    • Tabes Dorsalis
    • General paresis
  • Argyll Robertson Pupil
    • Accomodate but Does NOT react to Light
A

Tertiary stage - Treponema pallidum

(30% of Untreated, Years after Expsoure)

Dx: Specific tests, Non-specific tests may be Negative

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28
Q
  • Stillbirth - Neonatal death
  • Keratitis (Inflammation of Cornea)
  • Hydrops fetalis - Frontal bossing
  • Jaundice
  • Anemia
  • 8th nerve Damage
  • “Saddle Nose”
  • Notched Teeth - Hutchinson’s Teeth - Perioral fissures
  • Neonates born Asymptomatic or w/ Rhinitis
  • -> Widespread desquamating Maculopapular Rash
  • Tabes Dorsalis (syphilitic myelopathy - demyelination of the nerves –> loss of Proprioception, Vibrioception, and Dicriminating touch (Fine)
A

Congential Stage - Treponema pallidum

(Babies of IV-Drug using Parents)

Dx: Serology should revert to Negative w/in
3 months if Birth is Uninfected

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29
Q

How do you diagnosis Treponema pallidum?

A
  • Screening Test (RPR/VDRL)
    • Nontremponemal Antibody Screening Tests
    • Ab binds ot Cardiolipin
    • Visualize organism by Immunofluorescence or Dark-field Microscopy
  • Diagnostic Test (MHA-TP/FTA-ABS)
    • FTA-ABS
    • Treponemal Antibody Specific Diagnositc Test
    • Binds to Spirochetes
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30
Q

How do you treat Treponema pallidum?

A

Benzathine Penicillin (Primary and Secondary)

Penicillin G (Late and Congenital)

  • Jarisch-Herxheimer Reaction
    • 24 hrs after ABX treatment
    • Increase Temperature
    • Decrease BP
    • Rigors
    • Leukopenia
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31
Q
  • Thin Spirochetes w/ Hooks on the Ends
  • Too thin to visualize
  • Gram negative
  • Pts. w/ Influenza-like symptoms + GI symptoms
  • Occupational (Sewage / Water treatment) or Recreation exposure (Jet skiers) to Water aerosols
  • Hawaii Honeymooners
A

Leptospira interrogans

32
Q

How do you treat Leptospira interrogans?

A

Penicillin G or Doxycycline

Prevention: Doxycycline effective for Short-term exposure and Vaccination of domestic Lifestock and Pets, Rat Control

33
Q

Infections that Cross the Placenta?

(TORCHHeS)

A
  • TOxoplasma
  • Rubella
  • CMV
  • HIV
  • HErpes
  • Syphilis (Treponema pallidum)
34
Q

(7) Viruses that Cross the Placenta?

A
  • Herpes and HIV
    • CMV - Cytomegalovirus
    • Rubella
    • HSV 2 (primary infection)
    • Coxackie B
    • Polio
    • HIV
    • B19
35
Q

(1) Parasite that Cross the Placenta?

A
  • Toxoplasma gondii
36
Q

(2) Bacteria that can cross the Placenta?

A
  • Treponema pallidum (Syphilis)
  • Listeria monocytogenes
37
Q

What is the Site of Primary Infection for HSV-1 and HSV-2?

A

Mucosa

  • HSV establishes infection in the mucosal epithelial cells and leads to the formation of Vesicles.
  • The Virus travels up the Ganglion to establish lifelong latent infection.
  • Stress triggers reactivation of Virus in Nerve and Recurrence of Vesicles
  • Kissing or Sexual contact w/ Mucosa and Genitals
38
Q

What is the difference in Clinical Presentation between
HSV-1 and HSV-2?

A
  • HSV-1 –> above the Waist​
    • Gingivostomatitis (inf. of mouth and gums)
      • Latent in Trigeminal ganglion
    • Keratoconjunctivitis (inff. of Cornea and Conj.)
      • Lid swelling and Vesicles, Dendritic ulcers
      • Blindness
    • Pharyngitis (sore throat)
  • HSV-2 –> below the Waist
    • Genital Herpes
    • Neonatal Herpes
39
Q

What is the difference in Recurrent Clinical Presentation of
HSV-1 and HSV-2?

A
  • HSV-1
    • Cold sores
  • HSV-2
    • Genital Herpes
40
Q

Characteristics of Herpesviridae virus?

A
  • Large Linear dsDNA
  • Enveloped, Icosahedral
  • Derives envelope from Nuclear membrane
  • Latency in Sacral ganglia
  • Intracellular inclusion bodies
  • Establishes latency
41
Q

Vignette Characteristics of Herpesviridae virus?

A
  • Tzanck smear - smear open vesicle
    • ​detects Multinucleated Giant cells
  • Cowdry Type A Intracellular Inclusion Bodies​
  • Cold sores (HSV-1)
  • Keratoconjunctivitis (HSV-1)
  • Genital Vesicles (HSV-2) - Painful vesicles
    • Fever, Malaise, Myalgia
    • Latency in the Sacral nerve ganglia
  • Meningoenchephalitis / Encephalitis
    • Fever, Headache, Confusion
    • Focal Temporal Lesions and Perivascular cuffing
  • Neonatal disseminated / Encephalitis - Birth canal
    • Skin, Eyes, Mouth, and Liver
42
Q

What is the Rx for HSV-1 and HSV-2?

A
  • Acyclovir - is only activated in cells infected with
    HSV-1, HSV-2, or VZV.
  • The virus Thymidine Kinase is req’d to activate the Drug
  • Placing the First Phosphate on the Drug
    –> Followed by the Phosphorylation via Cellular enzymes
  • Famciclovir, Valacyclovir, Penciclovir alternates.
43
Q

Characteristics of Papillomaviridae (Papillomavirus)?

A
  • dsDNA virus
  • Circular
  • non-enveloped
  • Icosahedral
44
Q

Vignette clues for HPV?

A
  • Hyperkeratosis leads to formation of “Wart”s (vacuolization)
  • CIN I, II, III - Cervical Intraepithelial neoplasia
  • Infection of the Basal layer of the skin and Mucous membranes
  • Biopsy or Pap smear shows Koilocytic cells w/ Perinuclear cytoplasmic vacuolization and Nuclear enlargement
45
Q

What is the Tx for HPV?

A
  • Vaccine composed of HPV capsid proteins
    • Gardasil (6, 11, 16, 18)
    • Cervarix (16, 18)
  • Safe sex practicies
  • Cryotherpay, Electrocautery, Salicylic acid
  • Imiquimod (induces pro-inflammatory cytokines)
  • Interferon-α
  • Cidofovir
46
Q

What are the Features of Hepatitis?

A
  • Hepatitis B - Hepadnavirus
    • dsDNA - circular
    • Enveloped
  • Hepatitis C - Flavivirus
    • RNA - ss(+) - non-segmented
    • Enveloped
  • Hepatitis D - Defective - Co-infection w/ HBV (super)
    • RNA - ss(-) - circular
    • Enveloped
47
Q

Characteristics of HIV?

A
  • Enveloped, Truncated, Conical capsid (Type D retrovirus)
  • Icosahedra nucleocapsid
  • ss(+)RNA diploid
  • Targets: CD4 T cells, Dendritic cells, Monocytes, Macrophages, CCR5 co-receptor cells
  • RNA-dependent DNA polymerase (Reverse transcriptase)
  • Integrase
  • Protease
48
Q

Vignette Cluse for HIV?

A
  • Hairy Leukoplakia, Pneumocystitis pneumonia, Thrush, Toxoplasmosis, Kaposi sarcoma, Retinitis CMV
  • Homosexual Male
  • IV drug user
  • Sexually active Adult
  • Decreasing CD4 cell count
  • Opportunistic infections
  • Fatigue, Weight loss, Lymphadenopathy
  • Low-grade Fever
49
Q

HIV - Gag gene?

A
  • Group-specific antigens
  • P24
  • P7p9
  • p17
50
Q

HIV - Pol gene?

A
  • Reverse transcriptase
  • Integrase
  • Protease
51
Q

HIV- Env gene?

A
  • gp120
  • gp41
52
Q

HIV - LTR (U3, U5 gene)?

A
  • DNA, Long terminal repeats
  • Integration and Viral gene expression
53
Q

HIV - Tat gene?

A
  • Transactivator of upregulated Transcription
  • Spliced gene
54
Q

HIV - Rev gene?

A
  • Regulatory protein - upregulates transport of Unspliced and Spliced transcripts to the cell cytoplasm
  • Spliced gene
55
Q

HIV - Nef gene?

A
  • Responsible for Virulence of the Virus
  • Regulatory protein that Decreases CD4 expression and MHC 1 expression on Host cells
  • Manipulates T-cell activation pathways
  • Req’d for Progression to AIDS
56
Q

Toxoplasmosis?

A
  • Intracellular Protozoan parasite
  • Fecal-oral transmission
  • Cat feces, Undercooked meat, Water, Soil
    • Cat is essential definitive host
  • Cysts viable for up to 18 hours
  • Serology: High IgM or rising IgM
57
Q

Clinical presentation of Toxoplasmosis by Trimesters?

A
  • First-trimester
    • Death
    • CNS findings
  • Second-trimester - (3)
    • Hydrocephalus / Microcephaly
    • Calcifications w/in the Brain –> Convulsions
    • Chorioretinitis
  • Third-trimester
    • Asymptomatic
  • “Progressive Blindness in Child” later in life (Teens)
  • “Ring enhancing lesions” in AIDS pts.
  • “Heterophile negative mononucleosis“
58
Q

What is the Treatment for Toxoplasmosis?

A
  • Pyrimethamine + Sulfadiazine
  • Leukovorin
59
Q

Classification of Togaviridae Rubivirus?

A
  • Rubella (German measles)
  • Icosahedral nucleocapsid
  • Enveloped
  • ss(+)RNA non-segmented
60
Q

Clinical presentation of Togaviridae Rubivirus?

A
  • Rubella (German measles) - Erythematous rash that starts on the Forehead –> Downward
  • Pronounced Lymphanopathy
  • Blueberry muffin - extramedullary hematopoiesis
  • IUGR
  • Opthalmoligic
    • Cataracts in Infants
  • Cardiac
    • PDA, Peripheral Pumonary artery stenosis
  • Auditory
    • Deafness
  • Neurologic
    • Microcephaly
61
Q

What is the Tx for Togaviridae Rubivirus?

A
  • Live-attenuated Rubella Virus
    • MMR - Measles, Mumps, Rubella
  • Detection is made by Serology
    • IgM - Recent infection
    • IgG - Immune
  • Nasal specimen (highest yield), Blood, Urine, CSF, Throat swab
  • Virus in Amniocentesis indicates Congenital Rubella
62
Q

Classification of Herpesviridae Cytomegalovirus?

A
  • CMV or Herpesvirus 5
  • DNA virus
  • Icosohedra nucleocapsid
  • Enveloped - only virus that obtains its envelope by buddying from Nuclear membrane
  • DS Linear
  • Giant cells w/ Intranuclear Inclusion bodies “Owl’s Eye”
63
Q
  • Heterophile-negative mononucleosis in Children / Adults
  • Neonate w/ Jaundice
  • Hepatosplenomegaly
  • Thombocytic purpura
  • Owl-eye Intranuclear Inclusion bodies on Biopsy
A

Herpesviridae Cytomegalovirus

(CMV)

(Herpesvirus 5)

64
Q

Clinical presentation of CMV?

A
  • Cytomegalic Inclusion bodies (Basophilic) (newborns)
  • Heterophilic-negative mononucleosis
  • Splenomegaly, Jaundice, Petechiae, Hearing loss, Cataracts, Cardiac
  • Immunocompromised:
    • Retinitis
    • Pneumonitis
    • Esophagitis
    • Thrombocytic Purpura “Blueberry muffin Baby”
    • CNS damage to Death
  • Reactivation in Transplanted Organ or AIDS pts.
65
Q

What is the Tx for CMV?

A
  • Healthy –> Supportive
  • Immunocompromised –> Ganciclovir / Foscarnet + Human Immunoglobulin (NO Thymidine Kinase is made so Acyclovir will not work)
    • Resistance to Ganciclovir through hL97 gene
66
Q

What is Reiter Syndrome?

(Nieserria gonorrhea and Chlamydia)

A
  • Conjunctivitis - “Can’t See”
  • Urethritis - “Can’t Pee”
  • Polyarthritis - “Can’t Climb a Tree”
67
Q
  • Lower Abdomenal pain, Pruritis, Red, Fishy-odor, Thin grayish-white discharge
  • Imbalance of Normal Flora
    • Loss of Lactobacilli (G+ rods)
    • Changes in Hormone status, Sex activity, ABX, Douching
  • Clue-cells - epithelial cells coated w/ bacterial Rods
  • Whiff test for Amines (fishy)
  • What is the bug (2) and what are the Rx to Treat?
A

Gardenerella / Mobiluncus

Rx: Metronidazole

68
Q
  • Not sexually transmitted
  • Thick, curdy discharge
  • Vaginal erythma
  • pH is normal
  • Pseudohyphae present
A

Candidiasis

Rx: -azoles

69
Q
  • Yellow frothy discharge
  • Usually asymptomatic (especially in men)
  • Symptoms similar to Bacterial Vaginosis in Women
  • Increased risk of STDs and Transmission of HIV
  • Increased pH
  • Motile Flagellated Protozoan
A

Trichomoniasis

Rx: Metronidazole (Must treat both partners)

70
Q
  • Gram positve Rod
  • cAMP positive
  • Catalase positive
  • Transplacental transmission
  • Food poisoning during birth, cold lunch meats, hot dog juices.
  • Miscarriage, Still birth, Bacteremia, Meningitis
A

Listeria

71
Q
  • Gram negative Rod
  • Lactose positve
  • Sialic acid capsule
  • Transmission during birth
  • Bacteremia meningitis
A

E. coli K-1

72
Q
  • Gram positive
  • Coccus
  • Catalase negative
  • β-hemolytic
  • Bacitracin negative
  • Transmission during birth
  • Bacteremia, Meningitis
A

Group B Strep (GBS)

73
Q
  • Gram Positive Cocci often in Chains
  • Catalase negative
  • Beta hemolytic on Blood Agar
  • Bacitracin resistant
  • 40% of Normal Flora
    • Treat before delivery if Colonized
A

GBS (Group B Strep)

74
Q
  • Gram negative Rod
  • Ferments Lactose
  • Sialic Acid capsule (K1)
    • Anti-phagocytic properties
    • Not recognized as Foreign –> Ab not made to it
A

E-coli K1

75
Q
  • Gram Positive Rod
  • Catalase Positive
  • cAMP Positive
  • Usually acquired through Food
    • Cold lunch-meat
    • Hot dog juices
    • Unpasturized chees
  • Infection in Pregnant Women can cause Miscarriage or Stillbirth
A

Listeria Monocytogenes

76
Q
  • Gram negative diplococcus
  • Oxidase Positive
  • Chocolate agar w/ 5% CO2
  • Gonnococcal Opthalmia Neonatorum
    • Lid edema, erythema and purulent discharge (severe conjunctivitis) in neonate born vaginally from infected mother
    • Bilateral appearing 3-5 days after birth
A

Neisseria gonorrhoeae

77
Q
  • Obligate Intracellular bacterium w/ 2 stages
    • EB (extracellular)
    • RB (intracellular)
  • Most commonly reported STI in USA
  • Conjunctivitis and Pneumonia 5-12 days after birth
    • Unilateral conjunctivitis
    • Otitis media
    • Pneumonia
A

Chlamydia trachomatis

Pathology (36 decks)

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