Repro-End: STDs Flashcards
- Urethritis
- Gram-negative Diplococci in PMNs in Urethral exudate
Neisseria gonorrhoeae
- Urethritis
- Clear Discharge
- Asymptomatic in Women
- Unilateral Scrotal pain in Men
- Culture negative
- Inclusion bodies
Chlamydia trachomatis
- Urethritis
- Urease Positive
- No cell wall
Ureaplasma urealyticum
- Cervicitis
- Friable, Inflamed Cervix w/ Mucopurulent Discharge
- Gram negative Diplococci
- Probes and Culture used to distinguish
Neisseria gonorrhoeae
- Cervicitis
- Friable, Inflamed Cervix w/ Mucopurulent discharge
- Non-staining Obligate Intracellular parasite
- Probes or Culture used to Distinguish
Chlamydia trachomatis
- 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
- Neisseria gonorrhoeae
- Chlamydia trachomatis
- Or BOTH
- Genital Lesions
- Non-indurated
- Painful papule
- Suppurative w/ Adenopathy
- Slow to Heal
Haemophilus ducreyi
- Genital elephantitis
- Initial papule heals
- Lymph nodes enlarge and Develop Fistulas
Chlamydia trachomatis (L1-L3)
- 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
Chlamydiaceae trachomatis
- 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
Mycoplasmataceae
-
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
Chlamydia trachomatis
- Prevalent in Africa / Asia / South America
- Swollen lymph nodes –> Genital Elephantitis
- Tertiary: Ulcers, Fistulas
Lymphogranuloma venereum (L1-L3)
- Follicular conjuctivitis
- -> Conjunctival scarring and Inturned eyelashes
- -> Corneal scarring
- -> Preventable Infectious Blindness (A, B, Ba, C)
Chlamydia trachomatis
What Rx do you use to treat Chlamydia trachomatis?
Doxycycline or Azithromycin
Erythromycin in Infected Mothers
to prevent Neonatal disease
- Urease positive
- Non-Gram staining
- Alkaline Urine
- Adult Patient w/ Urethritis, Prostatitis, Renal calculi
Ureaplasma urealyticum
What do you use to treat Ureaplasma urealyticum?
Erythromycin or Tetracycline
- Gram negative in PMNs
- Kidney Bean shaped Diplococci w/ Flattened sides
- Thayer-Martin medium
- Oxidase positive
- Maltose not fermented
- No Capsule
Neisseria gonorrhoeae
- Sexually active pt.
- Urethral / Vaginal discharge (Leukorhea)
- Possible Arthritis
- Neonatal Ophthalmia (Neonatal Conjuctivitis)
- Gram Negative - Diplococcus in Neutrophils
Neisseria gonorrhoeae
- Male: Urethritis, Proctitis
- Female: Endocervicitis, PID (contiguous spread), Arthritis, Proctitis - Mucopurulent discharge (cervicitis/urethritis)
- Infants: Opthalmia (rapidly leads to Blindness if untreated)
Neisseria gonorrhoeae
What is the (1) treatment for Neisseria gonorrhoeae?
Ceftriaxone (gonorrhoeae)
w/ Azithromycin or Doxycycline (chlamidya)
- 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
Haemophilus ducreyi
- Enlarged lymph nodes
- Genital Ulcers
- PAINFUL Chancre “Chancroid”
- Slow to Heal w/out Treatment
- Open Lesions increase transmission of HIV
Haemophilus ducreyi
How do you treat Haemophilus ducreyi?
- Azithromycin
- Ceftriaxone
- Ciprofloxacin
-
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
Treponema pallidum
- Nontender “Painless” Genital Chancre full of Spirochetes
- Clean, Indurated edge
- Contagious
- Heals spontaneously 3 - 6 weeks
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
- 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
Secondary Stage - Treponema pallidum
(1 to 3 months)
Dx: Serology Non-specific and Specific
- 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
Tertiary stage - Treponema pallidum
(30% of Untreated, Years after Expsoure)
Dx: Specific tests, Non-specific tests may be Negative
- 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)
Congential Stage - Treponema pallidum
(Babies of IV-Drug using Parents)
Dx: Serology should revert to Negative w/in
3 months if Birth is Uninfected
How do you diagnosis Treponema pallidum?
-
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
How do you treat Treponema pallidum?
Benzathine Penicillin (Primary and Secondary)
Penicillin G (Late and Congenital)
-
Jarisch-Herxheimer Reaction
- 24 hrs after ABX treatment
- Increase Temperature
- Decrease BP
- Rigors
- Leukopenia
- 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
Leptospira interrogans
How do you treat Leptospira interrogans?
Penicillin G or Doxycycline
Prevention: Doxycycline effective for Short-term exposure and Vaccination of domestic Lifestock and Pets, Rat Control
Infections that Cross the Placenta?
(TORCHHeS)
- TOxoplasma
- Rubella
- CMV
- HIV
- HErpes
- Syphilis (Treponema pallidum)
(7) Viruses that Cross the Placenta?
- Herpes and HIV
- CMV - Cytomegalovirus
- Rubella
- HSV 2 (primary infection)
- Coxackie B
- Polio
- HIV
- B19
(1) Parasite that Cross the Placenta?
- Toxoplasma gondii
(2) Bacteria that can cross the Placenta?
- Treponema pallidum (Syphilis)
- Listeria monocytogenes
What is the Site of Primary Infection for HSV-1 and HSV-2?
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
What is the difference in Clinical Presentation between
HSV-1 and HSV-2?
-
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)
-
Gingivostomatitis (inf. of mouth and gums)
-
HSV-2 –> below the Waist
- Genital Herpes
- Neonatal Herpes
What is the difference in Recurrent Clinical Presentation of
HSV-1 and HSV-2?
- HSV-1
- Cold sores
- HSV-2
- Genital Herpes
Characteristics of Herpesviridae virus?
- Large Linear dsDNA
- Enveloped, Icosahedral
- Derives envelope from Nuclear membrane
- Latency in Sacral ganglia
- Intracellular inclusion bodies
- Establishes latency
Vignette Characteristics of Herpesviridae virus?
-
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
What is the Rx for HSV-1 and HSV-2?
-
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.
Characteristics of Papillomaviridae (Papillomavirus)?
- dsDNA virus
- Circular
- non-enveloped
- Icosahedral
Vignette clues for HPV?
- 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
What is the Tx for HPV?
- 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
What are the Features of Hepatitis?
- 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
Characteristics of HIV?
- 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
Vignette Cluse for HIV?
- 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
HIV - Gag gene?
- Group-specific antigens
- P24
- P7p9
- p17
HIV - Pol gene?
- Reverse transcriptase
- Integrase
- Protease
HIV- Env gene?
- gp120
- gp41
HIV - LTR (U3, U5 gene)?
- DNA, Long terminal repeats
- Integration and Viral gene expression
HIV - Tat gene?
- Transactivator of upregulated Transcription
- Spliced gene
HIV - Rev gene?
- Regulatory protein - upregulates transport of Unspliced and Spliced transcripts to the cell cytoplasm
- Spliced gene
HIV - Nef gene?
- 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
Toxoplasmosis?
- 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
Clinical presentation of Toxoplasmosis by Trimesters?
-
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“
What is the Treatment for Toxoplasmosis?
- Pyrimethamine + Sulfadiazine
- Leukovorin
Classification of Togaviridae Rubivirus?
- Rubella (German measles)
- Icosahedral nucleocapsid
- Enveloped
- ss(+)RNA non-segmented
Clinical presentation of Togaviridae Rubivirus?
- 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
What is the Tx for Togaviridae Rubivirus?
- 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
Classification of Herpesviridae Cytomegalovirus?
- 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”
- Heterophile-negative mononucleosis in Children / Adults
- Neonate w/ Jaundice
- Hepatosplenomegaly
- Thombocytic purpura
- Owl-eye Intranuclear Inclusion bodies on Biopsy
Herpesviridae Cytomegalovirus
(CMV)
(Herpesvirus 5)
Clinical presentation of CMV?
- 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.
What is the Tx for CMV?
- Healthy –> Supportive
- Immunocompromised –> Ganciclovir / Foscarnet + Human Immunoglobulin (NO Thymidine Kinase is made so Acyclovir will not work)
- Resistance to Ganciclovir through hL97 gene
What is Reiter Syndrome?
(Nieserria gonorrhea and Chlamydia)
- Conjunctivitis - “Can’t See”
- Urethritis - “Can’t Pee”
- Polyarthritis - “Can’t Climb a Tree”
- 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?
Gardenerella / Mobiluncus
Rx: Metronidazole
- Not sexually transmitted
- Thick, curdy discharge
- Vaginal erythma
- pH is normal
- Pseudohyphae present
Candidiasis
Rx: -azoles
- 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
Trichomoniasis
Rx: Metronidazole (Must treat both partners)
- Gram positve Rod
- cAMP positive
- Catalase positive
- Transplacental transmission
- Food poisoning during birth, cold lunch meats, hot dog juices.
- Miscarriage, Still birth, Bacteremia, Meningitis
Listeria
- Gram negative Rod
- Lactose positve
- Sialic acid capsule
- Transmission during birth
- Bacteremia meningitis
E. coli K-1
- Gram positive
- Coccus
- Catalase negative
- β-hemolytic
- Bacitracin negative
- Transmission during birth
- Bacteremia, Meningitis
Group B Strep (GBS)
- Gram Positive Cocci often in Chains
- Catalase negative
- Beta hemolytic on Blood Agar
- Bacitracin resistant
- 40% of Normal Flora
- Treat before delivery if Colonized
GBS (Group B Strep)
- Gram negative Rod
- Ferments Lactose
- Sialic Acid capsule (K1)
- Anti-phagocytic properties
- Not recognized as Foreign –> Ab not made to it
E-coli K1
- 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
Listeria Monocytogenes
- 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
Neisseria gonorrhoeae
- 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
Chlamydia trachomatis