Sexual Trans Inf - Bacterial Flashcards
1
Q
Chlamydia only grow how?
A
intracellular - they can only replicate WITHIN cells —> THEY CANNOT MAKE THEIR OWN ATP
2
Q
*Differ from other “reg” bac bc…
A
- only replicate intraceullularly
- have no peptidoglycan in cell wall
3
Q
most common species?
A
chlamydia trachomatis
4
Q
2 major diseases of chlamydia trachomatis
A
genital inf and conjunctivitis
5
Q
chlamydia & chlamyophilia - organism details:
A
- Small cocci
- obligate intracellular parasite –> Cannot make their own ATP
- Gram (-)-like envelope
- Similar to Gram(-)but do not have peptidoglycan in between 2 membranes LPS only has weak endotoxin activity
- Two distinct stages in life cycle: 1) Elementary bodies – infectious form and 2) Reticulate bodies – replicative form
6
Q
bacteria that has elementary and reticulate body life cycle and what those mean?
A
- chlamydia & chlamyophilia
- elementary is infectious form
- reticulate is replicative form
7
Q
elementary bodies info
A
- chlamydia & chlamyophilia
- adapted for life extracellularly
- rigid cell wall
- isolated organisms infectious - INFECTS
- RNA 1: DNA 1 content
8
Q
reticulate bodies info
A
- chlamydia & chlamyophilia
- fragile cell wall
- RNA 3: DNA 1 content
- isolated organisms not infectious
- adapted for intracellular growth - REPLICATES
9
Q
chlamydia trachomatis - bacteria inf details
A
- human is only known host
- mult serovars based on antigenic dif in major outer membrane protein (MOMP)
- Tropism for nonciliated, columnar, cuboidal and transitional epithelial cells of: Urethra, endocervix, endometrium, fallopian tubes, anorectum, respiratory tract and conjunctivae
- destruction of epithelia and proinflammatory cytokine response
- wihtout treatment inflammation becomes fibrosis (infertility)
- STI/urogenital inf, lyphogranuoma venereum, & inclusion conjunctivitis
10
Q
Serovars A, B, Ba, and C
A
trachoma
11
Q
Serovars D-K
A
urogenital tract disease
12
Q
Serovars L1, L2, L2a, L2b, L3
A
lymphogranuloma venereum
13
Q
C. trachomatis disease- Eye infections: Trachoma
A
- chronic conjunctivitis
- transmitted: droplets, hands, clothing, flies
- leading cause of preventable blindness in the world
14
Q
most common spread bacterial sexual inf in the US?
A
C. trachomatis
15
Q
C. trachomatis - in men
A
- most are symptomatic
- dysuria (pain when peeing) and a thin urethral mucopurulent discharge
- may progress to Reiter syndrome: urethritis, conjuunctivitis, and plyarthritis
16
Q
C trachomatis - in women
A
- 80% are ASYMPTOMATIC (reservoir for sperad)
- mucopurulent discharge
- Pelvic inflam disease of uterus, fallopian tubes and toher organs
17
Q
Lymphogranuloma venereum (LGV)
A
- C. Trachomatis
- serovars L1, L2, and L3 => MORE INVASIVE
- pt presents with primary -painless lesion/papule at site of inf
- inf and swelling of lymph nodes draining the site of initial inf, inguinal lymphadenopathy (swelling of lymphatics)
- node can rupture from fistulas
- proctitis (spread to rectum) common with lymphatic spread
18
Q
C trachomatis diagnossi
A
- Culture of sample with cells (as hosts) followed by staining with iodine identifies glycogen in RBs => note the inclusions
- Immunofluorescence of EBs, ELISA
- Requires sample of epithelial cells; Cervical scrapings; Urethral scrapings (men); Conjunctival scrapings
- Nucleic acid amplification tests (NAATs) from urine or urethral discharge are considered test of choice (Most commonly used)
19
Q
C trachomatis - treatment and prevention
A
- Treatment:
- Depends on pregnancy status, age and type of infection
- Doxycycline or macrolides
- Prevention:
- Control of re-infection: infection does not confer immunity
- Safe sex, early detection and treatment of symptomatic patients and their sexual partners
20
Q
neisseria - organsim details
A
-Gram (-), aerobic, diplococci–>
Gonococcus, meningococcus
-Oxidase +, Catalase +, Non-spore forming, non-motile
-Kidney bean appearance (peanut look) -SEEN IN PAIRS
-Exclusively human host
-N. gonorrhoeae and N. meningitidis cannot be distinguished under the microscope: Differentiate by sugar use patterns and sites of primary infection; N. meningitidis ferments maltose, N. gonorrhoeae does not
21
Q
N gonorrhoeae virulence factors:
A
- -Pilin - attachment, anti-phagocytic
- -por protein - promotes intracellular survival
- -opa(city) protein - attachment to eukar cells
- -lipooligosaccharide (LOS) - lipid A and core oligosac, lacks o-antigen, endotoxiin
- ***All above factors have antigenic variation: organism can change “look” of these things easily and quickly= difficult for immune system (NO IMMUNITY)
- outer membrane blebls- Contain LOS and OM proteins, enhance toxicity and absorb antibodies (tricks immune system to not kill pathogen)
- IgA1 protease - destroys IgA
- Beta-lactamase - hydrolyzes beta-lactam ring in penicillin
22
Q
N. gonorrhoeae - disease presentation
A
- STI
- asymptomatic especially in women-95% of all infected men have acute symptoms (versus 50% for women)
- more common in African American and southeastern US
- Higher risk for deficiency in late complement pathwys
- Characterized by mucopurulent discharge for involved site (e.g. urethra, cervix, epididymis, prostate, anus) and dysuria after 2- 5 day incubation period
- Complications: Men: epididymitis, prostatitis, periurethral abscesses; Women: salpingitis, tuboovarian abscesses, PID in 10- 20% of women, Infertility, ectopic pregnancy
23
Q
N. gonorrhoeae - pathogenesis and immunity
A
- gonocooci attach to mucosal cells (pili, ProB, Opa)
- Penetrate into cells and multiply
- Pass through cells to subepithelial space where infection is established: Primary site of infection for women is cervix* (bacteria infect endocervical columnar epithelial cells)
- LOS stimulates inflammation: chemokines and TNFα (proinflammatory cytokine) which is responsible for symptoms
24
Q
N. gonorrhoeae - diseminated infections
A
- (Gonococcemia)
- Septicemia and infection of skin and joints occur in 1-3% of infected women and much lower percentage of infected men
- Fever, migratory arthralgias, suppurative arthritis in the wrists, knees, and ankles, pustular rash on an erythematous base over the extremities but not on head or trunk
- -Leading cause of purulent arthritis in adults - PUS IN JOINTS
- lesions: larges, necrotic, gray central on eryhtematous base
25
other potential diseases of N gonorrhoeae
-Purulent conjunctivitis: Purulent ocular infection particularly in newborns infected during vaginal delivery (opthalmia neonatorum)
-Anorectal gonorrhea in 5% of women, and MSM
-Pharyngitis: usually mild to asymptomatic
Almost always accompanies genital infection
26
N gonorrhoeae - diagnosis
-Direct smear: Gram (-), bean-shaped diplococci in neutrophils: 95% accuracy in men; >60% accuracy in women: complicated by commensal flora
-Culture: Urethra scrapings (men) and cervical (women), rectal or throat swabs as appropriate;
Fastidious [Chocolate agar (nonselective) Thayer-Martin media (selective)]
**MOST COMMON and RELIABLE=**-NAAT (nucleic acid amplification); can combine with test for chlamydia
27
N meningiditis v gonorrhoeae capsule/phagocytosis?
- gono has no capsule and is readily phagocytosed
| - mening HAS capsule and is not readily phagocytosed
28
N. gonorrhoeae - treatment and prevention
- Treatment: Ceftriaxone, plus doxycycline or azithromycin to treat chlamydia (presumed with gonorrhea); Drug resistance becoming problematic (see CDC for guidelines)
- Neonates: prophylaxis with erythromycin ophthalmic ointment; opthalmia neonatorum is treated with ceftriaxone
-Prevention: Patient education; follow-up screening of sexual contacts; Condom
29
broad spectrum cephalosporin and what this specific drug does?
Ceftriaxone - binds PBPs and enzymes responsible for peptidoglycan synthesis
30
Doxycycline or macrolides mechanism of action
protein synth inh
31
neonatal conjunctivitis organism and treatment?
- C trachomatis
| - erythromycin eye drops
32
A biovar is a
variant prokaryotic strain that differs physiologically and/or biochemically from other strains in a particular species.
33
Serovar:
-A group of closely related microorganisms distinguished by a characteristic set of antigens. -Also called serotype
34
gonorrhoeae will be found in what cell type most likely? How does this present in patient?
- infect neutrophils
| - results in mucopurulent discharge
35
What is not a complication/symptom of infection with N. gonorrhoeae?
NOT: Enteritis
COMPLICATION: pharyngitis, conjunctivitis, pustular rash, ectopic prego
36
Syphilis acquired and how disease begins and pregresses?
- acquired by direct contact of mucous membranes during sexual contact
- disease begins with a lesion at the point of entry (genital ulcer)
- ulcers heal and organism spreads --> weeks later presents as generalized maculopapular rash (secondary syphilis)
- disease enters secondary eclipse stage=latency
- latent infection may be cleared by immmune system OR reappear as tertiary syphilis years to decades later
- tertiary syphilis = focal lesions (can target heart and/or brain)
37
organism that causes syphilis and info on disease (transmission, reservoir, stages
- Treponema pallidum
- STAGES: primary, secondary, latent, tertiary, and congentital
- Reservoir: HUMAN
- Transmission: Sexual contact or congenital
38
Treponema pallidum - organism details
- Thin, Gram-negative spirochete
- motile
- Flexible, peptidoglycan cell wall around which several axial fibrils/endoflagella are wound.
- The cell wall and axial fibrils are covered by an outer bilayered membrane (like outer-membrane
- Microaerophilic: extremely sensitive to oxygen toxicity
- Sensitive to heat, drying or disinfectants
* **-Does not grow in cell free culture, very difficult to grow in cell culture (doubling time 30 hours)
39
Treponema pallidum - how to observe these guys?
- too thin for light microscope (for stained samples)
- need to use Dark-field microscope (for unstained samples
- direct fluorescent antibody test
40
primary syphilis details;
- one or more lesions (chancres) at point of entry
- thought to be result of host response to infection
- LESION IS HARD AND PAINLESS!
41
secondary syphilis details
- Clinical signs of disseminated disease (2-8 wks post chancre)
- Flulike syndrome with sore throat, headache, fever, myalgias (muscle ache), anorexia, lymphadenopathy
- Prominent skin lesions dispersed over the entire body including **palms and soles**; Highly infectious; Resolves over a period of weeks to months
- Raised lesions called *condylomata lata* may occur in skin folds: Soft, flat, moist, pink-tan papules --> NOT PAINFUL
42
Latent syphilis details:
- Asymptomatic period lasting a few years to decades
- Continued infection is evidenced by serologic tests
- Transmission is possible from relapsing secondary lesions, blood transfusion, or transmission to fetus (congenital)
43
Tertiary (late) syphilis details:
- 1/3 of untreated patients proceed to tertiary syphilis
- Diffuse, chronic inflammation
- Can cause devastating destruction of virtually any organ or tissue (arteritis, dementia, blindness)
- Granulomatous lesions (**gummas**) may be found in bone, skin and other tissues
- Nomenclature of late syphilis reflects the organs of primary involvement. Most devastating: Neurosyphilis & Cardiosyphilis
44
cardiosyphilis results in:
-arteritis involving aorta resulting in necrosis leading to aneurysms
45
Neurosyphilis results in:
- often chronic meningitis with fever, focal neurologic findin and protein and cells in CSF
- Cortical degeneration of brain causes mental changes: decreased memory, dementia, psychosis
46
Tuskegee syphilis experiment
govt could have treated people with disease but instead they just watched them to see how disease progressed
47
Congenital syphilis
- Infected mothers can transmit to fetus resulting in fetal loss or congenital syphilis
- Presents similar to secondary syphilis in the adult:Rhinitis and maculopapular rash are common findings that develop after birth
- **Teeth and bone malformation**, blindness, deafness, and cardiovascular syphilis are common
48
syphilis diagnosis:
* *-Darkfield microscopy
* *-Direct fluorescent antibody microscopy
- Culture: not available
* *-Antibody detection/serology: Most common
49
Nontreponemal tests
- Syphilis serology
- Measures antibody directed against cardiolipin (lipid complex) --> CARDIOLIPIN ANTIBODIES ARE PRESENT IN OTHER DISEASES=NOT THAT SPECIFIC
- Rapid plasma Reagin (RPR) and Venereal Disease Research Laboroatory (VDRL)
50
Treponemal tests
- Syphilis serology
- Detect antibody specific to T. pallidum
- Fluorescent treponemal antibody (FTA-ABS)
- Microhemagglutination (MHA-TP)
51
Nontreponemal tests results rise, peak, and decline?
- rise in primary
- peak in secondary
- decline with adv age
- can revert to normal in weeks with treatment ***
52
treponemal tests results rise, pea and decline
- rise in primary
- peak in secondary
- decline with adv age
- Remain elevated even after successful treatment.***
53
syphilis - treatment and prevention*** KNOW THIS TREATMENT
- Treat with penicillin: Doxycycline or azithromycin for patients allergic to penicillin
- Prevention:Safe sex abrogates transmission
54
most common way to diagnose sypilis=
serology! (terponemal and nontreponemal stuff)
55
if patient comes in with urethritis ALWAYS test for:
chlamydia and gonorrhea
56
Symptoms of urethritis: men vs women
```
--MEN: Blood in the urine or semen
Burning pain while urinating (dysuria)
Discharge from penis
Fever (rare)
Frequent or urgent urination
Itching, tenderness, or swelling in penis or groin area
Pain with intercourse
--WOMEN: Abdominal pain
Burning pain while urinating
Fever and chills
Frequent or urgent urination
Pelvic pain
Vaginal discharge
```
57
Most common non-gonococcal urethritis:
| Other potentials?
===>chlamydia
| -others: Mycoplasma genitalium and Ureaplasma urealyticum
58
Mycoplasma and Ureaplasma organism details:
- Smallest free-living bacteria
- ***Do not have a cell wall: Resistant to penicillins, cephalosporins, vancomycin and other antibiotics that interfere with synthesis of the cell wall
- Not stained by Gram, Acid-Fast or other common methods
- Pleomorphic:
- Plasma membrane contains sterols (stolen not made) unlike other bacteria
- Extracellular pathogens
- Clinically relevant
- Mycoplasma: M. pneumoniae; *M. genitalium*; M. hominis
- Ureaplasma: *U. urealyticum*; U. parvum
59
Mycoplasma appearace:
fried egg
60
M. genitalium and M. hominis details and treatment:
- common inhabitants of genitourinary tract - hard to define their contribution
- M. genitalium: NGU in males and cervicitis/PID in females, resistant to doxycycline (treatment of choice for NGU caused by C. trachomatis). Azithromicin is effective.
- M Hominis: Resistant to erythromicin Doxycycline is effective.
61
Ureaplasma details and diagnosis/treatment:
- rarely found before pubery - most common in genital tract of sexually active individuals
- can be both normal and urethritic
- common cause of NGU in males
- Diagnosis and Treatment: -Men with non-gonococcal urethritis (suspect ureaplasma) should be treated with doxycycline (also active against Chlamydia)
- Recurrent non-gonococcal urethritis in men, treat with Azithromycin or quinolones
62
Chancroid general disease details:
- sexually trans genital ulcer disease
- caused by haemophilus ducreyi
- problem in Africa, Asia, and Caribbean
- inner city problem where people recently came back from travel
- Rare in the US but may be misdiagnosed
- used to be related to sex for drug (crack) or money exchanges
- inguinal lymphadenopathy is common
- SOFT AND PAINFUL ULCER OR CHANCRE (distinguishes it from syphilis)
- ASYMPTOMATIC IN WOMEN
63
Haemophilus organism details:
-Gram-negative, pleomorphic coccobacillus
ranging from coccobacilli to long, slender filaments
-Facultative anaerobe, catalase +
-Small size
-Fastidious: Require X and V factor for growth (DIFFICULT TO ROW =THATS WHY NEED EXTRA FACOTRS--> CHOCOLATE AGAR)
-X= hemin
-V= nicotinamide adenine dinucleotide (NAD)
-Both factors are present in heated blood agar (“chocolate” agar)
-Clinical importance: Haemophilus influenzae; *H. ducreyi*; H. aphrophilus
64
Haemophilus ducreyi diagnosis and treatment
- DIAGNOSIS -Syphilis and HSV must be excluded
- Slow growth on chocolate agar**
- Chocolate agar with vancomycin**
- TREATMENT: Treat with Macrolide: azithromycin, erythromycin
- Prevention: Condoms
65
Steps to diagnose Haemophilis ducreyi:
1. The patient has one or more painful genital ulcers
2. The patient has no evidence of T. pallidum infection by darkfield examination of ulcer exudate or by serology
3. Clinical presentation is consistent (including lymphadenopathy)
4. HSV testing is negative
66
Donovanosis or Granuloma inguinale caused by and disease details?
- Klebsiella granulomatis
- ***Primary lesions more wartlike than ulcerated***
- Lesions are painless but ***bleed easily***
- Inguinal granulomas that can rupture
- Significant genital damage can occur in untreated cases
67
Klebsiella granulomatis organism details:
- Gram-negative rod
- intracellular
- encapsulated
- Endemic in subtropics but rare in the US (~100 cases per year)
68
Klebsiella granulomatis diagnosis and treatment
- DIAGNOSIS: relies on ruling out other causes and appearance of **Donovan bodies** in pathological specimens
- Prolonged TREATMENT with tetracycline, sulfamethoxazole, gentamicin, ciprofloxacin or erythromycin
69
*Donovan bodies* diagnostic for:
Klebsiella granulomatis (Donovanosis or Granuloma inguinale)
70
*Syphilis ulcers are:
DEEP, FIRM (INDURATED) , NO PAIN and NO BLEEDING
71
*Chancroid ulcers are:
EXCAVATED, SOFT (NON INDURATED), TENDER (PAIN!) and BLEEDS,
72
*Donovanosis ulcers are:
ELEVATED & WART-LIKE, FIRM (INDURATED), NO PAIN, and BLEEDS
73
Pt with genital ulcer disease... MOST LIKELY ____ AND SECOND MOST LIKELY:
```
#1 Genital herpes
#2 Syphilis
```
74
All patients with GUD should be evaluated with
- Serologic test for syphilis or darkfield examination
- Diagnostic evaluation for Herpes
- Test for H. ducreyi where chancroid is prevalent
75
Treating pt suspected with chlamydia and doxycylcine doesnt help the inf... usually is? What other organism would also be killed if doxycycline helped the inf?
- Wouldnt help against M. Genetalium (would use azythromycin)
- Would also help against ureaplasma
76
confirm chancroid infection?
- chocolate agar
- rule out HSV and syphilis
- WILL HAVE INGUINAL LYMPHAPATHopy
77
how to confirm donovanosis?
-donovan bodies and neg for syphilis and HSV
78
which organism is normal vaginal flora during childbearing years?
Lactobacillus
79
Lactobacillus- organsim details:
- Gram-positive, microaerophilic or anaerobic rods
- Do not cause UTI because they cannot grow in urine
- Glycogen is metabolized to lactic acid by lactobacilli resulting in a vaginal pH of 4 to 5
- Optimal for growth and survival of lactobacilli and inhibits growth of many other organisms
80
Alteration in normal vaginal flora:
- Age: older women/young girls wihtout estrogen therapy have LOWER lactobacillus levels compared to women of reproductive age
- Menstruation
- Hysterectomy w/ cervix removal: increase in bacteroides; increased escheria coli and enterococcus (aerobes) --> may cause pelvic infections
81
Bacterial Vaginosis (BV) causes:
-Common, complex, and poorly understood clinical syndrome reflects abnormal vaginal flora=Dysbiosis (not balanced)
-Overgrowth of anaerobic species including Gardnerella vaginalis, Ureaplasma urealyticum, Mobiluncus species, Mycoplasma hominis, and Prevotella species
LESS LACTOBACILLUS
82
Bacterial Vaginosis (BV) symptoms:
- Can be asymptomatic
- Discharge
- Odor
- Pain
- Itching
- Burning.
83
bacterial vaginosis (BV) risk factors:
- Oral Sex
- Douching
- Smoking
- Sex during menses
- Intrauterine device
- Early age of sexual intercourse
- New or multiple sex partners
- Sexual activity with other women
- While BV is associated with sexual activity, BV is not considered to be a STD by the CDC
84
bacterial vaginosis (BV) diagnosis:
- Discharge, usually white or grey
- Microscopic evaluation of a vaginal-secretion saline preparation reveals clue cells
- Release of volatile amines produced by anaerobic metabolism (foul, fishy odor)- “whiff test”--->Several drops of a potassium hydroxide (KOH) solution are added to a sample of vaginal discharge to see whether a strong fishy odor is produced
- Determination of the vaginal pH (pH>4.5 is associated with BV)
- -----NEED 3 of 4 of these cirteria
-Nugent score
Numerical score based on semi-quantization of (1) large gram-positive rods (Lactobacillus spp.), (2) small gram-variable rods (G vaginalis or Bacteroides spp.), and (3) curved gram-variable rods (Mobiluncus spp.).
0-3: normal; lactobacillus dominant
4-6: intermediate; mixed morphotypes
7-10: BV; absence of lactobacilli; predominance of 2 other morphotypes
85
THIN WHITE OR GRAY DISHARGE. Disease??
bacterial vaginosis
86
clue cells
- epithelial cells that are studded with bacteria
| - bacterial vaginosis diagnostic
87
Bacterial vaginosis complication:
- susceptible to HIV infection
- increases chances to pass HIV to someone else
- increased chance o infection after surgery
- preterm deliveries, miscarriage, and infection after delivery
- inc susceptibility for other STIs (HSV, chlamydia, gonorrhea)
88
Bacterial vaginosis - treatment
- Oral Metronidazole
- Clindamycin
- Recurrence is common
89
Vulvovaginal Candidiasis - disease details:
- common fungal infection in women of childbearing age
- thick ordorless, white, discharge (cottage cheese like)
- Uncomplicated: sporadic or infrequent mild-to-moderate symptoms in otherwise healthy patient
- Complicated: recurrent (four or more episodes in 1 year) or severe VVC, non-albicans candidiasis, or the patient has uncontrolled diabetes, debilitation, or immunosuppression
- Caused by candida albicans
- more frequent after taking antibiotics
- diaper rash or oral thrush in kids
- esophagitis and can disseminate in immunodef
90
THICK, ODORLESS, WHITE DISCHARGE (cottage cheese-like), diease is?
Vulvovaginal Candidiasis
91
Vulvovaginal Candidiasis (VVC)- diagnosis/treatment
-DIAGNOSIS: observation of pseudohyphae or yeasts on microscopy with 10% KOH
-culture with Nickerson medium may be used
-TREATMENT: 1-3 day regimen of topical azole for uncomplicated VVC
7–14 days of a topical regimen or two doses of oral fluconazole 3 days apart for complicated VVC
92
candida species - organism details:
-oval yeastlike forms
-produce buds
pseudohyphae and hyphae present
-G+ budding yeast
-normal flora or GI, vag, urethra, skin, finger/toe nails
93
germ tube test - what happens what oganism?
- c albicans
| - when incubated at 37C it will form elongated hyphae
94
Trichomoniasis caused by and disease details:
- Trichomonas vaginalis
- The most common, curable sexually transmitted disease
- Most (70%) infected women are asymptomatic or have scant, watery vaginal discharge
- Symptoms can range from mild to severe vaginitis with inflammation associated with itching, burning and painful urination: Yellow-green, frothy, foul smelling discharge
- Men are primarily asymptomatic carriers who serve as reservoirs for infection: Occasional urethritis, prostatitis, or other urinary tract problems
95
YELLOW GREEN FROTHY FOUL SMELLING DISCHARGE, organism is?
trichomoniasis - Trichomonas vaginalis
96
Trichomonas vaginalis - organism details:
- Small, pear-shaped protozoa
- 4 anterior flagella & an undulating membrane are responsible for motility
- The rigid axostyle involved in attachment
- Anaerobic
- Exist only in trophozoite form*** NO CYSTS OR EGGS
- strict parasite, cannot survive long outside of host
- reservoir is human urogenital tract
97
ONLY PROTOZOAN THAT EXISTS IN TROPH FORM
Trichomonas vaginalis
98
Trichomonas vaginalis - pathogenesis:
- attacks/destroys squamous epith of genitourinary tract
- "strawberry cervix"
- NO IMMUNITY--> reinfection is possible
99
Trichomonas vaginalis - diagnosis and treatment
- DIAGNOSIS:
- Detecting swimming T. vaginalis in exudate (discharge) WET MOUNT
- Asymptomatic infection often detected by Pap smear
- TREATMENT:
- Metronidazole; treat both partners
100
Menstrual toxic shock syndrome (TSS) caused by what organism and disease details?
- S. aureus that multiply rapidly in hyperabsorbant tampons and release toxin
- TOXIN MEDIATED DISEASE - TSST-1
101
Staph. aureus - organism details?
- Catalase-positive, coagulase-positive, Gram-positive cocci arranged in clusters
- Normal flora on human skin and mucosal surfaces
- Person-to-person spread through direct contact or exposure to contaminated fomites (e.g., bed linens, clothing)
- Facultative intracellular
- Causes a variety of localized and systemic infections: skin infections, sepsis, endocarditis, pneumonia, osteomyelitis, septic arthritis, purulent meningitis, food poisoning, toxic shock
102
Menstrual toxic shock syndrome (TSS) -toxin info:
- TSST-1
- SUPERANTIGEN - stimulates T-cell activation and release of cytokines** (NO ANTIGEN SPECIFICITY) MASSIVE IMMMUNE INFLAMMATION
- heat and proteolysis resistant
- can penetrate mucosal barrier = negative effects
- Macrophages release IL-1β and TNFα
- T cells release IL-2, IFNγ, TNFβ
- IL-1β release results in fever
- TNFα and TNFβ release is associated with hypotension and shock
103
Menstrual toxic shock syndrome (TSS) usual symptoms:
- diarrhea
- general ill-feeling
- high fever sometimes with chills
- nausea & vomiting
104
Menstrual toxic shock syndrome (TSS) - diagnosis:
- MAJOR criteria:
- --Hypotension
- --Orthostatic syncope
- --Systolic BP <90 mm Hg for adults
- --Diffuse macular erythroderma
- --Temperature ≥38.8˚C
- --Late skin desquamation, particularly on the hands, palms, and soles of feet (1 to 2 weeks later)
- MINOR criteria (organ system involvement)
- --Gastrointestinal: diarrhea or vomiting
- --Mucous membranes: oral, pharyngeal, conjunctival (*RED EYES*), and/or vaginal erythema
- --Muscular: myalgia or creatinine phosphokinase level greater than twice normal
105
Menstrual toxic shock syndrome (TSS) - treatment:
- 5% fatality rate
- Remove tampon
- Send sample for culture
- Provide supportive measures (fluids, etc)
- Administer β-lactamase–resistant penicillin or vancomycin (if the patient is allergic to penicillin)
- **Women who have been treated for toxic shock syndrome are at considerable risk for recurrence.* Therefore, these women should avoid tampon use**
