Skildum's genital micro; 4.11

Question 1

Lactobacilli are the dominant microorganism in reproductive vaginas. What kind of bacteria are lactobacilli?

Answer 1

Gram+ rods/bacilli

Facultative anaerobes

Question 2

What do lactobacilli breakdown?

Answer 2

Glycogen → racemic lactic acid

Question 3

What is the significance of lactobacilli producing racemic lactic acid?

Answer 3

Humans can only take up L lactic acid…D lactic acid remains and decreases the pH

Question 4

What is necessary for glycogen formation in the vaginal epithelium?

Answer 4

Estradiol

Question 5

Other than lactic acid, what else is produced by lactobacilli?

Answer 5

Hydrogen peroxide (likely little consequence)
Hydroxyl radicals
Bacteriocins (form pores in other bacteria)

Question 6

What increases the likelihood of getting BV?

Answer 6

Not having a lactobacilli dominating vaginal flora…Gardnerella predominate instead

Question 7

How is BV treated?

Answer 7

Oral/intravaginal metronidazole
Boric acid (symptom relief)

Question 8

What is required for metronidazole efficacy?

Answer 8

Anaerobic organisms…like gardnerella

Question 9

What is SaPI1? What does it do?

Answer 9

Staph aureus Pathogenicity Island 1 → TSST-1 → superantigen

Question 10

What does SaPI1 contain?

Answer 10

Non-essential genes
Toxins
Other proteins that enhance virulence

Question 11

How does SaPI1 happen?

Answer 11

Viral (phage) transduction

Question 12

Toxic shock syndrome (TSS) is usually caused by staph a (90%). Do patients with TSS usually have Staph a sepsis?

Answer 12

No…patients WITH Staph a sepsis RARELY get TSS

And, patients that GET TSS usually DON’T have Staph a sepsis

Question 13

How does circumcision help protect from STDs?

Answer 13

Decreased anaerobes…increased aerobes and facultative anaerobes → reduced inflammation and decreased CD4+/CCR5+ macrophages in urethra

Question 14

What causes epididymitis in prepubertal patients?

Answer 14

E. coli

Question 15

What causes epididymitis in post-pubertal patients < 35yo?

Answer 15

Chlamydia

N. gonorrhea

Question 16

What causes epididymitis in patients > 35yo?

Answer 16

E. coli

Pseudomonas spp.

Question 17

Prostatitis is divided into types (I-IV). What is type I?

Answer 17

Type I is acute bacterial prostatitis

Question 18

What are the symptoms seen with type I prostatitis?

Answer 18

Dysuria
Suprapubic or perianal pain
Fever
Nausea
Sepsis

Question 19

What gram- bacteria can cause type I prostatitis?

Answer 19

E. coli (most common)
Klebsiella, proteus, pseudomonas
Neisseria, chlamydia

Question 20

What gram+ bacterium can cause type I prostatitis?

Answer 20

Enterococcus

Question 21

How is type I prostatitis diagnosed?

Answer 21

Culture organism from urine
>10 WBC per field in urine
Palpate prostate

Question 22

What is type II prostatitis?

Answer 22

Type II is chronic bacterial prostatitis?

Question 23

What are the symptoms of type II prostatitis?

Answer 23

Dysuria
Pain (penis, testicular, lower back)
Recurrent UTI
Urethritis
Epididyitis
NO systemic symptoms

Question 24

What is the second most common cause of type II prostatitis…because E. coli is still number 1?

Answer 24

Enterococcus is number 2

Question 25

How is type II prostatitis diagnosed?

Answer 25

Culture organism from expressed prostatic secretions or post-prostate massage urine
>10 WBC per field in urine

Question 26

What is type IIIa prostatitis?

Answer 26

Type IIIa is inflammatory chronic pelvic pain syndrome

Question 27

What are the symptoms of type IIIa prostatitis?

Answer 27

Pain

Sometimes dysuria

Question 28

What causes type IIIa prostatitis?

Answer 28

Maybe not bacteria…

Question 29

Type IIIb and IV are both asymptomatic…

Answer 29

but type IIIb is called noninflammatory chronic pelvic pain syndrome…and type IV is called asymptomatic prostatitis