STD's II

Question 1

general characteristics of gonorrhea

Answer 1

• caused by Neisseria gonorrhea (gonococcus)
• gram-negative, oxidases positive, and non-capsulated.
• glucose fermenter only

Question 1

what are the virulence factors of N. gonorrhea?

Answer 1

• pilli (attachment)
• IgA protease (cleave and destroy IgA antibodies)
• endotoxin LOS and OMP (outer membrane protein) allow the exchange of materials

Question 2

what are the clinical manifestations of gonorrhea in males?

Answer 2

Urethritis:
- infection of the urethra (primary)
- 90% symptomatic
- 2-7 days incubation period
- dysuria, purulent urethral discharge, and blood in semen or urine.
Epididymitis:
- testicular pain and swelling

Question 3

what are the clinical manifestations of gonorrhea in females?

Answer 3

1- endocervical infection (uncomplicated)
* vaginal discharge by dysuria
* cervical os may be erythematous
2- rectal infections (proctitis)
3- PID

Question 4

what is PID and where do we see it?

Answer 4

PID (pelvic inflammatory disease) is a term for the inflammation of the uterus, fallopian tube, and ovaries. seen in female patients with gonorrhea.
- give rise to acute salpingitis in the fallopian tube which may lead to sterility and ectopic pregnancy.

Question 5

what is Ophthalmia neonatorum, where is it seen, and how to treat it?

Answer 5

Ophthalmia neonatorum is seen in neonates with gonorrhea, transmitted to newborns during birth (PERINATAL).
- severe purulent eye discharge with peri-orbital edema, leading to blindness if untreated.
- prevented by using 1% aqueous silver nitrate, treated with topical erythromycin

Question 6

how to diagnose gonorrhea?

Answer 6

1- gram stain (by swab)
2- culture (chocolate agar)

Question 7

treatment for gonorrhea

Answer 7

• treat all contacts
• first-line therapy: ceftriaxone or cefixime
• other: cephalosporins & penicillin include fluoroquinolones (e.g. ciprofloxacin), azithromycin, tetracyclines, co-amoxiclav

Question 8

incubation period of syphilis

Answer 8

2 weeks - 3 months `

Question 9

primary clinical manifestation of syphilis

Answer 9

• chancre on genitalia, cervix, or the anogenital area (painless pouched-out ulcers)
• usually single
• disappear spontaneously after 3-8 weeks
• highly infectious
• inguinal LN enlargement
• exudate used for diagnosis

Question 10

what are the secondary clinical manifestations of syphilis?

Answer 10

• 2-16 weeks after chancre disappeared
• Maculopapular & pustular rash on soles and palms, skin and mucous membrane
• Heals spontaneously in 1-3 months
• Early neurosyphilis (CSF positive):

Question 11

what happens during the latent phase in syphilis?

Answer 11

No lesions, asymptomatic but serological evidence
exists

Question 12

*What are the clinical manifestations in the tertiary phase of syphilis?

Answer 12

(3-30 years)
– Neurosyphilis: Meningoencephalitis and paralysis
- cardiovascular: aneurysm of ascending aorta, aortitis
- granulomatous lesions in skin and bone

Question 13

clinical manifestation in congenital syphilis

Answer 13

• intrauterine death, abortion, low birth weight
• Facial abnormalities e.g saddle shape nose, frontal bossing
• Liver, kidneys, eyes, deafness, mouth and tooth abnormalities

Question 14

what are the methods to diagnose syphilis?

Answer 14

1. Detection of the organism in the exudates and lesions using dark field E.M or phase contrast, Immunofluorescent antibodies –
   primary syphilis
2. PCR
3. Chest X-ray for aortic aneurysm
4. Serology (may be negative in HIV patients)

Question 15

non-specific antibodies (serology) in syphilis

Answer 15

*may be negative in HIV patient
Non-specific antibodies (1-2 weeks after the primary chancre appears):
- Rapid plasma regain test /VDRL test (Venereal disease research laboratory): detecting anticardiolipin antibodies > sensitive not specific

Question 16

what tests are used for specific antibody detection in syphilis + congenital?

Answer 16

to confirm a positive non-specific result:
1) ELISA: Detect IgM and IgG
2) FTA-Abs (fluorescent Treponema antibodies-absorption)
3) TPHA (Treponema pallidum Haemagglutinin antibodies)
o Congenital syphilis: testing for IgM and retesting at 6 months of age,
Antibody titers remain elevated in babies with congenital syphilis
* maybe negative in HIV patients

Question 17

DOC for treating syphilis

Answer 17

Penicillin G 2.4 million units I.M