STD's/Syphilis

Question 1

Describe Neisseria gonorrhoeae

Answer 1

pyogenic, encapsulated, gram-negative diplococcus

facultative intracellular ogranism which binds to epithelial cells via adhesins or pili

Question 2

Neisseria gonorrhoeae virulence factors

Answer 2

adhesins (fimbriae and opa proteins in OM)
extensive antigenic variation of virulence factors
LOS and PG
iron-binding proteins
IgAase
resistance to killing by normal serum and complement

Question 3

Neiseria gonorrhoeae causes

Answer 3

urethritis, pharyngitis, proctitis;
mucopurulent discharge 5-7 days after infection
salpingitis may result in scarring and sterilization
men-urethral strictures and infertility

Question 4

Describe pathological findings of gonorrhea

Answer 4

exudative, purulent reactions followed by granulation tissue and fibrosis
focal abscesses with local spread to area tissues, glands

Question 5

Granuloma Inguinale (Calymmatobacterium donvani)

Answer 5

chronic, venerally transmitted disease with ulcerating and granulating lesions of the genital skin and mucosa

Question 6

Chancroid (Haemophilus ducreyi)

Answer 6

necrotic, soft chancre at site of inoculation
genital ulcers facilitate HIV transmission
epidemic in underdeveloped nations esp. Africa

Question 7

Trichomoniasis (Trichomonas vaginalis)

Answer 7

protozoan which causes superficial lesions of urethral surfaces
mild symptoms or asymptomatic
non-gonococcal urethrits in men
affected mucosa shows small blisters or papules
“strawberry mucosa”

Question 8

Describe Treponema pallidum (syphilus)

Answer 8

microareophilic spirochete
covered in outer sheath that masks bacterial antigens
sexual and transplacental transmission

Question 9

Describe diagnosis and serology of syphilis

Answer 9

RPR, VDRL - nonspecific tests for antibody to cardiolipin (false + with mono, lupus)
silver stain for organism
specific fluorescent treponemal antibody absorption test (FTA-Abs)

Question 10

Syphilis antibodies vs. presence of organism

Answer 10

primary - no abs; organism present
secondary - abs; organism present
tertiary - abs; no organism present

Question 11

Pathogenesis of syphilis

Answer 11

chancres infiltrated with TH1 cells
antibody response does not eliminate the infection
endarteritis central to pathology of all lesions

Question 12

What suggests central role for immune response in syphilis lesions?

Answer 12

scarcity of treponemes and intense inflammatory infiltrate

Question 13

Describe primary syphilis

Answer 13

hard chancre at site of spirochete invasion
intense mononuclear infiltrate with plasma cells
obliterative endarteritis
lymphadenitis, focal granulomas
heals after 3-6 weeks with/without therapy

Question 14

Describe secondary syphilis

Answer 14

2-10 weeks after primary chancre
widespread mucocutaneous lesions over entire body
macular discrete red-brown lesions esp on soles and palms
lymphoplasmacytic infiltrate, endarteritis
condylomata lata
painless lesions
lymphadenopathy, mild fever, malaise, weight loss

Question 15

Describe tertiary syphilis

Answer 15

rare, cardiovascular system most commonly affected
degenerative weakening of aortic wall leads to aneurysm/dissections, coronary insufficiency
neurosyphilis/tabes dorsalis/Charcot’s joint
syphilitic gumma

Question 16

CSF findings in neurosyphilis

Answer 16

pleiocytosis, increased protein and decreased glucose

Question 17

syphilitic gumma (benign tertiary syphilis) most often found in

Answer 17

liver, bones and testes

Question 18

Describe syphilitic gummas

Answer 18

delayed-type hypersensitivity reaction
skin, subcutaneous tissue, bone, joints
central necrotic debris surrounded by palisading macrophags and fibroblasts
surrounded by mononuclear leukocytes, chiefly plasma cells

Question 19

Congenital syphilis most common when

Answer 19

may be contracted by a fetus born up to 5 years after the mother first becomes infected
most common during secondary syphilis

Question 20

congenital syphilis causes

Answer 20

late abortion or fetal death

Question 21

infantile manifestations of congenital syphilis

Answer 21

nasal discharge and congestions during first few months

diffuse rash, disseminated lesions including destruction of bridge of nose (saddle nose deformity)

Question 22

late manifestations of congenital syphilis

Answer 22

infection of bones and teeth: saber shin and Hutchinson teeth
liver (gummas) and lung (interstitial fibrosis) involvement
late occurring form: interstitial keratitis and eighth nerve deafness

Question 23

Hutchinson’s Triad

Answer 23

1. Hutchinson’s teeth
2. Interstial keratitis
3. CN VIII deafness

Question 24

Viral STDs

Answer 24

Herpes HSV2
HIV/AIDS
Hepatitis B/Hepatitis C
Papilloma virus - cervical cancer, genital warts