STI: urethritis Flashcards
1
Q
Clinical presentation of urethritis
A
- Urethral inflammation due to infection
- Present w/ urethral discharge, dysuria, meatal pruritus, pain in testicles (in men) or worsening Sxs during menses (women)
- Systemic Sxs usually absent
- May be ASx in 50% of pts
- Dx: purulent discharge, ≥5 WBC on urethral smear, ≥10 WBC on urine sediment
2
Q
Neisseria gonorrheae 1
A
- GN diplococci, confirmed by growing the discharge on thayer-martin media (selective)
- Also N gonorrheae only ferments glc (N meningitidis ferments lc and maltose)
- Contains virulence factors: pili (attachment and resistance to PMNs), por proteins (promote intracellular survival), opacity proteins (mediate binding to cells), rmp proteins (protection from Abs), LOS (similar to LPS), plasmids
3
Q
Neisseria gonorrheae 2
A
- Transmission: verticle, male-> female (>50% per contact), female-> male (20% per contact)
- Cervicitis (1-10 day incubation): vaginal discharge, dysuria, bleeding, 90% ASx
- Other disease in women: urethritis, abscess (bartholin glands), endometritis, pelvic inflammatory disease (PID), extension into pelvis
- Acute urethritis (men): 2-5 day incubation, urethral discharge and burning, resolve spontaneously over weeks
4
Q
Neisseria gonorrheae 3
A
- Dx: gram stain and culture from infected site (first-void urine optimal), not recommended for endocervical, pharyngeal, or rectal specimens
- Other Dx methods: nuclei acid amplification test (NAAT): urine test (preferred test)
- Rx: resistance to penicillin, fluoroquinolones, and cephs are growing
- Now Rx is ceftriaxone + chalmydia Rx concurrently
- Disseminated gonorrhea (risk factors are complement def, menstruation, pregnancy): dermatitis (vesicles or pustules), arthritis, endocarditis
5
Q
Chlamydia trachomatis 1
A
- Most common STI in US, small obligate intracellular bacteria, disease has higher rates in women
- 2 forms: elementary body (EB, like spore) that is unable to replicate but is infectious, and reticulate body (RB) that is found intracellularly and can replicate but cannot infect
- A number of different serovars: A-C cause eye infections, D-K cause urogenital infection, and LGV serovars causes lymphgranuloma venereum
6
Q
Chlamydia trachomatis 2
A
- In women: mostly ASx carriers, can cause cervicitis, endometritis, urethritis, salpingitis, bartholinitis
- If left unRx in women can cause PID, infertility, increases HIV risk
- In men: 75% symptomatic, may be major cause of reactive arthritis
- Dx: cytology (giemsa stain), culture, urine NAAT (preferred)
- Rx: azithromycin (1 dose)
