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Micro Final (Lauren, Shelby, and Annie) > STIs 🕷 > Flashcards

STIs 🕷 Flashcards

1
Q

Which STI bacteria must be reported to the health department?

A

Treponema pallidum (syphilis)

Neisseria gonorrhea

Chlamydia trachomatis

Ureaplasma irealyticum

Mycoplasma genitalia morning

Haemophilus ducreyi

Calymmatoabcterium granulomatosis

(Prob dont need to know all these if we never even talked about them)

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2
Q

What are the 3 STIs that are Ulcerative (cause tissue damage)

A

Syphilis

Chancroid

Genital herpes

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3
Q

What are the 3 STIs that are nonulcerative?

A

Gonorrhea

Trichomoniasis

Chlamydia

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4
Q

Do all Treponoma species cause STDs?

A

No there are some that cause skin lesions in developing countries

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5
Q

What is “the great imposter”

A

Syphilis

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6
Q

What bacteria causes syphilis

A

Treponema pallidum

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7
Q

Treponema pallidum

gram:

Shape:

A

Gram negative

Spirochete

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8
Q

True or false:

Treponema pallidum is an obligate intracelluar parasite

A

True.

Reason we can’t make a syphilis vaccine (doesn’t do anything outside of a cell= no antibodies= no vaccine)

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9
Q

What are the virulence factors of treponema pallidum?

A

Fibronectin coat is antiphagocytic**

Hyaluronidase facilitates perivascular infiltration

Membrane proteins promote adherence

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10
Q

What causes the lesions in syphilis?

A

Over exaggerated immune response from the body. NOT from the bacteria

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11
Q

How do you usually get syphilis?

A

Sex with someone who has active primary or secondary lesion

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12
Q

Do monkeys and mice get syphilis?

A

No only humans

Makes it hard to study

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13
Q

What are the stages of syphilis?

A

Primary infection- symptomatic

Latency- 2-10 weeks- hiding inside your cells, asymptomatic

Secondary- symptomatic

Latency- can last many years

Tertiary- goes to brain/CSF, heart, bone, etc

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14
Q

During syphilis latency, do you ever go down to ZERO bacteria in your body

A

No, they are just dormant, hiding inside your cells

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15
Q

What happens in primary syphilis

A

Bug gets in through break in skin or through epithelial cells

Primary lesion develops and surface necrosis results in a CHANCRE formation which may be in an inapparent site (ex inside the vagina)

Untreated lesion heals in 3-8 weeks

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16
Q

What is the principal lesion of primary syphilis

A

Chancre

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17
Q

What are the stages of the syphilis chancre?

A

Begins as a papule->

Superficial erosion ->

Serous exudate with the formation of a grayish, bloody crust ->

Base is usually smooth and the border is RAISED, FIRM, and INDURATED

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18
Q

How long does the first latency period of syphilis last?

A

2-10 weeks *******

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19
Q

What happens in secondary syphilis

A

Development of a maculopapular** rash (lesions are highly infective)

Mucosal warty lesions (condyloma lata ***) in 1/3 of patients

Immune complexes form in arteriolar walls

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20
Q

What happens during latent syphilis?

A

Absence of all signs and symptoms

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21
Q

Why is it better to go into latent syphilis more than ONE YEAR after infection?

A

Because your body has had enough exposure to the active disease, it can build a memory-based immune response =

Less likely to get a relapse

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22
Q

What is the prognosis for untreated syphilis?

A

Spontaneous cure in 1/3

Seropositivity without disease in 1/3

Tertiary syphilis in 1/3

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23
Q

What happens in tertiary syphilis?

A

Neurosyphilis- meningovascular changes and cortical degeneration

Cardiovascular syphilis- aneurysm of ascending aorta

Granulomata (gummas)- warty lesions in skin, bones, joints= late/benign syphilis

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24
Q

How long after infection does tertiary syphilis show up?

A

5-20 yrs

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25
What are the symptoms that a baby was born with syphilis?
Maculopapular lesions Nasal obstruction with mucous discharge that is infectious Osteitis of nasal bones Neurosyphilis HUTCHINSONS TRIAD: Notched incisors 🦷 Interstitial keratitis 8th nerve deafness
26
What is Hutchinson’s triad?>
Signs of congenital syphilis 1. Notched incisors🦷 2. Interstitial keratitis👁 3. 8th nerve deafness 👂🏻
27
Where do chancres show up?
ANYWHERE ON THE BODY LOOK INSIDE THE VAGINE
28
Until proven otherwise, every genital lesion should be considered _________
Syphilitic
29
How do you diagnose syphilis?
Darkfield Microscopy- visualize treponema from lesions Nontreponemal tests-cheap, nonspecific screening tests (VDRL, RPR) Treponemal tests- expensive, SPECIFIC antibody tests used to confirm a positive screening test
30
How are most cases of syphilis diagnosed?
Serologically. (2 steps) 1st: Nontreponomal- RPR or VDRL as a nonspecific screening 2nd: Treponomal-specific antibody test that will CONFIRM a screening test
31
What things can neisseria gonorrhoeae cause
Arthritis** Urethritis Cervicitis Salpingitis PID Proctitis Bacteremia Conjunctivitis Pharyngitis
32
Neisseria gonorrhoeae gram: Shape:
Gram negative Diplococci
33
What are the virulence factors of neisseria gonorrhoeae
Variation of the antigens on Pili**- any abs you make are useless the next generation Nonpiliated phase variants- no antibodies made Porin protein IgA Protease Plasmid and chromosome-mediated resistance to penicillins, tetracyclines, spectinomycin and fluoroquinolones 💀
34
Is it common to see relapses of gonorrhoeae infection
Yes, because neisseria gonorrhoeae changes the antigen on its pili with every generation, so any antibodies you make will be worthless
35
Do we see much antibiotic resistance in neisseria gonorrhoeae?
YES Plasmid and chromosome-mediated resistance to penicillins, tetracyclines, spectinomycin, and fluoroquinolones ***
36
Can you get gonorrhea from a toilet seat
Unlikely. Nonsexual transmission is extremely rare
37
Who has the highest rate of gonorrhea
Adolescents
38
Why are we seeing more cases of gonorrhea?
People are slutty now No good way to detect asymptomatic cases Beta-lactamase positive strains Lack of public appreciation of its importance
39
What is the major reservoir of neisseria gonorrhoeae
The asymptomatic patient
40
How does neisseria gonorrhoeae cause cell damage
Lipooligosaccharide Peptidoglycan (even though its gram negative)
41
Let’s look at a summary of the pathogenesis of neisseria gonorrhoeae becasue he loves to ask questions about this shit and i dont know how to make cards for it
- attaches to epithelium via pili and surface proteins - bacteria alter their surface properties (antigenic variation of pili and surface proteins). Retardation of phagocytes activity due to surface proteins - injury to cells via released LOS and peptidoglycan - spread to other tissues via Pilar attachment
42
Do we see discharge with gonorrhea?
YES, a thick mucupurulent discharge in males
43
What are the complications of gonorrhea?
Acute salpingitis or PID Disseminated Gonococcal Infection (DGI) Local effects - blindness?
44
What is PID?
Bacteria spread along Fallopian tubes and into pelvic cavity causing peritonitis and abscesses Can lead to INFERTILITY**, ectopic pregnancies, and chronic pelvic pain
45
What organisms can cause PID
Gonorrhea, chlamydia, and anaerobes
46
What is Disseminated Gonococcal Infection (DGI)?
Neisseria gonorrhoeae gets into the BLOODSTREAM and spreads everywhere, especially into the JOINTS causing a PURULENT ARTHRITIS************** May also cause endocarditis or meningitis
47
What is the gold standard for diagnosing gonorrhea?
Nucleic acid amplification (PCR)
48
What is “nongonococcal urethritis”
A wastebasket diagnosis because it encompasses literally everything thats not gonorrhea: Chlamydia, ureaplasma, mycoplasma
49
What are the 3 kinds of chlamydia diseases?
Psittacosis due to c. Psittaci Pneumonia due to c. Pneumoniae Trachoma, conjunctivitis, lymphogranuloma venereum and non gonococcal urethritis due to c. Trachomatis
50
True or false: Chlamydia is an obligate intracellular organism
True, they require ATP from the host
51
Chlamydia trachomatis gram:
Gram negative TINY!! Can’t even see it with a microscope
52
Which organism has a reticulate body and elementary body
Chlamydia
53
Which form of chlamydia is infectious and which form is intracellular
Infectious: elementary body Intracellular: reticulate body (active growth form)
54
Who has the highest prevalence of chlamydia
Teenagers
55
Can chlamydia cause PID in women?
Yes, one of the major causes. Leads to sterility and ectopic pregnancy in chronic infections
56
If an infant is born to a mom with chlamydia, what are the major symptoms that the baby got it too
Inclusion conjunctivitis** 👀 pneumonia
57
What kind of penis discharge would we see with chlamydia
Watery | Vs gonorrhea that was mucoid
58
How does chlamydia present in men and women
Men: urethritis (often asymptomatic) and epididymitis, WATERY discharge 🌊 Women: cervicitis, salpingitis, PID
59
What is lymphogranuloma venereum?
Boils in the groin area caused by chlamydia, but a DIFFERENT serotype than the one that causes the STD stuff
60
If your patient showed up with huge boils in his groin and you suspected it was lymphogranuloma venereum, how would you make a definitive diagnosis?
Biopsy the boil and then look for chlamydia (either isolation in cell culture or nucleic acid probe)
61
What do we think causes chronic inflammation from chlamydia?
Toxin-producing strains. Toxin functions like Toxin B of C. Diff. The protein scaffolding of infected cells collapses, causing the cells to separate from each other.
62
What are the options for diagnosing chlamydia and which is the gold standard
Isolation in cell culture using human cell lines (gold standard) Nucleic acid probes (very sensitive**) Antigen detection
63
How do you isolate chlamydia in cell culture?
Drop sample onto human immortalized cell lines and look for intracellular inclusions/clearing zones ** Sensitivity less than 85%, but is still the gold standard test
64
What is ureaplasma urealyticum?
Closely related to mycoplasma, causes non gonococcal urethritis. No cell walls.
65
What are the 3 main categories of vaginitis?
Trichomoniasis Bacterial vaginitis Yeast vaginitis
66
What are the 3 types of trichomonas, and which ones are part of the normal flora
Trichomonas tenax- normal mouth flora Trichomonas hominis- normal intestine flora Trichomonas vaginalis- cause of STD
67
What is the size of trichomonas vaginalis?
HUGE
68
What does trichomonas vaginalis look like?
HUGE flagellated protozoan
69
Does trichomonas live intracellular?
No, is an Extracellular anaerobe
70
Is trichomoniasis a common STD
VERY common
71
What is the only form that trichomonas vaginalis exists in
Trophozoite
72
What is the lifecycle of trichomonas vaginalis
Trophozoite acquired via sex Parasite establishes on mucosa and multiplies You give it to your new boyfriend
73
What is the clinical presentation of trichomoniasis for men and women
Men: asymptomatic, maybe a little discharge 👨🏻👍 Women:Profuse vaginal discharge that is frothy and malodorous 🐟
74
What does trichomoniasis often lead to in women?
Bacterial vaginosis due to change in environment
75
How do you diagnose trichomoniasis?
A simple wet mount and look at with a microscope. Very very easy to identify. Other options: Culture Monoclonal antibody DNA probe test (Affirm VP III)
76
Can you pick up bacterial vaginosis from having sex
NO IT IS NOT AN STI!!!!!!!!! It is an overgrowth of OPPORTUNISTIC pathogens due to a change in pH!!!!!!
77
What causes bacterial vaginosis?
A pH change from something like TRICHOMONIASIS causes an overgrowth of opportunistic bacteria
78
What is the pH of vaginal secretions in normal people and in vaginosis
Normal: <4.5 Vaginosis: 5.0-6.0 (more basic)
79
What kind of cell is in a vaginal seceriotn that is a DEAD GIVEAWAY for bacterial vaginosis******************
CLUE CELLS | ******🐝🐝🐝🐝🐝
80
What are the criteria for bacterial vaginosis
Homogenous quality of secretions Presence of Clue cells ** Release fishy odor when 10% KOH is added**🐟 Vaginal pH >4.5
81
What tf are clue cells?
Epithelial cell studded with thousands of bacteria
82
What are some of the similarities between bacterial vaginosis and trichomoniasis?
Discharge- thin, homogenous, grey (BV) or yellow-grey (trich), fishy odor Basic pH Increased concentrations of anaerobes Response to metronidazole
83
What are the most commonly encountered opportunistic mycoses (aka fungal infections) in the world?
Candidiases
84
What are some causes of candidiasis?
Use of broad-spectrum antibiotics Absence of competing normal flora Introduction to abnormal site “Pathologic” change in microenvironment/pH Immune defect
85
Whch candida species causes the most vulvovaginal candidiasis (aka yeast infection)
Candida Albicans | C. tropicalis and C. glabrata cause the remainder
86
Can yeast infections be STDs?
Yes! You can pass it to your partner
87
Are yeast infections usually acquired from a sex partner?
No, most are endogenous infections
88
What does the vaginal discharge look like if woman has a yeast infection
Thick, white, frothy NO ODOR
89
What are the virulence factors of Candida albicans?
Not many.
90
Which form of candida is more adhesive: germ tube or yeast cell
Germ tube
91
How do you diagnose candida?
Direct microscopic examination
92
Which bacteria causes “Chancroid”
Haemophilus ducreyi****
93
Where is chancroid most common
Tropical countries (heat and humidity)
94
What does a chancroid lesion look like?
Tender papule on genitalia that develops into a tender ulcer with sharp margins. Bleeds readily, very painful, and does NOT have induration (raised border) ***MUCH angrier and painful than the syphilis chancre!!!******
95
How soon after infections with haemophilus ducreyi will you expect to see the “soft chancre” of chancroid develop
3-5 days (quick)
96
What is different between the edges of chancroids and chancres?
Chancre: hard raised edge Chancroid: soft ragged edge, pus, blood
97
How do you diagnose chancroid?
You need to ID haemophilus ducreyi from the chancroid ulcer or a lymph node. Growth on agar requires growth supplements (Lysed RBCs) PCR is available as well (But haemophilus species can be part of normal flora so this might not work)
98
What two organisms usually cause PID
Neisseria gonorrhoeae Chlamydia trachomatis
99
What conditions increase risk of developing PID?
STD, especially gonorrhea or chlamydia Prior episode of PID Sexually active adolescent Multiple sex partners Frequent couching
100
What are the symptoms of PID
Lower abdominal pain Abnormal vaginal discharge Painful intercourse Increased pain with menstruation Irregular menstruation Fever and chills Scarring
101
Which causes problems in PID: the infection or the body’s inflammation response?
INFLAMMATION
102
How do you diagnose PID?
Look for evidence of INFLAMMATION: fever, leukocytosis, high ESR
103
Which virulence factor for T. Pallidum may facillitate perviascular infiltration
Hyaluronidase
104
Which virulence factor for T. Pallidum is antiphagocytic
Fibronectin coat
105
Which viurlence factor for T. Pallidum promotes adhereence to host cells
Outer membrane proteins
106
Which virulence factor for n. Gonorrhoaeae confuses the host immune system
Antigenic variation of pili
107
Which virulence factor for n. Gonorrhoeae is associated with the host not making any antibodies
Nonpiliated phase variants
108
Which virulence factor for n. Gonorrhoeae aids in attachment
Porin protein
109
Which virulence factor for n. Gonorrhoeae “fights back” against the host immune system
IgA protease
110
How is n. Gonorrhoaea resistant to certain antibiotics?
Plasmid- and chromosome-mediated resistance

Micro Final (Lauren, Shelby, and Annie) (4 decks)

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