STIs And Gonorrhoeae

Question 1

Core sti groups

Answer 1

High prevalence of sti
High rate of partner change
Multiple concurrent partners
Dense sexual networks

Question 2

Bridging population

Answer 2

Moderate prevalence of stis
Ie clients of sex workers drug users

Drives sporadic transmission in general population

Question 3

Initial spread of stis are determined by

Answer 3

Rate of sexual exposure to infectious ppl
Efficiency of transmission per exposure
Duration of infectivity of those infected

Question 4

Syndromic approach

Answer 4

Patients are managed based on the presenting symptoms and sighs and risk factors

Question 5

Management of stis

Answer 5

Establish presence of urethritis (gram stained smear of discharge) should have more than 5neutrophils per 1000x field
Smear will have gram - intracellular diplococci (gonococcal infx)

Evaluate for complications or other diagnosis

Evaluate for gonococcal and chlamydial infx

Question 6

Neisseria

2 types meningitidis and gonorrhoea

Answer 6

Human only host

Aerobic gram negative diplococci

Question 7

N gonorrhea

Answer 7

Sexually transmitted
Primary infests urogenital tract
Gram negative, nonmotile, monococci or diplococci with flat sides

Second most common sexually transmitted disease

Enhances transmission of hiv bc of damaged epithelium

Has 3-4 genome copies per coccal unit (polyploidy) so increases antigenic variation and survival

Question 8

N meningitidis

Answer 8

Nervous and attacks on CNS

Question 9

N gonorrhoea affect on babies

Answer 9

Will have orogastric and oropharyngeal colonization

2-48% of exposed infants not given prophylaxis will develop ophthalmia neonatorum

Question 10

Transmission of gonorrhoea

Answer 10

40-60% transmission

More efficient from male to female

Question 11

Clinical presentation of gonorrhea

Answer 11

Urethritis pee pain 
Cervicitis
Proctitis rectum inflammation 
Pharyngitis
Conjunctivitis

Question 12

Gonorrhoeae outer membrane antigens

Answer 12

Los has endotoxins activity
Ops binds host cell CEACAMs to start invasion
PorB resists bactericidal effect of serum
Pilus mediates attachment and contributes to antigenic virulence and variation
IgA protease inactivated igA on the mucosal surface

Question 13

Opa

Answer 13

Important in adherence

Question 14

Porins a b

Answer 14

PorA Silent in gonorrhea but active in meningitidis

PorB most abundant
Prevents complement mediated serum killing and protects bacteria
Interferes w phagosome lysozyme fusion m prevents neutrophils from causing damage

PorB1A genotypic resistance, promotes epithelial cell invasion

Question 15

Host factors for gonorrhoea

Answer 15

Complement deficiencies c5-c9
Thus results in recurrent infections
IgA proteases cleave heavy chain of human IgA. Helps gonorrhea overcome mucosal immunity

Question 16

Detection of neisseriae

Answer 16

By th17 cells macrophages n dendritic cells via tlr n nlr

Infection promotes il8 il16 tnf il1-beta
These activate and recruit neutrophils that adhere to vessels

Question 17

Gonorrhea pathogenesis

Answer 17

Sexual contact
Established in urogenial tract w nonciliated epithelial cells
Infx leads to inflammation and pmn(polymorphonuclear) n macrophage influx

Toxic damage to ciliated epithelial cells by
Tnf from phagocytes
Gonococcal products (los, peptidoglycan)

Question 18

Clinical manifestations G in males

Answer 18

Incubation period 2-7days
Acute urethritis
Major manifestations in symptomatic men:
Purulent urethral discharge (thick yellow pus)
Dysuria (painful urination)

Question 19

Clinical manifestations of G in females

Answer 19

Mucopurulent cervicitis - infected columnar epithelium of cervix becomes reddened, friable w/ purulent discharge

Asymptomatic urethritis is more common

Symptoms develop within 10 days
Usually Lower abdominal discomfort
Painful intercourse

Both symptomatic and asymptomatic transmit infx

Abnormal bleeding

Question 20

PID

Answer 20

Pelvic inflammatory disease
Caused by gonorrhoea
Polymicrobial infx of upper genital tract

Also caused by trachomatis cmv tb

May result in sterility

Can cause abscesses in Fallopian tubes or ovaries or peritoneum
Abortions

Question 21

Gonococcal conjunctivitis

Answer 21

Incubation time 3-19 days
Treat w parenteral antibiotics
Characterized by hyperpurulent discharge (fountain of pus)
Can lead to blindness in 24hrs

Question 22

Ophthalmia neonatrium

Answer 22

Range 1-5days
Swelling and purulent drainage
Severe redness n swelling of conjunctiva

Treatment is systemic and local antibiotics

Question 23

Lab diagnosis of G

Answer 23

Inoculate immediately bc dry up very quickly
Grow in chocolate agar
Gram stain is not sensitive for women or in pharynx

Question 24

Treatment for G

Answer 24

Treat simultaneously for chlamydia
W azithromycin or docycline

Evaluate for other stis
Treat the partner as well