STIs with discharges - urethritis/cervicitis

Question 1

How do we break down STIs?

Answer 1

• STIs with discharges= vaginitis, urethritis/cervicitis, and pelvic inflammatory disease (PID).
• STIs without discharges/with lesions= genital ulcers and genital warts.
• other= HIV and viral hepatitis

Question 2

Does Neisseria gonorrhoeae continue to be one of the most common causes of STIs in the US?

Answer 2

YES

Question 3

What do we have to know about Neisseria gonorrhoeae? (SKETCHY)

Answer 3

• fastidious requiring media for growth. NO capsule.
• adversely affected by drying and fatty acids.
• IRON is essential for growth (Tbp1 and Tbp2 bind transferrin; Lbp binds lactoferrin).
• gram-negative diplococcus (LOS in cell wall) with pili (allows it to bind to cells and body will generate antibody response to it).
• lack of immunity to reinfection results from antigenic variation among pili proteins and from phase variation in pill expression.
• facultative intracellular growing inside PMNs.
• has BETA-LACTAMASE (destroys penicillins).
• has protease (cleaves IgA).
• THICK WHTIE PURULENT DISCHARGE

Question 4

What other proteins are found in N. gonorrhoeae’s outer membrane?

Answer 4

• Por proteins= porins

- Opa proteins= opacity proteins that mediate binding to epithelial cells.

Question 5

What causes the pathogenesis due to N. gonorrhoeae?

Answer 5

host inflammatory response (IL-1 and TNF-a) causing cellular damage.

Question 6

What immunoglobulin is produced most during infection with N. gonorrhoeae?

Answer 6

IgG3

Question 7

What are the clinical syndromes caused by gonorrhea?

Answer 7

• males= URETHRAL infection causing discharge and dysuria (painful urination). Rarely can also get prostatitis, epididymitis, or periurethral abscess.
• females= infects columnar epithelial cells of ENDOCERVIX causing vaginal discharge, dysuria, and abdominal pain. Rarely can also get salpingitis, tuboovarian abscess, PID, or if disseminated, septicemia, skin and JOINT infection.

Question 8

Can gonorrhea infect the SQUAMOUS epithelia of vagina?

Answer 8

NO

Question 9

What is the clinical manifestation of disseminated gonorrheal infection?

Answer 9

• fever, migratory ARTHRALGIAS, suppurative arthritis, or a pustular rash on extremities (not on head and trunk).

Question 10

What is the leading cause of purulent arthritis in adults?

Answer 10

N. gonorrhoeae

*after a week of infection, you will no longer be able to culture bacteria in the joint fluid.

Question 11

What are some other complications of gonorrhea?

Answer 11

• perihepatitis (Fitz-Hugh-Curtis syndrome).
• purulent conjunctivitis (especially in newborns; ophthalmia neonatorum).
• anorectal gonorrhea in homosexual men.
• pharyngitis

Question 12

How do we diagnose gonorrhea?

Answer 12

• gram stain and culture from genital specimens with selective media (thayer-martin media) and non-selective media (chocolate blood agar).
• PCR, but this won’t tell you antibiotic susceptibility.
• oxidase + and ferments glucose

Question 13

How do we treat gonorrhea?

Answer 13

• ceftriaxone + azithromycin (zithromax) bc you are often co-infected with chlamydia

Question 14

What is the number 1 most reported bacterial STI in the US?

Answer 14

• Chlamydia trachomatis

Question 15

What are the general characteristics of Chlamydia trachomatis? (SKETCHY)

Answer 15

• obligate INTRACELLULAR bacteria.
• poor gram-staining but weakly gram-negative with Giemsa stain. Does not have a peptidoglycan layer (no muramic acid).
• 2 forms: elementary body (EB)= infectious form, and reticulate body (RB)= non-infectious form that can REPLICATE.
• requires ATP and tryptophan from the host.

Question 16

What is the pathogenesis of Chlamydia trachomatis?

Answer 16

• serotypes A, B, C= serious eye infection (trachoma).
• serotypes D-K= urethritis, PID, ectopic pregnancy, neonatal pneumonia, and neonatal conjunctivitis.
• serotypes L1-L3= lymphogranuloma venereum (granulomas in inguinal nodes as it replicates in mononuclear cells).
• clinical manifestations occur due to host inflammatory response.

Question 17

After treatment for Chlamydia trachomatis do you get long term immunity?

Answer 17

NO, you can easily get reinfected.

Question 18

What is important in regard to urogenital Chlamydia trachomatis infections in women?

Answer 18

• 80% are asymptomatic

Question 19

What are the clinical syndromes associated with Chlamydia trachomatis?

Answer 19

• females= cervicitis, endometritis, urethritis, salpingitis, bartholinitis, and perihepatitis. If symptomatic, most show a WATERY discharge.
• males= most are symptomatic and usually get postgonococcal urethritis= co-infection with N. gonorrhoeae.

Question 20

What is reactive arthritis (Reiter’s syndrome) and with what is it associate?

Answer 20

• arthritis, uveitis, and urethritis in young white men due to Chlamydia trachomatis.
• main problem is polyarthritis.

Question 21

How do we diagnose Chlamydia trachomatis?

Answer 21

• Giemsa stain
• culture
• antigen detection (ELISA)
• NAAT (nucleic acid amplification test); aka PCR.

Question 22

How do we treat Chlamydia trachomatis?

Answer 22

azithromycin or doxycycline

*tetracyclines are contraindicated in pregnancy remember!