Ulcerative STDs and Non-ulcerative STDs

Question 1

characteristics of spirochetes

3 kinds

Answer 1

spiral shaped
corkscrew mobility
don’t gram stain
grow slowly or not at all in vitro

treponema
borrelia
leptospira

Question 2

haemophilus ducreyi

Answer 2

gram - coccobacilli
needs chocolate agar
causes CHANCROID

Question 3

chancroid

Answer 3

soft chancre caused by h. ducreyi

– ragged ulcer on genitalia with swelling and tenderness; regional LN are often enlarged and tender

Question 4

treponema

Answer 4

spirochete w no cell wall!
susceptible to penicillin

cannot grow in culture and cannot gram stain
-causes SYPHILLIS

see w darkfield microscopy, fluorescent antibody staining (DFA-TP), or silver stains

Question 5

borrelia

Answer 5

zoonotic spirochete
visualize with giemsa or wright stain
CAN be cultivated!

causes lyme disease

Question 6

leptospira

Answer 6

zoonotic spirochete
use darkfield or silver stains
can be grown

Question 7

primary syphilis

Answer 7

primary lesion is a chancre due to treponema
 heals spontaneously without treatment but the systemic infection persists in an asymptomatic form
 Increased risk of HIV

Question 8

secondary syphilis

Answer 8

lesions weeks later –> papulosquamous rashes (palms and soles), mucous patches (tongue), and genital lesions (condyloma lata)
 heal spontaneously without treatment, but the systemic infection persists in an asymptomatic form

Question 9

tertiary syphilis

Answer 9

lesions develop years after infection
 targets include the CNS (neurosyphilis, meningovascular syphilis), CV system (syphilitic aortitis), and late benign syphilis (gummas)

Question 10

diagnosing syphilis

Answer 10

Darkfield microscopy and Direct fluorescent antibody staining
o **CULTURES ARE NOT USEFUL for syphilis

Question 11

treatment for syphilis (T pallidum)

Answer 11

penicillin G

Question 12

distinguishing three bacterial STDs

gonorrhoeae, chlamydia, and mycoplasma/ureaplasma

Answer 12

Neisseria gonorrhoeae (gram negative diplococci)
Chlamydia (obligate intracellular)
Mycoplasma/ureaplasma (no cell wall)

Question 13

neisseria gonorrhoeae

Answer 13

gram - diplococci
requires CO2
high antigenic variation allows rapid antibiotic resistance

Question 14

neisseria gonorrhoeae virulence factors

Answer 14

colonization pili
transferrin, lactoferrin, and hemoglobin binding proteins
IgA1 protease
Opa (opacity) protein ligands

down regulate complement activation due to lack of capsule!

Question 15

• Gonococcal Urethritis

Answer 15

frequent, urgent and painful urination with a yellow mucopurulent discharge

Question 16

• Opthalmia Neonatorum

Answer 16

purulent conjunctivitis in newborn, can cause blindness; acquired during passage through birth canal

Question 17

Curtis-Fitz-Hugh Syndrome

Answer 17

gonococcal dissemination into the peritoneum from the fallopian tubes and lead to perihepatitis

Question 18

Gonococcal Upper reproductive Tract Infections (Male)

Answer 18

o Epididymitis; unilateral pain and swelling with low grade fever and chills; can also have painful urination, discharge from urethra, and blood in semen; pain on ejaculation

Question 19

• Disseminated Gonococcal Infection (DGI)

Answer 19

hematogenous spread to skin and joints causing dermatitis, gonococcal arthritis, and endocarditis

Question 20

what is a risk factor for disseminated gonoccoccal infection?

Answer 20

complement deficiency

Question 21

• How can gonococci disseminate through bloodstream without a capsule?

Answer 21

o Porin-mediated serum resistance (2 porin types: P1A and P1B)

o Sialylation of gonococcal lipooligosaccharide (LOS) – by gonococcal sialyltransferase

Question 22

How does gonorrhoeae damage the fallopian tubes?

Answer 22

o They adhere and directly damage w LOS and peptidoglycan

Question 23

• Gonococci can REVERSIBLY ADAPT with varying surface molecules due to….

Answer 23

variable expression of 3 surface molecules

• -colonization pili
• -opacity (opa) proteins
• -LOS (lipooligosaccharide)

Question 24

antigenic variation of colonization pili in gonorrhoeae

Answer 24

changes in pilin expression –> immune evasion; pilin variation is due to recombination

antigenic variation allows repeated infections!

Question 25

gonorrhea incubation requirements

Answer 25

chocolate agar 37 degrees 5% CO2

Question 26

gonorrhea treatment

Answer 26

ceftriaxone and azithromycin

Question 27

three types of chlamydia

Answer 27

o C. pneumoniae – community acquired pneumonia o C. psittaci – atypical pneumonia, endocarditis o C. trachomatis --- serovars are based on antigenic differences in the major outer membrane protein (MOMP) --Serovars A-C = conjunctivitis, trachoma --Serovars D-K = urethritis, cervicitis, inclusion conjunctivitis --LGV serovars L1-L3 = lymphogranuloma venereum

Question 28

chlamydia - description - forms

Answer 28

``` obligate intracellular bacteria cell envelope similar to gram negative bacteria BUT no detectable peptidoglycan o EB (elementary body) – small, extracellular infectious form; metabolically inactive o RB (reticulate body) – large, intracellular replicative form; metabolically active ```

Question 29

• Chlamydial Urethritis – Nongonococcal Urethritis (NGU)

Answer 29

frequent urgent and painful urination Usually asymptomatic with clear discharge (not purulent) in men

Question 30

most common cause of non-gonococcal urethritis? | 2nd most common?

Answer 30

Most common cause of NGU = Chlamydia trachomatis D-K (DicK) second most common cause is ureaplasma urealyticum

Question 31

reiters syndrome

Answer 31

urethritis, conjunctivitis, and polyarthritis | d/t chlamydia

Question 32

o Infant inclusion conjunctivitis

Answer 32

acquired at birth from mother; acute mucopurulent discharge, erythema, and edema; silver nitrate prophylaxis is NOT effective

Question 33

• Chlamydia trachomatis LGV infection (ulcerative STD)

Answer 33

tropism for lymphoid cells rather than epithelial cells; painless primary lesion  regional lymphadenopathy 1-6 weeks later  abscess formation necrotic foci =

Question 34

treatment for chlamydia

Answer 34

azithromycin or tetracycline/doxycycline | o Infant conjunctivitis: oral erythromycin

Question 35

mycoplasma / ureaplasma

Answer 35

cause nongonococcal urethritis (NGU) • Mycoplasma has no cell wall! • Lab diagnosis: inoculate medium (PPLO)  colonies appear

Question 36

nonoxynol-9

Answer 36

a spermicide that kills HIV but damages tissues so increases risk of STI!!!! BAD

Question 37

• Gonorrhea increases transmission of HIV how?

Answer 37

increases HIV viral load and inflammatory response brings in susceptible immune cells

Question 38

vaccine for gonorrhea or chlamydia?

Answer 38

no