Urethral Discharge

Question 1

Urethritis (Etiology)

Answer 1

Neisseria gonorrhea (Gonorrhea)
Chlamyda trachomatis (non-gonoccocal urethritis/NGU)
Mycoplasma genitalium

Question 2

Urethritis (Symptoms)

Answer 2

Dysuria (Ddx=UTI)
urethral pruritus
mucoid, mucopurulent, purulent discharge (rule out UTI)

Question 3

Urethritis (Diagnosis)

Answer 3

1) mucoid, mucopurulent, purulent discharge
2) gram stain of urethral secretions showing >=2 WBC per oil immersion field
3) positive leukocyte esterase test of first-void urine
4) microscopy of spun first-void urine showing >=10 WBC per high power field

Question 4

Urethrits (treatment)

Answer 4

*need culture to have a more specific/targeted treatment
Ceftriaxone - Gonorrhea
Azithromycin - NGU

Question 5

Cervicitis (Etiology)

Answer 5

Neisseria gonorrhea

Chlamydia trachomatis

Question 6

Cervicitis (Diagnosis)

Answer 6

Either or both:

1) mucopurulent exudate of endocervical lining visible in the endocervical canal or endocervical swab specimen
2) sustained bleeding of the endocervix which is easily induced by cotton swab through cervical os

Question 7

Cervicitis (Symptoms)

Answer 7

Often asymptomatic
Vaginal discharge
intermenstrual bleeding

Question 8

Gonorrhea (Etiology)

Answer 8

Neisseria gonorrhea
diplococcus, gram negative (unique), intracellular mostly associated with polymorphonuclear cells

fastidious
35-38 degrees C
exclusive human pathogen

Question 9

Gonorrhea (Symptoms)

Answer 9

Male: mucopurulent discharge (very symptomatic)
Female : remains asymptomatic until complications ensue (eg. Pelvic Inflammatory Disease); risk of passing on infection unknowingly

Question 10

Neisseria gonorrhea (Diagnosis)

Answer 10

Gram Stain: gram negative, intracellular diploccoci, bean-shaped; found in polymorphonuclear cells

Culture media: aerobic conditions
Modified Thayer-Martin Agar- 5% chocolate sheep blood; with Abx (Vancomycin, nystatin, colistin, trimethoprim)
round, glistening, elevated, mucoid, convex, transparent or opaque, non-hemolytic, non-pigmented culture

Culture: Neisseria gonorrhea vs other neisseria
Only N. gonorrhea and N. meningitidis grows on MTM Agar
N. gonorrhea and N. meningitidis are oxidase+
N. gonorrhea is Glucose+ but Maltose-
N. meningitidis is Glucose+ and Maltose+

Question 11

Neisseria gonorrhea (virulence)

Answer 11

Pili/Fimbriae: characteristic antigenic property; enhance attachment to host and resistant to phagocytosis

Por protein: pores in cell surface through which nutrients enter the cell; prevents phagosome-lysosome fusion

Opa proteins: adhesion within colonies and attachment to host cell receptors

RMP (Protein III): associated with Por

Lipooligosaccharide(LOS): endotoxicity; structurally similar to human glycosphingolipids which helps evade immune recognition

Question 12

Chlamydia trachomatis

Answer 12

obligate intracellular (cannot make ATP)
infects ocular and genitourinary epithelium
replicates within a cytoplasmic inclusion

Question 13

Chlamydia trachomatis (Diagnosis)

Answer 13

Culture

Nucleic acid amplification test (NAAT) : most sensitive

*if you have a patient presenting with signs and symptoms and NAAT is not available. use gram stain and the absence of intracellular diplococci highly suggests Chlamydia infection

Question 14

Chlamydia trachomatis (morphology)

Answer 14

Elementary body: MORE INFECTIOUS/non-dividing

Reticulate body: intracellular, REPLICATING FORM