Urethritis/Cervicitis: Ryan

Question 1

Which three organisms account for 60-80% of STIs with primary symptoms of discharge and dysuria?

Answer 1

Chlamydia trachomatis (Ct) and Neisseria Gonorrhoeae (GC)
Minor player Ureaplasma urelyticum (a mycoplasma)

Question 2

Can we grow Ct in artificial medium?

Answer 2

No, it is an obligate intracellular organism. Can be grown in tissue culture.

Question 3

What is the primary VF of Ct?

Answer 3

Ability to cause inflammation via heat shock protein

Question 4

What is the primary VF or GC?

Answer 4

LPS, invokes inflammatory response

Question 5

What does it mean when said that GC undergoes antigenic variation?

Answer 5

It has pili that are used to transmit various silent peptide encoding loci into other GC, basically transmitting genetic info and causing genetic rearrangement throughout the course of the infection that adds to antigenic variation and thus, to resistance.

Question 6

Discuss the possibility of dissemination among Ct and GC.

Answer 6

Ct- no dissemination

GC- may disseminate

Question 7

Ureaplasma are not susceptible to treatment with this Abx, for this reason.

Answer 7

Beta-lactams; no cell wall. (mycoplasma)

Question 8

Besides urethritis and cervicitis, what other diseases are caused by Ct or GC or both?

Answer 8

Salpingitis and PID
Epididymitis
Perihepatitis (Fitz-Hugh-Curtis Syndr.) - abdominal adhesions
Prostatitis (GC)
Pharyngitis (GC)
Conjunctivitis
Infant PNA- Ct only
Disseminated (GC)
Reiter's syndr.- reactive, non-septic arthritis

Question 9

Describe what is going on in PID.

How do we treat it?

Answer 9

Inflammatory process involving a variable combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.
Dull to severe lower abd. pain
Adnexal tenderness
Cervical motion tenderness
Fever
Serious problem, can lead to infertility.

Tx: Doxy and Cefoxitin (2nd Gen- covers gram -‘s)

Question 10

Describe the disseminated infxns of GC.

Answer 10

Fever
Rash
Septic arthritis
Rarely- endocarditis, meningitis

Question 11

Describe the infantile PNA of Ct.

Answer 11

Afebrile 
Repetitive cough with dyspnea
Hyperinflation w/ bilateral infiltrates
Serum IgM raised
Wheezing is rare (diff. from pertussis)

Question 12

Describe the Dx of Ct and GC

Answer 12

Gram stain (-) for GC
Can’t gram stain Ct. If you see poly’s but no cocci, probably Ct.
GC can be grown on chocolate agar (Thayer-Martin + Vanc.)
Most common Dx by Nucleic Acid Amplification Test (NAAT)
Sensitive, but expensive

Question 13

Describe tx for GC and Ct.

Answer 13

GC- Single IM inj. of ceftriaxone due to B-lactam res.

Ct- Azithromycin or Doxy
oral erythromycin for neonates/preg. mothers

Silver nitrate for infants with GC conjunctivitis

Question 14

What is Lymphogranuloma verereum (LVG)?

Answer 14

More invasive form of STD than urethritis/cervicitis caused by Ct. Invasion of inguinal lymph nodes.
Very rare in the US

Question 15

What is Trachoma?

Answer 15

Caused by strains of Ct that do NOT cause urethritis/cervicitis. Can be blinding. Prevalent in Asia, ME, Africa.

Question 16

Describe the intracellular development cycle of Ct.

Answer 16

Consists of two alternating forms:
A small metabolically inert but (INFECTIOUS) Elementary Body (EB) and a larger dividing or Reticulate (REPLICATING) Body (RB).
Host cell dies by lysis, releasing EBs to infect surrounding cells.