VII- Bacterial STI Flashcards
presentation of chyamydia trachomatis
serovars A,B,C
chronic follicular conjuctivitis > scarring > eyelids turn inward > eyelashes abrade cornea > corneal ulceration > blindness
chlamydia presentation women
serovars D-K
- vague abdom discomfort or spotting
- mucopurluent cervicitis > endometritis > endosalpingitis > pelvic peritonitis
pres of neisseria gonorrhoeae
in men
acute urethritis 95%
-discharge range from scant to profuse purluent
-epididymitis complication (unilateral testicular pain, swelling, tender)
pres of treponema pallidum
aka syphilis
1. primary = single painless lesion/chancre > cartilaginous ulcer > resolves in few weeks
2. secondary = skin lesions all over body but trunk and extremities first, pale red/pink, nonithcy + nonspecific + mucotaneous lesion
3. latent = no symps but still transmit and produce antibodies
4. late = tabes dorsalis (demyelination) + cardiovasc + benign gymma of solitary lesions ad central necrosis
neurosyphilis symptoms
- meningeal with headache/nausea/stiff neck/cranial nerves, seizures
- meningovascular syphilis with vasculitis and stroke
- general paresis - change in personality, halluncinate, delusions, inc reflex, mem loss
pres of mycoplasma genitalium
NGU in males, PID in women but commonly asymptomatic
non gonococcal urethritis
pres of ureaplasma urelyticum
NGU in males, pyelonephritis, spontaneous abortion, premature birth
pres of haemophilus ducreyi
chancroid in dev countries, sex workers, and drug users from break in skin during contact
-multiple lesions that bleed easy> inflammed papule > pustule > painful ulcer
H. ducreyi features
- fastidious
- gram neg coccobacillus
- growth factor X and V required
- chocolate agar
diagnose/treat H. ducreyi
- painful ulcers + lymphadenopathy without syphilis or HSV
- macrolide treat (azithromycin or erythromycin)
pres of klebsiella granulomatis
aka donovanosis associated with poor hygiene
-painless wartlike papule from trauma > ulcer
types of klebsiella lesions
- classic - beefy, red, bleed easy
- hypertrophic/verrucous ulcer with raised irreg edge
- necrotic - offensive smelling, tissue destruct
- sclerotic/cicatricial with fibrous scar tissue
Klebsiella granulomatis features
- gran neg rod
- capsule with mucoid like colonies
- donovan bodies on wrights stain- large mononuclear pund cells with intracytoplasmic cysts (deeply stain, safety pin)
epidemiology of chlamydia
most commonly reported in US
-entry thru microabrasions
epidemiology of N. gonorrhoeae
2nd most common reported bacterial in US
mycoplasma and ureaplasma features
- no cell wall so resistant to antibiotics that target
- sterols in cell membrane
- fried egg appearance
virulence factors for N. gonorrhoeae
- pili for adherence and transfer genetic material, resistance to neutrophil killing
- antigenic variation of pilins at C terminus
- opacity associated protein Opa
- porin
- LOS
- immunoglobulin A1 protease
- antibiotic resistance
life cycle of chlamydia
infected epi cells form membrane bound cytoplasmic inclusions
1. uptake of elementary bodies
2. initial inclusions
3. fusion of inclusions and RBs appear
4. RBs multiply and inclusion enlarges
5. RBs convert to EBs or persist as large aberrant if IFN-y then return to normal
6. RBs release
characteristics of chlamydia
- small nonmotile bacteria
- obligate intracellular parasite so needs ATP and will not grow on artificial media
- unique cell wall
chlamydia cell wall
- no peptidoglycan so not gram stain
- LPS pos - induces inflamm
- major outer membrane protein MOMP that determines serovar
- outer membrane protein 2 OMP2
elementary bodies features
- transmissible form of chlamydia
- adapted to extracellular survival bc of extensive OMP2 disulfide bondsthat inhibit lysosome/phagosome fusion
reticulate bodies featuers
- non infectious replicating form of chlamydia
- adapted to intracellular environ
- environmentally labile so can’t survive outside cell bc lack OMP2 sulfide bonds
types of chlamydia
- serovars A,B,C - ocular trachoma, not sex transmit
- serovars D-K - urogenital chlamydia
- serovars L1-3 - lymphogranuloma venereum
pelvic inflammatory disease
salpingitis
inflamm of fallopian tubes from ascending intraluminal spread from lower genital tract
-if untreated then scarring > occulsion > infertility
pres of chlamydia in men
serovars D-K
asymp or acute urethritis
-white mucoid exudate
-meatal srythema and tenderness
-dysuria, urethral itching
-can progress to epididymitis and reactive arthritis
pres of chlamydia in both men and women
serovars D-K
- conjunctivitis - unilateral discomfort with hyperemia + clear/cloudy secretions
- rectal infection, proctitis (severe pain, bloody mucopurulent discharge, fever, tenesmus)
- oropharyngeal infections- acute tonsilitis, pharyngitis, abnormal pharyngeal sensation syndrome
chlamydia vertical transmission presentations
- 5-14 days show conjunctivitis with variety of discharge, pseudomembrane form, erythema
- 4-12 weeks show pneumonia with afebrile, cough, congest, tachypnea, rales
- 2-3 yrs show urogenital infect
pres chlamydia
serovars L1-3
- genital lesions painless > ulcerate > heal in few days
- inguinal syndrome with painful lymphadenopathy, fever, headache, chills, meningismus, anorexia, myalgia, arthralgia
how to diagnose chlamydia
- NAAT gold standard on urethral discharge or urine from men, vaginal swabs from women
- tissue culture NOT artifical media
treating chlamydia
- nonpreg adults/adols = oral doxycycline x2/day for week
- preg women = oral azithromycin single dose
- neonates = oral erythrommycin base or ethylsuccinate for 4 doses/daily two weeks
- LGV = doxycycline x2 day for 21 days
N. gonorrhoeae features
- gram neg cocci/diplococci aka coffee bean appearance
- oxidase pos
- aerobic
- glucose acid production pos, maltose neg
Opa function
-bacterial adhesion
-epi cell invasion
-suppress lymphocyte activatin
-presence = local disease, absense = disseminated
N. gonorrhoeae
porin function
-forms pores in bacterial membrane
-bacterium endocytosis/epi cell invasion
-PorB. 1A if disseminated vs PorB.1B in localized
N. gonorrhoeae
LOS function
- lipid A and core oligosac but no repeating o antigen like most gram negs
- endotoxin activity for inflamm resp
- binding or directed antibodies
- contained in blebs released by growing bact
immunoglobulin A1 protease function
cleave hinge region of IgA1 to inactivate
N. gonorrhoeae
antibiotic resistance of N. gonorrhoeae
carry beta-lactamase gene so resist
-penicillin
-tetracycline
-ampicillin
pres of N. gonorrhoeae in women
mostly asymp but gonococcal cervicitis:
-scant discharge + intermenstrual bleeding
-dysuria + dyspareunia
-low back pain
also gonococcal vaginitis in pre-puberty girls and post menopause women so intense inflamm and pain in exam
combined pres of N. gonorrhoease
- anorectal gonorrhea
- pharyngeal - mild sore throat
- disseminated - skin lesions key, bunch of inflam, esp preg women or on period
- ocular gonorrhea- early (non pur conjunct) > progressing (eyelid swell, red, profuse pur) > late (ulcerative keratitis, blind)
vertical transmission gonorrhea
within 2-5 days show
-gonococcal ophthalmia neonatorum but prevented by silver nitrate or topical antibiotics at delivery, nonspecific conjunct > tense edema of eyelid + chemosis + profuse pur
can also present as resp, pharyngeal, anal infections
diagnosing gonorrhoeae
- gram stain for neg cocci in males with urethritis
- NAAT with cotesting for chlamydia
- culture on chocolate agar and selective media
treating gonorrhea
- if uncomplicated genital - ceftriaxone single IM + doxycycline or azyithromycin if preg and no chlamydia
- if pharyngeal - ceftriaxone single IM + test for cure 7-14 days later
treponema pallidum features
- spirochetes visualized with fluroescent tagged antibodies or darkfield microscopy
- microaerophilic
- no gram stain
congenital syphilis pres
classic stigmata
1. hutchinson teeth
2. mulberry molars
3. saddle nose
4. saber shins
but stillbirths common
diagnosing syphilis
- lipoidal test for screening - measures IgG and IgM vs cardiolipin-lectin-cholesterol antigen complex via FTA or TPPA
- treponemal test to confirm
treating syphilis
PENICILLIN
-long term if latent or neurosyphilis
treating mycoplasma genitalium
azithromycin or moxifloxacin NO cell wall inhibitors
diagnose via NAAT
treating ureaplasma
doxycycline
treating klebsiella
azithromycin for 3 weeks or until lesions healed
