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Reproductive System > Week 4 - "Silent Shadow" > Flashcards

Week 4 - "Silent Shadow" Flashcards

1
Q

What is pelvic inflammatory disease?

Microbiology

A

An infectious and inflammatory disorder of the upper female genital tract, including the uterus, fallopian tubes and adjacent pelvic structures

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2
Q

What is PID complicated by?

Microbiology

A

Some are often complicated by sexually transmitted infections (STIs)

Or other infections like bacterial vaginosis that are not STIs

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3
Q

Why is most of time PID left untreated?

Microbiology

A

Most of them are asymptomatic, and people do not know they are infected

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4
Q

What can untreated PID cause?

Microbiology

A

Tissue scarring and abscess formation which damages the reproductive system:
1. Infertility
2. Chronic pelvic pain Ectopic pregnancy
3. Tubo-ovarian abscess

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5
Q

How is infertility a complication of PID?

Microbiology

A

Untreated PID might damage the reproductive system and dramatically increase the risk of infertility

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6
Q

How is chronic pelvic pain?

Microbiology

A

Lasts for months or years, scarring of the fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation

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7
Q

How can ectopic pregnancies be a complication of PID?

Microbiology

A

The scar tissue prevents the fertilized eggs from moving through the fallopian tube to uterus

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8
Q
A
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8
Q

How can tubo-ovarian abscess be a consequence of PID?

Microbiology

A

Untreated abscesses in fallopian tubes and ovaries could develop into life threating infection

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9
Q

What % of untreated STDs progress to PID?

Microbiology

A

Up to 20% of untreated STDs

–> Untreated STD infection + inflammation = PID

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10
Q

What are the causative agents of primary PID?

Microbiology

A

Greater than 90% of PID cases are caused by Chlamydia rachomatis and Neisseria gonorrhea which are also the leading causes of STDs

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11
Q

What is the most common STD agent?

Microbiology

A

Chlamydia trachomatis

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12
Q

What is polymicrobial PID?

Microbiology

A

30 to 40% of cases, may begin as an isolated infection with N. gonorrhea or C. tachomatis which causes inflammation of the upper genitelia tract that facilitates the involvement of other pathogens

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13
Q

What are soem other examples fo causative agents in polymicrobial PID?

Microbiology

A

Gardenerella vaginalis, Haemophilus influenzae and anaerobes such as Peptococcus and Bacteroides species.

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14
Q

How many STDs are acquired everyday world-wide?

Microbiology

A

1 million every day

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15
Q

What period of time was there a drastic icrease in gonorrhe cases and why?

Microbiology

A

Flower-power era, co-exusted with HIV epidemic

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16
Q

What are the symptoms of most STDs like?

Microbiology

A

The majority of STDs have no symptoms or only mild symptoms that may not be recognized as an STD –> silent infections

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17
Q

What is the relation between STDs (such as Gonorrhea, HSV 2and syphilis) and HIV?

Microbiology

A

Gonorrhea, HPV 2 and syphilis increase the risk of HIV acquisition

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18
Q

What is a major threat to reducing the impact of STDs worldwide?

Microbiology

A

Drug resistance, espcially with gonorrhea

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19
Q

What is the most common affected population of new STDs?

Microbiology

A

15 to 24 years of age

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20
Q

What are the common agents for STDs? (10)

Microbiology

A
  1. Chlamydia trachomatis
  2. Nisseria gonorrhea
  3. Trichomonas vaginalis
  4. Treponema pallidum
  5. Mycoplasma genitalium
  6. Ureaplasma urealticum
  7. Hemophilus ducreyii
  8. HIV
  9. HPV
  10. HSV
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21
Q

What is C. trachomatis like?

Microbiology

A

Gram negative tiny bacteria, obligate inracellular
–> live in eukaryotic cells to use energy sources and amino acids

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22
Q

What are Ν. gonorrhea like?

Microbiology

A

Gram negative diplococci bacteria

Fastidious non-motile bacteria & strict human pathogen

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23
Q

What is trichomonas vaginalis?

Microbiology

A

Parasite, protozoa

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24
Q

What are mycoplasma genitalium and ureaplasma urealyticum?

Microbiology

A

Tiny bacteria without a cell wall

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25
Q

What is hemophilus ducreyii?

Microbiology

A

Gram negative coccobacilli

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26
Q

What does chlamydia trachomatis cause?

Microbiology

A
  1. Silent infections (asymptomatic): urethritis in 50% of emn
  2. Cervicitis infection: 60 to 75% of women do not show symptoms
  3. Contagous STD and increase in HIV acquisition
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27
Q

What can untreated chlamydia cause?

Microbiology

A

PID,
Infertility,
Ectopic pregnancy

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28
Q

How are Chlamydia trachomatis infections treated?

Microbiology

A

Curable with antibiotics

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29
Q

What is the lifecycle of chlamydia trachomatis like?

Microbiology

A

Biphasic with two unique forms of the organism

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30
Q

What are the two unique forms of the chlamydia bacteria during its lifecycle?

Microbiology

A

Elementary body (EB)
Retoiculate Body (RB)

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31
Q

What is the elementary body of chamydia trachomatis?

Microbiology

A

Infectious, extracellular form, metabolically inactive, non-replicative form and has a rigid cell wall

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32
Q

What is the reticulate body of chlamydia lifecycle like?

Microbiology

A

Non-infectious, intracellular, membrane-bound, no rigid wall, metabolically active and replicate by binary fusion

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33
Q

What virulnce factor does Chlamydia contain in the outer membrane?

Microbiology

A

LPS but no peptidoglycan, Chlamydia LPS has very weak activity as an endotoxin and does not induce innate immunity –> thus asymptomatic/silent infections

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34
Q

What is the pathogenesis of Chlamydia?

Microbiology

A
  1. Attachment of elementary body to cell surface –> attached to sialic acid receptors on the surface of columnar epithelial cells
  2. Internalization by endocytosis and inhibition of ednosome fusion to lysosome
  3. Transformation from EB to RB form
  4. Replication of RB form by binary fission –> until apoptosis is caused
  5. Immune evasion
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35
Q

Why is there no vaccine against Chlamydia?

Microbiology

A

Due to its antigenic variation –> subvert host defenses

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36
Q

What is the treatment for Chlamydia?

Microbiology

A

Azithromycin or Doxycycline for 7 days

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37
Q

How can Chlamydia be diagnosed in a lab?

Microbiology

A

Chlamydia is obligate intracellular ting bacteria so it can:
1. Grow in tissue culture cell lines and not on agar plates
2. Stained for inclusion bodies
3. NAAT
4. EIA: Enzyme immune assay

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38
Q

What family does Chlamydia belong to?

Microbiology

A

Chalmydiaceae family

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39
Q

How are Chlamydia infections acquired?

Microbiology

A

Direct contact with mucous membranes like the case in sexual contact

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40
Q

What other diseases can Chlamydia lead to?

Microbiology

A

Trachoma: inflammatory granulomatous process of eye surface
Adult inclusion conjuctivitis
Neonatal conjuctivitis
Infant pneumonia
Urogenital infections
Lymphogranuloma venereum

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41
Q

What can Gonorrhea cause?

Microbiology

A
  1. Sterility
  2. PID (in women)
  3. Sponteneous abortions and ectopic pregnancies
  4. Enhanced HIV transmission
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42
Q

What can maternal transmission of Gonorrhea lead to?

Microbiology

A

Blindness in newborns

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43
Q

What is the incubation period of Gonorrhea?

Microbiology

A

2 to 10 days

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44
Q

Which gended has a higher rate of Gonorrhea cases?

Microbiology

A

MEN

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45
Q

What is the health disparity among races?

Microbiology

A

Looking at data, the incidence of disease is higher among low class populations, due to the lack of education and awareness

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46
Q
A
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47
Q

What is the pathogenesis of Gonorrhea?

Microbiology

A

It induces robust innate immune resposnses but suppresses adaptive immunity (thus no vaccine has been developed yet)

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48
Q
A
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49
Q

How is Gonorrhea retrived?

Microbiology

A

Viable in neutrophils from gonorrhea discharge
It can survive in macrophages

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50
Q

How does N. gonorrhea evade killing by host defences?

Microbiology

A
  1. Immune evasion
  2. Virulenece factors
  3. IgA protease
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51
Q

How does immune evasion of Gonorrhea help evade killing?

Microbiology

A

Antigenic variation (which is the factor that allows for recurrence of the infection) of proteins expressed on the surface; modifications of bacterial targets like LPS

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52
Q

What are the virulenece factors of Gonorrhea?

Microbiology

A
  1. Fimbriae
  2. Pilli
  3. Porins (outer membarne proteins)
  4. LPS (reduces phagocytosis)
  5. Lactoferrin utilization
  6. Antioxidant and detoxification system
  7. Type IV secretion system
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53
Q

What is the role of type 4 secretion system as a virulenece factor in Gonorrhea?

Microbiology

A

It secretes chromosomal DNA into the environment.

This released DNA facilitates horizontal gene transfer, increasing genetic diversity and antibiotic resistance.

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54
Q

How does IgA protease help Gonorrhea evade killing by host defense?

Microbiology

A

Facilitates bacteria adherence to mucosa by blocking IgA antibodies

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55
Q

What kind of agar is used for Gonorrhea culture?

Microbiology

A

Chocolate agar due to iron

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56
Q

What is the main site of gonococcal infections?

Microbiology

A

Genital tract

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57
Q

What are examples of disseminated gonococcal infections?

Microbiology

A

Gonococcal pharyngitis
Neonatal opthalmia
Purulent eye infection
Gonococcal skin papules
Gonococcal arthiritis
Rectal gonorrhea

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58
Q

Which antibitics in gonorrhea resistant to?

Microbiology

A

Penicillin
Erythromycin
Fluoroquinolones

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59
Q

What is the causative agent of Syphilis ?

Microbiology

A

Treponema pallidium

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60
Q

What is venereal syphilis?

Microbiology

A

An STI with incubation period around 21 days, but can range from 10 days to 90 days

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61
Q

What type of agent is Treponema pallidium?

Microbiology

A

A motile spirochete bacteria, gram negatve but very thin t stain, visible under fluorescence and dark field microscopy

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62
Q

What is the importance of the helical structure of Treponema pallidum?

Microbiology

A

Allows it to move in a corkscrew motion through mucous membranes or enter minuscule breaks in the skin

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63
Q

What are the virulenece factors of Treponema pallidum?

Microbiology

A

Hyaloruniddase which attached to variety of cells: epithelail, endothelial and fibroblasts

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64
Q

What is primary syphilis?

Microbiology

A

Primary lesion called chancre appears at the site of inoculation, usually perists for 4 to 6 weeks and then heals spontaneously.

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65
Q

How is the primary lesion of primary syphilis cleared?

Microbiology

A

Macrophages phagocyte Treponema and clear the primary chancre butTreponeam can spread by blood and lymoh through out the body

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66
Q

What is secondary syphilis?

Microbiology

A

Generalized, non-tender lymphoadenopathy, parenchymal, constitutioal and mucutaneous manifestations of secondary syphilis usually appear 6 to 8 weeks after then chancre heals

(skin rashes and mucosal lesions)

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67
Q

What is latent syphilis?

Microbiology

A

Positive serologic tests for syphilis, together with a normal CSF examination anf the absence of clinical manifestations of syphilis

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68
Q

What is the only way to diagnose latent syphilis?

Microbiology

A

Serology tests will come back positive

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69
Q

What can untreated syphilis lead to?

Microbiology

A

Tertiary syphilis

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70
Q

What is tertiary syphilis?

Microbiology

A

Hyperimmune response that affects many organs including the skin. Treponema can move to the blood stream, spinal fluid and to other internal organs very rapidly via its internal flagella

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71
Q

What can tertiary syphilis lead to?

Microbiology

A

Neurosyphilis (syphilis in CNS)
Aortitis/carditis
Gummas/skin lesions

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72
Q

What are gummas?

Microbiology

A

Solitary lesions ranging from microscopic to several centimeters in diameter. They produce indolent, painless, indurated nodular or ulcerative lesions that may resemble other chronic granulomatous conditions, including TB, sarcoidosis, leprosy, and deep fungal infections

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73
Q

Why can Treponema not be cultured?

Microbiology

A

It is fastidious and very sensitive

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74
Q

What are the diagnostic approaches to Syphilis?

Microbiology

A

NAAT and secensitive PCR
Serologic testing

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75
Q

How is syphilis treated?

Microbiology

A

Penicillin

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76
Q

What are the two types of serology used for syphilis?

Microbiology

A

Nontreponemal and treponemal

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77
Q

What is the most widely used non-treponemal antibody test used for syphilis?

Microbiology

A

Rapid plasma reagin and venereal disease research laboratory tests –> measure the IgG and IgM directed against the cardiolipin-lecithin-cholesterol antigen complex

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78
Q

What are treponemal tests used for?

Microbiology

A

To measure antibodies to native or recombinant T pallidum antigens and include the FTA-ABS tests, and the TPPA test

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79
Q

What are the subspecies of Treponema pallidum?

Microbiology

A
  1. Treponema pallidum subspecies pallidum –> Syphilis STD
  2. Treponema pallidum sbspecies carateum –> Pinta
  3. Treponema pallidum subspecies endemicum –> Bejel (rare)
  4. Treponema pallidum subspecies pertenue –> Yaws (rare)
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80
Q

What does hemophilus ducreyi cause?

Microbiology

A

Chancroid

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81
Q

What is Chancroid?

Microbiology

A

An STD characterized by genital ulcers and enlarged regional lymph nodes

The esion are similar to those caused by Siphylis but they are painful

They increase the risk of HIV

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82
Q

What is hemophilus ducreyi like?

Microbiology

A

Gram negative coccobacili bacteria

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83
Q

How is Hemophilus ducreyi diagnosed?

Microbiology

A

Culture or chocolate agar
Diagnosed by biochemical test
PCR and NAAT

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84
Q

What is the treatment for hemophilus ducreyi?

Microbiology

A

Erythromycin
Trimethoprim - sulfamethaxazole orally x 10
OR
Amoxycillin-clavulan (augmentin) x7

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85
Q

What is mycoplasma genitalium?

Microbiology

A

The main cause of non gonococcal urethritis (NGU), mucopurulent cervicits, endometritis and PID

They are tiny bacteria that lack a cell wall and infect ciliated epithelial cells

86
Q

What are examples of mycoplsma genitalium virulence factors?

Microbiology

A

The ability to adhere to host epithelial cells using the terminal tip organelle with its adhesins, the release of enzymes and the ability to evade the host immune response by antigenic variation

87
Q

What does ureaplasma urealyticum cause?

Microbiology

A

Non-gonococcal urethritis (NGU), renal calculi, neonatonal abscesses

88
Q

What are ureaplamsa urealyticum?

Microbiology

A

They are tiny bacteria that lack a cell wall and infect ciliated epithelial cells

89
Q

What is the main virulence factor of ureaplasma urealyticum?

Microbiology

A

The hydrolization of urea

90
Q

What agar is specific to uregenital mycosplasma and ureaplasma?

Microbiology

A

A7 agar –> shows fried egg colony morphology

91
Q

What does Trichomonas vaginalis cause?

Microbiology

A

Trichomoniasis, asymptomatic silent infection in 70% of the cases

92
Q

What is trichomonas vaginalis?

Microbiology

A

Anaerobic flagellated protozoan parasite

93
Q

WHat are the symptoms of trichomonas infection?

Microbiology

A

In females: strawberry cervix, itching and pain
In males: burning sensation and itching

94
Q

What are important viruence factors of trichomonas parasite?

Microbiology

A

Fagella and undulating membrane to allow for motility

95
Q

What is the treatment for the trichomonas vaginalis protozoan?

Microbiology

A

Metronidazole

96
Q

What does brown discharge indicate?

Microbiology

A

No infection, tends to be normal during menstrual cycle

97
Q

What does white thick, creamy and clumpy discahrge indicate?

Microbiology

A

Yeast infection

98
Q

What does yellow discharge indicate?

Microbiology

A

STDs (trichomonas, chlamydia, gonorrhea)

99
Q

What does green discharge inidicate?

Microbiology

A

STDs (trichomonas, gonorrhea, chlamydia)

100
Q

What does smelly discharge indicate?

Microbiology

A

STD (trichomonas) or bacterial vaginosis

101
Q

What does pink dicharge indicate?

Microbiology

A

Cervical or endometrial cancer, vaginal infection (BV) or cervical erosion

102
Q

What does orange discharge indicate?

Microbiology

A

Vaginal infections

103
Q

What are clue cells and what do they indicate?

Microbiology

A

They are vaginal cells with bacteria stuck to them, they provide us with a clue hat there is something abnormal

104
Q

What is the vaginal microbiome like?

Microbiology

A

It consists of many species of bacteria, viruses and yeast that colonize the vagina

105
Q

Which is the dominant species of the vaginal microbiome?

Microbiology

A

Lactobacillus species are the dominant colonizing bacteria in health adult women

106
Q

What is reduced number of Lactobacillus indicative of?

Microbiology

A

Increased vaginal pH and altered vaginal microbiome (dysbiosis)

107
Q
A
108
Q

What is the normal pH environment of the vagina like?

Microbiology

A

Both the environmnet and the fluid are acidic

109
Q

What pH do Lactobacilli thrive in?

Microbiology

A

Low pH, below 4.5

110
Q

What are the Lactoboacillus bacteria like?

Microbiology

A

Gram positive bacilli, faculative anaerobic, non-spore forming bacteria

111
Q

What do Lactobacilli produce?

Microbiology

A
  1. Lactic acid from sugars through fermentation –> contributes to low vaginal pH –> other bateria cannot thrive at low pH so protects from infections
  2. Hydrogen peroxide (H2O2) which kills other bacteria
  3. Bacteriocins that kil other bacteria
112
Q

Where else are lactobacilli bacteria found in the body?

Microbiology

A

Digestive system
Urinary system
Genital system

113
Q

When does lactobacilli dominance develop?

Microbiology

A

In adult women during child-bearing age

114
Q

What is the environment/diversity of the vaginal microbiome in prepubertal girls and postmenopasual women?

Microbiology

A

Increased diversity –> thin vaginal mucosa –> low levels of glycogen –> low activity of lactobacilli –> high pH –> diverse environment

115
Q

How does a low pH allow for lactobacillus dominance?

Microbiology

A

Low pH –> thick vagina mucosa –> deposition of glycogen –> more glycogen metabolized by lactobacilli into lactic acid (for energy) –> low pH –> bacteria cannot survive –> lactobacillus dominance

116
Q

What is the effect of Lactobacilli towards pathogenic microorganisms?

Microbiology

A

It has been shown to inhibit in vitro growth of pathogenic microorganisms –> any alterations in the vaginal environment would allow for such microorganisms to thrive and ths cause an infection

117
Q

Is bacterial vaginosis a strictly STD related infection?

Microbiology

A

No, it can be due to an alteration (dysbiosis is the enviornment) of any nature

It does increase the risk of STDs though

118
Q

What is bacterial vaginosis?

Microbiology

A

Bacterial infection that is not STDs, caused by imbalance in the maount of bacteria in the vagina

It does not cause dysuria, dyspareunia, pruritus or vulvar inflmmation

119
Q

What are common agents that cause bacterial vaginosis?

Microbiology

A

Gardenerella vaginalis
Prevotella
Mobiluncus
Bacteroides
Peptostreptococcus
Fusobacterium
Veillonella
Eubacterium

120
Q

What is the most common cause of bacterial vaginosis?

Microbiology

A

Gardenella vaginalis

121
Q

What is Gardenella vaginalis like?

Microbiology

A

Gram variabe coccobacilli, faculative anaerobic bacteria that grow on blood and chocolate agar as tint colonies

122
Q

What are the characteristics of normal healthy vaginal discharge?

Microbiology

A

Healthy cervicovaginal mucosa and a small amount of oforless, clear like vaginal discharge

123
Q

What is vagina discharge like in the case of bacterial vaginosis?

Microbiology

A

Heavy, milky, homogenous vaginal discharge with bublles of gaseous by-products of anaerobic bacteria, fishy odor

124
Q

What is the microscopic results of bacterial vaginosis?

Microbiology

A

Vaginal epithelial cells covered by coccobacilli –> a feature of clue cells

125
Q

What infection shows up as yellow-green-gray discharge?

Microbiology

A

Trichomoniasis

126
Q

How is bacterial vaginosis diagnosed?

Microbiology

A

Microscopic examinations (wet mount) of vagina discharge swabs to inspect the presnec of clue cells

Vaginal swabs are also cultred for microbiological investiagations

127
Q

Which criteria are used to classify bacterial vaginosis?

Microbiology

A

Nugent Scoring System
Amsel

128
Q

What are the classifications of the Nugent Scoring System?

Microbiology

A

Lactobacillus morphotypes
Gardenella and Bacteroides morphotypes
Curved gram-variable rods

129
Q

What are the criteria of teh Amsel criteria?

Microbiology

A
  1. Thin, white, yellow, homogeneous discharge
  2. Clue cells
  3. pH of vaginal fluid > 4.5
  4. Release of fishy odor
130
Q

What are the characteristics of vaginal discharge in BV?

Microbiology

A

Grey, homogenous, amine odor

131
Q

What are the characteristics of vaginal discharge in gonorrhea?

Microbiology

A

Greenish yellow, mucopurulent, odorless

132
Q

What are the characeristics of vaginal dischage in chlamydia?

Microbiology

A

Greenish yellow, purulent, odorless

133
Q

What are the characteristsics of vaginal discahrge in Trichomonas?

Microbiology

A

Grayish yellow, purulent, often mixed with bubbles, amine odor

134
Q
A
134
Q

WHat are the characteristics of vagina discahrge in candida?

Microbiology

A

Whitish, cottage cheese-like consistency, odorless

135
Q

WHat are the characteristics of vaginal dischareg in lactobacillus overgrowth?

Microbiology

A

WHite, pasty, odorless

136
Q

What are the characteristics of vaginal discahrge in treponema?

Microbiology

A

Chancre ulcer no discharge

137
Q

What are teh characteristics of vaginal discharge in hemophilus ducreyii?

Microbiology

A

Typica chancroid ulcer, if severe infection vaginal discharge may be observed

138
Q

What is cytolytic vaginosis?

Microbiology

A

The overgrowth of lactobacilli bacteria, resulting in acidity and irritation

139
Q
A
140
Q

What are the signs of cytolytic vaginosis?

Microbiology

A

Moderate to profuse discahrge which is usally white, thick, pastry and odorless
Itching
Burning
Pain
Irritation

141
Q

How is cytolytic vaginosis diagnosed?

Microbiology

A

MIcroscopic examinations

142
Q

What is the treatment for cytolytic vaginosis?

Microbiology

A

Treated with a baking soda rinse solution

143
Q

What is vaginal candidiasis caused by?

Microbiology

A

candida species, mainly Candida albicans

144
Q

What are the symptoms of yeast infection, like the one cause by candida?

Microbiology

A

Fungal infections, irritation, swelling, vaginal itching, and cheesy white vaginal discharge

145
Q

What is herpes simplex virus and specifically genital herpes?

Microbiology

A

STI caused by HSV 1 and 2

146
Q

How is HSV transmitted?

Microbiology

A

Direct contact only

147
Q

What is the incubation period of HSV?

Microbiology

A

About 4 days

148
Q

What are the symptoms of HSV?

Microbiology

A

Itchy, painful vesicles when burst form a painful ulcer

149
Q

What kind of virus is HSV?

Microbiology

A

Enveloped DNA virus taht can stay latent in human host

150
Q

What is HPV?

Microbiology

A

The most common sexually transmitted viral infection in the US

151
Q

What are most HPV infections like?

Microbiology

A

Asymptomatic and resove spontaneously

Can cause skin and pantar warts and geniral warts

152
Q

What kind of virus is HPV?

Microbiology

A

DNA virus from the papillomavirus family

153
Q

Which cancer is associated with HPV?

Microbiology

A

Cervical cancers due to HPV 16 and 18

154
Q

What do the genital warts look like in HPV cases?

Microbiology

A

Small bumps or group of bumps n the genital area, they can be small or large, flat or raised or shaped like a cauliflower

155
Q

What are the common causes of genital warts? (HPV subtypes)

Microbiology

A

HPV 6 and 11

156
Q

What are the common causes of skin warts? (HPV subtypes)

Microbiology

A

HPV 1 and 2

157
Q

Which STIs can be transmitted transplacentally?

Pharmacology

A

Treponema Pallidum

158
Q

Which STIs can be transmitted during delivery from th emother to the child?

Pharmacology

A

N. gonorrhea

159
Q

How are bacterial STDs cured?

Pharmacology

A

Antibiotics treatment is detected eraly enoug

160
Q

What is the general aim of treatment in STDs?

Pharmacology

A

To resolve symptoms and prevent complications and prevent risk of transmission and re-infection

161
Q
A
162
Q

What is different about the treatment of viral vs bacterial STDs?

Pharmacology

A

Vira STDs cannot be cured even if detected early, unlike bacterial, their symptoms can ony be managed

163
Q
A
164
Q

How can we determine effectiveness of a drug?

Pharmacology

A

Monitoring the levels of infection before and after treatment –> drug resistance problems can also be fetected this way

164
Q
A
165
Q

What is Acyclovir?

Pharmacology

A

The prototype of synthetic nucleoside analogs

165
Q

How is HSV infection transmitted?

Pharmacology

A

Seual contact including oral sex or perinatally from mother to child

165
Q

What is the treatment for primary HSV?

Pharmacology

A

Oral antiviral therapy within 72 hours of lesion appearnce –> decrease in duraction and severity of illness by days to weeks and decreases in the risk of complications (like meningitis)

166
Q

What are examples of antiviral agents that can be used to treat primary HSV?

Pharmacology

A
  1. Acyclovir (Zovirax)
  2. Famciclovor (Famvir)
  3. Valacyclovir (Valtrex)
167
Q

Which is the antiviral drug of choice when it comes to treatment of primary HSV?

Pharmacology

A

Acyclovir, becuase it is cheaper

168
Q

What is the MOA of Acyclovir?

Pharmacology

A

Inhibits viral DNA replication by acting as a false substrate for DNA polymerase, DNA poymerase is blocked and thus assembly of DNA stops

169
Q

What is Valacyclovir?

Pharmacology

A

A prodrug of ACV with higher bioavailability (50 to 60%)

170
Q

What is Famciclovir?

Pharmacology

A

A prodrug of penciclovir, bioavailability of 70%
Its active triphosphate form is more stable than that of Acyclovir in HSV-infected cells, longer duration of action

171
Q

WHy is higher bioavailability a feature that we desire in pharamcological treatments?

A

SHortest doasge –> longest duration –> better compliance and less long term risks

172
Q

What changes are made to he dosage if the HSV+ atient is also HIV+?

Pharmacology

A

Dosage has to be higher

173
Q
A
174
Q

WHat are the side effects of Acyclovir?

Pharmacology

A

Quite safe drug

Nausea, vomiting, headache and fatigue

Long term effects of high dosaeg can lead to neurotoxicity (confusion, tremors) and seizures

175
Q

How are antivirals excreted?

Pharmacology

A

Rena excretion so caution in case of renal impairement –> reduction of dosage may be required

176
Q

How can antiviral therapy be optimised through the choice of drug?

Pharmacology

A

For instance in patients with HIV as well as HSV, instead of bi valacyclovir (500 mg) we can give once Famciclovir (1000 mg)

–> Point is trying to find alternatives that allow for better compliance by being taken once daily

177
Q

What happens during the initial phase of infection of Syphillis?

Pharmacology

A

The organism (treponema pallidum) disseminates widely, setting the stage for subsequent manifestations (primary, secondary and tertiary phases)

178
Q

Why is early treatment important is Syphilis infections?

Pharmacology

A

If untreated, syphilis can have a number of significant late manifestations, including cardiovascular, gummatous and neurological

179
Q

What is the drug of choice for syphilis treatment?

Pharmacology

A

Parenterally-delivered Penicillin G for all sages of syphilis, dosage may ony change depending on the stage of syphilis

180
Q

What is Penicillin G?

Pharmacology

A

A beta lactam –> acts as a cell wall inhibitor

181
Q

Who is penicillin therapy effective towards in the treatment of syphilis?

Pharmacology

A

Treating maternal disease, preventing transmission to the fetus and also treating established fetus disease –> in addition to normal patienst suffering from syphilis

182
Q

Which antibiotic types are indicated for the treatment of syphilis in the case the patient is allergic to penicillin?

Pharmacology

A

Tetracyclines (Doxocycine)
3rd generation cephalosporine (Ceftriaxone) –> if allergy is not severe

183
Q

What is the treatement of syphilis in prgenancy?

Pharmacology

A

Desensitize and administer Penicillin G benzthine as a regimen of choice

AVOID Tetracyclines –» teratogenic (affect bone development)

184
Q

What is Benzylpenicllin benzathine?

Pharmacology

A

Combination of penillin G with benzanthine

185
Q
A
186
Q

What is the purpose of benzanthine componenet in benzypenicillin benztahine?

Pharmacology

A

It slowly releases the penicillin making the combination long acting and very effectiev against T. pallidum’s slow growth rate

187
Q

How is Benzypenicillin Benztahine administered?

Pharmacology

A

IM in the buttocks or thigh region

188
Q

WHat is the drug of choice when it comes to the treatment of syphilis?

Pharmacology

A

Benzylpenicillin benzathine as it allows for prolonged antibiotic action (1 IM dose every 2 to 4 weeks)

Also wide therapeutic range –> safe

189
Q

What are the side effects of Penicillin G Benzathine?

Pharmacology

A

Hypersensitivity reactions (rashes to anaphylaxis)
Jarisch Herxheimer reactions

190
Q

What are Jarisch Herxheimer reactions?

Pharmacology

A

An inflmmatory recation to endoroxin-like products rleased by the death of the microorgansm during antibiotic treatment

191
Q

How do Jarisch-Herxheimer reactions manifest?

Pharmacology

A

A few hours after the first dose of antibiotic as fever, chills, hypotension, headache, tachycardia, hyperventilation, vasodialtion, myalgia, exacerbation of skin lesions

192
Q

What are alternative treatment regimens for syphilis?

Pharmacology

A

Doxocycine (tetracycline)
Ceftriaxone (3rd generation cephalosporin)
Amoxicillin & probenecid

193
Q

Why is probenecid given with Amoxicilln in the treatment of syphilis?

Pharmacology

A

It prevents renal excretion of penicllins by competing with the organic transporter in the peritubular capillaries that excretes them from the bood –> longer duration of action and reduced dosing frequency

194
Q

How is neurosyphilis treated?

Pharmacology

A

Neurosyphilis is the ate stage syphilis that has impacted the neurological function

IM Benzathine penicillin is ineffective becuase it does not cross the BBB

Instead iV treatment is preferred

195
Q

Why is IV treatment of neurosyphilis preferred over IM?

Pharmacology

A

The dose of IM benzanthine that is administered for other stages of syphilis does not produce measurabe CSF levels of drug, aqueous IV peniocillin has more chances of passing through the BBB

196
Q

What are the approaches when treating Gonorrhea?

Pharmacology

A

Treatment should :
1. Be highly effective at all anatomic sites of infection
2. Be well tolerated
3. Offer the feasibility of single-dose therapy

The selation of the actual regimen is based on drug resistance and the presence of co-pathogens

197
Q

What are some examples of co-pathogens of Gonorrhea?

Pharmacology

A

Chalmydia
Trachomatis
Mycoplasma genitallum

198
Q

What is the drug of choice for Gonorrhea?

Pharmacology

A

High dose of IM ceftriaxone as a single IM injection of 500mg or 1g (based on weight)

199
Q

What are alternative treatment regimens to Gonorrhea?

Pharmacology

A

Azithromycin plus gentamicin or gemifloxacin

200
Q

When are alternative treatments for Gonorrhea used?

Pharmacology

A

In patients who are severely allergic to cephalosporins

201
Q

Which other STIs is Azithromycin also effective against?

Pharmacology

A

Chlamydia which is a common co-pathogen of Gonorrhea, this way both can be treated

202
Q

What is the goal of treatment when it comes to Chlamydia?

Pharmacology

A

Prevent complicated infections related to Chamydia such as PID, infertility and ectopic pregnancies), decrease the risk of transmission, resolve symptoms and prevent re-infection

203
Q

What is C. trachomatis susceptible to?

Pharmacology

A

Tetracycline
Macrolides
Ony some Fluroquinolones

204
Q

What is the preferred treatment for Chlamydia infections?

Pharmacology

A

Doxocycline for seven days or Delayed release doxocycline which is just as effective and better tolerated

205
Q

What is the alternative treatment for Chamydia?

Pharmacology

A

Azithromycin or Levofloxacin

206
Q

What is treatemennt of Chlamydia like in pregnancy?

Pharmacology

A

Azithromycin or Amoxicillin, no Doxycycline because it is teratogenic

207
Q

Why is treatment of Chlamydia important during pregnancy?

Pharmacology

A

It prevents the transmission to infents during passage through the birth canal

208
Q
A

Reproductive System (4 decks)

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