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Bacterial STDs

Main reason for infertility in women ? * PID = from bacteria from an STD
Classification Based on STD Symptoms ? * Mucopurulent discharge - Chlamydia and Gono. Genital ulcers - Herpes...... Warts - HPV........ Pruritic lesions (mites or lice) - scabies ...... HIV symptoms
Neisseria general characteristics ? * G - Diplococci.... * is fastideous, and grows on a choccolate agar..... * Oxidase + = aerobic ..... * + on CTA
Neisseria classification based on a CTA ? * + glucose growth, and - with special agar, maltose, lactose, and sucrose
Clinical presentation ? * purulent discharge, often asymptomatic so why it spreads, and dysuria
Epidemiology of Gono. ? * increase after Vietnam war, infects more females than males, and 30% are carriers
Gono. rates by area/region ? * higher in the South and Midwest
Gonococcal Infections Sx ? * Urethritis --- Cervicitis --- Proctitis --- Pharyngitis --- Conjunctivitis (ophthalmia neonatarum)--- Epididymitis --- Pelvic inflammatory disease (PID) --- Arthritis (usu in larger joints)
Gono. Virulence factors ? * Have Pili to attach .... * antigenic variations among the pili (lots of different pili types, so hard to get rid of naturally).... * Lipooligosaccharide (LOS) ...* have slip strain mispairing among OMP (outer mem. proteins)
One thing that Gono. does NOT have ? * A Capsule
Gono. Pathogenesis ? * get from sexual contact, and attaches due to their pili..... * invades nonciliated columnar epi mucus membranes and cause discharge.... * can spread in Bd to get arthritis..... * Damage due to inflam response
Gono. Immunity ? * No immunity .... * can get repeat infections
Lab Diagnosis of Gono ? * swab from cervix or urethra... * Don't refrigerate... * Make Gram Stains - men show G- with diplococci, women need to be confirmed with culture
Gono. Tmt = ? * Ceftriaxone (3rd generation cephalosporin) plus Azithromycin or Doxycycline is recommended today..... * Use a Combo therapy
Gono. Prevention = ? * safe sex, trace down contacts, treat partners, and screen high risk asymp. pts
Chlamydia basics ? * see numerous neutrophils but no evidence of Gram-negative diplococci..... * Obligate intracellular parasites - unable to make ATP ....* Two Types: Elementary body: infectious -- Reticulate body: noninfectious
Chlamydia Classification ? * Chlamydia trachomatis - strains ABC show Trachoma..... *Ones we see the most are strains D-K - nongono. urethritis
Chlamydia Pathogenesis ? * attach to columnar epi cells -- * change from nonreplicating Reticulate bodies to Infectious Elementary Bodies.... * They then Lyse cell and spread Elementary Bodies
Diseases of C. trachomatis (A, B, & C) Blinding Trachoma ? * See Chronic keratoconjunctivitis develops if untreated can progress to conjunctival and corneal scarring and eventual blindness... * eye lashes are trapped under eye lid.... * spread p to p by fomites, and seen usually in Africas and Mid. East
Lab Dx and DOC for ABC = ? * Demonstation of chlamydial inclusions in conjunctival scrapings by Giemsa stain or DFA stain........ * Azithro. or a topical Tetracycline
Diseases of C. trachomatis (D-K) ? * Most common reportable sexually transmitted disease in US..... * Males: urethritis ..... *Females: mucopurulent cervicitis, salpingitis, and pelvic inflammatory disease ..... * Neonate: inclusion conjunctivitis and pneumonia
Chlamydia Epidemiology ? * 1 in 10 men have it, effects women more than men, women also more asymptomatic than in men, and has been steadily increasing..... * Regions: top in South and Midwest
Chlamydia and Dx and DOC ? * Direct antigen testing by EIA or ELISA..... * top today = Nucleic acid amplification test (Gen-Probe Aptima 2) ..... * Doxy or Azithro.
Complications of Chlamydia and Gonorrhea Infections ? * PID, increase infertility, spont. abortions, and ectopic preg.
Why teen girls are though to have a greater risk of infection ? * Columnar epithelial cells from the endocervix are present on the ectocervix. Both gonorrhea and chlamydia preferentially infect these cells.
Diseases of C. trachomatis (L1, L2, and L3) ? * Get Lymphogranuloma venereum ..... * see in africas and caribbean..... * form an ulcer on the genitalia and see lymph node blockage
Vaginitis basics ? * Vaginal discharge and the associated vulvar itching are the most common reasons for a woman to seek gynecological care...... * See odor, itching, discharge, discomfort
Vaginitis infectious causes ? * Bacterial vaginosis --- Candida vulvovaginosis --- Trichomoniasis
Vaginitis Lab Dx ? * based on analysis of vaginal discharge, pH shift above 4..... * KOH Test - to see if Candida and see a fishy odor produced
Bacterial Vaginosis (BV): Diagnostic Criteria ? * ph: above 4.5..... * thin vaginal discharge.... * release of fishy odor with KOH.... * see Clue Cells (tiny gram - dicplococci) different than normal Gram + normal flora
Etiologic agents of BV ? * defined as a disruption of the ecology of the vaginal microflora and characterized by a shift in microbial species from Lactobacillus species to Gardnerella vaginalis and anaerobic Gram -commensals
BV transmission ? * Not sexually transmitted
Candida Vulvovaginitis basics ? * Most common cause of non-bacterial Vaginitis .... * can get with risks such as DM,ABx Use, highe estrogen lvls, and immunosuppression
Candida Vulvovaginitis Cx presentation ? * Vulvar pruritis, dysuria, Erythema of vulva and vag mucosa -- Edema of vulva -- May be little or no discharge -- Discharge when present is white, thick, adherent, & clumpy (curd-like) -- Little or no odor.....* Basically looks like vag thrush
Candida Vulvovaginitis DOC ? * Metronidazle
Candida Vulvovaginitis etiology and patho. ? * mostly from Candida albicans ...... * Pathogenesis – due to overgrowth of Candida → decreased vaginal pH
Diagnosing Vaginitis ? * go in a get a Dx of the specimen... * Gram Stain to see which one is causing this
Vaginitis Tmt = ? * Fluconazole (oral) -- Miconizole (topical) – Monistat -- Clotimazole (topical) – Gyne-Lotrimin
Trichomoniasis (Trichomonas vaginalis) basics ? * Malodorous/Bad Odor, frothy discharge associated with burning, itching and chafing.....* Diffuse vaginal erythema
Tricho. Dx and Tmt = ? * Dx = use a wet mount ....... * DOC: Metronidazle
Treponema General Characteristics ? (2ndary syph.) * very thin G - rods that contain flagella at polar ends inside the membrane, and move by rotary/spinning... * have to see it in a dark field....* lack endotoxin
Treponema Classification ? * Treponema pallidum --> Syphilis ..... * these are all non-STDs and seen in endemic areas
Syphilis basics ? * classically STD, and even from mother to fetus..... * usu presents as single, non-painful genital ulcer (primary)..... * has several stages to ...* 2ndary = skin rash satge
Syphilis Epidemiology ? * pretty low, but have seen a small increase due to homosexual sex in US..... * low incidence in WV, and high in South.....* One that we see More MALES infected for once, and in Af. Americans
Syphilis Staging ? * primary exposure from another infected individual....* they multiply and cause and ulceration, and we get healing...* some after healing stops there forever....* Secondary = Skin lesions/rash.....* Tertiary = hypersens. RxN see Gumas and CNS involvement
Primary Syphilis ? * Usually a single ulcer develops after ~3 weeks.....* painless....* non tmt = 1/2 go on to 2ndary
Secondary Syphilis ? * usu a skin rash, on soles/palms.... * 2/3 develop latent syphilis
Tertiary Syphilis ? * Develops in about 15-20% of latent syphilis cases ....... * Gummas develop in skin or other tissues, characterized by granuloma formation
Can cause warts that look like HPV ? * Condylomata lata (not acuminata) – warts due to Treponema pallidum (secondary syphilis)
Syphilis Lab Dx ? * Treponema pallidum cannot be grown in culture ..... * Direct visualization with a Wet mount - must use dark field microscopy
Syphilis Serology ? * Serology – NONSPECIFIC = Wasserman antibody reacts on a RPR and VDRL Tests...... * If + tests , have to do a SPECIFIC Test to confirm = Fluorescent Treponemal Antibody (FTA) test
Syphilis TmT = ? * DOC: Benzathine penicillin G
Syphilis Prevention ? * condoms, treat contacts, serology at marriage/pregnancy
Chancroid (Haemophilus ducreyi) * soft sore, tends to bleed easily..... * Lab Dx: "School of fish look" and gram Staining that needs a special media ...... * See in Africas and Caribbeans, so look for travel Hx
Ectoparasites = ? * mites/bugs in pubic area ......* Pubic lice (Phthirus pubis) and Scabies (Sarcoptes scabiei)
Ectoparasite CxSx ? * See itchy, red papules all over the pubic area due to burrowing in the skin..... * can see in between the fingers also
Ectoparasite Dx = ? * Examine hair for nits/adult bugs for crabs ....* Scrappings + KOH Wet Mount for scabies (allows to dissolve cellular debry to see the bugs)
** Look at the Chart in the Lec. for a good summary chart **
Created by: thamrick800