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GU pathogens


Normal GU flora (women) Lactobacilli (most predominant); Staph. spp. (mostly coag neg); Strep. spp. (mostly Group B); Gardnerella vaginalis, Mycoplasma, Ureaplasma, Enterobacteriaceae; many anaerobes (Bacteroides, Clostridium, Peptostreptococcus)
Anaerobic bac normal GU flora (women) Bacteroides, Clostridium, Peptostreptococcus
most predominant normal GU flora (women) Lactobacilli
Affects female GU microbial population Microbial population under hormonal influence
Viral Genital Syndromes/Etiologic Agents HPV (genital warts / cervical dysplasia); HSV; HIV; Hepatitis B, C, D
Causes genital warts (Condyloma acuminatum)/cervical dysplasia HPV
Genital Herpes HSV Type 1 or 2 (used to by Type 2)
Effect of HSV-1 on HSV-2 Prior HSV-1 infxn blunts response to HSV-2
Can be transmitted on fomites; asymptomatic shedding important in dz transmission HPV
Non-gonoccocal urethritis (NGU) and cervicitis: Chlamydia trachomatis (50%); Mycoplasma hominis ; Ureaplasma; Trichomonas; Mycoplasma genitalium
main reservoir for infection: asymptomatic women Gonorrhea
infection in males usually limited to urethra Gonorrhea
present with dysuria ± penile discharge Gonorrhea
epididymitis & prostatitis rare complications Gonorrhea
primary site of infection in females is cervix Gonorrhea
If gonorrhea untreated can result in: ascending genital infection
1-3% of untreated women can develop disseminated disease Gonorrhea
penile discharge or dysuria: watery = (1); thicker = (2) (1) chlamydia; 2) gonorrhea
Nongenital gonorrhea infections Pharyngitis, neonatal conjunctivitis
Incidence of NGU cf to gono urethritis NGU twice as common (but mixed infxns can occur)
Most common bacterial STD C. trachomatis
Near epidemic in sexually active teenagers C. trachomatis
Alters vaginal normal flora → complex, ascending polymicrobial genital infections C. trachomatis
Disseminated gonococcal infection (arthritis, dermatitis) N. gonorrhoeae
Causes of bacterial vaginitis: Polymicrobic: G. vaginalis, Mobiluncus, non-Fragilis Bacteroides, Actinomyces
Cause of Chancroid Haemophilus ducreyi
Cause of Lymphogranuloma inguinale Chlamydia trachomatis (serovars)
Cause of Syphilis Treponema pallidum
Epididymitis/Prostatitis in males < 35 yrs.: C. trachomatis +/- N. gonorrhoeae
Epididymitis/Prostatitis in males > 35 yrs.: Enterobacteriaceae
Proctitis (anal receptive intercourse): C. trachomatis, N. gonorrhoeae
Characterize Treponema pallidum Organism is extremely labile; humans only host; not highly contagious
Treponema pallidum transmission dz transmitted by sexual contact, congenitally, or by transfusion
Primary syphilis characteristic (PAINLESS) chancre develops @ site of inoculation
Secondary syphilis flu-like symptoms followed by diffuse rash
tertiary syphilis any organ, rare now; CNS manifestations, gummas
confirmatory FTA for syphilis Always remains positive
"Imitator" diseases TB, Lyme, syphilis
Rare (in developed countries) STD characterized by PAINFUL, irregular genital ulcers Chancroid
Superficial exudate: yellow or necrotic, foul-smelling Chancroid
Dz also characterized by markedly, swollen painful inguinal nodes known as buboes Chancroid
Transmission strictly by sexual contact Chancroid
Chancroid prevalence Few hundred cases annually in US
School of fish pattern on microscopy Haemophilus ducreyi (chancroid)
Ulcerative STD, very rare in US, caused by a serovar of C. trachomatis (CT) Lymphogranuloma venereum
How does Lymphogranuloma venereum vary from other infxns caused by CT? LG affects lymphatic, not mucosal, tissue
primary LG ulcerative
secondary LG papular lesions; systemic symptoms
tertiary LG extensive scarring, chronic lymphatic obstruction, genital elephantiasis
Buboes may be present Chancroid (H ducreyi); Lymphogranuloma venereum
very rare (in US) genital ulcerative disease; very long incubation period Granuloma inguinale (Donovanosis)
Endemic in warmer climates: South America, Caribbean, southern Africa Granuloma inguinale (Donovanosis)
Etiologic agent of Granuloma inguinale (Donovanosis) Klebsiella granulomatis
Granuloma inguinale (Donovanosis) = unusual member of: the Enterobacteriaceae
Limit to growth of Granuloma inguinale (Donovanosis) Cannot be grown outside of cell
very small, pleiomorphic rod seen in clinical specimens in cytoplasm of neutrophils, macrophages Granuloma inguinale (Donovanosis)
disease acquired by sexual contact or trauma to genital area Granuloma inguinale (Donovanosis)
Trichomonas vaginitis: considered STD? Yes
Vaginitis etiology Can be bacterial, parasitic (urogenital protozoan) or fungal
Bacterial vaginitis (BV) results from: disruption of normal vaginal flora; clue cells seen on saline wet prep, Gardnerella, Mobilicus implicated
yeast vaginitis usually caused by: Candida spp
Yeast or bac vaginitis may be triggered by: postmenses (may see s/s more then)
Vaginitis: must tx partners if caused by: Trichomonas (b/c it's an STD)
non-specific inflammation of the penis Balanitis
Etiology of Balanitis Candida spp; HPV; T. pallidum; Gardnerella spp; Group A, Group B strep; etiologic agent often age-associated
Prototypical causative spp of Vaginitis/Balanitis Candida albicans
Other Candida spp that can cause Vaginitis/Balanitis Candida tropicalis, pseudotropicalis, krusei, glabrata (may be associated with resistance) = opportunistic infections
Tx for Candida Vaginitis/Balanitis Azoles, nystatin; topical or P.O
GU Parasitic Agents T. vaginalis (Trichomoniasis); Phthirus pubis (pubic lice); Sarcoptes scabei (Scabies)
flagellated protozoa that exists in trophozoite form only Trichomonas
Common Trichomoniasis S/S Infxn in men and women often asymptomatic
Transmission of Trichomonas Asymptomatic men reservoir for infxn; fomites rarely serve as means of transmission
Normal urinary tract flora Only anterior urethra
Normal urinary tract flora Only anterior urethra
Viral urinary syndromes: None
transient urinary tract colonizers: Enterobacteriaceae, Candida, Enterococcus
Acute cystitis (“lower” UTI): E. coli ( uropathic strain, approx. 80%); Staph. Saprophyticus; Enterococcus spp.; Enterobacteriaceae (Klebsiella, Proteus, Serratia, Providencia)
Pyelonephritis (“upper”) agents: Same as lower (cystitis)
Indigenous urinary tract colonizers: Lactobacillus, Corynebacterium, coagulase negative Staph.
#1 cause of UTIs (community & nosocomial) E. coli (uropathic strain)
infecting strains of E coli originate from: GI tract
Tx for E coli UTI SMZ/TMP is DOC; resistance emerging (in community = 11-12%); other common tx is macrobid/macrodantin
?? at increased risk of E coli infxn due to ?? women, due to short urethra
E coli UTI transmission via: fecal contamination of urethra or catheter use (hospitalized patients
Urinary GPC in clusters Staph sapro
Common in healthy young sexually active women; normal flora in skin of GU tract; poor hygiene plays role in infection Staph sapro
Urosepsis in older pts E coli
Staph sapro virulence factors: multiple antibiotic resistance; hemagglutinin; ? urease
Tx for Staph sapro Septra & cipro cover it; Macrodantin doesn’t cover it
Cutaneous, mucosal and anogenital syndromes HPV
GU viral pathogen; >100 types: HPV
HPV types 6 & 11 Associated with genital warts
HPV types 16 &18 Associated with cervical dysplasia
virus capable of oncogenic transformation HPV
Created by: Abarnard



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