Bacterial STDs
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| Main reason for infertility in women ? | * PID = from bacteria from an STD
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| Classification Based on STD Symptoms ? | * Mucopurulent discharge - Chlamydia and Gono.
Genital ulcers - Herpes...... Warts - HPV........ Pruritic lesions (mites or lice) - scabies ...... HIV symptoms
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| Neisseria general characteristics ? | * G - Diplococci.... * is fastideous, and grows on a choccolate agar..... * Oxidase + = aerobic ..... * + on CTA
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| Neisseria classification based on a CTA ? | * + glucose growth, and - with special agar, maltose, lactose, and sucrose
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| Clinical presentation ? | * purulent discharge, often asymptomatic so why it spreads, and dysuria
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| Epidemiology of Gono. ? | * increase after Vietnam war, infects more females than males, and 30% are carriers
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| Gono. rates by area/region ? | * higher in the South and Midwest
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| Gonococcal Infections Sx ? | * Urethritis --- Cervicitis --- Proctitis --- Pharyngitis --- Conjunctivitis (ophthalmia neonatarum)---
Epididymitis --- Pelvic inflammatory disease (PID) ---
Arthritis (usu in larger joints)
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| 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)
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| One thing that Gono. does NOT have ? | * A Capsule
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| 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
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| Gono. Immunity ? | * No immunity .... * can get repeat infections
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| 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
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| Gono. Tmt = ? | * Ceftriaxone (3rd generation cephalosporin) plus Azithromycin or Doxycycline is recommended today..... * Use a Combo therapy
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| Gono. Prevention = ? | * safe sex, trace down contacts, treat partners, and screen high risk asymp. pts
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| 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
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| Chlamydia Classification ? | * Chlamydia trachomatis - strains ABC show Trachoma..... *Ones we see the most are strains D-K - nongono. urethritis
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| Chlamydia Pathogenesis ? | * attach to columnar epi cells -- * change from nonreplicating Reticulate bodies to Infectious Elementary Bodies.... * They then Lyse cell and spread Elementary Bodies
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| 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
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| Lab Dx and DOC for ABC = ? | * Demonstation of chlamydial inclusions in conjunctival scrapings by Giemsa stain or DFA stain........ * Azithro. or a topical Tetracycline
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| 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
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| 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
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| 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.
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| Complications of Chlamydia and Gonorrhea Infections ? | * PID, increase infertility, spont. abortions, and ectopic preg.
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| 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.
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| 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
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| 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
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| Vaginitis infectious causes ? | * Bacterial vaginosis
--- Candida vulvovaginosis
--- Trichomoniasis
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| 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
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| 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
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| 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
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| BV transmission ? | * Not sexually transmitted
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| Candida Vulvovaginitis basics ? | * Most common cause of non-bacterial Vaginitis .... * can get with risks such as DM,ABx Use, highe estrogen lvls, and immunosuppression
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| 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
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| Candida Vulvovaginitis DOC ? | * Metronidazle
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| Candida Vulvovaginitis etiology and patho. ? | * mostly from Candida albicans ...... * Pathogenesis – due to overgrowth of Candida → decreased vaginal pH
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| Diagnosing Vaginitis ? | * go in a get a Dx of the specimen... * Gram Stain to see which one is causing this
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| Vaginitis Tmt = ? | * Fluconazole (oral)
-- Miconizole (topical) – Monistat
-- Clotimazole (topical) – Gyne-Lotrimin
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| Trichomoniasis (Trichomonas vaginalis) basics ? | * Malodorous/Bad Odor, frothy discharge associated with burning, itching and chafing.....*
Diffuse vaginal erythema
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| Tricho. Dx and Tmt = ? | * Dx = use a wet mount ....... * DOC: Metronidazle
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| 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
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| Treponema Classification ? | * Treponema pallidum --> Syphilis ..... * these are all non-STDs and seen in endemic areas
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| 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
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| 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
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| 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
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| Primary Syphilis ? | * Usually a single ulcer develops after ~3 weeks.....* painless....* non tmt = 1/2 go on to 2ndary
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| Secondary Syphilis ? | * usu a skin rash, on soles/palms.... * 2/3 develop latent syphilis
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| Tertiary Syphilis ? | * Develops in about 15-20% of latent syphilis cases
....... * Gummas develop in skin or other tissues, characterized by granuloma formation
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| Can cause warts that look like HPV ? | * Condylomata lata (not acuminata) – warts due to Treponema pallidum (secondary syphilis)
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| Syphilis Lab Dx ? | * Treponema pallidum cannot be grown in culture
..... * Direct visualization with a Wet mount - must use dark field microscopy
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| 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
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| Syphilis TmT = ? | * DOC: Benzathine penicillin G
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| Syphilis Prevention ? | * condoms, treat contacts, serology at marriage/pregnancy
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| 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
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| Ectoparasites = ? | * mites/bugs in pubic area ......* Pubic lice (Phthirus pubis)
and Scabies (Sarcoptes scabiei)
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| Ectoparasite CxSx ? | * See itchy, red papules all over the pubic area due to burrowing in the skin..... * can see in between the fingers also
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| 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)
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| ** Look at the Chart in the Lec. for a good summary chart ** |
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