STI's
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| Neisseria gonorrhoae | GN diplococci, kidney bean shaped, aerobic, oxidase+, pili, OMPs (Opa or Protein II) surf strx change antigenically, short chain LPS called LOS/Thayer-Martin/Martin-Lewis Selective Media/Chocolate, requires CO2 | Pain & purulent dischrge at infected site (urethritis, men/endocervix, wom->PID); highest in wom 15-19; men 20-24; asympt (esp wom); most men have acute symptoms; attack rate 20-50%; rarely spreads (prostate/epidy & fallop); DGI (migrating polyarth/rash) | lack of immunity (LOS and Opa proteins) | GRAM(GN diplococci bean shaped in PMNs, more sens in men; other bact in wom complicate); CULT(urethral-men/cervical swab-wom); NOTIFY LAB (ML-TM agar), oxidase +; DIRECT:DNA amplification (expensive) | THIRD GENERATION CEPHALOSPORINS (ceftriaxone); CIPRO (dev resistance); AZITHROMYCIN (both gon/chlym); Doxycycline (oral 7 days); silver nitrate/erythromycin eye drops for neonates; vaccine development difficult bc of pili antigen variations | PID (ectopic preg/sterility); opthalmia neonatorum; metastatic infections can lead to endocarditis/meningitis/purulent arthritis
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| Chalmydia trachomatis | obligate intracellular parasite, trilaminar OM, decr peptido, can't synth ATP (like Rickettsiae), complex life cycle (extracellular metab inactive infectious EB-->met active intracellular RB); EB-->RB intracellularly=cell death; infects columnar epi cells | most common STI; most common cuase of NGU (Ureapl urea 2nd); tropism for epithelial cells of endocervix, upper GU (wom), urethra, rectum, conjunctiva; causes PMN and inflamm response, chronic sequelae | no reliable protection, | All tests req collection of Epi cells, clean away inflamm cells;CULT rarely done, SEROL (common antigen false pos)IMMUN (only endocervix,urethra approved) no LGV or PID or DNA probes, PCR (urine) | Erythromycin, Tetracycline, Quinolones (cipro/levo); Inclusion Conjunctivitis (neonates) req systemic Erythromycin thereapy bc of possible colonization; NO B-lactams (??post gonococcal urethritis) | Ocular trachoma (CHRONIC follicular keratoconjunctivitis--incr vascularization and scarring of cornea, opaque blindness); transmitted fomites, flies, fluids) genital infection; most common in neonatal conjunctivitis (inclusion conjunctivits--ACUTE);PID
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| Lymphogranuloma venereum | caused by Chlamydia trachomatis strains L1, L2, L3 | transient genital lesions followed by multilocular suppurative involvement of the inguinal lymph nodes, primary genital lesion painless/unnoticed; painful inguinal adenopathy primary complaint | fevers, chills, HA, arthralgia, and myalgias common, can lead to anal strictures or hemorrhagic proctitis | culture the bubo? can't use immunologic bc only okayed for endocervix and urethral secretions | Lymphnodes may need to be aspirated to prevent rupture; | hemorrhagic proctitis, anal strictures
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| Haemophilus ducreyi | Chancroid; GNR, coccobacillary, require blood media (chocolate agar), smallest bacteria, polysaccharide capsule, require exogenous hematin/NAD (factors X and V) | common ds in developing countries, tender papule-->painful ulcer with sharp margin, satelite lesions are autoinfectious, regional lymphadenitis (unilat/bilat inguinal lympad), 1 lesion, rough edge, bigger than HSV, prostitutes, "soft chancre", short incub | no immunity due to CYTOLETHAL DISTENDING TOXIN which kills T cells, and ADHESIVE PILI that resist phagocytosis and complement mediated killing | gram stain and culture (hard to recover)--coccobacillary, railroad track appearance, CULTURE | ceftriaxone, azithromycin, cipro (almost all strains produce Beta Lactamase) | Chancroid, increased risk for HIV (CD4 recruitment, open lesion)
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| Treponema pallidum | grows slowly, dry dying, | (blank) | (blank) | Darkfield Microscropy, Immunoflourescence, Silver Impregnation (Warthin-Starry Stain) | (blank) | ruptured aortic aneurysm, dimentia
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