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2 PID Unit > 14 Neisseria gonorrhea & Chlamydia > Flashcards

14 Neisseria gonorrhea & Chlamydia Flashcards

1
Q

What disease is the second most commonly reported infectious disease in the US with >330,000 cases in 2012?

A

Neisseria gonorrhea

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2
Q

What disease is the first most commonly reported infectious disease in the US with 1.4 million cases in 2012?

A

Chlamydia

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3
Q 
What is the mode of transmission for N. gonorrhea?
Environmental
Human-human
Insect-borne
Animal-human
A

Human-human ONLY

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4
Q

What are the hallmark signs of N. gonorrhea?

A

Inflammation and purulent discharge from a mucosal surface

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5
Q

What mucosal surfaces can be involved in a N gonorrhea infection?

A

throat, anal, eyes of infants, male urethra, female cervix mucosa

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6
Q

What are the sx of gonorrhea urethritis in males?

Does the male seek treatment?

A

extensive urethral discharge
dysuria
rare complications
Yes, infected male seeks treatment 2-5 days after the sexual encounter

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7
Q

What are the sx of gonorrhea infection in females (gonorrheal cervicitis)?

A 
generally none - if symptoms, variable
Possibly:
abdominal pain
cervical discharge
dysuria
intermenstrual bleeding
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8
Q

What is the chance of an uninfected female engaging in genital sex with an infected male becoming infected?

A

50-73%

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9
Q

What is the chance of an uninfected male engaging in genital sex with an infected female becoming infected?

A

20%

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10
Q

Which portion(s) of the female reproductive tract are initially infected with N. gonorrhea?

A

Only the cervix (columnar epithelial cells)

Not the vaginal mucosa

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11
Q

What is the danger of untreated gonorrhea & Chlamydia in females?
Gonorrhea: What percentage of infected, untreated females have complications?

A

It ascends into the uterus and fallopian tubes (salpingitis)
PID (pelvic inflammatory disease), possibly causing fallopian tube scarring and/or persistent pelvic pain
10-20%

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12
Q

Define salpingitis:

A

inflammation of the fallopian tubes

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13
Q

What are the potential complications of damaged fallopian tubes?

A

infertility & ectopic pregnancy

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14
Q

What can happen if N. gonorrhea enters the blood stream? (systemic infection complications)

A

septic arthritis - fever, migratory arthralgiaas, reddened pustular lesions on extremities, petechiae
gonococcal meningitis
endocarditis

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15
Q

What is the most common cause of infectious arthritis in sexually active adults?

A

Septic arthritis caused by N. gonorrhea

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16
Q

Who is more susceptible to systemic complications of N. gonorrhea?

A

females

patients with late complement protein deficiencies

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17
Q

Define ophthalmia neonaturum:

When does it develop?

A

Purulent conjunctivitis leading to blindness if untreated

Develops 5 days after vaginal birth to a gonococcal-infected mother

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18
Q

What is the prophylaxis treatment for ophthalmia neonaturum?

When is it given?

A

Eye drops of erythromycin/neomycin administered within minutes after birth

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19
Q

What is happening during much of the incubation period for N. gonorrhea? How is it getting into the body? Where does it replicate?

A

Pili and other proteins allow them to adhere to non-ciliated epithelium
They trick epithelial cells to take them up into intracellular vesicles and then exit out the basolateral surface
Bacteria replicate in the sub-epithelial space

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20
Q

Bacteria replicating in the sub-epithelial space elicit what response? To what part of the bacterium?

A

They elicit a characteristically exuberant PMN response in response to LOS

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21
Q

What 5 virulence factors does N. gonorrhea use to survive PMN killin?

A
  • Opa (opacity protein) mediates firm attachment to epithelial cells and invasion into cells
  • Outer membrane porin (Por) prevents phagolysosome fusion following phagocytosis -> promoting intracellular survival
  • Rmp is an outer membrane protein that blocks bactericidal antibodies directed against Por and LOS
  • Other surface features block or cleave antibodies
  • Iron binding systems steal iron from lactoferrin, transferrin, and hemoglobin to overcome host’s nutritional immunity
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22
Q

If untreated, how long will N. gonorrhea infections persist?

A

months even after antibody titers reach high levels

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23
Q

How can N. gonorrhea persist for months even with high antibody titers?

A

Antigenic diversity: has numerous strategies for hypervariability of surface proteins (e.g. 1 in 100-10,000 bacteria make a novel pilin variant -> keeps gc ahead of immune system)

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24
Q

How is gonorrhea diagnosed in symptomatic males?

A

G- dipplococci observed in purulent discharge from the urethra (Gram stain)
can plate on chocolate agar for culture

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25
Q

How is gonorrhea diagnosed in females?

A

Because of complex vaginal flora, requires more than Gram stain
Streak cervical specimen onto Thayer-Martin agar (chocolate agar + antibiotics that select against normal vaginal flora) & plain chocolate agar
Diagnosis made by culture of bacteria on selective media

26
Q

What is the alternative lab procedure for diagnosis of gonorrhea in males or females?

A

PCR assay that identifies gc-specific DNA

27
Q

What are the pros/cons of PCR DNA assay over culture for gonorrhea diagnosis?

A

DNA assay faster than culture
DNA assay less invasive because can be conducted from urine specimen
DNA assay able to avoid fragile gc dying during specimen transport
Downside: DNA assay has no antibiotic sensitivity determinations; culture does

28
Q

Gonorrhea treatment?

A

Penicillin no longer effective because of beta-lactamase prevalence in last 30 years
Cephalosporins (ceftriaxone - 3rd gen broad spectrum) is effective

29
Q

If gonorrhea is diagnosed and removed but the symptoms remain, what is likely the problem?

A

there was an underlying Chlamydia problem that goes undiagnosed until the gonorrhea is removed. If not treated quickly, complications can arise

30
Q

What is the antibiotic treatment of a Chalmydia infection?

A

If Chlamydia trachomatis has not been ruled out, azithromycin or doxyxycyclin is also used

31
Q

What are 4 options for gonorrhea prevention?

A

No vaccine - hypermutable surface antigens
Barrier contraception - condoms + nonoxynol-9 containing spermicide
Abstinence
Wholly monogamous relationships

32
Q

What are the lab characteristics of Chlamydia?

A

obligate intracellular parasite

non-motile G- bacteria

33
Q

Being an intracellular parasite, Chlamydia relies on host machinery for what metabolism?

A

Rely on host enzymes to provide many amino acids and other building blocks
STEAL ATP from the host cell

34
Q

What is present on the outer membrane of human-specific Chlamydia?

A

LPS and lipid A but very little to no peptidoglycan

35
Q

What is the name for the active replicating form in the Chlamydia life cycle?

A

Reticulate body (RB)

36
Q

What is the name for the inactive, non-replicating infectious form of Chlamydia?

A

Elementary body (EB)

37
Q

Does Chlamydia cause acute or chronic infections?

A

both :)

38
Q

Which is resistant to harsh conditions?
reticulate body
elementary body

A

elementary body

39
Q

Which of these species are in the genus Chlamydia and which are in Chlamydophilia?
C. trachomatis
C. psittaci
C. pneumoniae

A

Chlamydia trachomatis
Chlamydophilia psittaci
Chlamydophilia pneumoniae

40
Q

Which is responsible for STDs, conjunctivitis, lymphogranuloma venereum, trachoma, infant pneumonia?
C. trachomatis
C. psittaci
C. pneumoniae

A

C. trachomatis

41
Q

Which is responsible for bronchitis, sinusitis, and primary atypical pneumonia syndrome while also being linked to atherosclerosis?
C. trachomatis
C. psittaci
C. pneumoniae

A

C. pneumoniae

42
Q

Which is responsible for severe influenza-like disease from psittacine birds (ornithosis or parrot fever)?
C. trachomatis
C. psittaci
C. pneumoniae

A

C. psittaci

43
Q

What is the most common bacterial sexually transmitted infection in the US and the most common cause of preventable blindness in the world?

A

C. trachomatis

44
Q

What infections are at peak incidence at ages 18-24?

A

gonorrhea & Chlamydia trachomatis

45
Q

What Chlamydia trachomatis serovars cause STDs?

A

D-K

46
Q

What is the diagnosis of nongonococcal urethritis in men? How often is it asymptomatic?

A

lack of pink diplococcic in Gram stain of exudate

Asymptomatic in at least 1/3 of males

47
Q

How does postgonococcal urethritis develop? When?

A

In men who are treated with antibiotics for diagnosed gonorrheal urethritis
2-3 weeks post-treatment of gonorrhea, Chlamydia becomes evident

48
Q

What signs/symptoms are present in mucopurulent cervicitis?

What is the complication if left unchecked?

A

No obvious symptoms
Careful speculum exam shows yellow mucopurulent discharge in 30-50% cases
Can progress to PID

49
Q

What bacterium can cause urethral infections in sexually active women, epididymitis, Reiter’s syndrome?

A

Chlamydia trachomatis

50
Q

What is epididymitis?

A

Unilateral scrotal pain, fever, epididymal tenderness or swelling
Most common local complication of Chlamydia trachomatis infection

51
Q

What is Reiter’s syndrome?

A

immune mediated disease: 3 combined conditions:

  • urethritis
  • arthritis
  • conjunctivitis
52
Q

What infection is found in newborns delivered vaginally by C. trachomatis-infected mothers?

A

conjunctivitis or TRIC (trachoma inclusion conjunctivitis) - profuse mucopurulent discharge
followed by neonatal afebrile pneumonia

53
Q

How is adult inclusion conjunctivitis contracted by adults? Severity?

A

transmitted thru hand-to-eye spread of infected genital secretions (Chlamydia trachomatis)
rarely leads to blindness (milder than trachoma)

54
Q

Define lymphogranuloma venereum:

A

rare disease in US
transient, painless papule or vesicle on any part of genitals; may rarely ulcerate. painful, multiocular suppurative lymphadenopathy, fever, headaches, conjunctivitis, skin rashes, nausea vomiting

55
Q

What is the treatment for Chlamydia trachomatis infection?

A

little protective immunity
no acquired antibiotic resistance
most infections treated with tetracycline/doxycycline or macrolides (erythromycin for neonatal infections or azithromycin)

56
Q

What are the recommendations on intercourse while treating C. trachomatis?

A

treatment of sexual partner key

abstain from intercourse for 7 days after therapy has begun

57
Q

What is the SAFE strategy?

A

Surgery for deformed eyelids, Azithromycin; Face washing and Environmental improvements
Blindness prevention public health effort

58
Q

Chlamydophila pneumonia diagnosis:

treatment?

A

difficult, tissue culture not routinely used
retrospective diagnosis
treatment: tetracycline or erythromycin

59
Q

Who are most at risk for a C. psittaci infection?

Mode of transmission

A

people who work with birds or at a poultry slaughter house

Generally acquired from birds via respiratory route

60
Q

Psittacosis is:

A

pneumonia with systemic manifestations (fever, headache, etc); spread to liver, spleen, heart, kidney

2 PID Unit (13 decks)

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