175: Gonorrhea, Mycoplasma and Vaginosis Flashcards
(199 cards)
1
Q
What is the most common reported STD in the US and its significance in women?
A
Chlamydia is currently the most common reported STD in the US and the most common cause of Pelvic Inflammatory Disease (PID) in women.
2
Q
What is the primary bacterium responsible for gonorrhea and its characteristics?
A
Neisseria gonorrhoeae is a gram-negative, aerobic, coccus-shaped bacterium found in pairs and visualized intracellularly within polymorphonuclear leukocytes.
3
Q
What are the major risk factors for acquiring gonococcal infection?
A
The major risk factors for acquiring gonococcal infection include:
1. New or multiple sex partners
2. Younger age
3. Unmarried status
4. Commercial sex work
5. Minority ethnicity (African Americans)
6. Substance and alcohol abuse
7. Inconsistent condom use
8. Any previous STD infection
4
Q
What is the incubation period for gonorrhea in men and the common symptoms?
A
The incubation period for gonorrhea in men is 2-8 days, and most infections are symptomatic by 2 weeks of exposure. The most common manifestation is urethritis, characterized by spontaneous, profuse, cloudy, or purulent discharge from the penile meatus.
5
Q
What percentage of women with gonorrhea are asymptomatic and what is the common site of local infection?
A
Approximately 50% of women with gonorrhea are asymptomatic. The common site of local infection is the endocervix, with Bartholin and Skene glands also being involved.
6
Q
What is the primary site of attachment for Neisseria gonorrhoeae in the human body?
A
The primary site of attachment for Neisseria gonorrhoeae is the mucosal cells of the male and female urogenital tract.
7
Q
What is the significance of early and appropriate antimicrobial therapy for STDs?
A
Early and appropriate antimicrobial therapy for STDs results in a good prognosis, reducing the risk of complications and further transmission.
8
Q
What are the clinical implications of high-risk patients often having coinfection with multiple STDs?
A
High-risk patients with coinfection of multiple STDs may experience more severe symptoms, increased risk of complications, and a higher likelihood of transmission to others, necessitating comprehensive screening and treatment.
9
Q
What is the role of pili and fimbriae in the pathogenesis of Neisseria gonorrhoeae?
A
Pili and fimbriae facilitate the bacterial attachment to columnar epithelial cells, which is crucial for the colonization and infection process of Neisseria gonorrhoeae.
10
Q
How does the epidemiology of gonorrhea in the US reflect on the demographics of affected individuals?
A
The epidemiology of gonorrhea shows that the highest rates of gonococcal infections are among sexually active teenagers and young adults aged 15 to 24 years, indicating a need for targeted prevention and education efforts in this demographic.
11
Q
What diagnostic methods are used for gonorrhea and other STDs?
A
Diagnostic methods for gonorrhea and other STDs include direct microscopy, culture, and newer diagnostic methods such as nucleic acid amplification tests.
12
Q
What is the significance of recidivism in the context of gonorrhea infections?
A
Recidivism, or the recurrence of gonorrhea infections, is an important risk factor for acquiring new gonococcal infections, highlighting the need for effective treatment and prevention strategies to reduce reinfection rates.
13
Q
What are the common symptoms of urethritis caused by N. Gonorrhoeae?
A
Common symptoms include:
- Mucopurulent discharge
- Vaginal pruritus
- Dysuria
Vaginitis does not occur in sexually mature women except in prepubertal and postmenopausal cases.
14
Q
What are the symptoms of proctitis associated with gonorrhea, particularly in MSM?
A
Symptoms of proctitis include:
1. Rectal mucopurulent discharge
2. Pain on defecation
3. Constipation
4. Tenesmus
MSM are at higher risk due to damaged anorectal epithelial integrity and local recruitment of HIV target cell types.
15
Q
What is the classic triad of symptoms associated with disseminated gonococcal infection (gonococcemia)?
A
The classic triad of symptoms includes:
1. Dermatitis
2. Migratory polyarthritis
3. Tenosynovitis
The condition occurs in 0.5% to 3% of cases.
16
Q
What are the key characteristics of Pelvic Inflammatory Disease (PID) in women with gonorrhea?
A
PID is characterized by:
1. Fever
2. Lower abdominal pain
3. Back pain
4. Vomiting
5. Vaginal bleeding
6. Dyspareunia
7. Adnexal or cervical tenderness during pelvic examination
Sequela of untreated infection includes:
1. Tubo-ovarian abscesses
2. Ectopic pregnancies (PERMANENT)
3. Chronic pelvic pain
4. Infertility (PERMANENT)
17
Q
What is Fitz Hugh Curtis syndrome and its association with PID?
A
Fitz Hugh Curtis syndrome is inflammation of the liver capsule associated with genitourinary tract infection. It presents in up to ¼ of women with PID caused by either N. gonorrhoeae or C. trachomatis, with symptoms including:
1. RUQ pain
2. RUQ tenderness
3. Abnormal liver function tests (LFTs)
Differential Diagnosis: Acute viral hepatitis.
18
Q
What are the symptoms of pharyngitis related to gonorrhea?
A
Symptoms of pharyngitis can range from:
- Cervical lymphadenopathy
- Mild to moderate pharyngeal erythema
- Severe ulceration with pseudomembrane formation
19
Q
What are the clinical features of tenosynovitis in the context of gonorrhea?
A
Clinical features of tenosynovitis include:
- Pain and swelling of the synovium or fluid-filled capsule surrounding a tendon
- Involvement of single or multiple joints asymmetrically
- True septic arthritis by gonorrhea is typically MONOarticular or PAUCIarticular.
Diagnosis: Clinical evaluation including cell count, gram stain, and culture of synovial fluid from affected joints.
20
Q
A 25-year-old sexually active woman presents with lower abdominal pain, fever, and vaginal bleeding. What is the likely diagnosis, and what are the potential complications if untreated?
A
The likely diagnosis is Pelvic Inflammatory Disease (PID). Potential complications include tubo-ovarian abscesses, ectopic pregnancies, chronic pelvic pain, and infertility.
21
Q
A male patient presents with painful defecation and rectal mucopurulent discharge. What is the likely diagnosis, and which population is at higher risk?
A
The likely diagnosis is proctitis. Men who have sex with men (MSM) are at higher risk due to damaged anorectal epithelial integrity.
22
Q
A patient with a history of multiple sexual partners presents with RUQ pain and abnormal liver function tests. What is the likely diagnosis, and what condition should be ruled out?
A
The likely diagnosis is Fitz-Hugh-Curtis syndrome. Acute viral hepatitis should be ruled out.
23
Q
A patient presents with a painless, nonpruritic rash on the palms and soles. What is the likely condition, and what is the causative organism?
A
The likely condition is disseminated gonococcal infection with dermatitis. The causative organism is Neisseria gonorrhoeae.
24
Q
A patient with a history of gonorrhea presents with fever, lower abdominal pain, and adnexal tenderness. What is the likely diagnosis, and what is the recommended treatment?
A
The likely diagnosis is Pelvic Inflammatory Disease (PID). Treatment includes a combination of antibiotics as per CDC guidelines.
25
A patient presents with a painless ulceration in the pharynx and cervical lymphadenopathy. What is the likely diagnosis, and what is the causative organism?
The likely diagnosis is pharyngeal gonorrhea caused by Neisseria gonorrhoeae.
26
A patient presents with symptoms of PID and a history of IUD use. What is the likely causative organism, and what is the recommended treatment?
The likely causative organism is Neisseria gonorrhoeae or Chlamydia trachomatis. Recommended treatment includes a combination of antibiotics as per CDC guidelines.
27
A patient presents with symptoms of PID and Fitz-Hugh-Curtis syndrome. What are the characteristic symptoms of this syndrome?
Characteristic symptoms include RUQ pain, RUQ tenderness, and abnormal liver function tests.
28
Why does vaginitis not occur in sexually mature women infected with N. gonorrhoeae?
Vaginitis does not occur in sexually mature women because the conditions do not support the growth of N. gonorrhoeae, except in prepubertal and postmenopausal women.
29
What factors increase the risk of MSM acquiring gonorrheal infections?
MSM are at higher risk due to:
- Damaged anorectal epithelial integrity
- Local recruitment of HIV target cell types (CCR5/CD4+ T cells and DC SIGN + dendritic cells)
30
What is the classic triad of symptoms for disseminated gonococcal disease (gonococcemia)?
The classic triad includes:
1. Dermatitis
2. Migratory polyarthritis
3. Tenosynovitis
31
Describe the skin manifestations associated with gonococcemia.
Skin manifestations include:
- 'Gun metal gray' lesions, which are small to medium-sized macules or hemorrhagic vesiculopustules on an erythematous base on palms and soles that are nonpruritic and painless.
32
What are the noncutaneous findings associated with pharyngitis in gonorrhea?
Noncutaneous findings include:
- Cervical lymphadenopathy
- Mild to moderate pharyngeal erythema
- Severe ulceration with pseudomembrane formation
33
What percentage of women with uncomplicated gonorrheal infections develop pelvic inflammatory disease (PID)?
10-40% of women with uncomplicated gonorrheal infections develop pelvic inflammatory disease (PID).
34
List the characteristic symptoms of pelvic inflammatory disease (PID).
Characteristic symptoms of PID include:
1. Fever
2. Lower abdominal pain
3. Back pain
4. Vomiting
5. Vaginal bleeding
6. Dyspareunia
7. Adnexal or cervical tenderness during pelvic examination
35
What are the sequelae of untreated pelvic inflammatory disease?
Sequelae of untreated PID include:
1. Tubo-ovarian abscesses
2. Ectopic pregnancies (PERMANENT)
3. Chronic pelvic pain
4. Infertility (PERMANENT)
36
What is Fitz Hugh Curtis syndrome and its association with PID?
Fitz Hugh Curtis syndrome is inflammation of the liver capsule associated with genitourinary tract infection, present in up to ¼ of women with PID caused by N. gonorrhoeae or C. trachomatis, presenting with:
1. RUQ pain
2. RUQ tenderness
3. Abnormal LFTs
37
What are the clinical features of tenosynovitis in gonorrhea?
Clinical features of tenosynovitis include:
- Pain and swelling of the synovium or fluid-filled capsule surrounding a tendon
- Involvement of single or multiple joints asymmetrically
- True septic arthritis by gonorrhea is typically MONOarticular or PAUCIarticular.
38
What diagnostic methods are used for tenosynovitis caused by gonorrhea?
Diagnosis is clinical and involves:
- Cell count
- Gram stain
- Culture of synovial fluid from affected joints
39
What is the significance of perivascular neutrophilia in gonococcemia?
Perivascular neutrophilia is significant as it indicates an inflammatory response associated with gonococcemia, which can lead to complications if untreated.
40
How does the presentation of gonorrheal infections differ in prepubertal and postmenopausal women compared to sexually mature women?
In prepubertal and postmenopausal women, vaginitis can occur due to the lack of hormonal support for the vaginal environment, allowing for the growth of N. gonorrhoeae, unlike in sexually mature women.
41
What are the potential long-term complications of untreated gonorrheal infections in women?
Potential long-term complications include:
- Ectopic pregnancies
- Chronic pelvic pain
- Infertility
42
What is the role of HIV target cell types in the increased risk of gonorrheal infections in MSM?
HIV target cell types, such as CCR5/CD4+ T cells and DC SIGN + dendritic cells, play a role in the increased risk of gonorrheal infections in MSM due to their recruitment and the resulting damage to anorectal epithelial integrity.
43
What are the common symptoms of disseminated gonococcal disease?
Common symptoms of disseminated gonococcal disease include:
- Dermatitis
- Migratory polyarthritis
- Tenosynovitis
44
What is the clinical significance of the 'gun metal gray' lesions in gonococcemia?
The 'gun metal gray' lesions are clinically significant as they indicate a systemic infection and can help in the diagnosis of gonococcemia.
45
What are the differential diagnoses for Fitz Hugh Curtis syndrome?
Differential diagnoses for Fitz Hugh Curtis syndrome include acute viral hepatitis, which can present with similar symptoms such as RUQ pain and tenderness.
46
What is the importance of recognizing the classic triad in diagnosing gonococcemia?
Recognizing the classic triad (dermatitis, migratory polyarthritis, tenosynovitis) is important for timely diagnosis and treatment of gonococcemia, preventing further complications.
47
How does the clinical presentation of PID help in its diagnosis?
The clinical presentation of PID, characterized by fever, abdominal pain, and tenderness during pelvic examination, aids in its diagnosis and indicates the need for prompt treatment.
48
What are the implications of chronic pelvic pain as a sequela of PID?
Chronic pelvic pain as a sequela of PID can significantly impact a woman's quality of life and may require long-term management strategies.
49
What is the importance of timely diagnosis and treatment of gonococcemia?
It is important for preventing further complications.
50
What is the significance of abnormal liver function tests (LFTs) in patients with Fitz Hugh Curtis syndrome?
Abnormal liver function tests (LFTs) indicate liver involvement and can help differentiate it from other conditions presenting with RUQ pain.
51
What is the relationship between gonorrhea and the development of ectopic pregnancies?
Gonorrhea can lead to pelvic inflammatory disease, which increases the risk of ectopic pregnancies due to scarring and damage to the reproductive organs.
52
What are the key features of the pain associated with tenosynovitis in gonorrhea?
Key features include asymmetrical involvement of joints and swelling of the synovium or fluid-filled capsule surrounding tendons.
53
What is the clinical approach to managing a patient with suspected gonococcal infection presenting with pharyngitis?
The clinical approach includes obtaining a thorough history and physical examination, testing for gonorrhea and other STIs, and initiating appropriate antibiotic therapy based on test results.
54
What are the implications of untreated gonorrheal infections on reproductive health?
Untreated gonorrheal infections can lead to serious reproductive health issues, including infertility, chronic pelvic pain, and ectopic pregnancies, necessitating early diagnosis and treatment.
55
What are the complications associated with meningitis and endocarditis?
Both meningitis and endocarditis can lead to death or permanent disability caused by CNS or cardiac damage.
56
What is the significance of a negative gram stain in asymptomatic men at high risk for gonococcal infection?
A negative gram stain CANNOT rule out gonococcal infection in asymptomatic men at high risk for infection.
57
What is the gold standard for diagnosing gonococcal infection?
Bacterial culture is the gold standard, requiring heme, NAD, yeast extract, and CO2, typically using Modified Thayer Martin medium.
58
What are the recommended prophylactic treatments for ophthalmia neonatorum in newborns?
Prophylactic treatments include silver nitrate drops, erythromycin, and tetracycline ophthalmic ointment, with erythromycin 0.5% ointment applied to both eyes immediately after birth.
59
What is the prognosis for previously treated gonococcal infections?
Previously treated gonococcal infection does not reduce the risk of reinfection, but there is a good prognosis if treated early and appropriately before permanent damage ensues.
60
What are the first-line treatment guidelines for gonococcal infection according to the CDC?
The first-line treatment is a combination of Ceftriaxone and Azithromycin, contraindicated in patients with a history of IgE mediated allergy to penicillin.
61
A newborn presents with profuse, purulent ocular discharge. What is the likely condition, and what prophylactic measures could have prevented it?
The condition is ophthalmia neonatorum. Prophylactic measures include the use of silver nitrate drops, erythromycin, or tetracycline ophthalmic ointment immediately after birth.
62
A patient with a history of gonorrhea presents with joint pain and swelling in multiple joints. What is the likely condition, and what diagnostic tests should be performed?
The likely condition is disseminated gonococcal infection with tenosynovitis or septic arthritis. Diagnostic tests include clinical evaluation, cell count, gram stain, and culture of synovial fluid from affected joints.
63
A sexually active woman presents with vaginal pruritus and mucopurulent discharge. What is the likely diagnosis, and what diagnostic test is most specific?
The likely diagnosis is urethritis caused by Neisseria gonorrhoeae. The most specific diagnostic test is a gram stain for urethral specimens.
64
A patient presents with a history of unprotected intercourse and a new onset of migratory polyarthritis. What is the likely diagnosis, and what is the causative organism?
The likely diagnosis is disseminated gonococcal infection. The causative organism is Neisseria gonorrhoeae.
65
A patient presents with a history of gonorrhea and now has symptoms of endocarditis. What is the likely affected valve, and what is the mortality rate?
The likely affected valve is the aortic valve. The mortality rate is 19%.
66
A patient presents with a history of gonorrhea and now has symptoms of meningitis. How does this condition compare to meningococcal meningitis?
Gonococcal meningitis is less severe than meningococcal meningitis and can recover even without treatment.
67
A patient presents with symptoms of urethritis and a history of recent travel. What is the likely diagnosis, and what are the diagnostic tests?
The likely diagnosis is gonorrhea. Diagnostic tests include gram stain, bacterial culture, and NAAT.
68
A patient presents with symptoms of urethritis and a history of recent sexual activity. What is the likely diagnosis, and what is the recommended treatment?
The likely diagnosis is gonorrhea. Recommended treatment is a combination of Ceftriaxone and Azithromycin.
69
A patient presents with symptoms of urethritis and a history of recent HIV diagnosis. What is the likely diagnosis, and what are the complications?
The likely diagnosis is gonorrhea. Complications include disseminated gonococcal infection and increased susceptibility to other STDs.
70
A patient presents with symptoms of urethritis and a history of recent syphilis diagnosis. What is the likely diagnosis, and what are the complications?
The likely diagnosis is gonorrhea. Complications include disseminated gonococcal infection and increased susceptibility to other STDs.
71
What are the potential complications of meningitis and endocarditis?
Both meningitis and endocarditis can lead to death or permanent disability caused by CNS or cardiac damage.
72
What is the gold standard for diagnosing gonococcal infection?
The gold standard for diagnosing gonococcal infection is bacterial culture, which requires heme, NAD, yeast extract, and CO2, typically using Modified Thayer Martin medium.
73
What are the recommended prophylactic treatments for ophthalmia neonatorum?
Prophylactic treatments for ophthalmia neonatorum include silver nitrate drops, erythromycin, and tetracycline ophthalmic ointment, with erythromycin 0.5% ointment to both eyes immediately after birth.
74
What is the prognosis for previously treated gonococcal infections?
Previously treated gonococcal infection does not reduce the risk of reinfection. However, there is a good prognosis if treated early and appropriately before permanent damage ensues.
75
What are the complications associated with gonococcal infection in newborns?
Complications of gonococcal infection in newborns can include growth retardation, low birth weight (LBW), prematurity, blindness, and infant death.
76
What is the recommended treatment for gonococcal infection according to the CDC guidelines?
The most current CDC guidelines recommend a combination of Ceftriaxone and Azithromycin as the first-line treatment for gonococcal infection.
77
What is the sensitivity of endocervical specimens for diagnosing gonococcal infection?
Endocervical specimens have less than 35% sensitivity for diagnosing gonococcal infection and should not be used as a screening tool.
78
What is the mortality rate associated with endocarditis in patients with no prior history of cardiac disease?
The mortality rate associated with endocarditis in patients with no prior history of cardiac disease is 19%.
79
What are the alternative treatments for gonococcal infection in patients with penicillin allergy?
Alternative treatments for patients with a history of IgE mediated allergy to penicillin include Gemifloxacin 320 mg PO and IM Gentamicin 240 mg + Azithromycin 2g PO.
80
What is the role of nucleic acid amplification tests (NAAT) in diagnosing gonococcal infection?
Nucleic acid amplification tests (NAAT) provide rapid diagnosis in 30 to 60 minutes and can be performed on various samples including urine, urethral, pharyngeal, or rectal samples.
81
What is the recommended dose of Ceftriaxone for treating gonococcal infection in newborns?
The recommended dose of Ceftriaxone for treating gonococcal infection in newborns is 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg.
82
What is the significance of vaginal specimens in diagnosing gonococcal infection?
Vaginal specimens are NEVER recommended for diagnostic purposes due to the vaginal mucosa resisting gonococcal infection.
83
What are the clinical features of endocarditis in male patients?
Endocarditis preferentially affects the aortic valve of male patients with no prior history of cardiac or valvular disease, with a 50% surgical intervention rate.
84
What is the recommended treatment for gonococcal infection in symptomatic men?
For symptomatic men, the recommended treatment for gonococcal infection is a combination of Ceftriaxone and Azithromycin as per CDC guidelines.
85
What is the importance of early treatment for gonococcal infection?
Early treatment of gonococcal infection is crucial as it leads to a good prognosis and helps prevent permanent damage.
86
What are the diagnostic criteria for gonococcal infection in symptomatic men?
The diagnostic criteria for gonococcal infection in symptomatic men include a high specificity (>99%) and high sensitivity (>95%) for urethral specimens.
87
What is the risk associated with pharyngeal or genital gonococcal infection in children?
Pharyngeal or genital gonococcal infection in children is often a sign of sexual abuse and warrants further investigation.
88
What is the recovery rate for meningitis compared to meningococcal meningitis?
Meningitis is generally less severe than meningococcal meningitis and can recover even without treatment.
89
What is the role of bacterial culture in diagnosing gonococcal infection?
Bacterial culture is considered the gold standard for diagnosing gonococcal infection, requiring specific growth conditions and media.
90
What are the potential outcomes of untreated gonococcal infection?
Untreated gonococcal infection can lead to serious complications including permanent joint damage, active bacteremia, and polyarticular issues.
91
What is the significance of the 50% surgical intervention rate in endocarditis?
The 50% surgical intervention rate in endocarditis indicates a significant need for surgical management in affected patients, particularly those with no prior cardiac history.
92
What are the key features of ophthalmia neonatorum?
Key features of ophthalmia neonatorum include profuse, purulent ocular discharge leading to severe corneal perforation and potential scarring.
93
What is the clinical significance of the 19% mortality rate in endocarditis?
The 19% mortality rate in endocarditis highlights the serious nature of the condition and the need for prompt diagnosis and treatment.
94
What are the implications of using vaginal specimens for diagnosing gonococcal infection?
Using vaginal specimens for diagnosing gonococcal infection is discouraged due to their ineffectiveness, as they are not recommended for diagnostic purposes.
95
What is the importance of rapid diagnosis in gonococcal infection?
Rapid diagnosis in gonococcal infection is crucial for timely treatment, which can prevent complications and improve patient outcomes.
96
What are the recommended treatments for gonococcal infection in children?
Recommended treatments for gonococcal infection in children include Erythromycin 0.5% ointment to both eyes immediately after birth and Ceftriaxone as needed.
97
What is the significance of the 1-2% dissemination rate in endocarditis?
The 1-2% dissemination rate in endocarditis indicates that it can spread to other areas of the body, emphasizing the need for early detection and treatment.
98
What is the general recommendation for the treatment of partners of patients diagnosed with gonorrhea?
Treatment of partners diagnosed with gonorrhea empirically is as or more effective than traditional reliance on referral, testing, and as needed treatment.
99
What yearly screening is recommended by the CDC for sexually active individuals?
The CDC recommends yearly screening for men who engage in receptive anal intercourse, all sexually active women younger than 25 years old, and any woman with a new sex partner, multiple sex partners, or partner with known STI.
100
What are the risk factors associated with Mycoplasma infections?
Risk factors for Mycoplasma infections include multiple partners, young age, ethnic minority, presence of other STIs, and past or present bacterial vaginosis.
101
What are the clinical features of Mycoplasma infection in men?
In men, the most common clinical feature of Mycoplasma infection is urethritis, which presents with dysuria, urethral pain, pruritus, and mucopurulent discharge.
102
What are the clinical features of Mycoplasma infection in women?
In women, the most common clinical feature of Mycoplasma infection is cervicitis, which presents with mucopurulent exudate visible in the endocervical canal, friable cervical os that bleeds with minimal manipulation, abnormal vaginal discharge, and intermenstrual vaginal bleeding.
103
A sexually active teenager presents with urethral pain, pruritus, and mucopurulent discharge. What is the most likely causative organism, and what is the first-line treatment?
The most likely causative organism is Mycoplasma genitalium. First-line treatment is Moxifloxacin 400 mg/day for 14 days.
104
A sexually active woman presents with intermenstrual vaginal bleeding and friable cervical os. What is the likely diagnosis, and what is the causative organism?
The likely diagnosis is cervicitis caused by Mycoplasma genitalium.
105
A patient presents with symptoms of urethritis but tests negative for gonorrhea and chlamydia. What is the likely causative organism, and what is the recommended treatment?
The likely causative organism is Mycoplasma genitalium. Recommended treatment is Azithromycin or Moxifloxacin.
106
A patient presents with symptoms of urethritis and a history of recent antibiotic use. What is the likely diagnosis, and what is the recommended treatment?
The likely diagnosis is Mycoplasma genitalium infection. Recommended treatment is Azithromycin or Moxifloxacin.
107
A patient presents with symptoms of urethritis and a history of recent surgery. What is the likely diagnosis, and what are the complications?
The likely diagnosis is Mycoplasma hominis infection. Complications include bacteremia, surgical wound infections, and pericardial effusions.
108
A patient presents with symptoms of urethritis and a history of recent trauma. What is the likely diagnosis, and what are the complications?
The likely diagnosis is Mycoplasma genitalium infection. Complications include respiratory tract invasion, osteomyelitis, and infectious arthritis.
109
A patient presents with symptoms of urethritis and a history of recent tuberculosis diagnosis. What is the likely diagnosis?
The likely diagnosis is Mycoplasma genitalium infection.
110
What is the likely diagnosis for a Mycoplasma hominis infection and its complications?
The likely diagnosis is Mycoplasma hominis infection. Complications include bacteremia, surgical wound infections, and pericardial effusions.
111
What is the likely diagnosis for a patient with urethritis and recent trauma, and its complications?
The likely diagnosis is Mycoplasma genitalium infection. Complications include respiratory tract invasion, osteomyelitis, and infectious arthritis.
112
What is the likely diagnosis for a patient with urethritis and recent tuberculosis diagnosis, and its complications?
The likely diagnosis is Mycoplasma genitalium infection. Complications include respiratory tract invasion, osteomyelitis, and infectious arthritis.
113
What is the likely diagnosis for a patient with urethritis and recent kidney transplant, and its complications?
The likely diagnosis is Mycoplasma hominis infection. Complications include bacteremia, surgical wound infections, and pericardial effusions.
114
What is the recommended screening frequency for sexually active women under 25 years old for gonorrhea according to the CDC?
Yearly screening is recommended for all sexually active women younger than 25 years old.
115
What are the three antibiotics not recommended for treating gonorrhea due to increasing resistance?
1. Tetracyclines
2. Fluoroquinolones
3. Penicillin
116
What is the role of Mycoplasma in pregnancy complications?
Mycoplasma may play a role in complications such as PROM, preterm labor, intraamniotic infection, and chorioamnionitis.
117
What is the prevalence of M. hominis among sexually active women?
M. hominis is found in 20-50% of sexually active women and is a commensal organism with low virulence.
118
What is the treatment for M. genitalium infection?
The treatment for M. genitalium infection is Moxifloxacin 400 mg/day for 14 days.
119
What are the common clinical features of urethritis in men caused by Mycoplasma?
Common features include dysuria, urethral pain, pruritus, and mucopurulent discharge.
120
What are the risk factors associated with Mycoplasma infections?
Risk factors include:
- Multiple partners
- Young age
- Ethnic minority
- Presence of other STIs
- Past or present bacterial vaginosis
121
What percentage of sexually active women in the United States are affected by Ureaplasma sp.?
Ureaplasma sp. affects 40-80% of sexually active women in the United States.
122
What are the clinical features of cervicitis in women with Mycoplasma infection?
Clinical features include:
1. Mucopurulent exudate visible in the endocervical canal
2. Friable cervical os that bleeds with minimal manipulation
3. Abnormal vaginal discharge
4. Intermenstrual vaginal bleeding
123
How does the rate of coinfection with other STIs compare between men and women with Mycoplasma infections?
Rates of coinfection are lower in men, except in the setting of HIV coinfection.
124
What are the noncutaneous findings associated with genital mycoplasma infections?
There is no clear relationship between genital mycoplasma and epididymitis or prostatitis. Other noncutaneous findings include respiratory infections, septic arthritis, surgical wound infections, and neonatal pneumonia.
125
What is the preferred diagnostic method for detecting genital mycoplasma infections?
The preferred diagnostic method is NAAT (Nucleic Acid Amplification Test) using a specimen of first voided urine.
126
What are the complications that can arise from genital mycoplasma infections?
Complications can result in respiratory tract invasion, osteomyelitis, or infectious arthritis.
127
What are the common clinical features of Chlamydia infections?
Common clinical features include urogenital infections, with the most common sites being the urethra in men and the urethra and cervix in women. Other features include proctitis and epididymitis, which presents as unilateral testicular pain and swelling accompanied by dysuria and fever.
128
What is the recommended treatment for urethritis caused by Chlamydia?
The recommended treatment for urethritis caused by Chlamydia includes a 7-day course of doxycycline, which is only effective in 1/3 of cases, or a single dose or 5-day course of Azithromycin, which is more effective.
129
What is the relationship between age and the prevalence of Chlamydia infections in sexually active women?
The prevalence of Chlamydia infections in sexually active women is inversely proportional to age, with the highest rates of infection occurring between the ages of 14 and 24 years old.
130
A sexually active man presents with unilateral testicular pain and swelling. What is the likely diagnosis, and what are the common causative organisms?
The likely diagnosis is epididymitis. Common causative organisms are Chlamydia trachomatis and Neisseria gonorrhoeae.
131
What are the limitations of commercial tests for antibodies in diagnosing mycoplasma infections?
Mere detection of antibodies is not sufficient to verify infection due to the possibility of prior colonization and cross-reaction. Increased titer levels may signify acute infection.
132
What is the prognosis for patients with genital mycoplasma infections?
The prognosis is excellent for patients with genital mycoplasma infections.
133
What does the CDC recommend regarding the treatment of PID in relation to mycoplasma?
The CDC guidelines for empiric treatment of PID do not recommend antibiotics that are effective against mycoplasma.
134
What is the effectiveness of doxycycline in treating urethritis caused by mycoplasma?
Doxycycline is only effective in 1/3 of cases when administered for 7 days.
135
What is the more effective treatment option for urethritis compared to doxycycline?
A single dose or a 5-day course of Azithromycin is more effective than doxycycline for treating urethritis.
136
What is the causative agent of Chlamydia and its characteristics?
Chlamydia is caused by C. trachomatis, which is a nonmotile, gram-negative, obligate intracellular bacterium.
137
What are the two phases of the Chlamydia life cycle?
The two phases of the Chlamydia life cycle are the elementary body and the reticulate body.
138
What mucous membranes are affected by Chlamydia infections?
Chlamydia affects the mucous membranes of the ophthalmic, genitourinary, and respiratory systems.
139
What are the target cells for Chlamydia infection?
The target cells for Chlamydia infection include the endocervix, conjunctiva, urethra, rectum, and epididymis.
140
What is the mode of transmission (MOT) for Chlamydia?
The mode of transmission for Chlamydia is oral, anal, or vaginal intercourse.
141
What is the most common manifestation of Chlamydia infections?
The most common manifestation of Chlamydia infections is urogenital infections.
142
What is the most common site of Chlamydia infection in men?
The most common site of Chlamydia infection in men is the urethra.
143
What is the most common site of Chlamydia infection in women?
The most common site of Chlamydia infection in women is the urethra and cervix.
144
What are the clinical features of epididymitis associated with Chlamydia?
Epididymitis is characterized by unilateral testicular pain and swelling accompanied by dysuria and fever, and it is the most common cause of epididymitis in male patients younger than 35 years of age.
145
What are the complications associated with Chlamydia infections?
Complications of Chlamydia infections can include PID (pelvic inflammatory disease), which encompasses endometritis, salpingitis, and peritonitis.
146
What is the significance of increased titer levels in commercial antibody tests for mycoplasma?
Increased titer levels may signify acute infection, but mere detection of antibodies is not sufficient to confirm infection.
147
What is the recommended specimen type for culture in diagnosing mycoplasma infections in men?
The recommended specimen type for culture in men is urethra or first voided urine.
148
What is the recommended specimen type for culture in diagnosing mycoplasma infections in women?
The recommended specimen type for culture in women is cervix, urethra, or vagina.
149
What is the role of horse serum in the culture of mycoplasma infections?
The culture for mycoplasma infections is enriched with horse serum to enhance growth.
150
What is the clinical significance of the age group most affected by Chlamydia infections?
The highest rates of Chlamydia infections occur in individuals aged 14 to 24 years, indicating a need for targeted prevention and education in this age group.
151
What are the common clinical features of proctitis associated with Chlamydia?
Proctitis associated with Chlamydia is characterized by inflammation of the rectum, often seen in serovars D to K.
152
What is the significance of the two-phase cycle in Chlamydia's life cycle?
The two-phase cycle of Chlamydia, involving the elementary body and reticulate body, is crucial for its ability to infect host cells and replicate.
153
What are the implications of the CDC's recommendation against routine screening for mycoplasma infections?
The CDC's recommendation against routine screening for mycoplasma infections suggests that current evidence does not support the necessity or effectiveness of such screenings in the general population.
154
What is the most common cause of epididymitis in male patients younger than 35 years?
The most common cause of epididymitis in male patients younger than 35 years is Chlamydia, along with N. gonorrhoeae.
155
What are the potential respiratory complications of mycoplasma infections?
Respiratory complications of mycoplasma infections can include respiratory tract invasion leading to pneumonia or other respiratory illnesses.
156
What is the importance of understanding the clinical features of Chlamydia infections?
Understanding the clinical features of Chlamydia infections is essential for timely diagnosis and treatment, which can prevent complications such as PID and infertility.
157
What is the relationship between mycoplasma infections and neonatal pneumonia?
Mycoplasma infections can lead to neonatal pneumonia, indicating the importance of screening and treatment in pregnant women to prevent transmission.
158
What are the implications of the lack of FDA-approved diagnostic laboratory tests for mycoplasma?
The lack of FDA-approved diagnostic laboratory tests for mycoplasma indicates a gap in reliable testing options, which may hinder accurate diagnosis and treatment.
159
What is the significance of the term 'obligate intracellular bacteria' in relation to Chlamydia?
The term 'obligate intracellular bacteria' signifies that Chlamydia can only replicate within host cells, which is crucial for its pathogenicity and survival.
160
What are the common clinical manifestations of urogenital infections caused by Chlamydia?
Common clinical manifestations of urogenital infections caused by Chlamydia include dysuria, abnormal discharge, and pelvic pain.
161
What is the role of NAAT in the diagnosis of Chlamydia infections?
NAAT (Nucleic Acid Amplification Test) is a highly sensitive and specific method for diagnosing Chlamydia infections, preferred for its accuracy.
162
What are the implications of the CDC's guidelines for treating PID in relation to mycoplasma?
The CDC's guidelines for treating PID highlight the need for effective antibiotics that target the most common pathogens, excluding those effective against mycoplasma, which may not be a primary concern in PID treatment.
163
What is reactive arthritis and what are its associated risks?
Reactive arthritis is an immune-mediated arthritis resulting from a mucosal infection and urethritis, often accompanied by conjunctivitis and cutaneous lesions involving the genitals. Individuals who are HLA-B27 (+) are at increased risk.
164
What are the perinatal infections that may result from gonorrhea?
Perinatal infections that may result from gonorrhea include:
1. Conjunctivitis or ophthalmia neonatorum (serovars A to C)
2. Pneumonia (within 8 weeks of birth) characterized by:
- Nasal symptoms
- Tachypnea
- Staccato cough
- (-) wheezing
- Symptomatic 3 weeks before presentation
- Diagnosis: nasopharyngeal swab
165
What is the preferred method for diagnosing gonorrhea and why?
The preferred method for diagnosing gonorrhea is NAAT (Nucleic Acid Amplification Test) because it is the most sensitive and almost specific as culture. It is FDA-approved for diagnosing urogenital infections only (not for rectal or oropharyngeal infections). Specimens can be collected from:
- Women: endocervical or vaginal
- Men: urethral
166
What is the first line treatment for gonorrhea?
The first line treatment for gonorrhea is:
- Doxycycline 100 mg PO BID for 7 days
- Azithromycin 1g PO single dose
167
What are the recommendations for screening and prevention of gonorrhea?
Recommendations for screening and prevention of gonorrhea include:
- Annual screening for:
1. All sexually active women younger than 25 years
2. Older women with risk factors (new sex partner or multiple sex partners)
- Screening for young men should only be considered in high prevalence clinical settings.
- Abstinence is recommended until the patient and all partners are treated.
- Both men and women should be retested at 3 months or within at least 1 year of treatment.
168
What is bacterial vaginosis and its common risk factors?
Bacterial vaginosis is the most common vaginal infection in women ages 15 to 44 years. It rarely occurs in prepubertal or virginal girls and boys. The most common risk factors include:
1. Having sex at an early age
2. Few or multiple sex partners
3. Smoking
4. Pregnancy
5. Use of IUDs, douching, tub bathing, bidet toilets
Hormonal contraception (Estrogen-Progestin and Progestin only) is protective against the development of BV.
169
A patient presents with conjunctivitis and a staccato cough within 8 weeks of birth. What is the likely diagnosis, and what diagnostic test should be performed?
The likely diagnosis is perinatal pneumonia caused by Chlamydia trachomatis. A nasopharyngeal swab should be performed for diagnosis.
170
A patient presents with symptoms of urethritis and a history of recent HPV diagnosis. What is the likely diagnosis, and what are the complications?
The likely diagnosis is Chlamydia trachomatis infection. Complications include reactive arthritis and cofactor with oncogenic HPV neoplastic transformation.
171
What is the likely diagnosis for a patient with urethritis and a recent HPV diagnosis?
The likely diagnosis is Chlamydia trachomatis infection.
## Footnote
Complications include reactive arthritis and cofactor with oncogenic HPV neoplastic transformation.
172
What is reactive arthritis and who is at increased risk?
Reactive arthritis is an immune-mediated arthritis resulting from a mucosal infection, urethritis, with concomitant conjunctivitis and cutaneous lesions involving the genitals. Individuals who are HLA-B27 (+) are at increased risk.
173
What perinatal infections may result from gonorrhea?
Perinatal infections from gonorrhea may result in conjunctivitis or ophthalmia neonatorum and pneumonia (within 8 weeks of birth).
## Footnote
Pneumonia is characterized by nasal symptoms, tachypnea, staccato cough, and is diagnosed using a nasopharyngeal swab.
174
What is the preferred method for diagnosing urogenital infections?
The preferred method for diagnosing urogenital infections is NAAT (Nucleic Acid Amplification Test) because it is the most sensitive and almost specific as culture, and it is FDA-approved for urogenital infections only.
175
What are the first-line treatments for gonorrhea?
The first-line treatments for gonorrhea are Doxycycline 100 mg PO BID for 7 days or Azithromycin 1g PO as a single dose.
176
What are the recommendations for routine testing after treatment for gonorrhea?
Routine testing for cure is not recommended in the early treatment period unless the patient is pregnant or lack of adherence therapy is suspected. It is recommended that both men and women should be retested at 3 months or within at least 1 year of treatment.
177
What is the most common vaginal infection in women aged 15 to 44 years?
The most common vaginal infection in women aged 15 to 44 years is bacterial vaginosis.
## Footnote
Common risk factors include having sex at an early age, having few or multiple sex partners, smoking, pregnancy, and the use of IUDs, douching, tub bathing, and bidet toilets.
178
What is the clinical significance of hormonal contraception in relation to bacterial vaginosis?
Hormonal contraception (Estrogen-Progestin and Progestin only) is protective against the development of bacterial vaginosis, reducing the risk of infection in women.
179
What screening recommendations does the CDC provide for sexually active women regarding gonorrhea?
The CDC recommends annual screening for all sexually active women younger than 25 years old and for older women with risk factors (new sex partner or multiple sex partners).
180
What is the recommended action for patients and their partners during treatment for gonorrhea?
The CDC recommends abstinence until the patient and all partners are treated to prevent reinfection and further spread of the infection.
181
What are the implications of NAAT results after single dose treatment for gonorrhea?
NAAT results after single dose treatment were negative in all women at 4 weeks, indicating effective treatment and resolution of the infection.
182
What are the main etiological factors contributing to bacterial vaginosis?
- **Polymicrobial** infection
- **Decreased population of Lactobacilli** sp. leading to reduced lactic acid, lactocin, and hydrogen peroxide, which results in a higher pH
- Increased population of pathogenic bacteria:
- **Gram negative anaerobic bacteria** such as Gardnerella vaginalis, M. hominis, Mycoplasma curtsii
- **Anaerobic gram negative rods** such as Prevotella, Porphyromonas, Bacteroides, Peptostreptococcus
183
What are the clinical presentations of bacterial vaginosis?
- **84% asymptomatic**
- Increased volume of **white or gray vaginal discharge** with a **fishy odor**, especially after contact with alkaline semen during intercourse
- **Absent or mild pruritus** and inflammation
- Physical examination may reveal **milky homogenous vaginal coating** adherent to the vaginal wall
184
What are the Amsel criteria for diagnosing bacterial vaginosis?
To meet the Amsel criteria, at least **3 out of 4** must be present:
1. **Profuse milky vaginal discharge**
2. **Positive whiff test** result (10-20% KOH, (+) fishy odor)
3. **Vaginal fluid pH** greater than 4.5
4. **Presence of clue cells** greater than 20% on microscopic examination (most reliable indicator)
185
What are the complications associated with bacterial vaginosis?
- **Risk factor for premature deliveries** and babies with low birth weight
- Increased risk of acquiring **HIV** and other STDs
- Higher risk of developing **postsurgical infections** after procedures such as hysterectomy or D&C
- Potential for **pelvic inflammatory disease (PID)**
- Possible postpartum complications such as **fever, endometritis, and postabortal infections**
186
What are the treatment recommendations for asymptomatic bacterial vaginosis in nonpregnant women?
- Treatment is **not necessary** for asymptomatic bacterial vaginosis in nonpregnant women.
- Benefits of treatment include:
1. **Relieving vaginal symptoms** and signs of infection
2. **Reducing risk** for infectious complications after various gynecologic features
- **Probiotics** may be useful for bacterial vaginosis
- **Routine screening** and empiric treatment in high-risk groups can help reduce transmission rates and disease burden.
187
What are the risks associated with bacterial vaginosis during pregnancy?
Risks include premature deliveries, low birth weight babies, and increased susceptibility to acquiring HIV and other STDs.
188
What diagnostic criteria and tests can confirm bacterial vaginosis?
Diagnostic criteria include Amsel criteria (3 out of 4): milky vaginal discharge, positive whiff test, vaginal fluid pH >4.5, and presence of clue cells. Tests include Nugent method, DNA probe, and OSOM BVBlue.
189
What is the likely diagnosis for a patient with a history of multiple sexual partners and a positive whiff test?
The likely diagnosis is bacterial vaginosis. The most reliable diagnostic indicator is the presence of clue cells on microscopic examination.
190
What is the likely diagnosis for a patient with urethritis and a history of smoking?
The likely diagnosis is bacterial vaginosis. Risk factors include smoking, multiple sexual partners, and use of IUDs.
191
What is the likely diagnosis for a patient with urethritis and a history of douching?
The likely diagnosis is bacterial vaginosis. Common causative organisms include Gardnerella vaginalis and Mycoplasma hominis.
192
What is the likely diagnosis for a patient with urethritis and a history of recent childbirth?
The likely diagnosis is bacterial vaginosis. Complications include postpartum fever, postpartum endometritis, and postabortal infections.
193
What is the likely diagnosis for a patient with urethritis and a history of recent miscarriage?
The likely diagnosis is bacterial vaginosis. Complications include postpartum fever, postpartum endometritis, and postabortal infections.
194
What is the likely diagnosis for a patient with urethritis and a history of recent diabetes diagnosis?
The likely diagnosis is bacterial vaginosis. Complications include postpartum fever, postpartum endometritis, and postabortal infections.
195
What are the key microbial factors contributing to bacterial vaginosis?
Bacterial vaginosis is characterized by a **polymicrobial** etiology, including:
- Decreased population of **Lactobacilli** sp. leading to reduced production of lactic acid, lactocin, and hydrogen peroxide, which results in a higher vaginal pH.
- Increased populations of pathogenic bacteria such as **Gardnerella vaginalis**, **M. hominis**, **Mycoplasma curtsii**, and anaerobic gram-negative rods like **Prevotella**, **Porphyromonas**, **Bacteroides**, and **Peptostreptococcus**.
196
What is the prognosis for patients with bacterial vaginosis?
The prognosis for patients with bacterial vaginosis includes:
- Suspecting concomitant infections such as **candidiasis** if symptoms do not resolve after treatment.
- Regular monitoring and follow-up are essential to manage potential complications and recurrence.
197
What diagnostic tests are used to confirm bacterial vaginosis?
Diagnostic tests for bacterial vaginosis include:
1. **Amsel criteria** (3 out of 4).
2. **Nugent method** (Gram stain).
3. **DNA probe-based test** (16 SrRNA gene) with a sensitivity of **92.8%**.
4. **AmpliSens Flourcenosis/Bacterial vaginosis - FRT multiplex real-time PCR** with **100% sensitivity** compared with Amsel’s criteria.
5. **Immunochromatographic test (OSOM BVBlue)** with sensitivity of **100%** and specificity of **98.3%**.
198
What are the benefits of routine screening for bacterial vaginosis in high-risk groups?
Routine screening for bacterial vaginosis in high-risk groups can:
- Aid in **reducing transmission rates** of the infection.
- Help in managing the **disease burden** associated with bacterial vaginosis and its complications.
- Facilitate early intervention and treatment to prevent adverse outcomes such as preterm labor and STDs.
199
What is the role of probiotics in the treatment of bacterial vaginosis?
Probiotics may play a role in the treatment of bacterial vaginosis by:
- Restoring the normal vaginal flora.
- Potentially alleviating symptoms and reducing recurrence rates.
- They are sometimes recommended as an adjunct to standard treatment, especially in recurrent cases.
