218- STDs

Question 1

Neisseria gonorrhoeae: what kind of bacteria is it? Pili vs Opa? What is the clinical picture? Tx?

Answer 1

gram neg diplococci
Pili show Antigen variation and are used for initial adherece. Opa cause intimate adherence and internalization.
Urethritis/cervicitis, disseminated gonococcal dz (fever, arthritis in knees, rash), PID, epidymitis and prostatitis, gonococcal ophthalmia
Tx with ceftriaxone. Also treat partner and tx for chlamydia

Question 2

clinical presentation of PID

Answer 2

1) mucopurulent vaginal discharge. 2)midline abdominal pain and abnormal vaginal bleeding 3) bilateral lower abdominal pain w/ nausea/vomiting

Question 3

Chlamydia trachomatis: what kind of bacteria? gram stain? Serovars associated w/ chlamydial STD? Lifecycle? Clinical picture? Any other illnesses? Treatment?

Answer 3

gram neg structure but doesn’t gram stain.
Serovars D-K
Elementary bodies outside of cell, reticulate bodies form inclusion bodies inside cell.
Urethritis and cervicitis, conjunctivitis of newborn, lymphogranuloma venereum (LGV),
Also causes trachoma, most common cause of preventable blindness (not an STD)
Tx with azithromycin or doxycycline

Question 4

what is LGV

Answer 4

lymphogranuloma venereum. Caused by chlamydia serovars. Initial ulcer followed by fever and swollen, tender inguinal nodes

Question 5

Treponema pallidum: what kind of bacteria is it? Known classically as? Does it have flagella? Clinical picture? Does it affect the newborn?

Answer 5

spirochete. The pox.
Flagella in periplasm, not external. (few external proteins in general makes it hard to clear)
Nontender chancre (primary) develops>resolution>rash on palms and soles (secondary)>resolution>cognitive changes, tabes dorsalis, enlargement of Ao, gummas (tertiary)
Causes stillbirth, prematurity, sabre shins, hydrops)

Question 6

How do you diagnose syphilis? Tx?

Answer 6

dark-field microscopy. Can make presumptive diagnosis based on Venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR).

Tx. with penicillin G

Question 7

haemophilus ducreyi

Answer 7

causes chancroid: similar to primary syphilis but is tender

Question 8

pear-shaped protozoa causing vaginitis? how do you treat?

Answer 8

trichomonal vaginalis

metronidazole

Question 9

Bacterial vaginosis: is it an STD? what organisms? What happens to cause problem? what does it present as? What is seen on wet prep? treatment?

Answer 9

debatable. More like a change in the flora
Gardnerella, mycoplasma hominis, mobiluncus spp.
Lactobacillus is replaced, pH goes up, more microbes
Fishy smelling, discharge, itching
Clue cells (WBCs coated with bacteria)
Tx with metronidazole