Bacterial STD

Question 1

What age group contributes to almost half of new STIs in the US?

Answer 1

15-24

Question 2

How are sexually transmitted microorganisms shed and spread?

Answer 2

Shed from urogenital tract

Spread through contact with mucosal surface, usually due to sexual activity

Question 3

What STDs can condoms inhibit? x4

Answer 3

HSV
HIV
Chlamydia
Gonorrhea

Question 4

What are bacterial infections of the genital tract for men?

Answer 4

Urethritis
Epididymitis

Question 5

What are bacterial infections of the genital tract for women?

Answer 5

Pelvic Inflammatory Disease: salpingitis, oophoritis, endometritis

cervicitis
vaginitis
urethritis

Question 6

What causes Pelvic Inflammatory Disease?

Answer 6

Ascending intraluminal spread of bacterial from lower genital tract

Question 7

What are the consequences of untreated pelvic inflammatory disease?

Answer 7

Tubal scarring
Impaired tubal function
Tubal occlusion
Infertility

Question 8

What are symptoms of pelvic inflammatory disease?

Answer 8

Fever
Dyspareunia
Lower back pain
Cervical motion tenderness

Question 9

What STI is the most prevalent in the US?

Answer 9

HPV

Question 10

What bacterial STDs are are the decline in the US and which are on the incline?

Answer 10

Decline: chlamydia, gonorrhea

Incline: syphilis, syphilis in newborns

Question 11

What groups are more affected by STIs?

Answer 11

Young people aged 15-24
Gay & Bisexual Men
Pregnant women
Racial and ethnic minority groups

Question 12

What are the characteristics of Chlamydia trachomatis?

Answer 12

Small, nonmotile bacteria

Obligate intracellular parasite

Unique cell wall - small amounts of peptidoglycan, LPS+, major outer membrane protein (MOMP), outer membrane protein 2 (OMP2)

Question 13

How does chlamydia enter cells?

Answer 13

entry through microabrasions

attaches to receptors on nonciliated columnar, cuboidal, transitional epithelial cells in mucous membranes of genital tract and conjunctivae to initiate infection

Question 14

Can you see chlamydia on grain stain?

Answer 14

no! not enough peptidoglycan

Question 15

Because chlamydia is an obligate intracellular parasite, it will not ______

Answer 15

Grow on artificial bacterial media

Question 16

What are the two morphological forms of chlamydia?

Answer 16

Elementary Body
Reticulate Body

Question 17

The ________ is the transmissible form of chlamydia and is adapted to extracellular survival because of its extensive OMP2 disulfide bonds

Answer 17

Elementary body

Question 18

The _______ is the non-infectious, replicating form of chlamydia and is adapted to the intracellular environment. It is environmentally labile because it lacks OMP2 disulfide bonds.

Answer 18

Reticulate body

Question 19

What are the 2 strain of chlamydia trachomatis?

Answer 19

Trachoma
Lymphogranuloma venereum (LGV)

Question 20

The serovars L1, L2, L3 form____

Answer 20

Lymphogranuloma venereum (LGV)

Sexually transmitted disease that is invasive, systemic STD marked by painful inguinal lymphadenopathy

Question 21

What are the 2 strains of trachoma?

Answer 21

Ocular trachoma
Urogenital chlamydia

Question 22

The serovars A, B, C of trochoma form ____

Answer 22

ocular trachoma

Leading cause of preventable blindness

Question 23

The serovars D-K of trachoma form______

Answer 23

Urogenital chlamydia

A sexually transmitted disease
In men, causes urethritis and proctitis
In women, causes mucopurulent cervicitis, pelvic inflammatory disease

Question 24

What serovars are ocular trachoma?

Answer 24

A, B, C

Question 25

Ocular trachoma is transmitted through contact with _______ from eyes of infected patients

Answer 25

Discharge

Question 26

How does ocular trachoma present?

Answer 26

Chronic follicular conjunctivitis --> scarring --> eyelids turn inward --> eyelashes abrade cornea --> corneal ulceration/scarring --> loss of vision

Question 27

What serovars are Lymphogranuloma venereum (LGV)?

Answer 27

L1-L3

Question 28

What is the disease progression of Lymphogranuloma venereum?

Answer 28

Initial genital lesions Small painless papule ulcerates and then heals within few days Inguinal syndrome

Question 29

What are the serovars of urogenital chlamydia?

Answer 29

D-K

Question 30

How does urogenital chlamydia present in women?

Answer 30

Asymptomatic Vague abdominal discomfort or spotting Mucopurulent cervicitis --> endometritis --> salpingitis --> pelvic peritonitis

Question 31

How does urogenital chlamydia present in men?

Answer 31

Asymptomatic infections common Acute urethritis Can progress to epididymitis and reactive arthritis

Question 32

How does urogential chlamydia present in both men and women?

Answer 32

Conjunctivitis Rectal infection - proctitis Oropharyngeal infections

Question 33

How do neonates get chlamydia serovars D-K?

Answer 33

Vertical Transmission

Question 34

What are the presentations of neonate chlamydia serovars D-K? 5-14 days: _____ 4-12 weeks: _____ Up to 2-3 yrs: ______

Answer 34

Conjunctivitis Pneumonia Urogenital infections

Question 35

How do we diagnose chlamydia trachomatis?

Answer 35

Culture - grow with tissue and not on artificial media NAAT - except for conjunctival swabs (use DFA)

Question 36

How do we treat chlamydia trachomatis for: nonpregnant adults/adolescents pregnant women neonates LGV

Answer 36

1. Oral doxycyline 2. Oral azithromycin 3. Oral erythromycin base or ethylsuccinate 4. doxycycline 5. Expediated partner therapy

Question 37

Because chlamydia trachomatis has lower peptidoglycan levels it is intrinsically resistant to _______ antibiotics and ________

Answer 37

Beta-lactams Vancomycin

Question 38

What are the characteristics of neisseria gonorrhoeae?

Answer 38

Strictly human pathogen Gram - cocci Aerobic - oxidase + Growth on chocolate agar or Thayer Martin media

Question 39

How do we differentiate between Neisseria gonorrhoeae and Neisseria meningitis?

Answer 39

Sugar Fermenation Glucose = acid production Maltose = no acid production

Question 40

What are the virulence factors of neisseria gonorrhoeae? x6

Answer 40

Pili Opa - Opacity Associate Protein Porin Lipopolysaccharide (LOS) Immunoglobulin A1 protease Antibiotic Resistance

Question 41

The ______ allow neisseria to adhere to cells, transfer genetic material, resistance neutrophil killing, and has pillins

Answer 41

Pili

Question 42

What contributes to antigenic variation of N. gonorrhea to reinfect?

Answer 42

Pilins - which have a conserved N terminus and a highly variable C-terminus The c-terminus is the main contributor

Question 43

The _______ allows bacterium-bacterium adhesion, bacterium-epithelial adhesion, epithelial cell invasion, and suppress lymphocyte activation

Answer 43

Opa

Question 44

The presence of _______ is associate with localized N. gonorrhoeae and the absence is associated with disseminated infections

Answer 44

Opa

Question 45

The _______ of N. gonorrhoeae forms pores in the bacterial membrane and bacterium endocytosis, epithelial cell invasion

Answer 45

Porin

Question 46

What porin of N. gonorrhoeae is associated with disseminated gonococcal infection and localized genital infection?

Answer 46

PorB. 1A - Disseminated PorB. 1B - localized

Question 47

The ______ of N. gonorrhoeae contains the Lipid A and core oligosaccharide. Lacks repeating O-antigen, has endotoxin activity, binding of directed antibodies, and contained in outer membrane blebs release by rapidly growing bacteria

Answer 47

Lipopolysaccharide (LOS)

Question 48

The ______ of N. gonorrhoeae helps cleave the hinge region of IgA1 to inactivate it

Answer 48

Immunoglobulin A1 protease

Question 49

What is N. gonorrhoeae resistant to?

Answer 49

Many strains carry Beta-lactamase gene Resistance to penicillin, tetracycline, and ampicilin

Question 50

What is the highest transmission risk of N. gonorrhoeae? What are other transmission methods?

Answer 50

Urethra --> vagina via semen Vagina --> urethra Mother to child transmission during childbirth

Question 51

What is the presentation of N. gonorrhoeae in men?

Answer 51

Acute urethritis: -dysurea -urethral discharge: scant, mucoid to profuse purulent - urinary frquency/urgency -epididymitis is possible complication

Question 52

What is the presentation of N. gonorrhoeae in women?

Answer 52

Gonococcal cervicitis - scant vaginal discharge, bleeding, dysuria, mucopurulent discharge from cervix, complications like salpingitis, tubo-ovarian abscess Gonococcal vaginitis - prepubertal girls and post-menopausal women, intense inflammation of vagina, pain on exam

Question 53

What is the presentation of N. gonorrhoeae for both men and women?

Answer 53

Anorectal gonorrhea - men who have sex with men (MSM) and women Pharyngeal gonorrhea - oral:genital exposure Disseminated gonococcal infection - common in women (menstrual cycle or pregnancy) Ocular gonorrhea in adults - autoinoculation from genital infection

Question 54

How does N. gonorrhoeae present in neonates?

Answer 54

Gonococcal Opthalmia Neonatorum Transmits vertically and can lead to respiratory, pharyngeal, and anal infections

Question 55

What are the symptoms of Gonococcocal Ophthalmia Neonatorum?

Answer 55

Onset is 2-5 days post birth 1st: nonspecific conjunctivitis with serosanguineous discharge 2nd: tense edema of eyelids, profuse purulent discharge Leads to corneal ulceration, blindness,

Question 56

How do you diagnose N. gonorrhoeae?

Answer 56

Urethritis in males - gram stain Other non-disseminated infections - NAAT Suspected dissemminated - NAAT, culture, antimicrobial susceptibility testing

Question 57

How do you identify N. gonorrhoeae with biochemical tests? What does each test help you distinguish between?

Answer 57

Gram - Oxidase + - Neisseria or Moraxella? Sugar fermentation + DNA hydrolysis - N. gonorrhoeae ferments glucose and N. meningitidis ferments maltose. Both negative for DNA hydrolysis

Question 58

How do you treat N. gonorrhoeae?

Answer 58

For uncomplicated genital infections - ceftriaxone, add doxycycline or azithromycin for pregnant women Pharyngeal infections - ceftriaxone Expediated partner therapy