Bacterial STD II

Question 1

What is syphilis caused by?

Answer 1

Infected with treponema pallidum

Question 2

What are the characteristics of treponema pallidum?

Answer 2

Spirochete

Severely limited metabolic activity - not able to be cultivated on artificial media

Grows slowly in tissue culture

Microaerophilic

Question 3

Can you gram stain treponema pallidum?

Answer 3

NO!

Question 4

How do you visualize treponema pallidum?

Answer 4

Darkfield microscopy or fluorescently tagged anti-treponema antibodies

Question 5

What is the course of disease for syphilis? x5

Answer 5

Treponema pallidum infection

Primary syphilis

Secondary syphilis

Latent syphilis

Tertiatory syphilis or resolves

Question 6

What types of syphilis can show up at any stage?

Answer 6

Neurosyphilis

Ocular syphilis

Otosyphilis

Question 7

How is treponema pallidum transmitted?

Answer 7

Sexual contact with infectious lesions, in utero, vertical transmission

Question 8

What are the symptoms of primary syphilis?

Answer 8

Lesion at site of inoculation (primary chancre)

Single, painless papule

Progresses to ulcer with raised margins

Cartilagenous feel

Question 9

___________ presents as skin lesions due to spread through bloodstream. Pale red or pink, nonpruritic, and appear first on trunk and then extremities.

Answer 9

Secondary syphilis

Question 10

Where do secondary syphilis mucocutaneous lesions present?

Answer 10

Genital and oral areas

Warm, moist lesions

Question 11

What is latent syphilis?

Answer 11

Persistent infection in absence of symptoms

Can last up to 30 years

Production of treponemal antibodies maintained.

Question 12

What are the the late manifestations of syphilis? x3

Answer 12

1. Tabes dorsalis
2. Cardiovascular syphilis
3. Late benign syphilis/gumma

Question 13

________ is a demyelination of posterior columns, dorsal root, and dorsal root ganglia. Late manifestation of syphilis

Answer 13

Tabes dorsalis

Question 14

Cardiovascular syphilis leads to _______ of the vasa vasorum that causes aortitis, aortic regurgitaiton, aneurysm, stenosis.

Answer 14

Endarteritis obliterans

Question 15

What is gumma?

Answer 15

Late benign syphilis. Leads to solitary lesions up to several cm in diameter

Question 16

What does neurosyphilis present with?

Answer 16

Meningeal syphilis

Meningovascular syphilis

General paresis

Question 17

What does congenital syphilis lead to?

Answer 17

40% fetal loss

Survivors often have fulminant congenital syphilis and appear healthy at birth and then later develop issues.

Question 18

What are classic stigmata of congenital syphillis? x4

Answer 18

1. Hutchinson’s teeth
2. Mulberry molars
3. Saddle nose
4. Saber shins

Question 19

How do you diagnose treponema pallidum?

Answer 19

Screening test = lipoidal

Confirmatory test = treponemal tests

Question 20

_________ measures IgG and IgM against the cardiolipin-lectin-cholesterol antigen complex. Includes RPR (rapid plasma reagin) and VDRL (venereal disease research laboratory)

Answer 20

Lipoidal test

Question 21

What does the treponemal test measure? What tests does it include?

Answer 21

Antibody to T. pallidum antigens

FTA-ABS test - fluorescent treponemal antibody absorbed test
TPPA test - T. pallidum particle agglutination test

Question 22

Treponemal tests remain ________ for year. May be the only positive marker in late syphilis infection and after appropriate treatment.

Answer 22

Positive

Question 23

What do you treat treponema pallidum with?

Answer 23

Penicillin

Long term penicillin for latent or neurosyphilis

Question 24

What are the characteristics of mycoplasma and ureaplasma?

Answer 24

Smallest free-living bacteria

No cell wall

Cell membrane contains sterols

Pleomorphic

Slow growth on artificial media

Question 25

What do colonies of mycoplasma and ureaplasma look like?

Answer 25

Fried eggs

Question 26

Mycoplasma and ureaplasma do not have a cell wall, which makes them resistant to _______

Answer 26

Penicillins, cephalosporins, vancomycin

Question 27

Mycoplasma pneumoniae presents in the _________ and causes diseases like tracheobronchitis, pharyngitis, and secondary complications.

Answer 27

respiratory tract

Question 28

Mycoplasma genitalium presents in the ___________ and causes diseases like NGU and PID

Answer 28

genitourinary tract

Question 29

Ureaplasma urealyticum presents in the ___________ and __________ and causes disease like NGU, pyelonephritis, spontaneous abortion, premature birth

Answer 29

Respiratory tract, genitourinary tract

Question 30

How do you diagnose mycoplasma genitalium?

Answer 30

NAAT is preferred Suspected in cases of persistent or recurrent cases of cervicitis and PID

Question 31

How do you treat mycoplasma genitalium?

Answer 31

Azithromycin or moxifloxacin ---> can't use cell wall inhibitors

Question 32

What treatment is ineffective to mycoplasma genitalium?

Answer 32

Doxycycine

Question 33

________ is most common in sexually active populations and can cause NGU in males. Suspected cases are treated with doxycycline

Answer 33

Ureaplasma

Question 34

What causes Chancroid?

Answer 34

Haemophilus ducreyi

Question 35

What are the characteristics of haemophilus ducreyi?

Answer 35

Fastidious Gram - coccobacillus Requires factor X and V for growth

Question 36

What does haemophilus ducreyi grow on?

Answer 36

Chocolate agar

Question 37

What populations or areas is Haemophilus ducreyi more common?

Answer 37

Developing countries Commercial sex workers Illicit drug use

Question 38

How is haemophilus ducreyi transmitted?

Answer 38

Break in skin during sexual contact

Question 39

What is the presentation of haemophilus ducreyi?

Answer 39

Tender inguinal lymph nodes Multiple lesions common - papule with surrounding erythema, forms pustule, and then ruptures to form ulcer.

Question 40

What are the distinguishing characteristics of the ulcers of Haemophilus ducreyi? x2

Answer 40

Painful Multiple lesions common

Question 41

What is a probable diagnosis of Haemophilus ducreyi? x4

Answer 41

1. Painful ulcers 2. No evidence of syphilis 3. Has lymphadenopathy 4. HSV negative

Question 42

How do you treat Haemophilus ducreyi?

Answer 42

Antbiotics - macroglides (azithromycine, erythromycin) Wear condoms

Question 43

What causes donovanosis/granuloma inguinale?

Answer 43

Klebsiella granulomatis

Question 44

What are the characteristics of Klebsiella granulomatis?

Answer 44

Gram - rod Capsule leads to mucoid like colonies

Question 45

Can Klebsiella granulomatis be cultured like other Klebsiella types?

Answer 45

No! Not on traditional medium

Question 46

_________ (bacteria) is rare in US and associated with poor hygiene. Presents with painless wartlike papule and ulcerates with trauma. Seen in countries like Papua New Guinea, Southern Africa, India, the Caribbean, French Guyana, Brazil, and aboriginal communities in Australia.

Answer 46

Klebsiella granulomatis

Question 47

What are the 4 lesion types of Klebsiella granulomatis?

Answer 47

1. Classic - beefy and red lesion that bleeds easy 2. Hypertrophic or verrucous ulcer with raised irregular edge 3. Necrotic - offensive smelling ulcer causing tissue destruction 4. Sclerotic or cicatricial lesion with fibrous scar tissue

Question 48

How do we diagnose Klebsiella granulomatis?

Answer 48

Appearance of lesions Donovan bodies PCR

Question 49

How do we visualize donovan bodies when diagnosing Klebsiella granulomatis?

Answer 49

Visualized upon Wrights staining

Question 50

________ are large mononuclear (Pund) cells within intracytoplasmic cysts. Inside cysts are deeply staining bodies, may show safety pin like staining

Answer 50

Donovan bodies

Question 51

How do we treat Klebsiella granulomatis?

Answer 51

Azithromycin