Bacterial Urethritis/Cervicitis and Sequalae

Question 1

What 3 bugs account for 60-80% of the cases of STIs with primary symptoms of dysuria and penile/vaginal exudation?

Answer 1

Chlamydia trachomatis (Ct), Neisseria gonorrhoaea (gonococcus or GC), and Ureaplasma urelyticum

Question 2

How is Lab Dx of Ct or GC usually made?

Answer 2

NAATs on urine or exudates for Ct and GC

Question 3

How are Ct and GC treated? What is common with them? and what does this mean for patients?

Answer 3

Proper diagnosis and antibiotics; subclinical/unapparent infections are common; they spread infections to sexual contacts

Question 4

What is the most serious sequelae of Ct and GC?

Answer 4

Lower genital tract infections that spread to the upper genital tract which leads to pelfic inflammatory dz and lead to sterility and ectopic pregnancy

Question 5

Can the newborn be infected during birth with Ct and GC?

Answer 5

Yes, resulting in conjunctivitis and or pneumonia (Ct)

Question 6

Are multiple episodes of Ct and GC common?

Answer 6

Yes

Question 7

Is infection with multiple STDs at the same time common?

Answer 7

Yes

Question 8

If someone is infected with GC, what are the chances they are also infected with Ct?

Answer 8

50%

Question 9

What kind of parasite is Ct?

Answer 9

Obligate intracellular (gram negative bacterium that is deficient in peptidoglycan) that can be grown in tissue culture but not artificial medium

Question 10

What is the developmental cycle of Ct?

Answer 10

It is a distinctive intracellular developmental cycle that consists of two alternating forms: A small, metabolically inert but infectious elementary body (EB) and a larger dividing reticulate body (RB)

Question 11

Where does the RB of Ct grow?

Answer 11

Within a membrane-bound vacuole (inclusion body) in the cytoplasm of mucosal epithelial cells

Question 12

In a productive Ct infection, what happens to the host cell?

Answer 12

It dies by lysis which releases EBs to infect nearby cells or to be sexually transmitted to a new host

Question 13

Because Ct reside in an isosmotic intracellular environment, what class of drugs are ineffective?

Answer 13

B-lactam antibiotics

Question 14

What is the primary virulence factor of Ct (besides the ability to grow inside eukaryotic cells)?

Answer 14

Their ability to cause inflammation

Question 15

Does GC have a capsule?

Answer 15

No capsule

Question 16

What is shed during GC infections?

Answer 16

LPS, it invokes an inflammatory response

Question 17

What is achieved by at least two mechanisms involving pili and their outer membrane surface proteins in GC?

Answer 17

Antigenic variation

Question 18

What is the pilus variation a result of?

Answer 18

Insertion of parts of various silent peptide-encoding loci into an expression locus which results in huge variety of antigens; can occur multiple times during course of single infections

Question 19

Are GCs extracellular parasites?

Answer 19

Yes, they are killed when phagocytksed by PMNs

Question 20

What do GCs secrete?

Answer 20

An IgA1ase

Question 21

Do Ct or GC invoke a protective immune response?

Answer 21

No, people do not become resistant

Question 22

Where is Ct limited to?

Answer 22

Mucosal epitheliim (no dissemination to blood/lymph) while GC can sometimes disseminate (septicemia and rash)

Question 23

Does Ureaplasma have a cell wall?

Answer 23

No, they lack a cell wall

Question 24

Is ureaplasma susceptible to any B-lactams?

Answer 24

No

Question 25

What are the uncomplicated lower genital tract infections caused by GC and Ct?

Answer 25

Cervicitis, urethritis

Question 26

What are the upper genital tract complications of GC and Ct?

Answer 26

Salpingitis and PID, epididymitis, perihepatitis fitz-hugh-curtis syndrome, prostatitis (Gc onle?)

Question 27

What are some diseases of other sites from GC and Ct? (Just writing the bolded terms here)

Answer 27

Pharyngitis (oral sex, GC), Conjunctivitis in the newborn, Infant pneumonia (1-4 mo, Ct), Disseminated (GC, sepsis w/ rash)

Question 28

What is Urethritis/Cervicitis?

Answer 28

Asymptomatic/inapparent/subclinical infections common in men and women

Question 29

What are the symptoms of Urethritis in men?

Answer 29

GC: Purulent penile discharge, Ct: less purulent, milky discharge, Dysuria for both

Question 30

What are the symptoms for Cervicitis?

Answer 30

Similar to men except discharge is from the endocervix

Question 31

What is PID?

Answer 31

An inflammatory process involving a variable combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis

Question 32

What are the symptoms of PID?

Answer 32

Dull to severe lower abdominal pain, Sx/Signs of cervicitis may be present, adnexal tenderness, cervical motion tenderness, and fever

Question 33

What are the serious complications of PID?

Answer 33

Often requires hospitalization, tubo-ovarian abscesses possible, may result in sterility, can lead to ectopic pregnancy, can result in chronic pelvic pain

Question 34

What are the symptoms of a disseminated GC infections?

Answer 34

Fever, Rash (often on fingers or toes and feet), Septic arthritis

Question 35

When does infant pneumonia (Ct) occur?

Answer 35

1-4 months postpartum

Question 36

What are the symptoms of Infant pneumonia?

Answer 36

Repetitive staccato cough with tachypnea, wheezing is rare

Question 37

What is the most important part about transmission/epidemiology?

Answer 37

Inapparent infections are common, many people are infected but do not know it (Ct especially)

Question 38

What is gram stained for bacterial STDs?

Answer 38

Penile exudates

Question 39

If a G- cocci is seen on gram stain, what is presumptive Dx?

Answer 39

GC

Question 40

If poly but no cocci are seen on gram stain, what is Dx?

Answer 40

Non-GC urethritis (most likely CT)

Question 41

What can't a gram stain detect?

Answer 41

Ct

Question 42

Unless Ct is excluded by a test, what must be done?

Answer 42

Patient w/ GC must be treated for GC and Ct

Question 43

What medium can GC be grown on?

Answer 43

Thayer-Martin medium, which is a rich chocolate blood agar w/ Abs to inhibit normal flora

Question 44

What is GC presumptively identified by?

Answer 44

Growth on T-M, G stain (gram neg diplococcus), oxidase positive test

Question 45

What is the most common Dx by (on urine or cervical/urethral exudates) for GC and Ct?

Answer 45

NAAT, Gold standart for Ct

Question 46

What does a rapid antigen detection test detect?

Answer 46

Ct directly in exudates

Question 47

What is the best treatment option for GC?

Answer 47

Single IM injection of ceftriaxone, but resistance is increasing

Question 48

Why can't fluoroquinolones be used anymore?

Answer 48

Resistance has developed

Question 49

What is the DOC for Ct?

Answer 49

Azithromycin (2nd DOC Doxy = CI'd in infants, young children, and pregnant women; Erythro for newborns, infants, and pregnant women)

Question 50

How do you prevent Ophthalmia neonatorum?

Answer 50

Silver nitrate/topical Abx in eyes of newborn for GC, silver nitrate/abx in eyes does not work for Ct so it does not prevent Ct infant pnuemo

Question 51

Compare the levels of GC and Ct in the US?

Answer 51

GC has been declining over the past 10 years but still shows a significant health problem, level of Ct increasing

Question 52

What is another Ct STD?

Answer 52

Lymphogranuloma venereum (LGV); swollen lymph nodes, supparation of lymph nodes, ulceration at site of entry, rare in US but need to be aware of LGV

Question 53

What is a non-STD Ct infection?

Answer 53

Trachoma, a significant potentially blinding chronic Dz