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Bugs > Gonorrhea and Chlamydia > Flashcards

Gonorrhea and Chlamydia Flashcards

1
Q

Scientific name for Gonorrhea?

A

Neisseria gonorrhoeae

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2
Q

Scientific name for Chlamydia?

A

Chlamydia trachomatis

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3
Q

Bacteriology of N. gonorrhoeae?

A

Diplococci, oxidase positive, Gram (-), LOS endotoxin, Chocolate agar culture, not encapsulated

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4
Q

Is gonorrhoeae cleared from the body spontaneously?

A

No. Cleared by complement from bloodstream, restrict infection to local sites. Complement deficiencies predispose for complications (bacteremia)

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5
Q

Gonorrhoeae drug resistance?

A

Plasmid-borne antibiotic resistance more common. Cephlasporin resistance

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6
Q

Transmission of gonorrhoea?

A

Sexually or congenital (birth). Single exposure contraction.

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7
Q

How does gonorrhoeae present in neonates?

A

Purulent conjunctivitis (uni/bilateral), eye pain, redness, discharge. Permanent blindness if untreated.

Pharyngeal, respiratory, rectal, or disseminated possible.

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8
Q

How does gonorrhoeae present in men?

A

Symptomatic. Anterior urethritis, dysuria, purulent discharge, unilateral epididymitis

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9
Q

How does gonorrhoeae present in women?

A

Possibly asymptomatic. Cervicitis, PID, sterility, ectopic pregnancy

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10
Q

Gonorrhoeae virulence factors?

A

IgA protease, pili attachment, Opa proteins, Porin A/B serum resistance (anti-complement)

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11
Q

Common secondary infection assoc. with gonorrhoeae?

A

Pelvic inflammatory disease (PID). Cervical infection spreads to fallopian tubes (pain, infertility, ectopic pregnancy risk).

Dysuria, tenderness, abdominal pain, vaginal discharge, intermenstrual bleeding

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12
Q

Symptoms that men and women can share?

A

genital tract, anorectal, pharyngeal, eye infections

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13
Q

What is Fitz-Hugh-Curtis syndrome?

A

Assoc. with gonorrhoeae and chlamydia.

Infection jumps from fallopian tube to liver capsule –> Acute perihepatitis.

Imaging may show thickened fallop. tubes or abscess

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14
Q

Pt with significant STI risk factors, presents with unexplained knee inflammation/pain, but no urogenital symptoms. What are you thinking?

A

Disseminated infection (DGI) of gonorrhoeae.

Can present with arthritis (jt pain), dermatitis (skin pustules), asymmetric tenosynovitis w. wrist/ankles pain, moderate fever, septic asymmetric arthritis (knee most common).

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15
Q

What are some rare sequelae of gonorrhoeae infection?

A

GONOCOCCAL meningitis: use spinal tap

ENDOCARDITIS: More common in men, aortic valve = common site, subacute fever/chills/sweats/malaise, chest pain and cough

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16
Q

How do you diagnose gonorrhoeae in men?

A

Urine and exudate testing: PMNs indicate urethritis, gram (-) diplococci seen in microscopy.

If negative, obtain urethral swab. Culture on chocolate agar (Thayer-martin). Colonies test gram (-), oxidase (+), and diplococci. Most sensitive and specific test.

17
Q

How do you diagnose gonorrhoeae in women?

A

Endocervical smear, culture on chocolate agar (Thayer-martin)

18
Q

Diagnosing disseminating infection (DGI)?

A

Swab, gram stain, culture mucosal surfaces and fluid draws.

Sample normally-sterile sites (blood, jt fluid) and culture on choco. agar.

19
Q

How does N. meningitidis differ from N. gonorrhoeae?

A

Only meningococci ferment maltose

20
Q

How is gonorrhoeae treated? Is concurrent infection possible? Treatment?

A

Rx: Ceftriaxone, cefixime. If penicillin allergy, cephalosporin. Be aware of resistance).

Septic joints: aspiration

Concurrent chlamydia infection often: Add azithromycin or doxycycline.

21
Q

Treating gonorrhoeae in neonates.

A

Application of erythromycin ointment or silver nitrate to eyes post-birth.

22
Q

Prevention of gonorrhoeae in adults?

A

Condoms, informing of sexual partners, expedited partner treatment

23
Q

What makes chlamydia replication so specialized?

A

Involves ELEMENTARY and RETICULATE bodies (forms).

ELEMENTARY body (infectious, metabolically inactive) attaches to cell surface (lung and mucousal epithelium). and is endocytosed. T3SS activated.

Endosome reorganized in RETICULATE body (non-infectious, metabolically active). Replication within endosome via binary fission. Forms Inclusion granule (EBs + RBs). Reverse endocytosis of microbes,48 hrs post-infect.

24
Q

Immunological response to chlamydia?

A

Symptomatic inflammatory cascade (swelling, discharge). No clearance of infection. No immune memory; reinfection possible.

25
Q

Different serovars of chlamydia are responsible for which diseases?

A

A, B, Ba, C: Blinding trachoma
L1-L3: lymphogranuloma venereum
D-K: genital tract infections

26
Q

What distinguishes chlamydia infection in men vs. women?

A

Men often asymptomatic. Disease reservoirs. Recurrent infections in women usually due to reinfection by undiagnosed male partner.

27
Q

Common symptoms of chlamydia infection.

A

Local mucosal inflammation and discharge. Urethritis, cervicitis, vaginitis.

28
Q

Link between chlamydia and HIV?

A

Chlamydia infection increases risk of HIV infection through open sores.

29
Q

Dangers of chlamydia during pregnancy?

A

Can be transmitted to infant during delivery

30
Q

Risk factors for chlamydia.

A

Non-barrier contraception use, <19 y/o, multiple sex partners, single, poor

31
Q

Potentially dangerous sequelae of chlamydia infection

A

PID. Cervical infection spreads to fallopian tubes (pain, infertility, ectopic pregnancy risk). Dysuria, tenderness, abdominal pain, vaginal discharge, intermenstrual bleeding

REITER SYNDROME (aka reactive arthritis): Immune response. Conjunctivitis, urethritis, arthritis (“Can’t see, can’t pee, can’t climb a tree”). Treat with NSAIDs. 2 years for resolution.

32
Q

How do you physically diagnose chlamydia in women?

A

Endocervical bleeding, mucopurulent endocervical discharge, intermenstrual bleeding, dysuria, abdominal pain

33
Q

How do you physically diagnose chlamydia in men?

A

Usually asymptomatic, but can present with urethral discharge, urinary frequency/urgency, dysuria, scrotal pain/tenderness, perineal fullness

34
Q

Diagnosing chlamydia through labs.

A

A. Cytologic diagnosis: microscopy will show inclusion bodies
B. Cell culture: Grows well in many cell lines
C. Chlamydia rRNA detection: Hybridization with DNA probe
D. ELISA and PCR of urine/exudate possible

35
Q

Treatment of chlamydia

A

Intracellular microbe. Need intracellular drugs.
Primary: doxycycline (NOT for preggos) and azithromycin
Secondary: Erythromycin and amoxicillin (Need fw-up testing)
Treat partner also

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