GU Infections- Davis/Lumen/Tarakanova Flashcards Preview

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Flashcards in GU Infections- Davis/Lumen/Tarakanova Deck (36):


What defense mechanisms do humans have against STIs?


  • Epithelial cells - barrier and antigen presentation
  • Native flora- competes for resources
  • Urethral length- UTI migration
  • Urine stream- UTI migration
  • Circumcision- prevents HIV, HPV, HSV transmission


  • Epthelial cells- barrier and antigen presentation
  • Native flora- competes for resources
    • Lactobacillus lowers vaginal pH 




What sexual practices most reduce the risk of STIs?


Which groups are considered "special populations" in terms of STI management?

  • Abstinence
  • Reduce number of partners
  • Pre-exposure vaccine
  • Condom use


  • Pregnant women- STIs may affect course of pregnancy
  • Adolescents/Children- lack of maturity about sex/ may indicate abuse
  • Correctional Facilites- usually very high rates
  • MSM- sexual practices may raise risk of STI
  • WSW- may "transmit" infections back and forth



Which STIs produce painful lesions?


Which STIs produce non-painful lesions?


  • Herpes
  • Chancroid
  • Lymphogranuloma venereum



  • Syphilis
  • Molluscum
  • Genital Warts



What are clue cells?


What disease do they indicate?


Clue cells are GU epithelial cells with irregular, shaggy borders


They indicate bacterial vaginosis.  



What older test is generally preferred to test for bacterial vaginosis?


What is the CDC-recommend diagnostic test for bacterial vaginosis?


Amsels Criteria

- Vaginal pH above 4.5

- Clue cells in fluid

- Milky vaginal discharge

- Fishy odor, esp after adding 10% KOH


CDC recommends nucleic acid-based diagnosis using DNA probes




What organism is typically responsible for bacterial vaginosis?


How is bacterial vaginosis treated?


Gardnerella Vaginalis, pleomorphic gram negative rod


Treated with Nitroimidazoles (aka metronidazole) or Clindamycin either can be oral or topical



How is Candidiasis diagnosed?


How is it treated?


How does it present?


Microscopic smears will show high concentrations of candida


Imidazole suppository or single dose of oral fluconazole


May present with discharge, but more likely with UNBELIEVABLE ITCHING (which was not mentioned in class for some reason)



What type of genome does the herpes virus have?


What is the architecture of the herpes virus?




Double stranded DNA


Envelope- Tegument- Capsid

Viral and cellular proteins collect in the tegument



What types of cells do herpes viruses infect in the lytic stage and in the latent stage?


How does the genome structure in the latent infection allow switching to a lytic infection?


In the lytic phase, HSV typically infects epithelial cells; in the latent phase, it affect neurons.  


In the latent infection, the bacterial genome is stored as an episome, which can allow the virus to activate at any time.



How is herpes diagnosed?


How is herpes treated?




PCR, immunofluorescence of HSV from active lesions OR antibody tests during latency


Famciclovir will treat lytic phase, but there is no cure or vaccine for the latent phase.  



How does herpes present?


How does herpes affect pregnancy?


Present as painful ulcers, crusted ulcers, or vesicles


Herpes can be transmitted during vaginal delivery, so C-section is necessary.  



What type of genome does molluscum contagiosum have?


Where does it replicate?  How does this appear on histology?


Double-stranded DNA


It replicates exclusively in the cytoplasm of epithelial cells; molluscum bodies, or large eosinophilic cytoplasmic inclusions are seen on histology.  



How does molluscum contagiosum present?


How is it treated?


Presents as clusters of painless, wart-like nodules


The virus is typically cleared by the body naturally; however, nodules can be physically removed and acyclovir/famciclovir can be given to the immunosuppressed. 



What type of genome does HPV have?


What architecture is seen in HPV?


Double Stranded DNA


Icosahedral capsid, no envelope



What happens to the genome during replication?


What results from HPV replication?


The genome is stored as an episome in the nucleus of the cell


Epithelial proliferation results in a wart



What strains of HPV are considered "high risk"?


Why are these strains high risk?


16, 18, 31, 45


They carry an increased risk of cervical cancer due to the expression of E6 and E7, which can cause genome integration



How is HPV diagnosed?


How is it treated?


Can be diagnosed via PCR of a wart or from a pap smear


Removal of warts and administration of the vaccine Gardasil (uses caspid protein L1)



What type of architecture does haemophilus ducreyi have?


How does it use oxygen?


Pleomorphic gram-negative rod


Facultative anaerobe



How does Haemophilus ducreyi infection present?


What secondary STI are you more at risk for when infected?


Tender papule that progresses to a PAINFUL ulceration with unilateral lymphadenopathy


HIV infection (and presumably HPV as well) due to open wound



How is Haemophilus ducreyi diagnosed?


How is it treated?


Diagnosed by culture or PCR of an ulcer or lymph node aspiration


Treated with ceftriaxone, ciprofloxcin, or azithromycin 



What is the architecture of ureaplasma urealyticum?


What enzymes does it produce?


Pleomorphic without cell walls (It's a mycoplasma)


Urease; it cleaves urea in the urine into ammonia giving it a fishy smell



What symptoms does a ureaplasma urealytica infection present with?


How is it diagnosed?




Dysuria and yellow, mucoid discharge (probably also fishy smell)


Diagnosed via PCR; can be cultured, but requires urea, cholesterol and forms very small colonies



How is ureaplasma urealytica treated?


What class of antibiotics would not work?


Erythromycin and Tetracycline


Beta-lactams won't work because it has no cell wall



What is the architecture of treponema pallidum?


What disease does it cause?


Gram negative spirochete with a flagella





What are the stages of infection in syphilis?



  • Primary
    • painless chancre
  • Secondary
    • bacteremia
    • fever, chills, lymphadenopathy
    • condyloma latum
  • Latent
    • asymptomatic infection
  • Tertiary
    • Gummatous- granulomas on skin and bones
    • Cardiovascular- destruction of aortic arch and aneurysm
    • Neurosyphilis- infarction and tabes dorsalis



What are the stages of congenital syphilis?


How can transmission from mother to baby be prevented?


  • Instant death
    • fetal syphilis has a very high mortality rate
  • Early congenital syphilis
    • similar to secondary syphilis in adults
  • Late congenital syphilis
    • similar to tertiary syphilis in adults
    • More cardiovascular, tooth, eye involvement


Mothers should be on antibiotic therapy for the first 4 months of pregnancy



How is syphilis diagnosed?


How is it treated?  What side effect of treatment can occur?


scrapings from a sore can be examined under darkfield microscopy; PCR or serology is used if no sores are visible


Penicillin, erythromycin, doxycycline

Jarisch-Herxheimer Phenomenon- symptoms ets worse before resolving due to release of pyrogens from the killed organisms



What architecture does chlamydia trichomatis display?


How do the forms of chlamydia affect its replication?


Gram-negative bacteria without peptidoglycan walls; very small and difficult to see


Elementary body-  a smaller form that does not divide, but acts as a storage reservoir and infects cells

Initial body- an intracellular form that is replication capable



How does chlamydia trachomatis get its energy?


What diseases can it cause?


ATP/ADP translocator allows it to steal ATP from the cell


  • Non-gonococcal urethritis
    • dysuria, mucoid discharge (similar to UU)
  • Pelvic Inflammatory Disease/Epipdidymitis
    • Vaginal discharge, bleeding, pain
    • Scrotal swelling, tenderness, pain
  • Lymphogranuloma venerum
    • painless pus-filled papule that infect the lymph node
  • Reiter's Syndrome
    • Autoimmune nightmare
    • Conjunctivitis, arthritis, scaly erythematous rashes



How is Chlamydia diagnosed?


How is it treated?


Diagnosis by excluding gonorrhea or by PCR


1 oral dose of azithromycin 


1 IM dose of ceftriaxone and 7 days of doxycycline



What is the architecture of Neisseria gonorrhea?


How does it enter the body?


Gram negative diplococci  

(also contains about a million structural adaptations such as porins, pili, and opa protein)


It is endocytosed by epithleial cells and released into the subepithelial space



What diseases does Neisseria gonorrhea cause in adults?


What disease does it cause in babies?


Inflammation of all genital-urito structures in both men and women, diffuse symptoms cause by bacteremia, and septic arthritis


opthalmia neonatorum- infection that damages the cornea and causes blindness



How is gonorrhea diagnosed?


How is it treated?


Gram stain with culture on VCN medium or PCR


Ceftriaxone for adults, topical erythromycin for opthalmia neonatorum



What class of organism is trichomonas vaginalis?


What is its architecture?




Shield shaped organism with four flagella



What diseases are caused by trichomonas vaginalis?



Urethritis and prostatitis can be found in males, but they are typically asymptomatic.  


Females may have watery discharge or vaginitis with itching, burning, and dysuria.  



How is trichomonas vaginalis diagnosed?


How is it treated?


Diagnosed by examination of urine, vaginal fluid or by PCR probe


Metronidazole, Tinidazole if resistant

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