gonorrhea cause mode of transmission presentation manifestations

cause - neisseria gonorrhea mode of transmission - sexual presentation asymptomatic 30% of the time if not, can manifest with: women cervicitis bartholinitis: _PID:_ → endometritis (uterus) → salpingitis (fallopian tubes) → tubo-ovarian (ovary) → peritonitis → Fitz-Hugh-Curtis syndrome (liver-abdomen adhesions) men urethritis anorectal infection both pharyngitis if disseminated: _poly-arthralgia_ - joint inflammation _tenosynoviti_s - skin rashes neonates: opthalmia neonatorum

GU: STIs - II & III Flashcards by Kara Rieth

gonorrhea

cause
mode of transmission
presentation
manifestations

cause - neisseria gonorrhea
mode of transmission - sexual
presentation
- asymptomatic 30% of the time
- if not, can manifest with:
  - women
    - cervicitis
    - bartholinitis:
    - PID: → endometritis (uterus) → salpingitis (fallopian tubes) → tubo-ovarian (ovary) → peritonitis → Fitz-Hugh-Curtis syndrome (liver-abdomen adhesions)
  - men
    - urethritis
    - anorectal infection
  - both
    - pharyngitis
    - if disseminated:
      - poly-arthralgia - joint inflammation
      - tenosynovitis - skin rashes
  - neonates: opthalmia neonatorum

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neisseria gonorrhea - characteristics

gram negative diplococcus
- kidney-bean shaped
- can be isolated on Thayer-Martin agar
- killed by cotton - must be calcium agnate swabs (not common swabs) to dx
infects columnar epithelial cells

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urethritis

cause
presentation
dx

causes
- neisseria gonorrhea
- chlamydia trachomatis
presentation:
- mucopurulent/purulent discharge from penile urethra
- +/- dysuria (painful urination)
dx
- if gonorrhea: gram - diplococci (kidney bean shaped)

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cervicitis

cause
transmission
presentation
dx

causes
- neisseria gonorrhea
- clamydia trachomatis
transmission - sexual
presentation
- purulent / mucopurulent discharge in endocervical canal
- +/-
  - abnormal vaginal discharge bleeding
  - external dysuria
  - urgency (rare)
- dx - purulent discharge on endocervical swab

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what is this?

cause?

Fitx-Hugh-Curtis Syndrome

liver-stomach adhesions resulting from ascending cervititis (d/t neisseria gonorrhea > chlamydia) that goes from → uterus (endometritis) → fallopian tubes (salpingitis)→ ovaries (tubovarian abcesses) → abdomen (peritonitis)

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what manifestations can result from ascending cervicitis?

endometriosis
salpingitis
tubo-ovarian abscess
peritonitis
fitz-hugh-curtis syndrome

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what manifestations can result from ascending cervicitis?

endometriosis
salpingitis
tubo-ovarian abscess
peritonitis
fitz-hugh-curtis syndrome

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how does gonorrhea manifest in heterosexual males?

with urethritis: purulent/mucopurulent discharge from penile urethra
- sx
  - usually symptomatic → dysuria

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how does gonorrhea manifest in homosexual males?

urethritis: purulent/mucopurulent discharge from penile urethra
anorectal infection: mucopurulent discharge from rectum + rectal pain
pharyngitis:
- sore throat
- tonsillitis

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how can disseminated gonococcal infections manifest?

usually asymptomatic

low grade fever
migratory polyarthralgia:
- pain/swelling/purulent synovial fluid in joint
tenosynovitis
- skin rashes

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how can neisseria gonorrrhea present in newborns?

opthalmia neonatorum: conjunctiva infection
pharyngitis
respiratory tract / GI tract infection

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dx of neisseria gonorrhea infection

patient hx
if on exam you see purulent discharge: collect a smear of the exudate and culture it:
- on Thayer-Martin:
  - a positive: intracellular gram negative diplococci
  - undetermined test: if extracellular gram negative diplococci
  - negative test: no gram negative diplococci
- NAAT techniques

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what is this?

cause?

bartholinitis

manifestation of gonorrhea

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what is this?

cause?

cervicitis
d/t
- n. gonorrhea
- c. trichomatus

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what is this?

cause?

opthalmia neonatorum: conjuncitivitis in the neonate

d/t neisseria gonorrhea

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what is this?

cause?

urethritis
cause
- neisseria gonorrhea (m/c cause in heterosexual men)
- chlamydia trachomatis

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what is this?

what is the cause?

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tenosynovitis

cause - disseminated gonorrhea

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n. gonorrrhoae - intracellular gram negative diplococci- are kidney bean shaped

what is non-gonoccal urethritis (NGU)?

causes?
presentation?

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= urethritis not d/t neisseria gonorrhea. caused by

causes
- chlamydia trachomatis - m/c cause of urethritis in heterosexual men
- mycoplasma genitalia
- gardnerella vaginalis, trichomonas vaginalis
demographics
- high risk = 15-30 w/multiple sexual partners
  - college campuses
  - rural america
presentation:
- CLEAR urethral discharge (rather than purulent)
- sx
  - itch in the meatal region
  - dysuria

NGU - presentation

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urethral discharge- clear rather than purulent
dysuria
itch in the meatal region

in what population is NGU most prevalent?

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men between the age of 15-30 that have multiple sexual partners are at most risk
- college campuses
- rural America

m/c causes of NGU

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chlamydia trachomatis (m/c)
mycoplasma genitalium

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NGU

clear urethral discharge

list the manifestations of chlamydia trachomatis

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in women
- cervicitis
- PID (from ascension)
in men
- urethritis
- epididymitis (from ascension)
neonates
- opthalmia neunatorum (not as severe as gonorrhea
- pneumonia

manifestations/complications of *chlamydia trachomatis* in women

* **cervicitis → PID.** can result in * infertility * ectopic pregnancy * conjunctivitis * arthritis/psorasis

manifestations/complications of chlamydia trachomatis in men

* **urethritis → epididymitis** * reiter's syndrome * conjunctivitis * arthritis/psoriasis

in what populations is chlamydia most prevalent?

* sexually active persons under 25 * AA \> white

manifestations of *chlamydia trachomatis* in neonates

* _5-12 days postpartum_: **opthalmia neonatorum** * presents later in gonorrhea * _1-3 mos_: **pneumonia**

PID * m/c * seen mostly in what populations * major complications

* *chlamydia trachomatis, neisseria gonorrhea* * in adolescent/young women * complications * **infertility** * **ectopic pregnancy**

neonatal pneumonia d/t chlamydia * presentation * dx

* **seen 1-3 months of age** * staccoato cough * tachypnea * lung hyperinfiltration / diffuse infiltrates * Dx = nasopharyngeal aspirates

A 25 YEAR OLD MALE, DYSURIA AND URETHRAL DISCHARGE. NO URGENCY OR INCREASED FREQUENCY. MOST APPROPRIATE DIAGNOSIS Urethritis Cystitis Pyelonephritis Prostatitis

urethritis

MOST LIKELY CAUSE? Treponema pallidum Chlamydia trachomatis Neisseria gonorrhoeae Trichomonas vaginalis Ureaplasma urealyticum

neisseria gonorrhea

TREATED PATIENT FOR GONORRHEA.THEY CAME BACK WITH DYSURIA AND DISCHARGE. MOST LIKELY CAUSE? Neiserria gonorrhoeae Chlamydia trachomatis Trichomonas vaginalis Ureaplasma urealyticum

chlamydia trachomatis

pelvic inflammatory disease (PID) - m/c etiologic agents

* *neisseria gonorrhoae* * *chlamydia trachomatis*

PID is most prevalent in what populations?

sexually active teenagers (3x more likely than 25-29)

clinical presentation of PID

major: * **bilateral lower abdominal pain** * **tenderness on cervical motion** * **tender adnexal masses** also could see: * moderate fever * inc vaginal discharge * irregular bleeding * nausea/vomiting

PID manifestations/sequelae

manifestations: * cervicitis * sx * **asx or vaginal discharge** * salpingitis * sx * **bilateral lower quadrant abdominal pain** * **adnexal tenderness** * could result in/progress to * _ovarian abscesses_ * _tubal occlusion, scarring, adhesions,_ which could result in * **ectopic pregnancy** * **infertility** * peritonitis * sx * **nausea / vomiting** * **abdominal tenderness / rigidly** * could result in/advance to * _peri-hepatitis_ * _Fitz-Hugh Curtis syndrome_ (abdominal-hepatic adhesions)

PID is the most common cause of?

involuntary infertility

what constitutes the definitive and presumptive diagnosis of PID

* definitive * direct visualization of inflammaed fallopian tubes (eg - laparaoscopy) * biopsy evidence of salpingitis * presumptive * made on clinical grounds: pt must be * sexually active with pelvic OR bilateral lower tenderness, with either * cervical motion tenderness * or * uterine tenderness, * or adnexal tenderness

genital warts (HPV)

* HPV

GU: STIs - II & III Flashcards

(40 cards)