Gynecological and Pregnancy Infections Part 2 (Staudinger)

Question 1

A 32 year-old-year female complains of a thick, mucoid vaginal discharge. She has a new sexual partner. On speculum exam, she has erythema of the cervix with purulent discharge coming from the os. If grown on Thayer-Martin chocolate agar, the bacteria responsible for her infection would be identified as an intracellular gram-negative diplococcus. What is a virulence factor of the bacteria responsible for her condition?

a. Flagella assisting mobility
b. Absence of a cell wall
c. Pili involved in adherence
d. Reticulate body

Answer 1

c. Pili involved in adherence

Question 2

What are possible pathogens for cervicitis?

Answer 2

Chlamydia and Gonorrhea (most common)
Trichomonas, Mycoplasma Genitalium and HSV are others

Question 3

Neisseria gonorrhea

Answer 3

intracellular gram negative diplococcus; grows on Thayer-Martin chocolate agar; virulence factor of pili (for adherence)

Question 4

Chlamydia trachomatis

Answer 4

gram negative TINY obligate intracellular bacteria; does NOT appear on gram stain (will give negative result); infectious particle is the elementary body; active parasite form is the reticulate body (steal ATP/ADP energy from the host)

Question 5

What bacterium is the same size of some viruses?

Answer 5

Chlamydia trachomatis; can cause cervicitis

Question 6

Role of the reticulate body of Chlamydia trachomatis?

Answer 6

active parasite form is the reticulate body; steal ATP/ADP energy from the host

Question 7

Mycoplasma genitalium

Answer 7

has no cells walls; causes non-gonococcal urethritis

Question 8

Bacterium without cells walls that causes non-gonococcal urethritis

Answer 8

Mycoplasma genitalium

Question 9

Empirical treatment for cervicitis?

Answer 9

IM Ceftrixone and oral Azithromycin (allergy to azithromycin then, Doxycycline)

Question 10

Ceftriaxone

Answer 10

3rd generation cephalosporin; most effective against gram positive; penetrates the CSF; avoid in jaundiced infants

Question 11

Azithromycin

Answer 11

Macrolide; 50S protein synthesis inhibitor; good in bacteria lacking cell walls (mycoplasma, legionella and chlamydia); take on empty stomach

Question 12

Doxycycline

Answer 12

Tetracycline; 30S protein synthesis inhibitor; AVOID during pregnancy (category D); strong chelator (don’t give w milk or Fe)

Question 13

Chandelier sign

Answer 13

cervical motion tenderness seen in pelvic inflammatory disease (PID); pt lifts buttock in air as if jumping after palpating the cervix

Question 14

What are the most common pathogens to cause pelvic inflammatory disease (PID)?

Answer 14

Neisseria gonorrhea and Chlamydia trachomatis

Question 15

Pathogenesis of PID?

Answer 15

begins in the vulva or vagina; spreads up genital tract and can get to the pyrosalpinx (Fallopian tube) and can reach both tubes and ovaries - tube-ovarian abscess

Question 16

What is a major PID complication?

Answer 16

tube-ovarian abscess - inflammation involving both tubes and ovaries; late stage of PID; adnexal mass; fever; increased WBCs and abdominal-pelvic pain

Question 17

Fitz-Hugh-Curtis syndrome

Answer 17

complication of PID; infection spreads into the peritoneal; sudden onset of severe abdominal pain +/- fever, n/v; long term results in infertility and ectopic pregnancy

Question 18

Neonatal conjunctivitis

Answer 18

vertical transmission from mom to baby due to gonorrhea (ophthalmia neonaorum) and chlamydia (neonatal inclusion conjunctivitis) complications; swelling of the eye surface membranes, erythema and discharge

Question 19

PID outpatient treatment

Answer 19

Ceftriaxone and Doxycycline (if complicated ie tube-ovarian abscess consider adding metronidazole)

Question 20

PID inpatient treatment

Answer 20

Doxycycline plus cefoxitin OR cefotetan
if pt is pregnant then Clindamycin and gentamicin

Question 21

cefoxitin and cefotetan

Answer 21

2nd generation cephalosporins; cell wall synthesis inhibitors; broad spectrum coverage;

Question 22

Gentamicin

Answer 22

Aminoglycoside; 30S protein synthesis inhibitor; do NOT use in pregnancy (category D); side effects of nephrotoxicity, ototoxicity (usually irreversible), and complete neuromuscular blockage

Question 23

Black Box warning for gentamicin

Answer 23

Nephrotoxic/Neurotoxic and irreversible ototoxicity

Question 24

What are the two category D drugs?

Answer 24

Gentamicin - Aminoglycoside; 30S protein synthesis inhibitor
Doxycycline - Tetracycline; 30S protein synthesis inhibitor