L39- Urogenital Infections II

Question 1

UTIs are mostly caused by (exogenous/endogenous) microbes

Answer 1

endogenous- mostly from urinary tract microbiota

Question 2

list some major concerns of STIs beyond the actual infection

Answer 2

• some STIs like HSV2, Syphilis an inc risk of HIV acquisition
• reproductive health consequences: i) PID –> infertility, ii) gonococcal opthalmia of fetus from mother
• drug resistance, main gonorrhea

Question 3

Trichomonas vaginalis microbial features

Answer 3

(sexually transmitted, fomite transmission possible)

• protozoa (parasite) –> no cyst form
• 4 flagella –> may lose it for ability to cross barriers
• short undulating membrane for motility

Question 4

Trichomonas vaginalis:

• (1) commonly affected group
• (2) infection site in men
• (3) infection site in women

Answer 4

1- young, sexually active women (for asymp. and symp. disease)

2- urethra
3- vagina

Question 5

Trichomonas vaginalis:

• (1) clinical presentations
• inc risk of (2)

Answer 5

1:

• asymptomatic
• genital inflammation = vulvovaginal trichomoniasis: fishy odor, green-white discharge, itching

2- HIV transmission

Question 6

Trichomoniasis Dx:

• (1) first check
• (2) gold standard test
• (3) non-culture tests
• (4) other DDx

Answer 6

1- vaginal pH, >4.5 is suggestive of disease (+ BV, not candidiasis)

2- Culture: modified Modified Diamond’s Media –> add 10% NaCl (look for **motile trophozoites) + 10% KOH whiff test (fishy odor)

3- NAAT (amplified test), DNA probe (non-amplified test), gram-stain smear

4- candidiasis: yeasts and pseudohyphae

Question 7

Urethritis, UTI male presentation

Answer 7

burning sensation, dysuria

Question 8

Urethritis, UTI female presentation

Answer 8

frequency, urgency, dysuria

fever, chills

Question 9

Urethritis, STI male presentation

Answer 9

hematuria. hematospermia, penile discharge
dysorgasmia, itching, tenderness, penile swelling
lymphadenopathy

Question 10

Urethritis, STI female presentation

Answer 10

vaginal discharge, itching

pelvic / abdominal pain, dyspareunia, stomach pain

Question 11

Neisseria gonorrhea microbial features

Answer 11

• Gram- diplococci
• non-motile
• fastidious growth
• oxidase+
• multiple outer surface Ags
• sexual transmission, inc risk of HIV infection

reservoirs: only humans, rare fomite transmission

Question 12

list results of all N. gonorrhea infections

Answer 12

1a) oropharyngeal infection –> pharyngitis –> 1% systemic spread (arthritis, endocarditis, meningitis)
1b) anal / genital infection –> local irritation w/ discharge OR asymptomatic (*women) —> 1% systemic spread
2) cervical infection (+/- Sxs) –> ascending infection –> uterine cavity, fallopian tube (PID, infertility, ectopic pregancy)
3) surface colonization during birth –> eye infection –> blindness or conjunctivitis

Question 13

Gonorrhea male and female presentation

Answer 13

Men (95% symptomatic)

• mainly restricted to urethra
• purulent discharge: yellowish pus
• dysuria

Women
-cervix infection
-dysuria
-vaginal discharge
-abdominal pain
(*inc risk of dissemination b/c more asymptomatic)

Question 14

describe the risk of gonorrhea infections in women (hint- 2)

Answer 14

-more likely asymptomatic (Sxs in 95% males) –> inc risk of dissemination
(+ inc risk HIV transmission)

-vertical transmission during birth => eye infection (blindness or conjunctivitis)

Question 15

list the attachment factors for N. gonorrhea

Answer 15

-pili: unusual, specialized mechanism of Ag variation by DNA rearrangement

• Opa (opacity protein)
• por protein (creates pore for nutrient extraction)
• Fe-binding proteins
• lipooligosaccharide (LOS)- induces TNFα

Question 16

N. gonorrhea:

• attachment factors bind to (1), using (2) as the anchor
• replication occurs in (3) manner (include main resulting Sx)

Answer 16

1- columnar epithelial cells of distal urethra (males) or cervix (females)

2- pili + outer surface proteins

3- in situ –> large numbers in virulent cells –> shed in secretions (men + women)

Question 17

N. gonorrhea:

• spread of infection occurs as (1)
• dissemination in to blood is common in (2) patients
• (3) is the result of chronic infection (men and women)

Answer 17

1: (Note- nonmotile, no flagella)
- males limited to urethra
- females –> as far as fallopian tube migration via urethral/uterine contractions

2- defective complement

3- scarring and stricture of fallopian tube or urethra

Question 18

N. gonorrhea Dx:

• (1) first properties tested for
• (2) next non-culture lab tests
• (3) describe culture (describe agar)

Answer 18

1- pus sample –> smear -> intracellular Gram- diplococci

2- NAATs- PCR (amplified test) or DNA probe (non-amplified test)

3- Thayer-Martin: chocolate agar w/ vancomycin, colistin, nystatin) –> oxidase+ colonies

Question 19

Chlamydia Trachomatis virulence factors

Answer 19

Atypical bacterium:

• Gram-
• EB infectious form, RB replicative form
• small obligate intracellular parasites
• entry via abrasions / lacerations
• may increase HIV transmission

Question 20

list the clinical presentations of C. trachomatis by serotype

Answer 20

A,B,Ba,C –> trachoma

D-K –> conjunctivitis, infant pneumonia, urogenital disease

LGV-1,2,3 –> lymphogranuloma venerum

Question 21

Chlamydia trachomatis clinical presentations

Answer 21

-usually no Sxs

Sxs: vaginal discharge, dysuria (burning- direct cell destruction, host inflammatory response)

• ~40% women –> PID = infertility, ectopic pregnancy, chronic pelvic pain
• uncommon male complications –> epididymitis, urethritis

Question 22

Chlamydia pathogenesis mainly involves the presence of (1) on (2) cells

Answer 22

1- EB receptors (epithelial cells)

2- mucous membranes urethra, endocervix, endometrium, fallopian tubes, anorectum, respiratory tract, conjunctiva

Note- no long lasting immunity post-infection

Question 23

Chlamydia Dx

Answer 23

NAATs- most sensitive method, urine sample (some for vaginal swab)

specimens: urine/urethra males, endocervix/female females, rectum, oropharynx

Question 24

describe distribution of genital ulcers based on geographic locations

Answer 24

USA:
i) HSV2
ii) syphilis (Treponema pallidum)
iii) chancroid (hemophilus ducreyi)
[iv) LGV / lymphogranuloma venereum- chlamydia trachomatis]

India, West Indies, Africa, S. America:
-Klebsiella granulomatis –> donovanosis / granuloma inguinale

Question 25

describe genital ulcers based on characteristics: - (1) number - (2) tenderness

Answer 25

1: HSV- clusters Syphilis- 1-2 others: 1 2: Tender: HSV, chancroid, 1/3 syphilis Painless: LGV, Donovanosis

Question 26

describe adenopathy of genital ulcers: - (1) HSV - (2) syphilis - (3) chancroid - (4) LGV - (5) donovanosis

Answer 26

``` 1- inguinal, very tender 2- rubbery, mildly tender 3- inguinal, fluctuant, very tender 4- fluctuant, 'groove sign' 5- firm, mimics LGV ```

Question 27

HSV1/2 viral features

Answer 27

large enveloped dsDNA icosahedral Note- highest spread during outbreaks, but there is spread between outbreaks

Question 28

``` HSV1/2- 1st episode, primary -(1) lesions / Sxs (at presentation) -(+/-) HSV-1 Ab -(+/-) HSV-2 Ab ```

Answer 28

1- lesions present, severe, bilateral 2- neg. 3- neg.

Question 29

``` HSV2- 1st episode, non-primary -(1) lesions / Sxs (at presentation) -(+/-) HSV-1 Ab -(+/-) HSV-2 Ab ```

Answer 29

1- lesions present, moderate 2- pos. 3- neg.

Question 30

``` HSV2- 1st episode, recurrence -(1) lesions / Sxs (at presentation) -(+/-) HSV-1 Ab -(+/-) HSV-2 Ab ```

Answer 30

1- lesions present, mild 2- pos. or neg. 3- pos.

Question 31

``` HSV2- symptomatic, recurrence -(1) lesions / Sxs (at presentation) -(+/-) HSV-1 Ab -(+/-) HSV-2 Ab ```

Answer 31

1- lesions present, mild, unilateral 2- pos. or neg. 3- pos.

Question 32

``` HSV2- asymptomatic infection -(1) lesions / Sxs (at presentation) -(+/-) HSV-1 Ab -(+/-) HSV-2 Ab ```

Answer 32

1- no lesions present, no Sxs 2- pos. or neg. 3- pos.

Question 33

describe the cells HSV invades and the types of infections

Answer 33

Lytic: most cells- Cowdry type A inclusion bodies, syncytia Persistent: lymphocytes, macrophages Latent: neurons

Question 34

(1) HSV mechanism to evade immune system | (2) recurrence triggers and severity

Answer 34

1- blocks IFN effects, prevents Tc/CD8+ recognition of infected cells, escapes Ig neutralization by latent (neuron) infection 2- stress usually, but triggers poorly understood --> episodes dec in severity

Question 35

HSV Dx: - (1) sample - (2) testing during outbreak - (3) testing between outbreaks

Answer 35

1- ulcers 2- PCR, cell culture, serology tests (glycoprotein G) 3- Ab testing

Question 36

Treponema pallidum microbial features

Answer 36

- thin, tightly coiled - **spirochetes - motile, endoflagellum - slow replication - obligate human pathogen - unusual outer membrane (no LPS, no porins) - inc likelihood of HIV transmission

Question 37

describe presentation and time course of primary Syphilis

Answer 37

(treponema pallidum) - 9-90 days post-infection - hard, painless ulcer --> thin, greyish crust - disappears 1wk after proper Tx - disappears 4-12 wks w/o Tx - 75% untreated infections do not progress

Question 38

describe presentation and time course of secondary Syphilis

Answer 38

(treponema pallidum) - 2-8 wks after ulcer (primary) - flu-like syndrome - 80% generalized maculopapular rash (copper color) + multiple Sxs indicative of systemic infection - condylomata lata lesions (swarming with organism): wet mucous patches, contagious

Question 39

describe presentation and time course of tertiary Syphilis

Answer 39

(treponema pallidum) - 15-20 yrs post-infection - diffuse chronic inflammation - neurosyphilis => dementia, meningitis, hallucinations - CVS: aortic aneurysm - Gummatous: hypersensitive granulomatous reaction (destructive to viscera or mucocutaneous areas)