Lec. 3 Gonorrhea and Chlamydia Flashcards by Justin Faulkner

What is the gram stain and oxidase status of N.gonorrhoeae (Gonorrhea)?

Gram (-) diplococci

Oxidase positive

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What special agars must be used to grow N. Gonorrhoeae (gonorrhea)?

Chocolate agar or Thyer-Martin

Unable to grow on blood agar

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Is N. Gonorrhoeae (Gonorrhea) an encapsulated bacteria?

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What is N Gonorrhoeae (Gonorrhea) very sensitive to?

Dehydration and cold

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What are the 2 resistances that can occur with N. Gonorrhoeae (Gonorrhea)?

Plasmid-borne Ab resistance

Cephalosporin

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How is Gonorrhea transmitted?

Sexually or at birth

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What are the virulence factors for gonorrhea?

IgA protease clears IgA from mucosal surfaces to facilitate colonization
Pili attach to columnar and transitional epithelium of mucosal surfaces, antiphagocytic
Opa: “Opacity-associated” proteins enhance cell adherence&entry
Porin A and B channels in outer membrane confer serum resistance, enhance cell entry
LOS: less immunogenic than LPS, but does induce local inflammatory response (The Drip, The Clap)

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What local immune reaction are cause by the endotoxin LOS?

irritation
Discharge
containment

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What occurs when males contract Gonorrhea?

Usually symptomatic

anterior urethritis

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What occurs when women contract Gonorrhea?

Often asymptomatic
Cervicitis
Type Iv pili confer twitching motility–progression to PID (pelvic inflammatory dz)

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What occurs when a neonate contracts Gonorrhea?

Purulent conjunctivitis

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What restrict the Gonorrhea from spreading?

Antibodies
Complement
Neutrophils

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What are findings on physical exam in males with Gonorrhea?

Urethritis
Dysuria
purulent discharge
Sometimes unilateral epididymitis

Symptoms develop within 10days

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What are findings on physical exam in females with Gonorrhea?

May be asymptomatic 
Purulent vaginal discharge
cervicitis
pelvic inflammatory disease--> sterility
ectopic pregnancy

Symptoms develop within 10 days

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What can both males and females show on physical exam when presenting with Gonorrhea?

Confection of:
Pharynx
Rectum
Eye

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What are the symptoms of pelvic inflammatory disease in women who present with Gonorrhea?

Lower abdominal pain
Vaginal discharge
Dysuria
Tenderness
Intermenstrual bleeding
Fitz-Hugh-Curtis syndrome: bacteria (either gonorrea or chlamydia) jump from fallopian tube to liver capsule –acute perihepatitis
Sonogram may show thick Fallopian tubes or abscess

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What is Fitz-Hugh-Curtis syndrome and what disease(s) is it seen in?

Bacteria jump from fallopian tube to liver capsule causing acute perihepatitis

Seen in gonorrhea and chlamydia

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Gonorrhea can often present with DGI or disseminated infection. What are the signs and symptoms of DGI?

Lack of urogenital symptoms
Arthritis/dermatitis
Septic arthritis
Rarely meningitis, endocarditis
Asymmetric tenosynovitis with pain in wrists and ankles
Moderate fever
Progression to septic asymmetric arthritis (knee common)

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What are the indications for Gonococcal meningitis?

admit and spinal tap

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What are the indications for endocarditis caused by gonorrhea?

Echo and cardio consult

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Is gonorrheal endocarditis more common in men or women?

Men

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Where is the most common site for gonorrheal endocarditis to develop?

Aortic Valve

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What are the symptoms of gonorrheal endocarditis?

Subacute onset--
Fever
Chills
Sweats
Malaise
Chest pain 
Cough

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What are findings on physical exam of a neonate with gonorrhea?

Bilateral conjunctivitis
generally infected at birth, can happen postpartum or in utero
Eye pain, redness, discharge
Infection may also be pharyngeal, respiratory, rectal, or disseminated.
Untreated— permanent blindness follows quickly

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What is the order of testing for a male suspected of having Gonorrhea?

First--test urine and exudate for PMNs and Gram (-) intracellular diplococci Next- Nucleic acid amplification tests (NAAT) give the best sensitivity&specificity for +/- (Organism is delicate, so sample handling can be a real issue for culture.)

What do PMNs found on grams staining indicate while testing for Gonorrhea?

Urethritis

Finding of Gram (-) bacteria while testing for Gonorrhea indicates what?

Gonorrhea

If repeat NAAT or culture is required, what should be obtained and what is found on culture?

obtain urethral swab Gram stain (same) Culture on Thayer-Martin: chocolate agar with drugs to inhibit normal flora Colonies tested for Gram(-), Oxidase(+) diplococci

If gonorrhea is suspected in a female, what test should be performed?

Obtain endocervical smear (urethral sample if hysterectomy); wipe off exudate first NAAT If needed, culture on Thayer-Martin

A disseminated gonococcal infection (DGI) is suspected in a patient, what test should be performed to confirm this dx?

Gram stain, NAAT, and cultures from all affected areas Blood, joint fluid may be cultured on nonselective chocolate agar Immunofluorescence may give better results than gram stain on pustule samples

When performing test to confirm disseminated gonococcal infection(DGI), what are we trying to differentiate the infection from?

Differentiating N. meningitidis from N. gonnorrhoeae: Only meningococci ferment maltose. Alternatively, immunofluorescence

What are the treatment options for a patient dx with gonorrhea and what are some special considerations?

Begin antibiotics before labs come back --Ceftriaxone, cefixime, cephalosporin Add azithromycin or doxycycline for confection with chlamydia Aspirate septic joints Special considerations: Admit if--Pregnant/PID/DGI/Endocarditis/Meningitis/Purulent joint infection

How is gonorrheal conjunctivitis prevented in neonates?

Prophylactic Erythromycin ointment or silver nitrate on eyes at birth

What is the culture staining for C. Trachomatis (Chlamydia)?

Poorly staining

C. Trachomatis (Chlamydia) has a unique lifecycle, describe it...

Elementary bodies (EBs) attached to cell, endocytose, survive, unpack into reticulate bodies (RBs) RBs replicate, metabolize, and pack into EBs and escape the host ONLY the EBs are infectious ONLY the RBs (fragile Gram (-) membrane) can replicate

What are the serovars A, B, Ba, C of Chlamydia trachomatis considered?

Blinding trachoma

Describe the pathogenesis of chlamydia serovars A, B, Ba, C...

Leading cause of preventable blindness Spread by secretions, fomites Endemic to africa, southern asia

What are the serovars L1-L3 of Chlamydia trachomatis considered?

Lymphogranuloma venereum

Describe the pathogenesis of Chlamydia serovars L1-L3...

Small ulcer proceeds to painfully swollen lymph nodes near genitals Sexually transmitted Endemic to south and central america

What are the serovars D-K of Chlamydia trachomatis considered?

Genital chlamydia

Describe the pathogenesis of Chlamydia serovars D-K...

Most common STD in US Often asymptomatic May spread sexually or infect newborns at birth Infection increases risk of acquiring HIV Commonly local mucosal inflammation & discharge: urethritis or urethritis/vaginitis/cervicitis

What are the risk factors for contracting Genital chlamydia (serovars D-K)?

Nonbarrier contraceptive use Multiple sexual partners Single marital status Age

What is a leading cause of PID and infertility in women?

Chlamydia Trachomatis

What does PID increases the risk of developing what?

Chronic pain and ectopic pregnancy

What are the signs and symptoms to diagnose Blinding Trachoma (Chlamydia serovars A, B, Ba, C) ?

Eyelashes turned inward, travel to endemic area

What are the signs and symptoms to diagnose Lymphogranuloma venereum (LV) (Chlamydia serovars L1-L3)?

Buboes, history of sex while traveling

What are the signs and symptoms to diagnose Genital chlamydia (serovars D-K)

History- Nonbarrier contraceptive, Multiple sex partners, age

What symptoms define Reiter syndrome/reactive arthritis?

Defined as Conjunctivitis + Urethritis + Arthritis Chlamydia is one of the known triggers of Reiter syndrome

80% of patients with Reiter syndrome/reactive arthritis are positive for what antigen?

HLA- B27

What are the signs and symptoms found on physical exam in female patients who present with genital Chlamydia?

``` May be asymptomatic Mucopurulent endocervial discharge Bleeding Dysuria Abdominal pain Progression to PID ```

What are the signs and symptoms found on physical exam in male patients who present with genital chlamydia?

urethral discharge Dysuria Scrotal pain Perineal fulness

Patients, male and female, are at risk of developing what when they have genital chlamydia?

Reiter syndrome/reactive arthritis

What are the signs and symptoms found on physical exam in infants who present with chlamydia?

Ocular trachoma | Pneumonia

What are the options for labs when a patient presents with urogenital chlamydia?

NAAT--best reliable results Cell culture--C. Trachomatis grows well in many common cell lines Cytologic diagnosis--Infants with ocular trachoma

What is cytologic diagnosis used for when a chlamydia infection is suspected in a patient?

Infants with ocular trachoma | -swab eye--microscopy stained with Giemsa or IF for chlamydial inclusions

What test is not useful for the diagnosis of N. gonorrhoeae or C. trachomatis, why?

Serology | Past infection too common

What are the treatment options for patients diagnosed with Chlamydia?

Antibiotics--but must be able to penetrate infected cell membranes - -doxycycline (contraindicated for peds and pregnant) or azithromycin - -peds, pregnant, allergic---Erythromycin and amoxicillin Treat all sexual partners--reinfection is very common

Female patient presents with Frothy yellow-green abnormal vaginal discharge and PID. A colposcopy is performed and colitis macularis (strawberry cervix) is found. What STI does this patient most likely have?

Trichomoniasis

What are the symptoms found on physical exam for a male with trichomoniasis?

Urethritis and prostatitis

What is the treatment for Trichomoniasis?

Oral metronidazole (Flagyl)

What is the most common organism involved in bacterial vaginosis?

Gardnerella vaginalis

What is the most likely cause of bacterial vaginosis?

Loss of balance among vaginal normal flora leading to irritation--this increases risk of other STIs or complications of pregnancy

What are the signs and symptoms found on physical exam for females with bacterial vaginosis?

Vaginal irritation Odor Discharge

What organism causes Chancroid?

Haemophilus ducreyi --small, gram(-) facultative anaerobic bacillus

What is found on physical exam in males with Chancroid?

Multiple painful genital ulcers with yellow-gray exudate If untreated-- become deeper and superinfected

What is found on physical exam in females with Chancroid?

Usually asymptomatic but may be the same as males

What is the treatment for bacterial vaginosis?

Metronidazole or Clindamycin

What is the treatment for Chancroid?

Drain leasions, oral Azithromycin, Ceftriaxone, or Ciprofloxacin

Lec. 3 Gonorrhea and Chlamydia Flashcards

(68 cards)