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Ahmed Repro Path Sadness > Lecture 7: Infections of the Lower Genital Tract > Flashcards

Lecture 7: Infections of the Lower Genital Tract Flashcards

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1
Q

HSV-2 infection in the neonate may be mild, but more commonly what course does it follow and what’s affected?

A
  • More commonly is fulminating
  • Generalized LAD, splenomegaly, and necrotic foci throught the lungs, liver, adrenals and CNS
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2
Q

With STD can cause cervical dysplasia and cancer; as well as vuvlvar cancer in females?

A

HPV

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3
Q

Lymphogranuloma venereum is caused by what organism?

A

Chalmydia trachomatis

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4
Q

HPV and herpes virus are associated with what type of inflammatory response?

A

Cytopathic-cytoproliferative reactions

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5
Q

What is the major infectious cause of corneal blindness in the United States?

A

HSV-1

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6
Q

What is the major cause of fatal sporadic encephalitis in the US?

A

HSV-1

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7
Q

Infection by which organism increases the risk of HIV transmission by 4-fold and increases the risk of HIV acquisition by 2-3 fold?

A

HSV-2

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8
Q

Which congenital infection may resemble erythroblastosis fetalis; infants w/ intra-uterine growth retardation, jaundice, hepatosplenomegaly, anemia, thrombocytopenia and encephalitis?

A

CMV –> Cytomegalic inclusion disease

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9
Q

L. monocytogenes infection during pregnancy can lead to what complications?

A

Amnionitis —> abortion, stillbirth, or neonatal sepsis

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10
Q

Which infection in neonates involves the formation of pyogenic granulomas distributed over the whole body; what organism is responsible?

A
  • Granulomatosis infantiseptica
  • Listeria monocytogenes
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11
Q

Finding of gram-positive, most intracellular bacilli in CSF is virtually diagnostic for which organism?

A

Listeria monocytogenes

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12
Q

Infants born with L. monocytogenes sepsis often have what clinical finding and what will be seen in the placenta?

A
  • Papular red rash over the extremities (Granulomatosis infantiseptica)
  • Listerial abscesses can be seen in the placenta
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13
Q

Untreated N. gonorrheae infection in a woman can lead to pelvic inflammatory disease which may can what 2 complications?

A
  • Ectopic pregnancy
  • Inferitility
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14
Q

Neonatal N. gonorrheae infection causes what?

A

Conjunctivitis which may lead to blindness

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15
Q

Which organism is responsible for causing chancroid (soft chancre) in both males and females; what is its morphology and gram stain?

A

Haemophilus ducreyi = Gram negative coccobacillus

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16
Q

Where is Haemophilus ducreyi seen most commonly?

A
  • Tropical and subtropical areas
  • Most common cause of genital ulcers in Africa and SE Asia
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17
Q

Who is Haemophilus ducreyi most commonly seen in?

A

People of lower socioeconomic status and men who have frequent sex with prostitutes

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18
Q

Where do most ulcers associated w/ H. ducreyi develop in females; are they painful or painless?

A

Vagina or periurethral area; PAINFUL erythematous papule

*Haemophilusducreyi(it’s so painful, you “do cry”)

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19
Q

How does the ulcer of H. ducreyi differ from that of syphillis; what is seen morphologically at the base of the ulcer?

A
  • Ulcer is NOT indurated, and multiple lesions may occur
  • Base of ulcer is covered by shaggy, yellow-gray exudate
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20
Q

What is seen in 50% of patients with H. ducreyi within 1-2 weeks following primary infection?

A

Regional LN’s become large and tender

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21
Q

Microscopically how does the ulcer of chancroid (H. ducreyi) appear?

A

Superficial zone of neutrophilic debris + fibrin w/ underlying zone of granulation tissue containing areas of necrosis and thrombosed vessels

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22
Q

Which organism is associated with granuloma inguinale (donovanosis) in both males and females; what is its gram stain and morphology?

A

Klebsiella granulomatis = Encapsulated,gramnegativecoccobacillus

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23
Q

Which organism endemic in rural areas of some developing countries can lead to extensive scarring, often assoc. w/ lymphatic obstruction and lymphedema (elephantitis) of the external genitalia?

A

Klebsiella granulomatis (aka donovanosis)

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24
Q

How does the lesion of granuloma inguinale begin and how does it progress over time?

A
  • Raised papular lesion on moist stratified squamous epithelium of genitalia
  • Eventually ulcerates and develops abundant granulation tissue, manifesting grossly as a protuberant, soft, PAINLESS mass
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25
Which cause of genital ulcers if left untreated is sometimes associated with urethral, vulvar and anal strictures?
*Klebsiella granulomatis*
26
What is one major difference about the pathogenesis of *H. ducreyi* and *K. granulomatis?*
- ***H. ducreyi*** often has **regional LN** involvement; become **large** and **tender** - ***K. granulomatis*** typically **spares** the **regional LN's**
27
Which stain of a culture can be useful in identifying *K. granulomatis*; what is characteristically seen?
- **Giemsa-stain** shows minute, encapsulated coccobacilli (**Donovan bodies**) inside **macrophages** - **Silver stains** may also be used
28
What is the **microaerophilic** spirochete that causes syphillis?
*T. pallidum*
29
What is the gram stain and unique shape of spirochetes?
**Flagellated**, gram **negative**, slender **corkscrew-shaped** (or **spiral**)
30
*T. pallidum* is too slender to be gram stained so what is used for visualization?
**Silver stain** and **immunofluorescence** techniques
31
Which pathological process is characteristic of **all** stages of syphillis?
**Proliferative endarteritis** of **small vessels** w/ surrounding plasma cell-rich infiltrate
32
Primary syphillis occurs about 3 weeks after infection and is characterized by what?
**Single**, firm, **nontender**, raised, **red lesion** (**hard chancre**) at site of treponemal invasion of the **penis, cervix, vaginal wall,** or **anus**
33
2-10 weeks after untreated primary syphilis the pt enters second stage of syphillis which is characterized by what?
- **Palmar rash** (palms or soles of feet) that may be **maculopapular, scaly**, or **pustular** - Moist areas of skin i.e., anogenital region, inner thighs and axillae may have **condyloma lata** = **broad-based**, elevated **plaques** - **Mild fever + LAD** + **malaise** + **weight loss** = common - **Asymptomatic neurosyphillis** may develop
34
How long is the typical latent period between secondary syphillis and tertiary syphillis?
**5+ years**
35
What are the main manifestations of tertiary syphillis that may occur alone or in combination?
- **Cardiovascular syphillis** - **Neurosyphillis** - **Benign tertiary syphillis** (aka **gummas**)
36
What is the most common clinical manifestation of tertiary syphillis and what is seen?
- **Cardiovascular syphillis** - **Aortitis** ---\> progressive **dilation** of **aortic root** and **arch**, which may cause **aortic valve insufficiency** and **aneurysms** of **prox. aorta**
37
What is the characteristic finding of benign tertiary syphillis and what are the signs/sx's?
- **_Gummas_** in **bone**, **skin**, and **mucous membranes** of **upper airway** and **mouth** = **nodular lesions** - Skeletal involvement causes **pain, tenderness**, and **swelling** + **pathologic fractures** - Skin/mucous membranes w/ **nodular** or, rarely, **destructive, ulcerative** lesions
38
What are the clinical manifestations of infantile syphillis?
- **Nasal discharge** and **congestion** (**snuffles**) in first few months of life - **Desquamating** or **bullous rash** --\> sloughing **skin**, particularly of the **hands** and **feet** and **around** the **mouth** + **anus** - **Hepatomegaly** and **skeletal abnormalities** = **common**
39
What is seen on histological examination of a gumma associated with tertiary syphillis?
**Centers** of **coagulated**, **necrotic** material and **margins** composed of **plump**, **palisading** macrophages and **fibroblasts** surrounded by large numbers of mononuclear leukocytes, **mainly plasma cells**
40
The later manifestations of congenital syphillis inculde what distinct triad?
- **Interstital keratitis** - **Hutchinson teeth** - **CN VIII deafness**
41
Syphillitic osteochondritis and periostitis affect all bones, but lesions of which 2 areas are most distinct and what is classically seen?
- **Nose** --\> destruction of **vomer** causes **collapse** of **bridge**, later on **saddle-nose deformity** - **Legs** --\> periostitis of the **tibia** leads to **excessive** new bone growth on **anterior surfaces** and **anterior bowing**, or **SABER SHIN**
42
What is the gram stain and special feature of *Chlamydia trachomatis?*
Small **gram-negative**, **obligate intracellular parasite**
43
What are the 2 forms that *Chlamydia trachomatis* exists in during its life cycle and characteristic of each?
- **Elementary body** = infectious, metabolically **inactive** form, which is taken up by the host cell - **Reitculate body** = metabolically **active** form, uses host ATP and AA's to replicate
44
Lymphogranuloma venereum caused by which serotypes of *C. trachomatis?*
**L serotype (L1-L3)**
45
Lymphogranuloma venereum is endemic where?
Parts of **Asia, African**, the **Caribbean region**, and **S. America**
46
Characteristics of the genital ulcers and LAD seen in lymphogranuloma venereum?
**PAINLESS** genital ulcers, **PAINFUL** LAD (i.e., **buboes**)
47
Urethritis causes by *C. trachomatis* is characterized by what?
**Mucopurulent** **discharge** containing **predominance** of **neutrophils**
48
What is the characteristic morphology of the lesions and regional LN's involvement in lymphogranuloma venereum?
- Mixed **granulomatous** and **neutrophilic** inflammatory response - **Regional LAD** within **30 days**, granulomatous rxn assoc. w **irregular shaped foci of necrosis** containing **neutrophils** (**stellate abscesses**) - Over time **extensive fibrosis** + local lymphatic **obstruction** + **lymphedema** + **strictures**
49
*Candida* vaginitis is common in which settings?
Women who are **diabetic**, **pregnant**, or on **oral contraceptives**
50
Which sign's and sx's are common to *Candida* vaginitis?
**Intense itching, erythema, swelling** and a **thick, curdlike** discharge ("**cottage cheese-like**")
51
What is the characteristic morphology of *Candida?*
**Pseudohyphae** and **budding yeast**
52
How is the diagnosis of *Candida* vaginitis made; which stain and what's seen?
**Pseudospores** or **filamentous fungal hyphae** in **wet KOH mounts** of discharge or on pap smear
53
How do the lesions of HSV-2 on genital mucosa appear early on and describe their progression; cervical and vaginal lesions present with what?
- **Red papules** ---\> **vesicles** ---\> **painful coalescent ulcers** - **Cervical** or **vaginal** lesions present w/ severe **purulent** discharge and **pelvic pain**
54
Smears of the inflammatory exudate of HSV-2 show what characteristic cytopathic changes?
**Multinucleated** squamous cells containing **eosinophilic** to **basophilic** viral inclusions w/ **"ground-glass"** appearance
55
Detection of anti-HSV antibodies in the serum is indicative of what?
**Recurrent****/latent** infection
56
Which type of *Molluscum contagiosum* virus is most often sexually transmitted?
**MCV-2**
57
What family of viruses is *Molluscum contagiosum;* what is unique about its replication?
- **Poxvirus**; ds**DNA** and **linear** virus - _ONLY_ DNA virus to **replicate** in the **cytoplasm**
58
What is the characteristic appearance of the papules seen w/ *Molluscum contagiosum* infection?
- **Pearly**, **dome-shaped** w/ **dimpled umbilicated center** - Central **waxy** core contains cells w/ **cytoplasmic viral inclusion** bodies
59
What is the morphology of *Trichomonas vaginalis?*
**Large,** **flagellated** ovoid **protozoan**
60
What are the common presenting signs and sx's of *Trichomonas vaginalis?*
- **Yellow-green**, foul-smelling, **frothy** vaginal discharge - **Vulvovaginal** discomfort + **dysuria** - **Dyspareunia** (painful intercourse)
61
Which STI is associated with a fiery-red vaginal and cervical mucosa, with marked dilation of cervical mucosal vessels resulting in the characteristic "strawberry cervix" appearance?
*Trichomonas vaginalis*
62
Diagnosis of *Trichomonas vaginalis* is made how; use what stain?
**Motile trophozoites** in **methylene blue wet mount**, present w/ **corkscrew motility**
63
What is the gram-stain and shape of *Gardnerella vaginalis?*
**Pleomorphic,** Gram-**variable** bacillus
64
What is the typical presentation of *Gardnerella vaginalis?*
Present w/ **thin**, **green-GRAY**, vaginal discharge w/ **fishy** smell
65
What will a pap smear of pt with *Gardnerella vaginalis* show?
**Superficial** and **intermediate** squamous cells covered with **shaggy** coatin of coccobacilli (**clue cells**)
66
Which test for *Gardnerella vaginalis* will enhance the fishy odor?
**Amine whiff test**: mix discharge w/ 10% **KOH**
67
Pelvic inflammatory disease arising after spontaneous/induced abortions and normal or abnormal deliveries are referred to as what; most commonly caused by what organisms?
- **Puerperal infections** - Typically **polymicrobial**: staphylococci, streptococci, coliforms, and *Clostridium perfringens*
68
How does PID causes by gonococcal infections differ from that caused by staphylococcis, streptococci, and other puerperal invaders; which is more often assoc. w/ bacteremia?
- **Gonococcal** shows marked acute inflammation of **mucosal surfaces**; spread upward to involve **fallopian tubes** and **tubo-ovarian** region - **Puerperal** invaders have _less_ mucosal involvement and more inflammation of **deeper layers**; spread via **lymph** and **veins**; **bacteremia** is a more frequent complication
69
What are the common signs/sx's of PID?
- **Pelvic pain** + **adnexal tenderness** - **Fever** - **Purulent cervical discharge**
70
Which part of the female genital tract is usually spared in Gonococcal infections?
**Endometrium**
71
What are the acute vs. chronic complications which may arise from PID?
- **Acute** = peritonitis and bacteremia ----\> **endocarditis**, **meningitis**, and **suppurative arthritis** - **Chronic** = **infertility** and **tubal obstruction**, ectopic preg., pelvic pain, and **intestinal obstruction**
72
Which infection is associated with strikingly enlarged cells and intranuclear basophilic "owl eye" inclusions?
CMV
73
Lesions of genital HSV infection develop 3-7 days after transmission and are often accompanied with what systemic sx's?
**Fever + malaise** + **tender inguinal LAD**
74
What is the gravest consequence of HSV infection?
**Transmission to the neonate** during birth (**active** and **primary/initial** infection) is assoc. w/ **high mortality rate**
75
What is a rare complication of PID that occurs almost exlusively in women?
Fitz-High Curtis Syndrome

Ahmed Repro Path Sadness (6 decks)

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