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REPRO > Microbiology of GU Tract > Flashcards

Microbiology of GU Tract Flashcards

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1
Q

What are common bacterial causes of STIs? (2)

A
  • Chlamydia Trachomatis
  • Neisseria Gonorrhoea
----sidelines: Mycoplasma Genitalium
Treponema Pallidum (syphillis)
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2
Q

Viral causes of STIs? (2)

A
  • Genital warts: HPV
  • Genital Herpes: HSV
  • Hepatitis and HIV
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3
Q

What parasites may cause STI?

A
  • Trichomonas Vaginalis
  • Phthirus Pubis (“crabs”/pubic lice)
  • Scabies
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4
Q

What is characteristic of Gonococci?

State a clincal symptom.

A
  • huge PUS formation d/t an INTENSE neutrophil response

- pain with urination

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5
Q

How diff. is an infection by C.Trachomatis?

A
  • prodn of a MILD, watery discharge

- or no symptoms at all

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6
Q

What is taken into account for index of the infectiousness of the case ?

A
  • conc. and PHENOTYPE of the organism
  • susceptibility of the sexual partner
  • resistance of the host (hereditary/acquired or innate)
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7
Q

What should be kept in mind when testing for a specific STI?

A
  • IMMUNITY is RARE
  • re-infections are common
  • vaccine development is difficult
  • THEREFORE check for multiple STI
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8
Q

Which pathological lesion of the GU tract can predispose a person to acquiring HIV ?

A
  • Genital ULCERS
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9
Q

Which 2 STIs contribute to urethritis?

A
  • Gonorrhoea
  • Chlamydia
  • —coninfections are common so CHECK for ALL
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10
Q

What is the importance of specifically choosing which patients for STI testing?

A
  • ensure from the hx that STI testing is required

- or they are likely to fall in the FALSE positive region

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11
Q

What bacterial spp. is predominant in the normal vaginal flora?

A
  • Lactobacillus spp.

L.Crispatus and L.jesenii

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12
Q

What pH does the normal vaginal flora create and why?

A
  • d.t prodn of LACTIC ACID +/- hydrogen peroxide by the lactibacillus spp.
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13
Q

Apart from the lactiobacillus spp. in the normal vaginal flora, what other organisms are found in the flora?

A

+/- Group B Beta-hemolytic streptococcus (get rid of in pregnancy)

+/- Candida spp. *small no. is NORMAL

+/- Strep Viridans gr.

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14
Q

Describe the appearance of lactobacillus on epithelial cell on histology.

A
  • Gram Positive bacilli

- purple staining of the rod-shaped bacteria

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15
Q

How does Candida Albican appear on gram film?

A
  • budding

- Yeasts and Hyphae

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16
Q

What are predisposing factors of Candida?

A
  • RECENT antibiotic therapy
  • high estrogen levels (pregnancy/ contraceptives)
  • poor DM control
  • immunocompromised pts ( low CD4 counts and HIV )
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17
Q

How is a candida infections presented as and how to diagnose it?

A
  • INTENSELY itchy w/ WHITE vaginal discharge

- dx by HIGH vaginal swab for culture

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18
Q

How to treat candida vaginal infection?

What specific fungal pathogen is apparently resistant to azoles?

A
  1. TOPICAL CLOTRIMAZOLE (pressary/cream)…available as OTC
  2. Oral FLUCONAZOLE

….non-albicans candida species are more likely to be azole resistant

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19
Q

What is a candidal infection in men called and how does it present as?

A
  • Candida Balantitis
  • red spotty rash on penis
  • —very uncommon
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20
Q

Describe the pathogenesis of the GC infection…

A

GC attaches to HOST epithelium cells and is endocytosed within the host cell and released into the sub-epithelium space

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21
Q

What cascade of chemokines is triggered with a typical GC urethral infection?

A
  • prominent inflammation and
  • release of lipo-oligosaccharide and peptidoglycan fragments
  • release chemotactic factors
  • this attracts neutrophils
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22
Q

Why do some gonoccal strains cause asymptomatic genital infection?

A
  • differences in the organism’s ability to bind complement-regulatory proteins that DOWNREGULATE the prodn of chemotactic peptides
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23
Q

Describe the appearance of N.Gonorrhoea with gram stain and under the microscope.

A
  • Gram (-)ve INTRACELLULAR diplococci

- paired PINK spheres in the cell

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24
Q

How common is N.Gonorrhoea and which part of the body does it infect?

A
  • much LESS common than chlamydia

- infects the URETHRA, RECTUM, throat and eyes and endocervix

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25
What is characteristic of the lifeline of N.gonorrhoea?
- it's a Fastidious organism (dies easily) | - therefore should do molecular tests to check for its presence
26
How to test for presence of N.Gonorrhoea?
1. Microscopy of urethral/ endocervical swabs 2. Culture on Selective AGAR plates (for rectal, throat and endocerival swabs)---may come out as false negative 3. NAATs- urine specimen and vaginal swabs
27
What is NAAT?
- Nucleic Acid Amplification Test - increase in sensitivity - searches the genetic material of the micro-organism
28
What is required for the pt to do, after they have done their first NAAT test?
-----pt to come in, in 5 weeks time to do "test for cure" tests
29
What is the commonest STI in the UK and what areas are commonly affected ?
- chlamydia trachomatis | - urethra, rectum, throat and eyes, endocervix
30
Why is C.Trachomatis known as an energy parasite?
- it does NOT reproduce OUTSIDE a host cell | - it's an obligate intracellular bacteria with biphasic life cycle
31
What serological groupings of chlamydia trachomatis are a/w an STI?
Serovars D-K (genital infection) Serovars L1-L3 (lymphogranuloma venereum)
32
Which chlamydial sero group is a/w MSM?
- L1-L3
33
What is treatment for C.Trachomatis?
- Doxycycline 100mg bd x 7 days - azithromycin 1g single dose - erythromycin for 14 days
34
How is the NAAT test sample obtained from men and women differently?
Men: First pass URINE sample; not mid-stream Female: High vaginal swab or vuvlo-vaginal swab, or endo cervical (speculum needed tho) -----for both: rectal, throat and eye swabs ----vuvlo-vaginal can be SELF-TAKEN
35
What is the historic mainstay dx of the gonorrhea?
by CULTURE; generally with antibiotic-containing selective media
36
What are the advantages of NAATs?
- slight increase in sensitivity over culture | - can test urine specimens and vaginal swabs
37
What is a disadvantage of NAAT?
- can't perform antimicrobial susceptibility testing | - poor or inadequately defined positive predicitve value of some NAAT when -used to test LOW-prevalence popns
38
What is the risk of performing NAAT in an area of low prevalence of N.Gonorrhoeae?
- risk of FALSE-POSITIVE screening
39
What is Trichomonas vaginalis/Bacterial Vaginosis caused by?
- a single celled protozoal parasite - divides by binary fission (human host) - transmitted by sexual contact
40
What does trichmonas vaginalis present as?
- vaginal discharge (frothy and fishy smell) - vaginal bleeding - genital burning/itching
41
How to dx and rx t.vaginalis?
- high vaginal swab for MICROSCOPY (PCR test) | - rx: Oral metronidazole
42
What will a wet mount reveal for bacterial vaginosis?
- the ABSENCE of lacto-bacilli | - a lot of CLUE cells (as epithelial cells are coated with coccobacili)
43
Which STI is a.w increased risk of HIV acquisition?
women with Bacterial vaginosis d/t disturbance of microbiology
44
What is the danger with BV and pregnancy?
- risk of pre-term delivery | - d/t Premature rupture of the membranes
45
Which STI condition is a.w Upper genito-tract infection?
- Bacterial vaginosis | - ----may cause endometritis and salpingitis
46
How to treat Bacterial vaginosis?
- directed against the anaerobic flora with metronidazole for 7 days ----relapse is 30 % (no benefit from treating male sexual partners)
47
What is syphilis caused by?
- TREPONEMA PALLIDUM | does not stain gram stain
48
How is syphilis diagnosed?
- PCR or Serological blood tests | - --can't be grown in artificial culture media
49
Can a syphilis test come across as positive despite not having sexual contact?
- yes - 3 more Treponema Palidum Subspecies that are non-sexually transmitted variants; but can't be serologically differentiated from one another - Syphilis; Yaws; Bejel; Pinta
50
What are the 4 stages of syphilis?
1. Primary Lesion (chancre): innoculation site 2. Secondary Stage: systemic manifestations 3. Latent Stage- no symptoms (spirochaete multiply in t.intima of small blood vessels) 4. Late Stage- CVS/ Neurovascular complications years later (DEMENTIA/ TABE DORSALIS/ gait imbalance/GUMMA/AORTIC ANEURYSM and CORONARY ARTERITIS)
51
What are the manifestations in the secondary stage of syphilis?
- generalised rash - flu-like symptoms - meningitis - nephritis - "snail-track" mouth ulcers - neurosyphilis, aseptic meningitis, CN defiicits
52
Why is an animal model challenging for syphilis?
- because humans are the ONLY HOST for syphilis
53
What are the non-specific serological tests for syphilis ? What are these tests useful for?
- VDRL (venereal diseases research lab) - RPR (rapid plasma reagin) - to monitor RESPONSE to therapy...(usually negative after successful rx/over time)
54
When are non-specific serological test for syphilis falsely positive?
- SLE - Malaria - Pregnancy
55
How to dx Primary stage Syphilis?
- PCR - IgM (+)ve in 1st 2 weeks - dark ground microscopy
56
How to dx secondary and tertiary stage Syphilis?
-by serology
57
If the combined syphilis IgM and IgG screening test comes out as positive , what is then done?
- IgM ELISA - VDRL test/ RPR - TPPA test
58
Rx of syphilis?
- injection of long-acting penicillin ---can't check sensitivities to syphilis strain as it cannot grow in artificial culture
59
Why is syphilis known as one of the most sensitive yet resistant bacteria?
- sensitive: smallest penicilin conc. is bactericidal | - resistant: the time for which it MUST BE exposed to, to be killed
60
What causes genital herpes?
HSV 1 and HSV2 - ---enveloped virus containing double stranded DNA - ---spread by genital-genital or oropharyngeal-genital
61
What is the pathogenesis of genital herpes?
- virus replicates in DERMIS and epidermis - gets in NERVE endings (why VERY painful) - multiple small vesicles appear - ----virus migrates to sacral root ganglion and "hides" ---may reactivate later - -----intermittent "virus SHEDDING" may occur
62
How to dx herpes?
- swab of virus of deroofed blister for PCR test | - serology (IgG)
63
How to treat herpes?
- aciclovir - pain relief - ---pre- and post- exposure vaccines SUCK
64
How to treat pubic lice?
- Malathion Lotion
65
How long do the lice live for?
Male: ~22days Females: 17 days

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