What are the primary non-ulcerative STIs?
N. gonorrhoeae C. trachomatis (servars D-K) Mycoplasma and Ureaplasma
no detectable peptidoglycan
DNA, RNA, 70s ribosomes
Gram negative Capnophilic Pyogenic coccus
What type of infections does N. gonorrhoeae cause?
Urethritis in men>women Cervicitis 50% asymptomatic Pharyngitis Proctitis Opthalmia neonatorum PID, Endometritis, Salpingitis Epididymitis DIG
Discribe the manifestations of disseminated gonococcal infection.
Dermatitis-hemorrhagic papular lesions, fingers, wrists and feet (Reactive) Arthritis-large joints, synovial fluid cultures postive in 30% Endocarditis
What are gonococcal virulence factors?
colonization pili - adheres to epithelium
Fe receptors - lactoferrin, transferris, Hb
IgA1 specific protease
Opa proteins - invade epithelial cells
LOS - addition of host derived sialic acid
Porin P1A & P1B bind C4bp and FH
Why are repeated gonococcal infections so common?
Homologous recombination of the pilE genes with pilS loci results in 10^17 different types of pili May be immunosuppressive by inducing Th17 pathway
How is gonorrhea diagnosed in the laboratory?
Gram stain -95% sensitive in men, 50-70% in women PCR/DNA (NAAT) - urine or cervical discharge Culture - chocolate or thayer martin in candle jar
What is current treatment for gonococcal infections?
ceftriaxone with azithromycin or doxycycline
Symptoms of Chlamydial Urethritis/cervicitis?
Men -symptomatic discharge clear
Women -usually asymptomatic
LGV-ulcerative disease of the lymphatics
What can an ascending Chlamydial infections result in?
Reiter's syndrome (urethritis, conjunctivitis, polyarthritis) Epidydimitis Endometritis, salpingitis, PID
What is the most common form of neonatal conjunctivitis in the US?
What are elementary bodies and reticulate bodies?
EM-extracellular, infectious, metabolically inactive form of C. trach. Contains disulfide cross-linked outer membrane proteins
RB-Larger, intracellular replicative form of C. trach. Osmotically fragile
What is the pathogenesis of C. trachomatis?
induce acute and chronic inflammation
cytopathic effect on host cells
tissue damage (fallopian tube scarring) caused by host response
heat shock proteins may play a role
How is Chlamydia diagnosed?
direct fluorsecent antibody test
Culture with MOMP-specific antibody
How is Chlamydia treated?
single dose of azithromycin
Tetracycline or Doxy for 7 days
LGV- doxy for 21days
Conjunctivitis- oral erythromycin
Ureaplasma urealyticum and Mycoplama genitalium account for what percent of nongonococcal urethritis cases?
How do you diagnose Mycoplasma/Ureaplama spp.?
rule out other causes
Inoculate specail transport media (PPLO)
Colonies will appear on solid agar plates in 2-5 days
Nuc. acid and other rapid diagnostic tests in development
What's the most common CDC reportable STI?
How does coinfection affect HIV transmission?
-inflammatory response brings WBCs to site of infection
-HIV viral load higher in gonorrhea secretions
-ulceritive STIs increase suceptibility
Why are younger women at increased risk of Chlamydia and Gonorrhea?
columnar epitheilium less resistant to infection
What is nonoxynol-9 and how does it affect STI transmission?
increases transmission by disrupting endothelial cells (detergent action)
inflammation brings in WBCs for HIV to infect