Symptoms of Urethritis in Men and Women:
Symptoms that are all common with gonorrhea and chlamydia. MUST TEST for C and G if patient has urethritis
Most common cause of Non-gonococcal Urethritis (NGU):
Chlamydia
Other causes of Non-Gonococcal Urethritis outside of C. Trachomatis:
Mycoplasma Genitalium and Ureaplasma Urealyticum
Features of Mycoplasma and Ureaplasma:
SMALLEST FREE-LIVING BACTERIA Do NOT Gram stain Plasma membranes contain STEROLS They DO NOT have a cell wall
Significance of sterols in Mycoplasma and Ureaplasma:
Only bacteria that have sterols in cell membrane. They steal this from their host.
Implications of Mycoplasma and Ureaplasma not having a cell wall:
They are resistant to penicillins, cephalosporins vancomycin and other Abx that interfere with cell wall synthesis
Colonies of Mycoplasma have an appearance of what:
Fried Egg
Mycoplasma Genitalium and Mycoplasma Hominis features + NGU:
Common inhabitants of GU tract, thus makes their contribution to NGU difficult.
Mycoplasma Genitalium disease in men and women:
Men: NGU Female: Cervicitis/PID
Mycoplasma Genitalium significant feature:
RESISTANT TO DOXYCYCLINE (Which is treatment of choice for C. Trachomatis) Must use AZITHROMICIN
Ureaplasma common cause of:
COMMON CAUSE of NGU in MALES
Treatment of Acute + Recurrent Ureaplasma:
Doxycyline (also active against C. Trachomatis) if reoccurring after treatment> possible Mycoplasma Genitalium infection treat with Azithro!
Definition of NUG:
Non-gonococcal Urethritis: Infection of urethra that is NOT caused by Gonorrhoeae
What is a Chancroid and what is the causative agent?
Sexually transmitted genital ulcer disease caused by Haemophilus Ducreyi
Incidence of Chancroid in the US:
Currently: VERY LOW. Late 1980s: outbreak with sex workers and crack cocaine. More common in Africa, Asia + Caribbean)
**Haemophilus Ducreyi Features:
Gram (-) coccobacillus. Facultative anaerobe. Catalase (+)
**Haemophilus Ducreyi requirements for growth in culture
They are fastidiuous- X and V factor BOTH required for growth. Both of these factors present in heated blood agar (chocolate agar)
Symptoms of Haemophilus Ducreyi/Chancroid infection:
**ONE OR MORE PAINFUL and SOFT chancre/lesions ** Inguinal lympadenopathy also common and important in diagnosis.
Risk of Haemophilus Ducreyi Infection:
increased risk for HIV/AIDS transmission
Treatment of Haemophilus Ducreyi/Chancroid :
Macrolide: Azithro or Erythro
Making differential diagnosis of Haemophilus Ducreyi (4):
Appearance: MULTIPLE PAINFUL, SOFT genital ulcers. Negative for Syphilis. Negative HSV. Lymph adenopathy present.
Distinguishing Syphilis from Chancroid caused by H. Ducreyi:
Syphilis: SINGULAR, PAINLESS + INDURATED. Chancroid: MULTIPLE, PAINFUL + SOFT
Donovanosis/Granuloma Inguinale causative agent:
Klebsiella Granulomatis
*Symptoms of Donovanosis/Granuloma Inguinale:
Lesions that are: PAINLESS, more WARTLIKE + BLEED EASILY
Complications of Donovanosis/Granuloma Inguinale infection:
Can lead to significant genital damage if untreated
Diagnosis of Donovanosis/Granuloma Inguinale:
Appearance of Donovan bodies and ruling out other causes
First two differentials with a patient who is young, sexually active and has genital, anal or perianal ulcers:
Genital Herpes (HSV-2) + Syphilis
Chancroid and Donovanosis infections are associated with:
patients who have travelled
Progression of diagnosis and treatment for patient with genital ulcer disease:
1) Serologic test for syphilis or darkfield exam. 2) Diagnostic evaluation for HSV. 3) Can now test for H. Ducreyi or Klebsiella Granulomatis. Frequently must treat BEFORE test results available or there may not be a definitive diagnosis made.
Klebsiella granulomatis Characteristics
gram- rod, encapsulated, intracellular
Treatment for Klebsiella granulomatis
sulfamethoxazole, erythromycin, tetracycline, ciprofloxacin, many treatment options