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Repro-End: STDs Flashcards

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1
Q
  • Urethritis
  • Gram-negative Diplococci in PMNs in Urethral exudate
A

Neisseria gonorrhoeae

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2
Q
  • Urethritis
  • Clear Discharge
  • Asymptomatic in Women
  • Unilateral Scrotal pain in Men
  • Culture negative
  • Inclusion bodies
A

Chlamydia trachomatis

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3
Q
  • Urethritis
  • Urease Positive
  • No cell wall
A

Ureaplasma urealyticum

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4
Q
  • Cervicitis
  • Friable, Inflamed Cervix w/ Mucopurulent Discharge
  • Gram negative Diplococci
  • Probes and Culture used to distinguish
A

Neisseria gonorrhoeae

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5
Q
  • Cervicitis
  • Friable, Inflamed Cervix w/ Mucopurulent discharge
  • Non-staining Obligate Intracellular parasite
  • Probes or Culture used to Distinguish
A

Chlamydia trachomatis

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6
Q
  • Pelvic Inflammatory Disease (PID)
  • Adnexal tenderness
  • Bleeding
  • Deep Dypareunia
  • Vaginal discharge
  • Fever
  • Tenderness from Cervical Movement
  • Possible Inflammatory Mass on Bimanual exam
  • Onset often follows Menses
A
  • Neisseria gonorrhoeae
  • Chlamydia trachomatis
  • Or BOTH
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7
Q
  • Genital Lesions
  • Non-indurated
  • Painful papule
  • Suppurative w/ Adenopathy
  • Slow to Heal
A

Haemophilus ducreyi

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8
Q
  • Genital elephantitis
  • Initial papule heals
  • Lymph nodes enlarge and Develop Fistulas
A

Chlamydia trachomatis (L1-L3)

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9
Q
  • Obligate Intracellular Parasite
  • Elementary body
  • Infective form: Extracellular Elementary Body (Enfectious) –> Transforms into Reticulate body
  • Metaboically active replicating Reticulate body
  • -> Replicates by Fission
  • Not seen on Gram stain
  • Cannot make ATP
  • Cell wall lacks Muramic acid
A

Chlamydiaceae trachomatis

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10
Q
  • Smallest free-living Bacteria (Extracellular)
  • Makes Normal ATP
  • Sterols in membrane
  • Requires Cholesterol for in vitro Culture
  • “Fried-egg” colonies on Eaton’s media
  • Does not have Peptidoglycan in Cell Envelope
A

Mycoplasmataceae

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11
Q
  • Sexually active patient or Neonate
    • Adult: Urethritis, Cervicitis, PID, Inclusion conjunctivitis –> Infertility
    • Neonate: Inclusion conjunctivitis, Pneumonia (Staccato cough)
  • Immigrant from Africa / Asia
  • Genital Lymphadenopathy
  • Cytoplasmic Inclusion bodies in Scrapings on Giemsa or Fluorescent Antibody smear
A

Chlamydia trachomatis

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12
Q
  • Prevalent in Africa / Asia / South America
  • Swollen lymph nodes –> Genital Elephantitis
  • Tertiary: Ulcers, Fistulas
A

Lymphogranuloma venereum (L1-L3)

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13
Q
  • Follicular conjuctivitis
  • -> Conjunctival scarring and Inturned eyelashes
  • -> Corneal scarring
  • -> Preventable Infectious Blindness (A, B, Ba, C)
A

Chlamydia trachomatis

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14
Q

What Rx do you use to treat Chlamydia trachomatis?

A

Doxycycline or Azithromycin

Erythromycin in Infected Mothers
to prevent Neonatal disease

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15
Q
  • Urease positive
  • Non-Gram staining
  • Alkaline Urine
  • Adult Patient w/ Urethritis, Prostatitis, Renal calculi
A

Ureaplasma urealyticum

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16
Q

What do you use to treat Ureaplasma urealyticum?

A

Erythromycin or Tetracycline

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17
Q
  • Gram negative in PMNs
  • Kidney Bean shaped Diplococci w/ Flattened sides
  • Thayer-Martin medium
  • Oxidase positive
  • Maltose not fermented
  • No Capsule
A

Neisseria gonorrhoeae

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18
Q
  • Sexually active pt.
  • Urethral / Vaginal discharge (Leukorhea)
  • Possible Arthritis
  • Neonatal Ophthalmia (Neonatal Conjuctivitis)
  • Gram Negative - Diplococcus in Neutrophils
A

Neisseria gonorrhoeae

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19
Q
  • Male: Urethritis, Proctitis
  • Female: Endocervicitis, PID (contiguous spread), Arthritis, Proctitis - Mucopurulent discharge (cervicitis/urethritis)
  • Infants: Opthalmia (rapidly leads to Blindness if untreated)
A

Neisseria gonorrhoeae

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20
Q

What is the (1) treatment for Neisseria gonorrhoeae?

A

Ceftriaxone (gonorrhoeae)

w/ Azithromycin or Doxycycline (chlamidya)

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21
Q
  • Gram negative
  • Pleomorphic rod
  • Req’s Enriched media of Factor X (hemin) and Factor V (NAD) for growth on Nutrient or Blood agar
  • 10% CO2
  • “Satellite” phenomenon w/ S. aureus in Blood agar
A

Haemophilus ducreyi

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22
Q
  • Enlarged lymph nodes
  • Genital Ulcers
  • PAINFUL Chancre “Chancroid”
  • Slow to Heal w/out Treatment
  • Open Lesions increase transmission of HIV
A

Haemophilus ducreyi

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23
Q

How do you treat Haemophilus ducreyi?

A
  • Azithromycin
  • Ceftriaxone
  • Ciprofloxacin
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24
Q
  • Spirochetes: Spiral w/ Axial Filament (Endoflagellum)
    • Axial Filaments
    • Endoglagella
    • Periplasmic flagella
  • Gram negative
  • Obligate pathogen (but NOT intracellular)
  • Poorly visible - Thin spirochete - Cannot Culture
  • Endotoxin-like Lipids
A

Treponema pallidum

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25
* Nontender "Painless" Genital Chancre full of Spirochetes * Clean, Indurated edge * Contagious * Heals spontaneously 3 - 6 weeks
Primary Stage - *Treponema pallidum* (10 days to 3 months after exposure) Dx: **Dark-field** or **Fluorescent microscopy** of Lesion **50% pts** will be **negative** by **nonspecific serology**
26
* Maculopapular - **"Copper colored" Rash** * **Diffuse** * Includes **_Palms_** and **_Soles_** (Infectious) * **Patchy Alopecia** (Scalp, Beard, Facial Hair) * **Condylomata lata:** Flat, **Wartlike perianal** and * *_Mucous "Patches" membrane lesions_** - -\> Highly Infectious
Secondary Stage - Treponema pallidum (1 to 3 months) Dx: Serology Non-specific and Specific
27
* Gummas in CNS (Granulamatous Lesion w/in CNS) * Cardiovascular system issues * Aortic aneurysms (Aortitis) * CNS Inflammation * Tabes Dorsalis * General paresis * Argyll Robertson Pupil * Accomodate but Does NOT react to Light
Tertiary stage - *Treponema pallidum* (30% of Untreated, Years after Expsoure) Dx: **Specific tests, Non-specific tests may be Negative**
28
* **Stillbirth** - Neonatal death * **Keratitis** (Inflammation of Cornea) * **Hydrops fetalis - Frontal bossing** * **Jaundice** * **Anemia** * **8th nerve Damage** * **"Saddle Nose"** * **Notched Teeth** - Hutchinson's Teeth - **Perioral fissures** * Neonates born Asymptomatic or w/ **Rhinitis** - -\> Widespread desquamating Maculopapular Rash * **Tabes Dorsalis** (syphilitic myelopathy - demyelination of the nerves --\> loss of Proprioception, Vibrioception, and Dicriminating touch (Fine)
Congential Stage - *Treponema pallidum* (Babies of IV-Drug using Parents) Dx: Serology should revert to Negative w/in 3 months if Birth is Uninfected
29
How do you diagnosis *Treponema pallidum*?
* **_Screening Test (RPR/VDRL)_** * _**Nontremponemal Antibody** Screening Tests_ * Ab binds ot **Cardiolipin** * Visualize organism by **Immunofluorescence** or **Dark-field Microscopy** * **_Diagnostic Test (MHA-TP/FTA-ABS)_** * FTA-ABS * _**Treponemal Antibody** Specific Diagnositc Test_ * Binds to **Spirochetes**
30
How do you treat *Treponema pallidum*?
**Benzathine Penicillin** (Primary and Secondary) **_Penicillin G_** (Late and Congenital) * **Jarisch-Herxheimer Reaction** * 24 hrs after ABX treatment * Increase Temperature * Decrease BP * Rigors * Leukopenia
31
* **Thin Spirochetes** w/ **Hooks on the Ends** * **Too thin to visualize** * **Gram negative** * Pts. w/ **Influenza-like symptoms _+_ GI symptoms** * **Occupational (Sewage / Water treatment)** or **Recreation** **exposure (Jet skiers) to Water aerosols** * **Hawaii** Honeymooners
*Leptospira interrogans*
32
How do you treat *Leptospira interrogans*?
**Penicillin G** or **Doxycycline** **Prevention: Doxycycline** effective for Short-term exposure and Vaccination of domestic Lifestock and Pets, Rat Control
33
Infections that Cross the Placenta? | (TORCHHeS)
* ***TO**xoplasma* * **R**ubella * **C**MV * **H**IV * **HE**rpes * **S**yphilis (*Treponema pallidum*)
34
(7) Viruses that Cross the Placenta?
* Herpes and HIV * CMV - *Cytomegalovirus* * *Rubella* * HSV 2 (primary infection) * Coxackie B * Polio * HIV * B19
35
(1) Parasite that Cross the Placenta?
* *Toxoplasma gondii*
36
(2) Bacteria that can cross the Placenta?
* *Treponema pallidum* (Syphilis) * *Listeria monocytogenes*
37
What is the Site of Primary Infection for HSV-1 and HSV-2?
Mucosa * HSV establishes infection in the mucosal epithelial cells and leads to the formation of Vesicles. * The Virus travels up the Ganglion to establish lifelong latent infection. * **Stress** triggers reactivation of Virus in Nerve and Recurrence of Vesicles * Kissing or Sexual contact w/ Mucosa and Genitals
38
What is the difference in Clinical Presentation between HSV-1 and HSV-2?
* **HSV-1 --\> above the Waist​** * _Gingivostomatitis_ (inf. of mouth and gums) * **Latent in Trigeminal ganglion** * _Keratoconjunctivitis_ (inff. of Cornea and Conj.) * Lid swelling and Vesicles, Dendritic ulcers * Blindness * _Pharyngitis_ (sore throat) * **HSV-2 --\> below the Waist** * _Genital Herpes_ * _Neonatal Herpes_
39
What is the difference in Recurrent Clinical Presentation of HSV-1 and HSV-2?
* HSV-1 * Cold sores * HSV-2 * Genital Herpes
40
Characteristics of *Herpesviridae* virus?
* Large Linear **dsDNA** * **Enveloped, Icosahedral** * Derives envelope from **Nuclear membrane** * Latency in **Sacral ganglia** * **Intracellular inclusion bodies** * **Establishes latency**
41
Vignette Characteristics of Herpesviridae virus?
* **_Tzanck smear_** - smear open vesicle * **​detects Multinucleated Giant cells** * _**Cowdry Type A Intracellular Inclusion Bodies****​**_ * Cold sores (HSV-1) * Keratoconjunctivitis (HSV-1) * Genital Vesicles (HSV-2) - Painful vesicles * Fever, Malaise, Myalgia * **Latency in the Sacral nerve ganglia** * Meningoenchephalitis / Encephalitis * Fever, Headache, Confusion * **Focal Temporal Lesions** and Perivascular cuffing * Neonatal disseminated / Encephalitis - Birth canal * Skin, Eyes, Mouth, and Liver
42
What is the Rx for HSV-1 and HSV-2?
* **_Acyclovir_** - is only activated in cells infected with HSV-1, HSV-2, or VZV. * The virus **_Thymidine Kinase_ is req'd to activate the Drug** * Placing the First Phosphate on the Drug --\> Followed by the Phosphorylation via Cellular enzymes * **Famciclovir, Valacyclovir, Penciclovir** alternates.
43
Characteristics of *Papillomaviridae* (Papillomavirus)?
* dsDNA virus * Circular * non-enveloped * Icosahedral
44
Vignette clues for HPV?
* Hyperkeratosis leads to formation of "Wart"s (vacuolization) * CIN I, II, III - Cervical Intraepithelial neoplasia * Infection of the Basal layer of the skin and Mucous membranes * Biopsy or Pap smear shows **Koilocytic cells** w/ **Perinuclear cytoplasmic vacuolization** and **Nuclear enlargement**
45
What is the Tx for HPV?
* Vaccine composed of HPV capsid proteins * Gardasil (6, 11, 16, 18) * Cervarix (16, 18) * Safe sex practicies * Cryotherpay, Electrocautery, Salicylic acid * **Imiquimod** (induces pro-inflammatory cytokines) * **Interferon-α** * **Cidofovir**
46
What are the Features of Hepatitis?
* Hepatitis B - Hepadnavirus * dsDNA - circular * Enveloped * Hepatitis C - Flavivirus * RNA - ss(+) - non-segmented * Enveloped * Hepatitis D - Defective - Co-infection w/ HBV (super) * RNA - ss(-) - circular * Enveloped
47
Characteristics of HIV?
* Enveloped, Truncated, Conical capsid (Type D retrovirus) * Icosahedra nucleocapsid * ss(+)RNA diploid * Targets: CD4 T cells, Dendritic cells, Monocytes, Macrophages, CCR5 co-receptor cells * RNA-dependent DNA polymerase (Reverse transcriptase) * Integrase * Protease
48
Vignette Cluse for HIV?
* Hairy Leukoplakia, Pneumocystitis pneumonia, Thrush, Toxoplasmosis, Kaposi sarcoma, Retinitis CMV * Homosexual Male * IV drug user * Sexually active Adult * Decreasing CD4 cell count * Opportunistic infections * Fatigue, Weight loss, Lymphadenopathy * Low-grade Fever
49
HIV - Gag gene?
* Group-specific antigens * P24 * P7p9 * p17
50
HIV - Pol gene?
* Reverse transcriptase * Integrase * Protease
51
HIV- Env gene?
* gp120 * gp41
52
HIV - LTR (U3, U5 gene)?
* DNA, Long terminal repeats * Integration and Viral gene expression
53
HIV - Tat gene?
* Transactivator of **_upregulated Transcription_** * Spliced gene
54
HIV - Rev gene?
* Regulatory protein - **_upregulates transport_** of Unspliced and Spliced transcripts to the cell cytoplasm * Spliced gene
55
HIV - Nef gene?
* Responsible for **Virulence** of the Virus * Regulatory protein that **Decreases CD4 expression** and **MHC 1 expression** on Host cells * Manipulates T-cell activation pathways * Req'd for Progression to AIDS
56
Toxoplasmosis?
* Intracellular Protozoan parasite * Fecal-oral transmission * Cat feces, Undercooked meat, Water, Soil * **Cat is essential definitive host** * Cysts viable for up to 18 hours * Serology: **High IgM** or **rising IgM**
57
Clinical presentation of Toxoplasmosis by Trimesters?
* _First-trimester_ * Death * CNS findings * _Second-trimester_ - (3) * **Hydrocephalus / Microcephaly** * **Calcifications w/in the Brain --\> Convulsions** * **Chorioretinitis** * _Third-trimester_ * Asymptomatic * "**Progressive Blindness** **_in Child"_ later in life (Teens)** * **"Ring enhancing lesions"** in **AIDS pts.** * **"_Heterophile negative mononucleosis_"**
58
What is the Treatment for Toxoplasmosis?
* **Pyrimethamine + Sulfadiazine** * Leukovorin
59
Classification of *Togaviridae Rubivirus*?
* Rubella (German measles) * Icosahedral nucleocapsid * Enveloped * ss(+)RNA non-segmented
60
Clinical presentation of *Togaviridae Rubivirus*?
* **Rubella (German measles) - Erythematous rash that starts on the Forehead --\> Downward** * **Pronounced Lymphanopathy** * **Blueberry muffin** - extramedullary hematopoiesis * **_IUGR_** * Opthalmoligic * **_Cataracts_ in Infants** * Cardiac * **_PDA_, Peripheral Pumonary artery stenosis** * Auditory * **_Deafness_** * Neurologic * **Microcephaly**
61
What is the Tx for *Togaviridae Rubivirus*?
* Live-attenuated Rubella Virus * MMR - Measles, Mumps, Rubella * Detection is made by Serology * IgM - Recent infection * IgG - Immune * Nasal specimen (highest yield), Blood, Urine, CSF, Throat swab * Virus in Amniocentesis indicates Congenital Rubella
62
Classification of *Herpesviridae Cytomegalovirus*?
* **CMV** or Herpesvirus 5 * **DNA virus** * **Icosohedra nucleocapsid** * **Enveloped** - only virus that obtains its envelope by buddying from Nuclear membrane * **DS Linear** * **Giant cells** w/ **Intranuclear Inclusion bodies "Owl's Eye"**
63
* Heterophile-negative mononucleosis in Children / Adults * Neonate w/ Jaundice * Hepatosplenomegaly * Thombocytic purpura * Owl-eye Intranuclear Inclusion bodies on Biopsy
*Herpesviridae Cytomegalovirus* (CMV) (Herpesvirus 5)
64
Clinical presentation of CMV?
* Cytomegalic Inclusion bodies (Basophilic) (newborns) * Heterophilic-negative mononucleosis * **Splenomegaly, Jaundice, Petechiae, Hearing loss, Cataracts, Cardiac** * Immunocompromised: * Retinitis * Pneumonitis * Esophagitis * **Thrombocytic Purpura "Blueberry muffin Baby"** * CNS damage to Death * Reactivation in Transplanted Organ or AIDS pts.
65
What is the Tx for CMV?
* Healthy --\> Supportive * Immunocompromised --\> **_Ganciclovir_** / Foscarnet _+_ **Human Immunoglobulin (_NO Thymidine Kinase_ is made so _Acyclovir will not work_)** * **Resistance** to Ganciclovir through **hL97 gene**
66
What is Reiter Syndrome? | (*Nieserria gonorrhea and Chlamydia*)
* Conjunctivitis - "Can't See" * Urethritis - "Can't Pee" * Polyarthritis - "Can't Climb a Tree"
67
* Lower Abdomenal pain, Pruritis, Red, Fishy-odor, Thin grayish-white discharge * Imbalance of Normal Flora * Loss of Lactobacilli (G+ rods) * Changes in Hormone status, Sex activity, ABX, Douching * Clue-cells - epithelial cells coated w/ bacterial Rods * Whiff test for Amines (fishy) * What is the bug (2) and what are the Rx to Treat?
Gardenerella / Mobiluncus Rx: Metronidazole
68
* Not sexually transmitted * Thick, curdy discharge * Vaginal erythma * pH is normal * Pseudohyphae present
Candidiasis Rx: -azoles
69
* Yellow frothy discharge * Usually asymptomatic (especially in men) * Symptoms similar to Bacterial Vaginosis in Women * Increased risk of STDs and Transmission of HIV * Increased pH * Motile Flagellated Protozoan
Trichomoniasis Rx: Metronidazole (Must treat both partners)
70
* Gram positve Rod * cAMP positive * Catalase positive * Transplacental transmission * Food poisoning during birth, cold lunch meats, hot dog juices. * Miscarriage, Still birth, Bacteremia, Meningitis
Listeria
71
* Gram negative Rod * Lactose positve * Sialic acid capsule * Transmission during birth * Bacteremia meningitis
E. coli K-1
72
* Gram positive * Coccus * Catalase negative * β-hemolytic * Bacitracin negative * Transmission during birth * Bacteremia, Meningitis
Group B Strep (GBS)
73
* Gram Positive Cocci often in Chains * Catalase negative * Beta hemolytic on Blood Agar * _Bacitracin resistant_ * 40% of Normal Flora * Treat before delivery if Colonized
GBS (Group B Strep)
74
* Gram negative Rod * Ferments Lactose * Sialic Acid capsule (K1) * Anti-phagocytic properties * Not recognized as Foreign --\> Ab not made to it
E-coli K1
75
* Gram Positive Rod * Catalase Positive * cAMP Positive * Usually acquired through Food * Cold lunch-meat * Hot dog juices * Unpasturized chees * Infection in Pregnant Women can cause Miscarriage or Stillbirth
Listeria Monocytogenes
76
* Gram negative diplococcus * Oxidase Positive * Chocolate agar w/ 5% CO2 * Gonnococcal Opthalmia Neonatorum * Lid edema, erythema and purulent discharge (severe conjunctivitis) in neonate born vaginally from infected mother * Bilateral appearing 3-5 days after birth
Neisseria gonorrhoeae
77
* Obligate Intracellular bacterium w/ 2 stages * EB (extracellular) * RB (intracellular) * Most commonly reported STI in USA * Conjunctivitis and Pneumonia 5-12 days after birth * Unilateral conjunctivitis * Otitis media * Pneumonia
Chlamydia trachomatis

Pathology (36 decks)

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