Sexually Transmitted Infections and Urinary Tract Infections (Quiz 2)

1. Mycoplasma

General Characteristics

-> Lack rigid ___ ___

-> Not affected by ________

-> Can be treated with __________

-> Small: 125 - 250nm

-> Pleomorphic (occur in various forms)

-> Require _________ for growth

Have sterols in their membrane but cannot synthesize it

-> Colonies have a “_____ ____” appearance

cell wall

Penicillin

Tetracyclines

cholesterol

Fried egg

1. Mycoplasma

Diagnosis

Best diagnosis is by _____ _____, reinforced by serological tests and or PCR assays

clinical signs

Chlamydia

-> Energy parasites; requiring living cells for ______

-> Small round to ovoid organism

-> Have 2 lipid bilayers and very little peptidoglycan

-> Three species commonly infect humans

1. Chlamydia _______

2. Chlamydia _______

3. Chlamydia _______

growth

trachomatis

psittaci

pneumoniae

Chlamydia

Intracellular Development Cycle

-> Infectious particle is called an “______ body” (EB) which is metabolically _______

-> Within hours (6-8), EB reorganizes into a larger metabolically _______ body called “______ body”

elementary

inactive

active

reticulate

"Elementary Body"

infectious or not infectious?

Infectious

"Reticulate Body"

infectious or not infectious?

not infectious

Life cycle of Chlamydia is about __ hours/_ days -> to start seeing clinical signs

48

2

Chlamydia

Life cycle of Chlamydia Summary

The __________ body (EB) is the infectious form of Chlamydia that attaches to a host cell __________ and enters the cell. Once inside, the EB reorganizes into the __________ body (RB), which is metabolically __________ but non-infectious. The RB replicates by __________ __________ within a membrane-bound structure called an __________. During replication, host DNA synthesis __________, and the RB produces its own __________, __________, and __________. The RBs then reorganize back into __________ bodies (EBs), causing __________ to increase. Finally, the host cell undergoes cell __________ or releases EBs, allowing infection of neighboring cells.

Elementary

receptor

Reticulate

active

binary fission

inclusion

declines

DNA

RNA

protein

Elementary

infectivity

lysis

Chlamydia

Life cycle of Chlamydia Summary

- Intracellular ______ are diagnostic of chlamydial infections

- Chlamydia trachomatis inclusion bodies (brown) in a McCoy cell (mouse) culture.

- Within a eukaryotic cell, Chlamydia resides in a membrane-bound vacuole known as the _______

- Inclusion contains _______

- ______ can be used as an energy source

inclusion

inclusions

glycogen

Chlamydia

1. Chlamydia trachomatis -> Associated with ___

2. Chlamydia psittaci -> Associated with ___

3. Chlamydia pneumoniae -> Associated with ___

Causes a range of _____ (GU) and _____ infections

STI

Respiratory Tract

Respiratory Tract

genitourinary

eye

Chlamydia trachomatis

Serotype -> A, B, C

Clinical Syndrome(s): _________

Trachoma

Chlamydia trachomatis

Serotype -> D - K

Clinical Syndrome(s): _________

Cervicitis

Endometritis

Epididymitis

Infant pneumonia syndrome

Chlamydia trachomatis

Serotype -> L1, L2, L3

Clinical Syndrome(s): _________

Lymphogranuloma venereum

Chlamydia trachomatis

Serotype -> D - K

Most common ______ STD in the USA

bacterial

Chlamydia trachomatis

Serotype -> D - K

Adult males -> urethritis, epididymitis, proctitis (anal and rectal inflammation)

Adult women -> cervicitis, salpingitis (inflammation of the fallopian tube), vaginitis, infertility

Chlamydia trachomatis

Serotype -> D - K

Causes: Inclusion ________

- Named for the inclusion bodies seen in the infected conjunctiva epithelial cells

-> Newborn - conjunctivitis from genitally infected ______. Approximately 10% of infected infants will present with or develop _________

-> Adults – conjunctivitis from ______ infection

-> Does not lead to ________

conjunctivitis

mothers

pneumonia

genital

blindness

Chlamydia trachomatis

Serotype -> D - K

Does this serotype lead to blindness?

No

Chlamydia trachomatis

Serotype -> L1, L2, L3

Causes: _____________ Venereum (LGV)

More ______ STD than serotypes D-K

_______ in the USA

Lymphogranuloma

invasive

Uncommon

Chlamydia trachomatis

Serotype -> L1, L2, L3

____ infection (Primary stage): Painless primary lesion(s), fever, headache and myalgia (muscle pain)

_________ (Secondary stage): Infection spreads to lymph nodes. Symptoms include inflammation and swelling of inguinal and perirectal lymph nodes

______ ______ _____ (Tertiary stage): Ulcers, fistulas and genital elephantiasis (due to obstruction of the lymphatics)

Local

Dissemination

Progressive tissue damage

Chlamydia trachomatis

Serotype -> A, B, C

Causes: _______

- Major cause of ________ in Asia and Africa

- Chlamydia invades the epithelium of the conjunctiva

Modes of transmission:

- _____ to _____

- Flies

- Linen, towels

Trachoma

blindness

Finger to eye

Chlamydia trachomatis

Serotype -> A, B, C

Does this serotype lead to blindness?

Yes

Chlamydia trachomatis

Effects of Trachoma

- ______ inflammation of conjunctiva

- Scarring of ______

- Distortion of external portions of the eye

- Can lead to ________

Chronic

cornea

blindness

Chlamydia trachomatis

Diagnosis

____

NAAT (Nucleic Acid Amplification Test)

Chlamydia trachomatis

Gram (+) or (-)?

(-)

Chlamydia trachomatis

Treatment

Adults and adolescents?

Doxycycline (tetracycline)

Chlamydia trachomatis

Treatment

Small children and why?

Erythromycin or azithromycin for small children because of the effects of tetracyclines on teeth and bones. Tetracyclines discolor developing teeth by binding to Ca2+ ions in teeth which becomes yellow, then brown after eruption due to oxidation and exposure to light

- Tetracyclines negatively affects bone development

Chlamydia trachomatis

Treatment

Pregnant women?

Azithromycin

Chlamydia psittaci

- Many serotypes

- Zoonotic species of chlamydia (from birds)

- Affects the respiratory tract causing pneumonia (psittacosis)

KNOW -> _______ absent from inclusion

Glycogen

How are Chlamydia psittaci and Chlamydia pneumoniae different from Chlamydia trachomatis?

- Important

Chlamydia psittaci's inclusions lack glycogen

Chlamydia pneumoniae

- One serotype

- Human pathogen spread by _______ _______

- Infection is common but usually not severe

- Symptoms include bronchitis, pneumonia, sinusitis

KNOW -> _______ absent from inclusion

respiratory droplets

glycogen

Neisseria

Pathogens:

1. N. meningitidis (meningococcus) -> Commensal or Pathogen?

2. N. gonorrhoeae (gonococcus) -> Commensal or Pathogen?

Commensal

Pathogen

Neisseria

Morphology

- Gram ______ ______ (Important)

- N. gonorrhoeae: polysaccharide capsule _______ --> Vaccine or no?

- N. meningitidis: polysaccharide capsule _______ --> Vaccine or no?

negative

diplococci

absent

no

present

yes

Which is more resistant to abtibiotics?

N. gonorrhoeae or N. meningitidis

N. gonorrhoeae

Neisseria

Cultivation

N. _________ → Chocolate agar

- It is usually isolated from sterile body fluids (blood or CSF).

- No normal flora are present to compete with or overgrow it.

- Therefore, a non-selective medium like chocolate agar is sufficient.

N. _________ → Thayer-Martin agar (Chocolate agar with antibiotics)

- It is collected from non-sterile sites (urethra, cervix, rectum, pharynx).

- These sites contain lots of normal bacteria and fungi.

- Selective antibiotics in Thayer-Martin suppress other organisms so N. gonorrhoeae can grow. (antibiotics are needed to kill the others)

meningitidis

gonorrhoeae

Neisseria

Cultivation

Neisseria gonorrhoeae → Thayer-Martin agar

Types:

a. Vancomycin – kills most gram _____

b. Colistin - kills most gram _____

c. Nystatin - kills most _____

positives

negatives

fungi

Neisseria

Virulence Factors of Meningococcus and Gonococcus:

A. Polysaccharide _______ - resists phagocytosis, only in _________ as a virulence factor

B. ___ - also resist phagocytosis, protein in nature, enhance attachment to host cells, important for both species, and particularly for __________

C. Lipo-oligosaccharide (LOS) – An LPS variant that triggers inflammatory cytokine release

capsule

meningococcus

Pili

gonococcus

Neisseria

Virulence Factors of Meningococcus and Gonococcus:

D. ______ proteins (Opa)- Outer membrane proteins; prevents phagocytosis

E. Porin _ - essential outer membrane protein present in ___________. It serves as the primary channel for nutrient uptake and plays a secondary role in host cell attachment and invasion.

F. Ig_ protease - important for _______ species

Opacity

B

gonococcus

A

both

IgA protects what?

-Frequent boards question-

Mucosal surfaces

Neisseria

Gonococcus

Disease and Epidemiology

- Gonococci attack mucous membranes of genito-urinary tract, eye, rectum, and throat

1. Reservoir: An infected person

2. Transmission: ______ contact

sexual

Neisseria

Gonococcus

Clinical Forms:

a. Acute urethritis in the male: not so common in the female

b. Endocervicitis → Pelvic Inflammatory Disease (PID)

c. ______ _____ in sexually promiscuous individuals -> *Blood in Joints*

d. Eye infections

In adult: Auto-infection

In newborn: Ophthalmia neonatorum, acquired through passage of birth canal

- Most common manifestation in ______

- Treatment: ________ ophthalmic ointment

e. Proctitis: Inflammation of the _____ and _____

f. Pharyngitis

Pyogenic arthritis

infants

Erythromycin

anus

rectum

Neisseria

Gonococcus

Diagnosis

-> _____

-> _____ ______ : Gram _ _______

NAAT

Gram stain

(-) diplococci

Neisseria

Gonococcus

Treatment

a. ______ injection is first choice

b. ______ is added if coinfection with Chlamydia trachomatis is not ruled out

- If testing for chlamydia has not been done, doxycycline is added to ensure both pathogens are treated and to prevent persistent infection or complications because Neisseria gonorrhoeae infections frequently occur alongside Chlamydia trachomatis

c. ______ is no longer used due to resistance

Ceftriaxone

Doxycycline

Penicillin

Neisseria

Meningitis - N. meningitidis

- Reservoir: Humans, in the ___________

- Transmission is by inhalation of ________ ________

nasopharynx

respiratory droplets

Neisseria

Meningitis - N. meningitidis

Clinical Forms

a. Respiratory symptoms may initially occur (mainly asymptomatic)

b. Septicemia (Meningococcemia): Bacteria cross the epithelial lining of the nasopharynx and enter the blood stream where they rapidly multiply

b. Meningitis: Bacteria can travel to meninges from the blood Inflammation occurs resulting in purulent meningitis

Neisseria

Meningitis - N. meningitidis

Main Symptoms:

sensitivity to ______ -> Important

headache

fever

_____ _____ -> Important

vomiting

rash

Can lead to coma and death

light

stiff neck

Neisseria

Meningitis - N. meningitidis

Diagnosis

- _____

- Culture on Chocolate agar

- _____ _____

NAAT

Gram stain

Neisseria

Meningitis - N. meningitidis

Treatment

___________ antibiotic

Ceftriaxone

Neisseria

Meningitis - N. meningitidis

Prevention?

Vaccination

Spirochetes

Three genera pathogenic to humans:

Treponema - syphilis, yaws, pinta

Borrelia - relapsing fever, Lyme disease

Leptospira - leptospirosis

Spirochetes

Borrelia recurrentis

Disease: ________ fever

Transmission: ______ and ______

Symptoms: Flu-like symptoms that resolves and ______

Relapsing

Ticks and lice (bite)

recurs

Spirochetes

Borrelia burgdorferi

Disease: _____ disease

Transmission: _____

Symptoms: Rash (______ migrans), flu-like symptoms, joint pain, neurological

problems

Lyme

Ticks

erythema

Spirochetes

Leptospira

Disease: Leptospirosis

Transmission: ______ of an infected animal e.g. rats and mice

Urine

Spirochetes

General Characteristics

A. _____ shaped gram _______ bacteria

B. Possess __________ (axial filaments underneath the outer membrane)- for motility

C. Chemical composition of cell wall and cell membrane is similar to other Gram negative bacteria, except the wall is not _____

= Does not stain well

Spiral

negative

endoflagella

rigid

Spirochetes

Morphology

1. Treponema - ____, regular coils

2. Borrelia - Coarse, ______ coils

3. Leptospira - Very ____ coils, end(s) ______

Tight

irregular

tight

hooked

Spirochetes

Treponema Species

A. T. pertenue - yaws in tropical

Infection of the skin, bone and joints

B. T. carateum - pinta in Central & South America

Skin disease

C. T. denticola - present in the mouth, implicated in gingivitis, periodontitis, acute ________ ________ ________

necrotizing ulcerative gingivitis

Spirochetes

T. pertenue

Yaz affects what?

Know!

Skin, bone, joints

Spirochetes

T. carateum

Pinta affects what?

Know!

Skin only

Spirochetes

T. denticola

Acute necrotizing ulcerative gingivitis main features?

Painful, bleeding gums, and ulceration of inter-dental papillae

Spirochetes

General Features of Yaws and Pinta

1. _______ diseases - chronic skin lesions

2. Non-venereal

3. Associated with poor personal hygiene or insect vectors

4. Positive syphilitic serology (false (+) results)

5. Respond well to penicillin

Tropical

What is the incubation period for T. Pallidum (Syphilis)?

3 weeks

Spirochetes

T. Pallidum (Syphilis)

Clinical Manifestation:

a. _______ Stage:

- Non-tender, indurated ulcer (chancre)

- Highly ________ but heal spontaneously in 3 – 6 weeks

- Patients do not recall their primary lesions (chancre) because they are painless and inconspicuous (especially for females because it's inside the vagina)

- Usually not noticeable + a tiny sore

Primary

infectious

Spirochetes

T. Pallidum (Syphilis)

Clinical Manifestation:

b. ________ Stage:

- Organism spreads throughout the body via the _______ and _______

- ______ to ______ after Primary Stage

- Red maculopapular rash on body including palms and soles of feet

- Pale moist flat papules in the anogenital regions (called condylomata lata), armpits and mouth

Secondary

blood and lymph

Weeks to months

Spirochetes

T. Pallidum (Syphilis)

Clinical Manifestation:

c. ________ Syphilis

- ___________ but positive serology (antibodies in the serum)

Latent

Asymptomatic

Spirochetes

T. Pallidum (Syphilis)

Clinical Manifestation:

d. _____ (tertiary) Stage

- _ to __ years after Primary Stage

- Involves _________ system (aortitis)

- _______ ______ system (neurosyphilis)

- No organ of the body is immune

- _________ disease -> granulomatous- like lesions in the skin, bones and liver

Late

3 to 30

cardiovascular

Central nervous

Gummatous

Which of the stages are infectious?

Primary and Secondary only.

Spirochetes

T. Pallidum (Syphilis)

Laboratory Diagnosis:

A. Direct visualization of organisms - for Primary & Secondary stages

(1) ________ microscopy

(2) Direct Fluorescent ________ Test

Darkfield

Antibody

Darkfield microscopy is looking for?

Organisms

Direct Fluorescent Antibody Test is looking for?

Antibodies

Spirochetes

T. Pallidum (Syphilis)

Laboratory Diagnosis:

B. Serology antibody tests

-->Detects 2 different antibodies

1. Anti-treponemal antibody test

- Looks for antibodies specific to treponemal ________ antigen (antibodies against bacteria)

OR

2. Non-treponemal antibody (reagin) test

- Looks for antibodies specific to _________ host cell phospholipid components (such as cardiolipin)

Antibody stimulated by cellular _______

surface

damaged

damage

Spirochetes

T. Pallidum (Syphilis)

Laboratory Diagnosis:

B. Serology antibody tests

1. Anti-treponemal antibody test

- Fluorescent Treponemal Antibody–Absorption (FTA-ABS) test

• This is a type of anti-treponemal antibody test

• Used in laboratory diagnosis of _______

• Detects antibodies specific to Treponema ________

syphilis

pallidum

Spirochetes

T. Pallidum (Syphilis)

Laboratory Diagnosis:

B. Serology antibody tests

(2) Non-treponemal (reagin) antibody tests

- Part of laboratory diagnosis of syphilis

- Detect antibodies against cellular __________ of products, not T. pallidum itself

- Target ______ (e.g., cardiolipin) released from damaged host cells

- Antibodies are produced due to cellular damage

Types:

(1) _____ test

- Detects agglutination microscopically

- Named after the lab that developed it

(2) _____ test

- Detects agglutination without a microscope

- Cardiolipin is linked to particles (e.g., carbon) to make results visually easier to see

breakdown

lipids

VDRL (Venereal Disease Research Laboratory)

RPR (Rapid Plasma Reagin)

Spirochetes

T. Pallidum (Syphilis)

Treatment?

Penicillin G

Other Urogenital Infections

Trichomoniasis

- Caused by _____ ____ protozoan parasite

• Spread by ______ contact

• Most infected persons have minimal or no symptoms

• Some infected men have symptoms of urethritis, epididymitis, or prostatitis, and some infected women have vaginal discharge that might be diffuse, malodorous, or yellow-green with or without vulvar irritation

Trichomonas vaginalis

sexual

Other Urogenital Infections

Trichomoniasis

Treatment?

Metronidazole

What is the most prevalent non-viral STD in the USA

Trichomoniasis

Other Urogenital Infections

Bacterial Vaginosis (BV)

• BV is a polymicrobial clinical syndrome resulting from replacement of the normal Lactobacillus sp. in the vagina with high concentrations of other bacteria such as _______.

• BV is associated with having multiple male or female partners, a new sex partner, douching, lack of condom use, and lack of vaginal lactobacilli; women who have never been sexually active are rarely affected

• BV is the most prevalent cause of vaginal discharge or ________ however most women are asymptomatic

- Essentially, the pH of the vagina becomes more alkaline rather than acidic

Gardnerella vaginalis

malodor

Other Urogenital Infections

Bacterial Vaginosis (BV)

Treatment?

Metronidazole

_______ ______ are responsible for 80 - 85% of UTIs

__________ _________ are responsible for 5 - 15% of UTIs

Know!

Escherichia coli

Staphylococcus saprophyticus