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Bacterial Diseases of the urogenital tract
n/a
8
Medical
Professional
09/19/2009

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Term
Neisseria gonorrhoeae
Definition
  • gram-, oxidase+, glucose+, maltose- diplococci
  • rich growth medium required
  • clinical picture
    • m - prurulent discharge, edema, painful urination - prompt treatment
    • f - often cryptic - endocervicitis, discharge, or no symptoms - treatment delayed
  • pathogenesis
    • pili for adherence
    • gonobactin for Fe uptake
    • IgA protease
  • Other gonococcoal infections
    • disseminated --> meningitis, endocarditis, arthritis
    • conjunctivitis
    • pharyngitis
    • opthalmia neonatorum
  • Immunity
    • phase variation: piliated/nonpiliated
    • antigenic variation: changes in pilin protein
      • pilE and pilS
  • Diagnosis
    • culture and ID of organisms on Thayer-Martin medium
    • gram- diplococci in urethral smears
  • Treatment - penicillin if no resistance, plus azithromycin for Chlamydia
    • plasmid-borne β-lactamase
    • chromosomal-mediated resistance
    • reports of resistance to spectinomycin, tetracycline, fluoroquinolones
Term
Chlamydia trachomatis
Definition

I. non-gonoccoal urethritis

  • gram-, EB and RB, obligate intracellular parasite
  • may also be caused by Ureaplasma urealyticum
  • Diagnosis - PCR, absence of gram- diplococci
  • Treatment: antibiotics that penetrate cells (not penicillin)

II. Lymphogranuloma venereum

  • 1°: penile lesion
  • 2°: inguinal adenitis
  • fever, chills, headache, joint pain
  • associated with sex holidays to tropical regions
  • diagnosis - isolation in tissue culture, PCR of male urine/cervical swab
  • treatment - Azythro + cephalosporin/ quinolone
Term
Treponema pallidum
Definition
  • gram-, highly motile, microaerophilic spirochete
  • does not sythesize many compounds - transporters to get from host
  • difficult to culture - rabbit testicles, epithelial cells
  • virulence
    • attachment via terminal end structure
    • motility - dissemination to lymph and organs
    • invasion of tight jxn b/w epithelium
    • immunevasion - few surface proteins
    • phenotypic variation
  • Clinical picture
    • primary: Hunterian chancre
      • venereal
      • hard-edged, painless lesion 10 - 90 days after infection (lots of spirochetes)
      • self-healing - clearance by CMI?
      • can also be asymptomatic
    • secondary: rash
      • 25% progress to 2° w/out treatment
      • lots of spirochetes in lesions and blood
      • 60 - 70% self-curing
    • tertiary: gummatous lesions
      • 25 - 50% of 2° progress to 3° w/out treatment
      • destruction of tissue due to body's response to treponemal Ags
      • small number of spirochetes present
      • lesions will still heal with antibiotic, but damage permanent
      • cutaneous and gummatous lesions, cardio, CNS involvement
    • latent
      • in between 1°, 2°, and 3°
      • unknown if transmissable
    • neuro
      • 2° or 3°
      • treponemes in CNS
      • loss of sensory and motor ability
      • Charcot's joint
      • Tabes dorsalis
      • diagnosed w/ CSF tests
    • congenital
      • treponems infect fetus in utero
      • fetal death or newborn with 2°/3°
      • generalized rash, Hutchinson's incisors, interstitial keratiti, gummatous infiltration
      • completely preventable by penicillin therapy early in pregnancy
  • diagnosis
    • spirochetes in lesions
    • PCR and RFLP
    • non-treponemal Ag tests (not specific)
      • RPR, VDRL
      • pt serum + cardiolipid --> clump
      • non-specific Ab decline after cure
    • treponemal Ab tests
      • active and inactive (specific Ab remain high after cure)
      • FTA - killed T pallidum + pt serum + fluorescent labeled γ-globulin
      • MATP - RBCs w/ treponemes + pt serum --> clumping
  • synergy with HIV
  • Treatment
    • penicillin
    • Jarish - Herxheimer rxn
  • Other treponemal diseases
    • Yaws
    • Pinta
Term
Calymmatobacterium granulomatis
Definition
  • small gram- rod, resembles Klebsiella
  • normal flora of intestine
  • slow progreeive ulceration of skin and mucous membranes - granuloma inguinal
  • 1° lesion is a bubo that ruptures and spreads
  • diagnosis
    • ID of organisms in tissue (Donovan bodies in monocytes)
    • requires rich growth medium
  • uncommon in US, endemic in tropical areas
  • Treatment: streptomycin + tetracyclines
Term
Hemophilus ducreyi
Definition
  • short gram- oxidase+ catalase- non-motile rod
  • cultivation difficult - grows slowly on complex medium
  • causes chancroid or soft chancre - irregular ulcers with soft edges, very painful
  • localized to lymph nodes that swell to form bubos
  • can be confused with 1° syphilis, LGV, genital herpes
  • Diagnosis (exclusion - rule out other STDs)
    • gram stained smears of ulcer exudate or bubo aspirate
    • "school of fish" formation
  • Treatment - erythromycin, ceftriaxone
Term
Trichomonas vaginalis
Definition
  • flagellated protozoan
  • causes trichomoniasis - malodorous, brownish discharge, non-itchy
  • treatment: metronidazole (Flagyl)
Term
Bacterial vaginosis
Definition
  • polymicrobial infection associated with Gardnerella vaginalis and anaerobic Bacteroides spp.
  • non-specific vaginitis with at least three of
    • excessive discharge
    • vaginal pH > 4.5
    • fishy, amine-like odor with KOH treatment
    • presence of clue cells (epithelium coated with bacteria)
  • treatment: metronidazole, clindamycin
Term
UTIs
Definition
  • Types
    • aymptomatic bacteruria
      • bacteria on mucosal surface of bladder
      • no damage to bladder or urethral wall
    • symptomatic bacteruira
      • bacteria penetrate deeper layers of bladder
      • frequent, urgent, painful urination (dysuria), low-grade fever
    • acute pyelonephritis
      • inflammation of renal pelves
      • fever, shaking chills, temp. spikes, flank pain, pus in urine
    • chronic pyelonephritis
      • no symptoms or periodic until renal failure develops
  • complications
    • bacteremia
    • endotoxic shock
    • circulatory collapse
    • renal damage or failure
  • route of infection
    • ascending from urethra
    • hematogenous spread
  • types of organisms
    • community - 95% gram- (UPEC, Proteus, Enterobacter)
  • Predisposing factors - age, sex, pregnancy, diabetes, obstruction, instrumentation
  • Diagnosis - "clean catch" - gram stain of unspun urine
    • adults >100,000 gram-, >10,000 gram+
    • children >10,000 gram+/-
    • infants - any counts from catheterization
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