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Bacterial STDs I & II by Mind Map: Bacterial STDs I & II
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Bacterial STDs I & II

Mucopurulent discharge

Neisseria

Morphology, Gram-neg diplococci, "Coffee bean shapped" (2 bacteria together)

Culture, Fastideous, Require enriched growth medium, Needs increased CO2 concentration, Oxidase pos (aerobic), Produce weak acidic products on cystine trypticase agar

3 types, N. meningitidis, Moraxella catarrhalis, N. gonnorhoeae, Clinical presentations, Urethritis, Cervicitis, PID, Proctitis, epididymitis, Pharyngitis, Conjunctivitis, Ophthalmia neonatarum, Septic arthritis, Epidemiology, Infects only humans, Prevalence higher in the South and Midwest, Virulence factors, Pili, Variation and diversification d/t silent loci recombinations, chimeric pilin types, Lipooligosaccharide (LOS), inflammation and tissue damage, Outer membrane proteins (OMP), OMP I - works with OMP III to resist serum killing, OMP II (aka Opa) - renders colonies transleucent, Not in strains that cause dissemination, OMP III - stimulates Ab that bind IgG and intereferes w/ intracellular killing, IgA1 protease, NOTE: NOT CAPSULE!!!, Pathogenesis, Encounter, Sexual contact, Spread and mult, Invade non-ciliated columnar epi, acute suppuration (creamy discharge), Damage d/t brisk inflammatory response, Infxn may spread to uterine tubes (female) or epididymis (males), Severe infxns can -> septic arthritis, Dx, Specimens collected from cervix (F) or urethra (M), Use Thayer-Martin medium, Transport in Amies charcoal, OR can use Gen-Probe Aptima 2 (nucleic acid amplification test, Tests for both NG and Chlyamidia trachomatis, M w/ polys and G- diplococci is positive for NG, F require culture and isolation of NG, Immunity, No protective immunity, Reinfection possible (and likely), Tx, Ceftriaxone (3rd gen cephalosporin), Historically procaine penicillin G was DOC

Chlamydia

General, Obligate intracellular parasites, Can't make ATP, Resemble G- bacteria, Exist in 2 forms, Elementary = infectious, Reticulate = noninfections, Classification, Serotype A,B,C, Trachoma, Clinical, Chronic keratoconjunctivitis, corneal scarring and blindness, Lab Dx, Demonstration of chlamydial inclusions by Giemsa or DFA stain, Isolation in McCoy cells, Presence of Ab by micro IF, Tx, DOC = tetracyclines (Doxy) or sulfonamides, D-K, Repro stuff, M - urethritis, F - mucopurulent cervicits, salpingitis, and PID, Neonate - Inclusion conjunctivitis and pneumonia, Lab Dx, Direct antigen testing (EIA or ELISA), DFA stain and smear, Isolation by McCoy cell ine, Gen-Probe Aptima 2, Presence of Ab in micro IF, DOC = tetracyclines or sulfanoamide, L1, L, L3, Lymphgranuloma vernerum, Clinical, Ulcer on genetial, Suppurative inguinal adenitis, Lymphatic obstruction and rectal strictures, Epidemiology, Asia, Africa, S. America, Carribean, Lab Dx, Frei skin test (historically), All the usual

Pathogenesis, 1) attach to cells and are phagocytized, 2) Change from non-replicating elementary bodies to metabolically active reticulate bodies, 3) Replicate and develop into elementary bodies, 4) E. bodies lyse host cell and invade new one

Bacterial Vaginitis

Dx

Vaginal pH > 5

Thin, homogenous vaginal discharge

Release of amine-like odor when mixed with 10% KOH

Clue cells on gram stain

Etiology

Gardnerella vaginalis

Mobiluncus sp., Curved anaerobic G- rod

Trichomonas vaginalis, Presentation: malodorous, frothy discharge w/ burning, itching, chafing, Diffuse vaginal erythema

NOT STDs!!! Don't need to Tx partner

Genital Ulcers

Treponema

General, Long, thin, helical bacteria, Rototary motility, G- wall (w/ NO endotoxin!)

Classification, All not STDs, T. pertenue (Yaws), Warm, humid, tropical areas, T. carateum (Pinta), Rural, impoverished areas of S. and C. America and Caribbean, T. endemicum (Bejel), STD: T. pallidum (Syphilus), Epidemiology, Prevalent in the South, African A., and MSM, Clinical, Can be passed from mother to fetus, Presents in 3 stages, Primary, single chancre develops at spot where treponema entered body ~3 wks post infxn, Lasts ~ 1 month, If unTx, 1/2 will develop secondary stage, Secondary, Skin rash, Lesions are infectious, Will resolve w/ or w/o Tx, 1/3 will cure spontaneously; 2/3 will progress to latent syphilus, Tertiary, Develops in 15-20% of pts w/ latent syphilus, Gummas develop throughout body (hypersensitivity rxn), characterized by granuloma formation), Lab Dx, Treponema pallidum cannot be grown in culture!!!, Direct visualization via wet mount using dark field microscopy, Fluorescent Ab staining, Serology, RPR and VDRL, Dx of neurosyphilus requires a VDRL test w/ CSF!, Tx, DOC = Benzathine penicillin G

Chancroid (haemophilus ducreyi)

Clinical, "Soft chancre", Painful, sloughy and purulent edges, Bleed easily

Lab Dx, Culture requires special media, Slow growing

Ectoparasitic Sx

Phthirus public (pubic lice)

Lab Dx, Examine hair follicles for nits and adult lice

Sarcoptes scabiei (scabies

Lab Dx, Skin scraping w/ KOH wet mount

Clinical, Itchy reddish papules around groin, axilla, waist, and elbows