Ch. 27 - Genitourinary Tract Infections and Sexually Transmitted Infections

A person receiving ART typically takes three drugs

two nucleoside reverse transcriptase inhibitors (NRTIs) and either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI)

This viral STI usually results in AIDS

untreated HIV infection

In men, chlamydial infection usually involves the

urethra; spreads to epididymis, causes acute pain and swelling that may lead to infertility

Symptomatic infections of Trichomoniasis in men have

urethral discharge, burning pain with urination, painful testes, or a tender prostate gland.

Factors influencing incidence of gonorrhea include

use of birth control pills, asymptomatic infection (20% of men, 60% of women), and lack of immunity after recovery from infection

Various opportunistic infections became known as

"AIDS-defining conditions"

Most of the time, the viral DNA for this STI (1) exists within nerve cells in a non-infectious form, causing no symptoms. In this state, only a single gene is expressed, and it encodes a small segment of RNA called a _________ (2).

(1) Genital herpes; (2) microRNA

________ HIV protein between capsid protein and envelope, stabilizes virion

Matrix (MA or p17)

causative or etiologic agent of gonorrhea

Neisseria gonorrhoeae

_________ is usually transmitted by sexual intercourse

Syphilis

Preventing HIV transmission via sexual contact involves

use of latex condoms; testing to determine HIV status; circumcision lowers risk up to 60%; pre-exposure prophylaxis (PrEP) for high-risk uninfected adults - a single pill, taken daily, contains a fixed dose of two reverse transcriptase inhibitors (not a 100% effective, use in combination with other preventive methods)

Gonorrhea can also be transmitted from mother to child during

vaginal birth

Chlamydia trachomatis can be transmitted by

vaginal, oral, or anal sex.

This mechanism for person-to-person transmission of HIV involves transmission from mother to fetus or newborn during pregnancy, passage through birth canal, or breastfeeding

vertical transmission

Characteristics of Treponema pallidum

very slender, highly motile spirochete; outer membrane lacks lipopolysaccharide (LPS); viewed with dark-field microscopy, silver stain; endoflagella propel in corkscrew-like motion, allow penetration of variety of tissues and organs; lacks many metabolic abilities including TCA cycle, electron transport chain; thought to obtain most macromolecules from host

_________ STIs cannot be cured with antivirals, but these medications can reduce severity and duration

viral

________ (bacterial or viral) STIs are at least as common as ___________ (bacterial or viral) STIs, but incurable; effects can be severe and long-lasting

viral; bacterial

True/False. ART does not cure HIV disease. It can improve the quality of the person's life, reduce the risk of other complicating other diseases, and lower the HIV set point.

True

True/False. Although neurosyphilis symptoms are usually seen during the tertiary stage, they can also be experienced during the first and secondary stages of the disease as meninigits

True

True/False. Antibiotics are ineffective for tertiary syphilis because most of the organisms are not actively multiplying.

True

True/False. Blood and blood products are now screened for the presence of HIV antibodies, so that the blood is not used

True

True/False. Chlamydia infections can persist for months by avoiding host defenses.

True

True/False. Drug rehab and education about condom use can help with promoting safer sex practice

True

True/False. HIV is not highly contagious, and most transmissions can be prevented by behavioral changes

True

True/False. HPV strains are easily spread by sexual intercourse; asymptomatic people are infectious

True

True/False. Human papillomavirus is a major factor in the development of cervical cancer

True

True/False. If anti-HIV medications are stopped then the viral set point can rebound in absence of treatment

True

True/False. If the mother has recurrent disease of genital herpes, the risk to the baby is very low

True

True/False. In nature, T. pallidum infects only humans.

True

True/False. Infection rates of trichomoniasis are highest in men and women with multiple sex partners.

True

True/False. Lowering the HIV set point lowering the chance of drug resistance

True

True/False. Most people who have human papillomavirus (HPV) infections clear them without ever developing signs or symptoms

True

True/False. Neither HSV-1 nor HSV-2 have animal reservoirs.

True

True/False. Newborn infants can contract T. vaginalis from infected mothers during vaginal birth.

True

True/False. Once infected with genital herpes they are forever at risk of transmitting the virus to another person.

True

True/False. Quick identification and treatment of sexual contacts are important in limiting the spread of syphilis.

True

True/False. Signs and symptoms of pelvic inflammatory disease might be mild and difficult to recognize. Some women have no signs or symptoms

True

True/False. Syphilis infection can occur from kissing a person secondary syphilis or by contact with a primary ulcer infected with T. pallidum

True

True/False. The complement system is activated for gonorrhea; neutrophils release damaging chemicals.

True

True/False. The frothy discharge of trichomoniasis is probably due to the hydrogen gas produced by the organisms.

True

True/False. The number of reported cases for Chlamydial infections has been rising because of increased awareness of the disease and better diagnostic tests

True

True/False. There is much research effort directed at developing a vaccine for HIV; recombinant vector vaccine protected about 30% of trial participants; DNA vaccines and peptide vaccines are under development

True

True/False. To prevent infection to a baby that will be delivered from a mother with a primary infection of genitals herpes, it is best to use cesarean section.

True

True/False. Using a condom does not always give full protection because herpes lesions can occur on parts of the genitalia that a condom does not cover.

True

True/False. When a person first contracts HIV, he or she has an HIV infection. A person can be infected with HIV but may not be ill.

True

True/False. Women should have annual pap smear

True

In women, the infection commonly involves the

cervix; may lead to pelvic inflammatory disease (PID); uterus often becomes infected, leads to pain, bleeding; infection of fallopian tubes can lead to infertility

Characteristic human immunodeficiency viruses

enveloped retroviruses; duplicate copies of single-stranded RNA genome; two types: HIV-1 and HIV-2

Newborns infected at birth with Chlamydia may have

eye inflammation

Signs and symptoms of HIV

fever, head and muscle aches, sore throat, enlarged lymph nodes; perhaps a rash

True/False. The general trend for the number of males getting a circumcision is dropping slightly overall

true

The normal range for helper T cell counts is

800-1500 cells/microliter

Structural proteins on HIV are by

1. abbreviation of function or location and 2. size in kilodaltons

Gardasil 9 (9vHPV) is part of the routine vaccine schedule for adolescents at age

11 to 12 years

HPV types _____ and ____ are responsible for about 70% of cancers

16 and 18

Incubation period of gonorrhea is

2-5 days; frequently asymptomatic

Signs and symptoms of HIV appear when helper T cell counts fall bellow _________ cells/microliter, causing the viral load to increase and infections and cancers to increase

200

_____ other antigenic types cause lymphogranuloma venereum

3

Place the steps of HIV pathogenesis in order: 1. DNA copy enters nucleus; IN inserts randomly into host genome 2. Virus causes infected cells to fuse with those nearby, allowing virus to spread while hidden from antibodies 3. Virus attaches to CD4 protein found on helper T cells, macrophages, dendritic cells 4. Helper T cells killed by HIV infection; adaptive immune response weakens 5. New virions bud from host cell, gaining envelope 5a. Membranes fuse and virus enters the cell 5b. Then binds to co-receptor, usually cytokine receptors CCR5 or CXCR4 6. Reverse transcriptase (RT) makes DNA copy of viral RNA genome; sequence slightly different due to frequent mistakes 7. HIV DNA copy is transcribed, creating RNA copies. RNA genome for new viral particles; mRNA that is transcribed to make viral proteins 8. Slight differences in new virions due to mutations allow HIV to evolve quickly, altering antigens and avoiding immune response 9. Infected macrophages and dendritic cells survive, but serve as reservoir for replicating HIV; don't function normally; weakens immune response

3, 5b, 5a, 2, 6, 1, 7, 5, 8, 4, 9

If the mother has a primary infection near the time of delivery, the baby has about a ___ % risk of acquiring the infection. The baby often dies from the infection or is permanently disabled by it

30

More than _____ _______ people worldwide have died of AIDS over the last three decades, and nearly _______ ______ are currently living with HIV

35 million; 37 million

______ antigenic types (non-venereal strains) cause trachoma, an eye infection that can lead to blindness

4

HSV types _____ and _____ cause more than 90% of genital warts

6 and 11

HIV disease develops _____ days to _____ weeks after initial infection; many are asymptomatic

6; 6

Chlamydia Symptoms generally appear ______ to _______ days after exposure

7 to 14

_____% of women and _____% of men are asymptomatic for chlamydia

75; 50

About _____ antigenic types are responsible for most Chlamydial STIs

8

Half of untreated patients progress to AID within ______ to _______ years; others with low viral set points survive many years

9 to 10

Cancer of the uterine cervix, invasive could indicate

AIDS

Kaposi's sarcoma could indicate

AIDS

Progressive multifocal leukoencephalopathy (a brain disease caused by the JC polyomavirus) could indicate

AIDS

Salmonella infection of the bloodstream that is recurrent could indicate

AIDS

The ______ epidemic was first recognized in the United States in 1981 when a number of young, previously healthy homosexual and bisexual men developed Pneumocystis pneumonia, a disease caused by an organism of such low virulence that it seldom affects healthy people.

AIDS

The last stage of HIV disease in which the level of CD4+ helper T cells drops and certain cancers and opportunistic infections develop

AIDS

Toxoplasmosis of the brain could indicate

AIDS

Wasting syndrome (weight loss of more than 10% due to HIV); also known as slim disease could indicate

AIDS

candidiasis involving the esophagus, trachea, bronchi, or lungs could indicate

AIDS

coccidioidomycosis, of tissues other than the lung could indicate

AIDS

cryptococcosis, of tissues other than the lung could indicate

AIDS

cryptosporidiosis of duration greater than 1 month could indicate

AIDS

cytomegalovirus disease of the retina with vision loss or other involvement outside liver, spleen, or lymph nodes could indicate

AIDS

encephalopathy (brain involvement with HIV) could indicate

AIDS

herpes simplex virus causing ulcerations lasting a month or longer involving the esophagus, bronchi, or lungs could indicate

AIDS

histoplasmosis of tissues other than the lung could indicate

AIDS

isosporiasis (a protozoan disease of the intestine) of more than 1 month's duration could indicate

AIDS

lymphomas, such as Burkitt's lymphoma, could indicate

AIDS

mycobacterial diseases, including tuberculosis could indicate

AIDS

pneumocystis (pneumonia due to Pneumocystis jirovecii)

AIDS

pneumonias occurring repeating

AIDS

Most people with AIDS also suffer from weight loss, fever, fatigue, and diarrhea—a set of problems referred to as the

AIDS-related complex (ARC)

As other groups of people developed unusual opportunistic infections for no apparent reason, the CDC began calling this syndrome __________ __________ ______ to describe the unexplained increased susceptibility that indicated underlying immunosuppression.

Acquired Immunodeficiency syndrome or AIDS

______ for capsid protein is same as p24 for 24 kDa; it is an abundant protein and can be used to detect early HIV infection; coats protein

CA

causative or etiologic agent of Chlamydia

Chlamydia trachomatis

1. Elementary body attaches to mucosal epithelial cell, induces endocytosis 2. Creates an inclusion body inside which reticulate body multiplies 3. Divides by binary fission, produces elementary bodies that emerge, infect other cells This pathogenesis describes which type of STD?

Chlamydial infections

The most common of all notifiable bacterial infectious diseases in the United States.

Chlamydial infections

______ HIV proteins project from envelop

Env

True/False. Gonococcus (GC) can attach to squamous epithelium, such as that lining the adult vagina, or to ciliated cells.

False, it CANNOT

True/False. ART eliminates HIV DNA copy from host cell genome

False, it DOES NOT

True/False. The high percentage of asymptomatic infections, especially in women, helps transmission of the trichomoniasis.

False, it is in men.

True/False. There is a vaccine to prevent gonorrhea

False, there is NO vaccine because of Gonococci's antigenic variation and lack of a suitable animal model

True/False. There is a vaccine for syphilis.

False, there is NO vaccine for syphilis

__________ ______ is a vaccine developed to protect against HPV types 16 and 18, which are responsible for about 70% of cancers, and HSV types 6 and 11, which cause more than 90% of genital warts

Gardasil 9 (9vHPV)

This STI can be prevented by abstinence, monogamy, avoiding sexual intercourse during active signs or symptoms (outbreak), using condoms with spermicide that inactivates HSVs

Genital herpes

Sexual transmission of this STI is most likely to occur during the first few days of symptomatic disease, but can happen in the absence of signs or symptoms of the disease. In the U.S., 25 million are infected with this STI with 500,000 new cases each year.

Genital herpes (HSV)

__________ is among the most common of the STIs; only infects humans

Gonorrhea

T. vaginalis causes tissue damage, so people with this disease are at higher risk of contracting _____

HIV

The concentration of virions in the bloodstream during clinical latency remains relatively stable and is referred to as the ________ _______ ______ . This set point, which is measured as HIV RNA in plasma, is important because it serves as a predictor of disease progression—the higher the viral set point in an infected person, the more quickly he or she is likely to develop AIDS.

HIV (viral) set point (or viral load)

Making a vaccine against HIV has been difficult because

HIV is highly variable genetically due to high error rate, antibodies do not protect against new variants; syncytia can form, allowing the virus to pass from cell to cell without contacting antibodies; lack of good animal model to test new vaccines

Problems with ART include

HIV strains are now resistant to medications, toxic side effects, and cost

This type of HIV causes the most AIDS cases (many strains)

HIV-1

This type of HIV causes less severe disease in Africa

HIV-2

________ are thought to enter and infect the deeper layers of epithelium through microscopic abrasions.

HPVs

Either herpes simplex virus type 2 (HSV-2) or type 1 (HSV-1) can infect mouth and genitalia, but _________ usually causes more severe genital lesions with greater frequency of recurrence

HSV-2

____________ can survive for short periods on fomites or in water, but non-sexual transmission is rare.

HSV-2 (herpes simplex virus type 2)

___________ ___________ __________ ________ _____, the cause of "cold sores" ("fever blisters"), can also cause genital herpes

Herpes simplex virus type 1 (HSV-1)

causative or etiologic agent of HIV/AIDS

Human immunodeficiency viruses

This viral STI can cause genital warts and cervical cancer

Human papillomavirus

People at Increased Risk for HIV Disease include

Injected-drug abusers who have shared needles; Sexually promiscuous men and women, especially sex workers, drug abusers, and men who have sex with men; People with history of hepatitis B, syphilis, gonorrhea, or other sexually transmitted infections that may be markers for unprotected sex with multiple partners; People who have had blood or sexual exposure to any of the people listed above.

HIV Surface protein called ______ or ______, allows viral attachment and entry; cap-like portion of the spikes

SU or gp120

This place is currently the most affected region, with 1 in 20 adults living with HIV

Sub-Saharan Africa

HIV Transmembrane protein called _______ or _______, which anchors the spike in the viral envelope; stalk-like portion of the spikes

TM or gp41

Treatment of ______ syphilis limits the progression of disease, but does not correct tissue damage that has occurred.

Tertiary

Causative or etiologic agent of syphilis

Treponema pallidum

Another name for Trichomoniasis is

Trich

Causative or etiologic agent of trichomoniasis

Trichomonas vaginalis

___________ _________ is a widespread (worldwide distribution) human parasite that has no other reservoirs and is usually spread by sexual contact. It is easily killed by drying, but can survive for a time on moist objects such as towels, so it can occasionally be transmitted non-sexually.

Trichomonas vaginalis

This STI is often asymptomatic, especially in men; it is a sexually transmitted protozoan disease; it causes vaginitis and preterm births in women; men and women both have genital discharge and painful urination.

Trichomoniasis

Neonatal gonococcal conjunctivitis (ophthalmia neonatorum) is prevented by putting an antibiotic ointment such as erythromycin directly into the eyes of all newborn infants within 1 hour of birth. True/False. This prophylactic treatment is required by law in the U.S.

True

Most strains of N. gonorrhoeae are susceptible to

UV light, cold, and desiccation

___________ increases risk of HIV infection

Ulceration (HSV)

The most important risk factor for acquiring genital HPV infection is

a history of multiple sex partners

Combination therapy of _______ injection and ________ is recommended to prevent spread of antimicrobial resistance for N. gonorrhoeae strains

ceftriaxone; azithromycin

Syphilis and Trichomoniasis can be prevented by

abstinence, monogamous relationships, and condom

Prevention of gonorrhea includes

abstinence, monogamous relationships, consistent and correct use of condoms, rapid identification and treatment of sexual contacts

Prevention of Chlamydial infections involves

abstinence, monogamous relationships, correct use of condoms; test sexually active people at least once yearly to rule out asymptomatic infection

HPV can be prevented by

abstinence, monogamy, proper condom use (does not offer complete protection)

Signs and symptoms that indicate this early stage of HIV disease coincide with high levels of virus replication and are called the _______ _________ __________; they are often mild and go away by themselves in about a month (4-6 weeks)

acute retroviral syndrome (ARS)

Early signs of congenital syphilis resemble

adult secondary syphilis

Preventing HIV transmission via vertical transmission

anti-HIV therapy for mother; delivery of infant by cesarean section; avoid breastfeeding

Treatment for Chlamydial infections

antibiotics (Azithromycin - single dose; tetracyclines and erythromycin - multiple doses); sexual partners also treated

Medications to treat HIV are __________, designed to block replication of the virus, but do not affect viral nucleic acid already integrated in the genome of host cells.

antiretrovirals (ARVs)

Screening tests have also significantly reduced the risk of HIV transmission from

artificial insemination and organ transplantation

_______ STIs are curable with antimicrobials, but some are resistant to most available options

bacterial

The mechanisms Gonococci uses to avoid immune response

bind to host's complement regulatory proteins; antigenic variation delays production of effective antibodies; binds host sialic acid to disguise from immune cells; stimulate uptake by neutrophils, where they replicate; attach to helper T cels, preventing activation, proliferation; produces proteases that destroy IgA of mucosa; produces protein that prevents phagosome maturation; produces protein that "steals" iron from host; significant mechanisms of horizontal gene transfer

This mechanism for person-to-person tramission of HIV involves IV drug abusers who share needles; healthcare workers by a needle stick, low risk

blood and blood products

HIV is present in

blood, semen, vaginal secretions

Despite the significant advances made in understanding HIV and AIDS and the billions of dollars spent trying to control the AIDS pandemic, the disease still ________ be cured and is far from conquered

cannot

This is a very common STD, especially among young people. It is estimated that 1 in 20 sexually active young women aged 14-24 years has this STD

chlamydia (chlamydial infections)

After the initial burst of HIV viral replication, viral levels decrease but persist without causing symptoms for many years—a period of __________ __________

clinical latency

______ syphilis prevented by treating mother before fourth month of pregnancy

congenital

In pregnant women, Treponema pallidum can easily cross the placenta and infects the fetus, causing

congenital syphilis

Late symptoms of congenital syphilis occur after 2 years. These include

deformation of bones, cartilage, and teeth; eye inflammation and deafness

Gonorrhea is transmitted almost exclusively by _________ contact. This contact is almost always sexual, including vaginal, oral, anal.

direct

Systemic infection that can be caused by certain strains of Neisseria gomorrhoeae is characterized by fever, rash, and arthritis. It may lead to endocarditis or meningitis

disseminated gonococcal infection (DGI)

HIV Transmission by blood and blood products has been lowered dramatically by ________ _________ to 1 in 1.5 million transfusions.

donor and blood screening

This is the infectious form of Chlamydia trachomatis and survives outside of host cell

elementary body (EB)

Chlamydia trachomatis is unusual in that it has two forms in its life cycle

elementary body and reticulate body

Symptom recurrence for genital herpes can be caused at times because the

entire chromosome is transcribed and infectious virions are produced

Types of antiretroviral medications are

entry inhibitors; NRTIs (nucleoside reverse transcriptase inhibitors); NNRTIs (non-nucleoside reverse transcriptase inhibitors); integrase inhibitors; protease inhibitors

Congenital syphilis can occur in the absence of any signs or symptoms of syphilis in the mother and at any stage of pregnancy, but damage to the fetus does not generally happen until the

fourth month

There is no cure for __________ ________ , although anti-HSV medications such as acyclovir and famciclovir can decrease the severity of the first attack and the incidence of recurrences.

genital herpes

This viral STI can recur for years

genital herpes

This viral STI has the following pathogenesis: Infection of epithelial cells, which lyse following replication creating small, fluid-filled blisters (vesicles) with infectious virions and it can rupture producing painful ulcers

genital herpes

This viral STI has the following signs and symptoms: -genital itching and burning after about a week (2-20 days); sometimes, severe pain -clusters of small, red bumps appear on genitalia or anus, depending on site of infection -become blisters surrounded by redness; break in 3-5 days to leave ulcerated area that dries, crusts -less commonly, discharge from penis or vagina, headache, fever, muscle, and in women, painful urination -most severe in first 1 to 2 weeks; disappear within 3 weeks -recurrences common, but usually less severe

genital herpes

Characteristics of Neisseria gonorrhoeae

gonoccous (GC), a fastidious, gram-negative diplococcus; produces pili (fimbriae) for attachment; outer membrane of GC has highly branced oligosaccharide structure (lipooligosaccharide - LOS)

1. Infection begins when GC attaches by means of its pili to receptors on non-ciliated columnar mucosal cells, including those of the urethra, cervix, mouth, pharynx, rectum, and conjunctiva 2. Some bacteria direct host cells to engulf them; multiply within cells or released on other side of mucosal lining This pathogenesis describes what disease?

gonorrhea

This STI has declined in the U.S. since the emergence of HIV/AIDS, probably due to increased condom use

gonorrhea

This disease is increasingly resistant to antimicrobial medications; now considered by CDC to be an "urgent threat"

gonorrhea

Neisseria gonorrhoeae can be diagnosed based on

gram stain of discharge and direct immunofluorescence

Genital herpes is usually caused by __________ _________ _______ ________ _____, an enveloped, double-stranded DNA virus of the Herpesviridae family.

herpes simplex virus type 2 (HSV-2)

_____-________ ________ can decontaminate surfaces exposed to body fluids; dilute household bleach effective for general use

high-level disinfectants

The genome of _____ - _____ (cancer-associated) HPV types can integrate into the chromosome of the host cell; they are oncogenic ("cancer causing") because they code for a protein that allows excessive cell growth. Small percentage of infections result in cancer; takes average of 20 years to develop.

high-risk

antiretrovirals (ARVs) are given in combinations called __________ ________ _________ ________ or _________ ________, so resistant mutants are less likely to develop

highly active antiretroviral therapy (HAART) or antiretroviral therapy (ART)

Certain strains of ____________ _________ can cause cervical cancer; also cause oral, penile, vaginal, and anal cancers

human papillomavirus (HPV)

This viral STI can have warts appear approximately 3 months after infection on head or shaft of penis, at vaginal opening, or around anus; the infection can persist after wart removal and cause more warts; can sometimes partially block urethra or birth canal; infants can be infected at birth

human papillomavirus (HPV)

This viral STI can lead to cancer

human papillomavirus infections

causative or etiologic agent of human papillomavirus

human papillomaviruses

Chlamydia signs and symptoms in women

increased vaginal discharge, sometimes painful urination, abnormal vaginal bleeding, abdominal pain, and pain during sexual intercourse; can lead to pelvic inflammatory disease (PID)

If gonorrhea is untreated in women

infection can spread to fallopian tubes, cause pelvic inflammatory disease (PID), sometimes infertility; infection perhaps carried by sperm cells; scarring of fallopian tube can lead to ectopic pregnancy; occasionally spreads into abdominal cavity

If gonorrhea is untreated in men

inflammation can produce scar tissue that obstructs urethra, slows urination, increases risk of UTIs; infection may produce prostatic abscesses and orchitis; infertility can result

The signs and symptoms of chlamydial infections are largely due to the

inflammatory and immune response

This HIV-encoded enzyme inserts DNA copy of viral genome into host cell genome

integrase (IN)

The symptoms of gonorrhea are primarily due to the

intense inflammatory response.

Chlamydia infections avoid host defenses by

interfering with MHC-antigen complex formation and inhibiting apoptosis in infected cells

Symptomatic infections of Trichomoniasis in women are characterized by

itching of the vulva and inner thighs, itching and burning of the vagina, and a frothy, sometimes smelly, yellowish-green vaginal discharge; sometimes with burning pain with urination; vulva, vaginal wall are red and slightly swollen, and may develop pinpoint hemorrhages

HPV warts often regress but can be removed by

laser treatment, freezing with liquid nitrogen, surgical excision, acid treatment; variety of creams/ointments None of these cure the infection, so warts may recur

This stage of syphilis has no outward signs; antibodies are present in those infected; 25% recover; 25% remain at this stage; remainder progress to next stage

latent syphilis

_______________ plays a role in the virulence and pathogenicity of gonoccous (GC)

lipooligosaccharide (LOS)

The genome of _______ - ______ (wart-causing) HPV types exists in infected cells as extrachromosomal, closed DNA circles, but the mechanism by which warts arise is unknown.

low-risk

Some specific strains of Chlamydia can cause ________________ _____________; lymph nodes of groin swell, painful, and drain pus, small painless sore on genitalia, swelling of labia (women). If untreated, eventual obstruction of lymphatic vessels may cause extreme swelling of genitalia and rectal bleeding in cases of ________ ________

lymphogranuloma venereum; anal chlamydia

The signs and symptoms of trichomoniasis are thought to be due to ______________ ___________ by the axostyle of the moving protozoa

mechanical trauma

Most strains of Trichomonas vaginalis respond quickly to _____________ or __________, a few resistant

metronidazole; tinidazole

Treponema pallidum easily penetrates __________ _________ and _________ ______. It has a low infectious dose of less than ________ cells

mucous membranes and damaged skin; 100

A program that gives people sterile syringes and needles in exchange for used ones to prevent HIV tranmissions

needle and syringe exchange programs

Babies born to mothers who have symptomatic or asymptomatic gonorrhea can develop

neonatal conjunctivitis

Characteristic of human papillomaviruses

non-enveloped, double-stranded DNA viruses of Papillomaviridiae; more than 100 types of HPVs; tissue an species specific; at least 40 transmitted by sexual contact; approximately 15 strongly associated with cancer

Other strains of human papillomavirus cause

non-warty lesions of mucosal surfaces, such as uterine cervix

Most reliable ways to prevent STIs include

not having sex, monogamous relationship with uninfected person, condom use, vaccination, and male circumcision

An infection of the female reproductive organs. It most often occurs when sexually transmitted bacteria spread from vagina to the uterus, fallopian tubes or ovaries

pelvic inflammatory disease (PID)

_________ sex may be a risk factor for mouth and throat cancers

oral

When signs and symptoms of pelvic inflammatory disease (PID) are present, they most often include

pain (mild to severe) in your lower abdomen and pelvis; abnormal or heavy vaginal discharge that may have an unpleasant odor; abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles; pain during intercourse; fever, sometimes with chills; painful, frequent or difficult urination

Signs and symptoms of gonorrhea in men are

pain during urination; thick, pus-containing discharge from penis

Signs and symptoms of gonorrhea in women are

painful urination, vaginal discharge; pelvic inflammatory disease (PID), possible scarring

Some strains of human papillomavirus cause _________ (warty growths) on external and internal genitalia

papillomas

In _________ syphilis, T. pallidum multiplies in a localized area of the genitalia, spreading to the lymph nodes and the bloodstream. The hard chancre is caused by an intense inflammatory response to the bacteria; disappears within 2-6 weeks

primary

________ and _________ syphilis are easily treated with an antibiotic such as penicillin—the dose and drug type depend on the stage of the disease.

primary and secondary

This stage of syphilis has the following signs and symptoms: painless, red ulcer (hard chancre) that appears at site of infection within about 3 weeks; usually on genitalia, but may occur anywhere on body; often unnoticed if hidden in vagina or rectum; local lymph nodes enlarge

primary syphilis

The clinical stages of syphilis are

primary syphilis; secondary syphilis; tertiary syphilis; latent syphilis

These stages of syphilis are infectious

primary, secondary, and early latent syphilis

Bacteria for gonorrhea release blebs with LOS and peptidoglycan, releasing

pro-inflammatory cytokines

This HIV-encoded enzyme cleaves viral polyprotein into functional components

protease (PR)

Characteristics of Trichomonas vaginalis

protozoan with four anterior flagella and a posterior flagellum attached to undulating membrane; slender rigid rod (axostyle) protrudes from posterior; used for attachment; unmistakable jerky motility by microscopy; lacks cyst to aid in survival away from host's body; does not have mitochondria; instead, hydrogenosomes

N. gonorrhoeae strains are now frequently ________ to many antibacterial medications, including penicillins, tetracyclines, sulfonamides, and fluoroquinolones.

resistant

This is the intracellular replicating form of Chlamydia trachomatis

reticulate body (RB)

This HIV-encoded enzyme makes DNA copy of RNA genome

reverse transcriptase (RT)

Three important HIV-encoded enzymes that are targets of HIV medications are

reverse transcriptase (RT), protease (PR), and integrase (IN)

In _______ syphilis, many of the signs and symptoms are from immune complexes that form as antibodies that bind to circulating spirochetes (T. pallidum); the spirochetes have become systemic; infectious lesions occur on skin and mucous membranes; this stage can last for weeks to months or even a year, then it subsides; after 5 to 20 years or longer, some people develop tertiary syphilis

secondary

This stage of syphilis has the following signs and symptoms: symptoms usually appear 2-10 weeks later; infection spreads systemically; most common sign is a rash that includes palms and sores; white patches on mucous membranes; runny nose and watery eyes, aches and pains, sore throat, fever, malaise, weight loss, headache; occasionally hepatitis and renal disease occur

secondary syphilis

This stage of syphilis the person is most infectious

secondary syphilis

This mechanism for person-to-person transmission of HIV involves transmission from male-to-male and male-to-female; risk for transmission is greater for anal vs vaginal sex

sexual contact

Common mechanisms for HIV person-to-person transmission include

sexual contact; blood and blood products; vertical transmission

Characteristics of Chlamydia trachomatis

spherical, obligate intracellular gram-negative bacterium

Common outcomes of congenital syphilis include _____________ _________, ________, and ___________ __________; nearly all survivors develop signs, symptoms

spontaneous abortion, stillbirth, and neonatal death

In _________ syphilis, signs and symptoms from hypersensitivity reactions to small numbers of T. pallidum that grow and persist in the tissues. In this stage, the patient is no longer infectious. The organisms may be present in almost any part of the body, and the outcome depends on where the hypersensitivity reactions occur. If infection is in the skin, the bones or other areas not vital to existence, then the disease is not life-threatening. If infection is in a major blood vessel, then the vessel could rupture

tertiary

After a latent period that can last for many years, signs and symptoms of this stage have: -gummatous syphilis: localized tissued damage from prolonged inflammation; gummas are chronic granulomas, can occur anywhere in the body -cardiovascular syphilis: aneurysms in ascending aorta -neurosyphilis is rare, however, includes personality change, emotional instability, delusions, hallucinations, memory loss, impaired judgement, speech defects, pupil abnormalities -other signs and symptoms: blindness, vertigo, insomnia, stroke, meningitis

tertiary syphilis

T. pallidum must be grown in the

testicles of laboratory rabbits since it does not replicate in vitro

Avoiding breastfeeding in developing countries to prevent tranmssion of HIV to baby is a problem because

there is a need to transmit maternal antibodies for protection against other endemic diseases and a lack of clean water to make formula

Chlamydia signs and symptoms in men

thin, gray-white discharge from urethra; sometimes painful testes, pain on urination, fever

Peptidoglycan fragments released from gonococcal cells are ______ to nearby ciliated mucosal epithelial cells.

toxic

The pathogenesis of _________ is not fully understood. The bacteria produces a variety of adherence factors specific for vaginal epithelium, allowing it to colonize the vulva and vagina walls.

trichomoniasis