Microbiology Ch. 26: Microbial Diseases of the Urinary and Reproductive Systems

What is the MIC of Neisseria gonorrhaeae needed for treatment when using Azithromycin?

0.25 ug/mL

The prevalence of genital herpes (have for life) among 14-49 year olds in US is______ a) 1 in 6 b) 1 in 60 c) 1 in 1000

1 in 6 (prevalence) Note: not treatable but can be controlled

What are 2 common "Oral-facial Herpes"? Note: picture is of acute gingivostomatitis and herpes labialis

1) Acute Gingivostomatitis Acute gingivostomatitis is the commonest manifestation of primary herpetic infection. The patient experiences pain and bleeding of the gums. 1 - 8 mm ulcers with necrotic bases are present. Neck glands are commonly enlarged accompanied by fever. Usually a self limiting disease which lasts around 13 days. 2) Herpes labialis (cold sore) Following primary infection, 45% of orally infected individuals will experience reactivation. The actual frequency of recurrences varies widely between individuals. Herpes labialis (cold sore) is a recurrence of oral HSV. A prodrome (mild symptoms) of tingling, warmth or itching at the site usually heralds the recurrence. About 12 hours later, redness appears followed by papules and then vesicles.

Inflammations caused by Urinary System Infections **Do know the 3 of them

1) Cystitis 2) Urethritis 3) Ureteritis

What are some ways to diagnose Syphilis? (to see if someone has it) **Know VDRL, RPR, EIA

1) Direct diagnosis: Staining with fluorescent-labeled monoclonal antibodies 2) Indirect, rapid screening: VDRL, RPR, EIA (know these 3) 3) Confirming: FTA-ABS tests for anti-treponemal antibodies, and PCR too

What are 2 Genital "Discharge"Diseases and some traits on them?

1) Gonorrhea 2) Chlamydia the traits on these are on the picture table

The Reproductive Systems NOTE: no bolded words here so not sure what you need to know. However, this chapter is based off of diseases of the Urinary/Reproductive system.

1. The female reproductive system consists of two ovaries, two uterine tubes, the uterus, the cervix, the vagina, and the external genitals. 2. The male reproductive system consists of two testes, ducts, accessory glands, and the penis; seminal fluid leaves the male body through the urethra.

Which age group (in MEN) is most afffected by Syphillis?

25-29

What age group (in WOMEN) have the highest low/high risk of HPV?

Age 20-24, but otherwise it's pretty consistent amongst all age groups

What are some HPV associated cancers according to the CDC?

Although nearly all cervical cancers are caused by HPV, cancer in some other areas of the body are often, but not always, caused by HPV. In general, HPV is thought to be responsible for about: 2) 90% of anal cancers 3) 65% of vaginal cancers 4) 50% of vulvar cancers 5) 35% of penile cancers Recent studies show that about 60% of oropharyngeal cancers (cancers of the back of the throat, including the base of the tongue and tonsils) are linked to HPV.

What is Herpetic Whitlow? And who are affected by this?

An infection of the finger. Often occurs in nurses and physicians who attend patients with HSV infections. Also occurs in people who have genital herpes.

PYELONEPHRITIS

An inflammation of one or both kidneys Pyelonephritis can result from lower urinary tract infections or from systemic (go through whole body) bacterial infections. Opportunistic gram-negative bacteria from the intestines often cause urinary tract infections (self autoinocculation) Nosocomial infections following catheterization occur in the urinary system. E. coli causes more than half of these infections. Treatment of urinary tract infections depends on the isolation and antibiotic sensitivity testing of the causative agents. CAUSATIVE AGENT: Usually E. coli SYMPTOMS: Fever; back or flank pain DIAGNOSIS: 104 CFUs/ml and + LE test TREATMENT: Cephalosporin

URETHRITIS

An inflammation of the urethra

CYSTITIS

An inflammation of the urinary bladder 1) USUAL CAUSATIVE AGENTS: a) E. coli b) Staphylococcus saprophyticus 2) SYMPTOMS: a) Dysuria (difficult or painful urination) b) Pyuria (pus in urine) 3) DIAGNOSIS: >100 CFU/ml potential pathogens and + LE test TREATMENT: Trimethoprim-sulfamethexazole (aka Bactrim)

Recent CDC Study on Sexually Transmitted Infections (STIs) Good question: when it comes to gonorrhea, are MEN or WOMEN more symptomatic?

Answer: MEN are more symptomatic Gonorrhea (Neisseria gonorrhoeae). In 2009, the national rate of reported gonorrhea cases reached an historic low of 98.1 cases per 100,000 population. However, during 2009-2012, the rate increased slightly each year, to 106.7 cases per 100,000 population in 2012. Thus, INCREASING PROBLEM EACH YEAR. In 2013, the rate decreased slightly to 105.3 cases per 100,000 population. In 2014, a total of 350,062 gonorrhea cases were reported, and the national gonorrhea rate increased to 110.7 cases per 100,000 population.

What can Bacterial Vaginosis lead to?

Answer: increases risk to STIs BACTERIAL VAGINOSIS is a condition in women where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. Often Gardnerella vaginalis. Women who have never had sexual intercourse may also be affected. Diagnosis of G. vaginalis is based on increased vaginal pH, fishy odor, yellow/grey frothy discharge, and the presence of clue cells. Note: clue cells = epithelial cells that show up in paap smears Treatment: Metronidazole

Nongonococcal Urethritis (NGU)

Any inflammation of the urethra not caused by N. gonorrhoeae - Most cases are caused by Chlamydia trachomatis (this infection is the most common STI, may be transmitted to infant's eyes at birth) - Symptoms often mild or lacking (uterine tube inflammation and sterility may occur) - Diagnosis based on the detection of chlamydial DNA in urine

Recent CDC study on Sexually Transmitted Infections (STIs) NOTE: chlamydia was bolded so know some parts A good question is what remains the most commonly reported infectious disease in the US?

CHLAMYDIA (Chlamydia trachomatis) Chlamydia remains the most commonly reported infectious disease in the United States. In 2014, a total of 1,441,789 chlamydial infections were reported to CDC in 50 states and the District of Columbia (women more symptamatic) During 2013-2014, the national rate of reported cases increased 2.8% to 456.1 cases per 100,000. overall prevalence among young adults in the U.S. is >4% at least 2 - 3 times as common as gonorrhea (2nd most reported STI and men are more symptomatic but for chlaymidia = women are more symptomatic) CDC recommends annual chlamydia screening for young women under the age of 26. Chlamydia is a leading cause of early infant pneumonia and conjunctivitis (pink eye) in newborns. Symptoms often go undetected. Bacteria initially infect the cervix and urethra and lead to abnormal vaginal discharge or burning sensation when urinating. In men, discharge and burning sensation when urinating. Easily treated with azithromycin or doxycycline.

The most commonly reported STI is: a) Herpes b) Chlamydia c) Gonnorhea d) HIV

Chlamydia

NONSPECIFIC URETHRITIS is caused by:

Chlamydia trachomatis Mycoplasma hominis Ureaplasma urealyticum

Compare the total cases of Syphilis to those who actually prepare it?

DAMN! I love you!

What are the diagnosis and treatment of gonorrhea?

DIAGNOSIS: Gram stain, ELISA, PCR TREATMENT: Fluoroquinolones

Sexually transmitted infections are sometimes acquire from contaminated surfaces: a) True b) False

False

What is Eczema herpeticum? Is it latent or active?

Found in children with ACTIVE eczema. The virus can spread to other organs such as the liver and adrenal glands.

Genital Herpes Note: no bolded parts here so not sure what you need to know. You did underline something "persists longer"

Genital lesions may be primary, recurrent or initial. Many sites can be involved which includes the penis, vagina, cervix, anus, vulva, bladder, the sacral nerve routes, the spinal and the meninges. The lesions of genital herpes are particularly prone to secondary bacterial infection eg. S.aureus, Streptococcus, Trichomonas and Candida albicans. Dysuria is a common complaint, in severe cases, there may be urinary retention. Local sensory nerves may be involved leading to the development of a radiculitis. A mild meningitis may be present. **60% of patients with genital herpes will experience recurrences. Recurrent lesions in the perianal area tend to be more numerous and PERSISTS LONGER than their oral HSV-1 counterparts.

What happens if gonorrhea infections are left untreated?

Gonorrheal endocarditis, gonorrheal meningitis, and gonorrheal arthritis are complications that can affect both sexes if gonorrheal infections are untreated.

What do Herpes Simplex Virus 1 & 2 cause? Note: nothing was bolded here but know general

Herpes simplex viruses (HSV-1 and HSV-2) cause genital herpes. Symptoms of the infection are painful urination, genital irritation, and fluid-filled vesicles (NOTE: not lesions or warts) The virus might enter a latent stage in nerve cells. Vesicles reappear following trauma and hormonal changes. Neonatal herpes is contracted during fetal development or birth. It can result in neurological damage or infant fatalities. Suppression: Acyclovir = mimics nucleotide which will get inserted into DNA = the correct nucleotide doesn't get to be inserted b/c acyclovir places inserts itself into DNA growing strand = thus strand growth stops = stops viral replication

Name the HSV disease that affects the eyes?

Herpetic keratitis (Ocular Herpes) HSV causes a broad spectrum of ocular disease, ranging from mild superficial lesions involving the external eye, to severe sight-threatening diseases of the inner eye. Diseases caused include the following: 1) Primary HSV keratitis - dendritic ulcers 2) Recurrent HSV keratitis 3) HSV conjunctivitis 4) Iridocyclitis, chorioretinitis and cataract

What causes Genital Warts? And what is the main way to prevent it and required by UWRF university before admitting students?

Human papillomaviruses causes warts: covers 2 different serotypes (by antigens) Results during 2003-2005 document an overall high-risk HPV prevalence of 23%. Prevalence was 27% in STD clinics, 26% in family planning clinics, and 15% in primary care clinics. Prevalence by age group was 35% in those aged 14-19 years, 29% in those aged 20-29 years, 13% in those aged 30-39 years, 11% in those aged 40-49 years, and 6.3% in those aged 50-65 years. Warts in genital area HPV 16 causes cervical cancer and cancer of the penis Treatment: Podofilox; imiquimod Prevention: Vaccination against HPV strains (which is required now)

If left untreated, syphilis can lead to what in women?

INFERTILITY Untreated STDs can lead to serious long-term health consequences, especially for adolescent girls and young women. CDC estimates that undiagnosed and untreated STDs cause at least 24,000 women in the U.S. each year to become infertile.

Has the visits to physicians offices for Genital Warts increase or decrease the past 50 years?

Increase = there is variability, but overall it has an increasing trend

Has the rate of Chlamydia been increasing or decreasing over the past 20 years?

Increasing

Haave Chancroid Reported Cases decrease or increase withing the past 20 years?

It has decrease (one of the few that have decreased!! Others have increased)

Within the past 20 years, have the reported cases of gonorrhea increase, stay the same, or decrease?

It has decreased (or stay the same)

Lower UTI vs Upper UTI Note: again, no bolded words here but just know general

Lower UTIs occur in the urethra or bladder and are more common in women than in men (because the female urethra is much shorter and provides less of a barrier to bacterial invasion) Upper UTIs are infections that involve kidneys (pyelonephritis), ureters (ureteritis), or both. Upper UTIs can occur in both men and women as a complication of a lower UTI. (can spread to kidneys) Symptoms of an upper UTI include fever, chills, lower back pain, nausea, and vomiting. The most common organism is E. coli.

What are the Signs/Symptoms of Chlamydia in both women and men?

Males 1) causes inflammation of the urethra 2) symptoms mimic gonorrhea; discharge and painful urination 3) untreated infections may lead to Epididymitis [swelling (inflammation) of the epididymis] = tube in testes Females 1) cervicitis 2) discharge 3) Salpingitis (PID) (inflammation of the fallopian tubes) Note: PID = pelvic inflammatory disease

What are some Gonorrhea Male Symptoms and Female Symptoms? Just know some, general ones

Men - burning sensation when urinating, or a white, yellow, or green discharge from the penis - painful or swollen testicles. Women - often mild or no symptoms; or mistaken for a bladder or vaginal infection - painful or burning sensation when urinating, increased vaginal discharge, vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms. Pelvic inflammatory disease (PID).

Outbreak of syphillis is based on??

Men with men

What 2 age group are the highest in MEN and WOMEN that report gonorrhea?

Men: 20-24 (1st), 25-29 (2nd) Women: 20-24 (1st), 15-19 (2nd)

Bacterial Diseases of the Reproductive System Note: condoms don't work against herpes, HPV. Colonizes outside penis

Most diseases of the reproductive system are sexually transmitted diseases (STDs), now called sexually transmitted infections (STIs). Most STIs can be prevented by the use of condoms and are treated with antibiotics.

Life Cycle of Trichomoniasis (Protozoan) How does it multiply?

Multiplies by longitudinal binary fission Note: Only humans (i'm assuming only affects humans?) the protozoa survives through transmission

Chancroid (Soft Chancre) **know symptoms, diagnosis, treatment

NOTE: Trichomonas known to increase change of getting STI by 4-6x Chancroid, a swollen, painful ulcer on the mucous membranes of the genitals or mouth, is caused by Haemophilus ducreyi. Chancroid, as well as genital herpes and syphilis, is a risk factor in the transmission of HIV infection SYMPTOMS: Painful ulcers of genitals swollen lymph nodes in groin DIAGNOSIS: Culture TREATMENT: Erythromycin; cetriaxone

What causes gonorrhea?

Neisseria gonorrhoeae

Within the past 10 years, have all women reported cases of gonorrhea?

No, those age 15-19 have had a decline in reporting or getting check ups.

Most cases of Chlamydia are reported where? a) Non-STD Clinic b) STD Clinic c) Both d) Neither

Non-STD (women)

More pics of acute gingivostomatitis and herpes labialis

Note: latent = integrated into DNA but not activated till triggered

What are the 8 Herpes Viruses?

Note: there are lots of different herpes but they all differ in target cell and latency (latent = integrated into DNA but not activated till triggered) Herpes 1/2/3 = more known and causes shingles Also, Herpes 3 (aka Varicella Zoster Virus) causes chickenpox/shingles. Thus, the shingles shot is called a Zoster shot (FYI)

What eye infection can be acquired by infants with gonorrhea infected mothers?

Ophthalmia neonatorum is an eye infection acquired by infants during passage through the birth canal of an infected mother.

Chlamydia Signs and Symptoms continuation NOTE: nothing was bolded, but know general

PID is a frequent sequelae of female chlamydial infection 1) A woman is even more likely to experience PID as a result of Chlamydia infection than gonorrhea 2) 75% of Chlamydia infections are asymptomatic, which puts women at risk for developing PID because they don't seek treatment for the initial infection 3) PID itself may be acute and painful, or asymptomatic, allowing damage to the upper reproductive tract to continue unchecked

What is Pelvic Inflammatory Disease caused by?

Polymicrobic (more than 1 organism responsible) usually 1) N. gonorrhaeae 2) C. trachomatis Salpingitis (infection of uterine tubes)

Stages of Syphilis **know Chancre, Gummas, Congenital

Primary stage: CHANCRE at site of infection Secondary stage: Skin and mucosal rashes Latent period: No symptoms Tertiary stage: GUMMAS on many organs Treatment: Benzathine penicillin CONGENITAL: Neurological damage

What is RPR?

Rapid plasma reagin test RPR test refers to a type of rapid diagnostic test that looks for non-specific antibodies in the blood of the patient that may indicate a syphilis infection.

What are SYMPTOMS and TREATMENT for PID?

Symptoms: Chronic abdominal pain Treatment: Doxycycline and cefoxitin

What are SYMPTOMS, DIAGNOSIS, and TREATMENT for Nongonococcal Urethritis?

Symptoms: Painful urination and watery discharge; in women, possible complications, such as PID Diagnosis: Culturing, PCR Treatment: Doxycycline, azithromycin

More general info on Syphilis. Note: Not sure what you need to know from here but know general points

Syphilis is caused by Treponema pallidum, a spirochete that has not been cultured in vitro. Laboratory cultures are grown in rabbits or cell cultures. The primary lesion is a small, hard-based chancre at the site of infection. The bacteria then invade the blood and lymphatic system, and the chancre spontaneously heals. The appearance of a widely disseminated rash on the skin and mucous membranes marks the secondary stage. Spirochetes are present in the lesions of the rash. The patient enters a latent period after the secondary lesions spontaneously heal. At least 10 years after the secondary lesion, tertiary lesions called gummas can appear on many organs (a type of granuloma) Congenital syphilis, resulting from T. pallidum crossing the placenta during the latent period, can cause neurological damage in the newborn. T. pallidum is identifiable through darkfield microscopy of fluid from primary and secondary lesions. Many serological tests, such as VDRL, RPR, and FTA-ABS, can be used to detect the presence of antibodies against T. pallidum during any stage of the disease.

What does Treponema pallidum cause? (Reemerging disease, worse now)

Syphilis. Has 3 stages: primary, secondary, tertiary. - 2009: 14,000 reported cases of primary and secondary (P&S) syphilis — the most infectious stages of the disease — the highest number of cases since 1995 and an increase over 2007 (11,466 cases) - symptoms: firm, round, small, and painless sore on the genitals, anus, or mouth, or a rash on the body, especially on palms of the hands or soles of feet

Viral Diseases of the Reproductive Systems Genital Herpes

The latest HSV-2 data - CDC 2010 Morbidity and Mortality Weekly Report (MMWR) - indicates that overall national HSV-2 prevalence remains high at 16.2%. Note: Symplex I is above (increase?) whereas Symplex II is below (decrease?) = refer to handout

In what US region is gonorrhea most prominent?

The south and East

Normal Microbiota note: microbiota = flora (means the same thing)

The urinary bladder and upper urinary tract are sterile under normal conditions. Lactobacilli dominate the vaginal microbiota during the reproductive years. -Produce H2O2 -Grow on glycogen secretions The male urethra is normally sterile Infection is indicated by 3 things: 1) >10,000 bacteria/ml 2) 100 coliforms/ml 3) Positive urine leukocyte esterase (LE) test = if "+" means that its positive for urine infection

What causes trichomoniasis? And what phylum is it in?

Trichomonas vaginalis causes trichomoniasis. Phylum: Protozoa The prevalence of Trichomonas vaginalis infection in the United States is estimated to be 2.3 million (3.1%) among women ages 14-49. Prevalence in STI clinics >25%. FOUND in semen or urine of male carriers (rarely have symptoms). Vaginal infection causes irritation and itching, profuse foul, greenish-yellow frothy discharge, increase pH. Relatively BENIGN but can cause preterm delivery Diagnosis: Microscopic identification, DNA probe Treatment: Metronidazole

Multiple sexual partners and early sexual debut are associated with STIs among adolescent and young adult males. a) True b) False c) Not sure

True

What are the 2 most prevalent types of HPV among women aged 14-59 years old for Cervicovaginal? Options: Types 6, 11, 16, 18

Types 16 and 18 are the most prevalent Types 6 and 11 exist, but not as prevalent

Structure and Function of Urinary System

URINARY SYSTEM: Two kidneys Two ureters One urinary bladder One urethra Urine is transported from the kidneys through ureters to the urinary bladder and is eliminated through the urethra. Infection prevented by: 1) Valves prevent backflow to uninary bladder and kidneys 2) Acidity of urine (prevents colonization) 3) Mechanical flushing

Urinary Tract Infection Note: no bolded words here so know generally

Urinary tract infections (UTIs) account for more than 12 million physician visits annually in the United States. UTIs may be caused by bacteria, viruses (herpes simplex Type 2), fungi (Candida), and a variety of parasites (worms, protozoa). Importantly, UTIs have become increasingly resistant to first-line antibiotic therapy.

What is VDRL?

Venereal Disease Research Laboratory Test The VDRL test is a screening test for syphilis. It measures substances (proteins), called antibodies, that your body may produce if you have come in contact with the bacteria that cause syphilis. Most often done using a blood sample

Which age group and gender are most affected by Chlamydia?

Women, age 20-24 (college age group)

What is EIA?

aka ELISA Test = enzyme-linked immunosorbent assay a test that detects and measures antibodies in your blood. This test can be used to determine if you have antibodies related to certain infectious conditions

What is the Life Cycle of Chlamydia?

root nodules grows inside host cell then eventually later wards itself as it grows

IN which U.S. region is the Chlamydia rate the highest?

the South, in particular the South East