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