Sexually Transmitted Bacterial Infections PDF

Microbiology for Health Science FHS 204 ◼ Systemic infections ( bacteriology) ◼ Microbes meet Systems: Sexually transmitted infections Three bacterial: chlamydia: Chlamydia trachomatis gonorrhoea: Neisseria gonorrhoea syphilis: treponema pallidum and one parasitic STIs (trichomoniasis...

Microbiology for Health Science FHS 204 ◼ Systemic infections ( bacteriology) ◼ Microbes meet Systems: Sexually transmitted infections Three bacterial: chlamydia: Chlamydia trachomatis gonorrhoea: Neisseria gonorrhoea syphilis: treponema pallidum and one parasitic STIs (trichomoniasis) Sexually transmitted Diseases: Bacterial Reproductive Tract Infections ◼ Gonorrhea: – Neisseria gonorrhoeae ◼ “gonococci” gram negative diplococci ◼ Adhere to urinary tract & make endotoxin: Lipooligosaccharide (LOS)→ damage to fallopian tubes ◼ Typical symptoms of gonorrhoea include a thick green or yellow discharge from the vagina or penis, pain when peeing and, in women, bleeding between periods. But around 1 in 10 infected men and almost half of infected women do not experience any symptoms. ◼ Complication: Pelvic Inflammatory Disease – Damage to fallopian tubes – Sterility; ectopic pregnancy  Transmission: sexual, during delivery….. Infect eyes and can cause blindness in children Treatment treat as soon as possible. antibiotics called cephalosporins. These include: ceftriaxone, usually given by injection and is the preferred treatment cefixime, usually given orally with Gram stain: not very sensitive another antibiotic, azithromycin, but only when ceftriaxone is not feasible. Molecular testing: vaginal swabs, urine Possible complications Untreated N. gonorrhoeae infections can lead to complications and sequelae in women, such as pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. Complications in men are scrotal swelling, urethral stricture and infertility. Neonatal conjunctivitis (eye infection) if untreated may lead to blindness. In rare cases, disseminated gonococcal infection can occur and it is manifested as fever and infection in multiple organs of the body such as skin, heart, joints and meninges.  Sexually transmitted Diseases: Bacterial Reproductive Tract Infections ❑ Chlamydia trachomatis Symptoms in women ▪ This is the MOST prevalent of all At least 70% of women have no STDs symptoms ▪ Non gonococcal urethritis pain when urinating unusual vaginal discharge Complication: Pelvic pain in the tummy or pelvis Inflammatory Disease pain during sex Damage to fallopian tubes bleeding after sex Sterility; ectopic pregnancy bleeding between periods Symptoms in men At least 50% show no symptoms Treatment: antibiotics pain when urinating doxycycline white, cloudy or watery discharge from azithromycin the tip of the penis burning or itching in the urethra (the tube that carries urine out of the body) pain in the testicles  Gram-negative, anaerobic bacterium an obligate intracellular human pathogens. Chlamydia are acquired by direct contact with mucous membranes or abraded skin, that is, by sexual contact or by direct inoculation into the eye in the case of trachoma or neonatal conjunctivitis. Two forms of the organism are needed for infection and disease to occur: the infectious, extracellular form called an elementary body (EB) and the noninfectious but metabolically active intracellular form called a reticulate body (RB). Receptors for EBs are primarily restricted to nonciliated columnar, cuboidal, and transitional epithelial cells, which are found on the mucous membranes of the urethra, endocervix, endometrium, fallopian tubes, anorectum, and conjunctivae.The reticulate body divides through binary fission The reticulate body contains no cell wall and is detected as an inclusion in the cell.. Possible complications pelvic inflammatory disease (PID), can experience abdominal and pelvic pain, and in later stages develop infertility and ectopic pregnancy Men : epididymitis, epididymo-orchitis). In rare cases, this can lead to infertility. may cause arthritis symptoms, such as swollen joints (arthritis) and inflammation of the eyes. Neonatal infection can cause conjunctivitis (eye infection) and pneumonia. It can also cause preterm deliveries and low birth weight. Sexually transmitted Diseases: Bacterial Reproductive Tract Infections ◼ Syphilis: – Treponema pallidum ◼ Gram negative spirochete ◼ Systemic infection follows (3 stages) ◼ Tertiary stage: damage to cardiovascular and nervous system https://microbenotes.com/pathogenesis-and-clinical-manifestations-of-treponema- pallidum/  Syphilis Symptoms Many people with syphilis do not notice any symptoms. Untreated, syphilis lasts many years. Primary syphilis (first stage): usually lasts around 21 days a round, painless, usually hard sore (chancre) appears on the genitals, anus ,heal in 3–10 days Secondary syphilis: includes a non-itchy rash, usually on the palms and soles of the feet white or grey lesions appear in warm and moist areas, such as the labia or anus symptoms will go away without treatment. Latent syphilis-Tertiary: often has no symptoms progresses to the third and final stage of syphilis (tertiary) after years if untreated tertiary syphilis can lead to brain and cardiovascular diseases, among other conditions. Transmission Treatment ◼ Syphilis is treatable and curable ◼ person-to-person by ◼ The early stage of syphilis is direct contact with a treated with a benzathine penicillin injection. As second line syphilitic sore, known as treatment, doctors may also use a chancre. doxycycline, ceftriaxone or ◼ Chancres can occur in, azithromycin on, or around the penis, **Doxycycline is not used for vagina, anus, rectum, and pregnant women. lips or mouth. Syphilis ◼ Penicillin is also used to treat later can spread during vaginal, stages of syphilis, but more doses anal, or oral sex. are required. Doses are usually given once per week for three ◼ Pregnant people with weeks, including when it is not syphilis also can transmit possible to identify the stage of the infection to their infection. unborn child. ◼ Penicillin can prevent syphilis from being passed from a mother to baby. Babies born with syphilis (congenital syphilis), or babies **Penicillin G, administered parenterally, is whose mother had untreated the preferred drug for treating patients in syphilis, need to be treated right all stages of syphilis (CDC). away to avoid serious health problems. Possible complications Syphilis increases the risk of acquiring HIV infection Severe disease:Without treatment, the tertiary phase of syphilis may lead to several complications decades after infection. At this stage, syphilis can affect multiple organs and systems, including brain, nerves, eyes, liver, heart, blood vessels, bones and joints. Tertiary syphilis can also cause death. Neurosyphilis, ocular syphilis and otosyphilis: can occur at any stage of the disease. Congenital syphilis: Untreated syphilis may lead to severe negative consequences, such as stillbirth, neonatal death, prematurity, low birth weight and life-long health problems to the infected infant.  RPR and TPHA A variety of serologic tests for syphilis are available, including: RPR (Rapid Plasma Reagin) TPHA (Treponema Pallidum Microhemagglutination Assay) Syphilis is a sexually transmitted infection (STI) caused by a type of bacteria known as Treponema pallidum.  RPR principle The rapid plasma reagin (RPR) 18-mm circle card test is a macroscopic, nontreponemal flocculation card test used to screen for syphilis Unfortunately in this test, the antibody detects antigens, which are nonspecific The test does not look for antibodies against the bacterium itself, Treponema pallidum, but rather for antibodies against substances released by cells when they are damaged by T. pallidum (cardiolipin and lecithin). In this test serum is mixed with reagin (a purified mixture of lipids such as cardiolipin, lecithin, and cholesterol) on a white card, and flocculation, or clumping, of the mixture is read “reactive” (if clumping occurs) or “nonreactive” (if there is no clumping). The charcoal particles coagglutinate with the antibodies and show up as black clumps against the white card. It is a qualitative test for screening of syphilis The RPR is performed with undiluted serum. Results are reported as non-reactive or reactive.  In a healthy person, the test is negative. damage to host tissue by RPR Results interpretation infection, immunization, pregnancy, age-related changes, or autoimmune diseases can result into false- positives careful clinical interpretation of test results and other evidence is necessary for proper diagnosis: conduct some other tests to exclude other diseases. The sensitivity of nontreponemal and treponemal tests for syphilis increases with duration of infection, and ranges from approximately 75% in the primary stage to virtually 100% in the secondary stage.  TPHA Treponema pallidum Hemagglutination Assay (TPHA Based on the principle of passive haemagglutination detects anti-treponemal antibodies (IgG and IgM antibodies) in serum or CSF. used as a confirmatory test for the diagnosis of Treponema pallidum infection RPR testing requires confirmation with treponemal serologic tests such as the TPHA. Although false-positive results also occur with TPHA it is unlikely that a patient will have both false-positive reagin and false-positive treponemal serologies. Therefore, the presence of a reactive nontreponemal test and a reactive treponemal test is diagnostic of syphilis Reactive (R): Reactive results may indicate an active, past, or successfully treated infection. A diagnosis should be made with a careful history of the patient and a physical examination as well as pertinent laboratory results. Some women with BV may not notice any symptoms:  Bacterial vaginosis Fishy odor when potassium hydroxide solution is added to vaginal secretions “whiff test”) Vaginal pH greater than 4.5 lack of BV is the most common cause of abnormal vaginal discharge in lactobacillus spp., females. a shift in the vaginal microbial environment away from the native clue cells, “good” lactobacillus species that is a part of the normal vaginal environment, towards a more diverse “bad” bacterial species, most commonly Gardnerella vaginalis. Others: mobiluncus, anaerobes Bacterial vaginosis isn’t sexually transmitted, but it’s linked to sexual activity. Topical treatment Clindamycin 2% vaginal cream 5 g at bedtime for seven days Metronidazole vaginal gel (Metrogel vaginal) 5 g twice daily or  Complications of BV?? BV is a very common condition and does not usually cause serious complications. However, if untreated it could lead to: problems in pregnancy (for example, spontaneous abortion and preterm delivery) higher risk of sexually transmitted infections, including HIV pelvic inflammatory disease. Vaginal cleansing and douching can increase the risk of developing BV. Intravaginal practice, e.g. insertion of herbs or other products into the vagina, is another risk factor.  Transmission, direct contact with open lesions and exudates from lymph nodes during sexual intercourse painful necrotizing genital ulcers that may be accompanied by inguinal lymphadenopathy. It is a highly contagious but curable disease. Azithromycin 1 g orally in a single dose Ceftriaxone 250 mg IM in a single dose Ciprofloxacin 500 mg orally 2 times/day for 3 days Erythromycin base 500 mg orally 3 times/day for 7 days Summary ; clinical manifestations of STI ◼ Asymptomatic: common in females ◼ Disuria: diff/pain urinating ◼ Urethral discharge: exudate ◼ Vaginitis; inflammation of vaginal mucosa ◼ Lesions of skin and mucous membranes – T.pallidum:chancre-painless – H.ducrey: chancroid-painful ◼ Cervicitis ◼ Prostatitis ◼ Orchitis: inflammation of the testes. In boys or men with mumps, orchitis develops between 4 and 7 days after the salivary gland swelling. The testis swells and is painful