You are on page 1of 5

Notes on STD:

Sexually Transmitted Disease

Referred to VD (venereal disease)


Most common in adolescents and young adults
Acute manifestations progress to chronic disease
Physiological, psychological, and economical impact on patients

Risk factors
Genetic susceptibility
Circumcision status
Prior/coexisting STD
Age of coital debut
Sexual practices
Alcohol and drug use
Contraceptive method
Intravaginal/intra-anal preparations
Inflammation in area
A. Syphilis
General Features of Treponema

Venereal syphilis, nonvenereal syphilis ()

Pathogenesis
T. pallidum from denuded ulcerative lesions of the skin ()
1. Primary syphilis 3 weeks; chancre (hard genital/oral lesion at site of
inoculation)
2. Secondary syphilis 2-12 weeks after chancre; red, maculopapular rash;
condyloma lata; general lymphodenopathy and splenomegaly
3. Latent syphilis no symptoms; 3-30 years; bacteria may be eradicated/remain
viable; serologic evidence persists
4. Tertiary syphilis decades after primary; 1/3 of untreated patients; slow,
progressive, destructive inflammatory disease
Cardiovascular
Neurosyphilis
B. Congenital Syphilis transmitted 10-15 weeks of pregnancy; straight to
secondary syphilis
Lab Dx:
Definitive demonstration of T. pallidum from specimen by dark microscopy
1. Direct microscopy detect spirochetes using dark field microscopy ()
2. Serologic Test

a. Nonspecific Ab that react with nontreponemal antigen/ Rapid plasma


reagin test nonstreponemal Ab called regain; low cost; simple; low
specificity ()
*VDRL mixture of cardiolipin, cholesterol, and lecithin; IgM and IgG Ab in
sera or CSF causes antigen to flocculate; (+) in 70% of primary and 99%
of secondary; (-) in late syphilis; confirms diagnosis of congenital syphilis
b.

Specific Ab ()
i.

ii.
iii.

FTA-ABS important immunofluorescent assay; bound Ab with


fluorescein labeled conjugate and UV microscopy; (+) in 80% of
primary and 100% of secondary ()
TPHA RBC surface coated with T. pallidum + Ab intest are =
HEMAGGLUTINATION
Others immobilization and ELISA

Problems:
False-Positive: VDRL after strong immunological stimulus
FTA-ABS other spirochetes
Treatment:

Penicillin
Alternative erythromycin ()
Jarisch-Herxheimer reaction

Nisseria gonorrhea non-motile, gram (-) diplococcus; kidney-bean shaped ()


Virulence Factors:
1.
2.
3.
4.
5.

Capsule anti-phagocytic
Pili adherence; transfer of DNA
IgA protease evade sIgA
LPS release of endotoxin induces inflammations
Outer membrane proteins adhesions

Pathogenesis

Nisseria stick to mucous secreting but non ciliated ()


Endocytosis directed by porins ()
Massive inflammation
Destruction of ciliated and non-ciliated host cells
Organism resist killing Ab
Attachment to endothelial cells ()

Clinical Pattern

Local mucosal infection Direct external salpingitis or pelvic


peritonitis/epididymitisScarringInfertility/Ectopic pregnancy (**yung iba di ko na
nasulat)
Growth in culture

Chocolate agar/ Thayer Martin agar colony morphology


Fastidious
Capnophilic
Will not grow at 22C
Ferment glucose but not maltose ()

Definite Dx:
1. Isolation of N. gonorrhea ()
Chlamydia C. trachomatis (causes STI); contain DNA, RNA, and ribosomes; make
own proteins and nucleic acids; possess inner and outer membrane of gram (-); no
peptidoglycan layer; unable to make own ATP
Structure and Physiology
A. Elementary body infectious form; rigid outer membrane with many disulfide
links; infects columnar epithelial cells and macrophages
B. Reticular body non-infectious; metabolically active and replicating body;
fragile membrane
Virulence Factors
1. Attachment to target epithelial cells
2. Prevention of phagosomal or lysosomal function
Genital tract infection
a. C. trachomatis (biovar: trachoma)
b. C. trachomatis (biovar: LGV) human are only natural hosts
Transmission person-to-person
Clinical Syndromes:
1.
2.
3.
4.
5.

Trachoma
Inclusion conjunctivitis
Infant pneumonia
Ocular lymphogranuloma venereum
Urogenital infections urethral discharge, dysuria, pyuria; PID (Pelvic
inflammatory disease)
6. Lymphogranuloma venereum primary lesion: small painless vesicular
lesions; secondary lesions: painful buboses; genital ulcers and elephantiasis

Lab Dx:
1. Cytology inclusion bodies
2. Cultures
Treatment tetracyclines ()
Bacterial vaginosis condition in women where normal balance of bacteria in vagina
is disrupted and replaced by overgrowth of bacteria
Organisms: bacteroides ()
Risk factors:
1. Changing sex partners
2. Douching
3. IUD
Gardnella vaginals small pelomorphic; homogenous vaginal discharge; pH>4.5;
clue cells
Mobiluncus gram (-) bacilli; part of normal flora
Candidiasis overgrowth of C. albicans; oval budding of yeast cells and
pseudohyphae
Culture: ()
Genital herpes Herpes simplex virus (HSV); painful

SKIN INFECTIONS
S. aureus most pathogenic; coagulase positive; protein A; infection or intoxication
Virulence:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Surface proteins
Surface factors
Invasions
Biochemical factors
Immunological disguises
Membrane damaging toxins
Exptpxins
Resistance to antimicrobial agents
Act as super antigen and non specific stimulator of cells

Clinical Significance
1. Localized skin infection

2.
3.
4.
5.
6.
7.

Deep localized infection


Acute endocarditis
Septicemia
Pneumonia
Nosocomial infection
Toxinoses

Streptococcus pyogenes strict parasite; man significant reservoir; gram (+) in


chains; capsule; cell wall (fimbriae M protein and lipotechoic acid; C carbohydrate;
protein F); extracellular products (SPE, cytolytic toxins)Streptolysin O, Streptolysin
S, Streptokinase (); hyaluronidase capsule and m protein; c5a peptidase
streptokinase, streptodonase ()
*Ecthyma
*Necrotizing Fascitis/Myositis
Pseudomonas group
Psedomonas aeruginosa major pathogen; opportunistic infection; gram (-) obligate
aerobes and rods; flagella for motility
Virulence factors:
1.
2.
3.
4.
5.
6.

Pili
Capsule
Lipopolysaccharide endotoxin
Exotoxin A
Leucocidin, PMN inhibitor
Proteases, elastases ()

Pathogenesis colonizes membrane of skin


Pigments:
1.
2.
3.
4.

Pyocyanin bluish
Pyoverdin green (usually does not belong)
Pyorubin red
Pyomelanin black

Growth characteristics growth at 37-42C; oxidase (+)