gyne - gc ct
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Gyne - GC CT.pptTRANSCRIPT
Neisseria GonorrheaChlamydia Trachomatis
Group III
Chlamydia Trachomatis
Infection Suggestive Signs/Symptoms
Presumptive Diagnosisa
Confirmatory Test of Choice
MenNGU, PGU Discharge, dysuria Gram's stain with >4
neutrophils per oil-immersion field; no gonococci
Urine or urethral NAAT for C. trachomatis
Epididymitis Unilateral intrascrotal swelling, pain, tenderness; fever; NGU
Gram's stain with >4 neutrophils per oil-immersion field; no gonococci; urinalysis with pyuria
Urine or urethral NAAT for C. trachomatis
WomenCervicitis Mucopurulent cervical
discharge, bleeding and edema of the zone of cervical ectopy
Cervical Gram's stain with 20 neutrophils per oil-immersion field in cervical mucus
Urine, cervical, or vaginal NAAT for C. trachomatis
Salpingitis Lower abdominal pain, cervical motion tenderness, adnexal tenderness or masses
C. trachomatis always potentially present in salpingitis
Urine, cervical, or vaginal NAAT for C. trachomatis
Urethritis Dysuria and frequency without hematuria
MPC; sterile pyuria; negative routine urine culture
Urine or urethral NAAT for C. trachomatis
Infection Suggestive Signs/Symptoms
Presumptive Diagnosisa
Confirmatory Test of Choice
Adults of Either Sex Proctitis Rectal pain, discharge, tenesmus, bleeding; history of receptive anorectal intercourse
Negative gonococcal culture and Gram's stain; at least 1 neutrophil per oil-immersion field in rectal Gram's stain
Rectal NAAT for C. trachomatis or culture
Reiter's syndrome NGU, arthritis, conjunctivitis, typical skin lesionsGram's stain with >4 neutrophils per oil-immersion field; lack of gonococci indicative of NGU
Urine or urethral NAAT for C. trachomatis
LGV Regional adenopathy, primary lesion, proctitis, systemic symptoms
None Culture of LGV strain from node or rectum, occasionally from urethra or cervix; NAAT for C. trachomatis from these sites; LGV CF titer, 1:64; micro-IF titer, 1:512
Comparison between Neisseria Gonorrrhea
& Chlamydia Trachomatis
Comparison between N. Gonorrhea & C. Trachomatis
Neisseria Gonorrhea
Chlamydia Trachomatis
Reservoir • Humans only (no immunity to repeated infections)
• Humans• Morphologic Note: Gram (-)
but lacks peptidoglycan layer & muramic acid
Gram Stain Gram NegativeIncubation Period
3-5 days after exposure 7-21 days after exposure
Transmission
Sexual transmission • Direct personal contacta. Eyesb. Genitalsc. Lungs
Chlamydia Life Cycle
Gonorrhea Life Cycle
Comparison between N. Gonorrhea & C. Trachomatis
Neisseria Gonorrhea
Chlamydia Trachomatis
Pathogenesis/Virulence
attachment of the bacterium to nonciliated epithelial cells via pili (fimbriae) and the production of lipopolysaccharide endotoxin – produces IgA proteases which promote virulence. adherence to epithelial cellsAntigenic variationAntiphagocytic: binds bacteria tightly to host cell preventing phagocytosis•Outer membrane proteins: Protein I: porinProtein II (opacity protein) : presence asstd w/ dark, colonies- for adherenceToxins: Endotoxin- Lipopolysaccharide
• Resistant to lysozymes (since their wall lacks muramic acid)
• Prevents Phagosome: lysosome fusion
• Non-motile• No pili• No exotoxins
Comparison between N. Gonorrhea & C. Trachomatis
Neisseria Gonorrhea
Chlamydia Trachomatis
Clinical Manifestations
• Asymptomatic (but still infectious)
• Men: urethritis• Women: cervical gonorrhea
can progress to PIDComplications of PID• Sterility• Ectopic pregnancy• Abscess• Peritonitis• PerihepatitisBoth men and women:• Gonococcal bacteremia• Septic arthritis: gonococcal
arthritis is the most common cause of septic arthritis in sexually active individuals
• Neonates: Ophthalmia Neonatorium- conjunctivitis in newborn. Infection acquired through the infected birth canal; usually erupts w/in the 1st 5 days
Serotype A, B &C•Trachoma: causes scarring of the inside of the eyelid, resulting in redirection of the eyelashes onto the corneal surface. This results to corneal scarring and blindnessSerotypes D thru K•Inclusion conjunctivitis (ophthalmia neonatorium)•Infant pneumonia•Urethritis, cervicitis, PID (in women)•Non-gonococcal urethritis,epidymitis and prostatis (in men)Complications:•Sterility, ectopic pregnancy and chronic pain after PID•Reiters Syndrome: triad of conjunctivitis, urethritis and arthritis•Fitz-Hugh-Curtis Syndrome: PerahepatitisSerum L1, L2, L3•Lymphogranuloma Venereum
Comparison between N. Gonorrhea & C. TrachomatisNeisseria Gonorrhea Chlamydia Trachomatis
Treatment 1st line: 3rd gen Cephalosporin such as Ceftriaxone (+doxycycline 2 cover incubating C. Trachomatis & Syphilis)2nd Line ( but not effective in syphilis): fluoroquinolones,spectinomycinOphthalmia Neonatorium: Erythromycin eye drops immediately after birth, as prophylaxis against both N. Gonorrhea and C. Trachomatis conjunctivitis. Infants w/ Ophthalmia Neonatorium require systemic tx w/ ceftriaxone. Erythromycin syrup should also be provided 2 cover 4 possible concurrent Chlamydial disease (failure to treat Chlamydial conjunctivitis can lead 2 Chlamydial pneumonia)
Genital Eye infection:•Doxycycline (use for adults)•Erythromycin (for infants and pregnant women)•AzithromycinNote: Systemic treatment is needed for chlamydial eye infection especially for the infants who can develop chlamydial pneumonia after chlamydial conjuctivitis
Comparison between N. Gonorrhea & C. Trachomatis
Neisseria Gonorrhea
Chlamydia Trachomatis
Treatment Infants w/ Ophthalmia Neonatorium require systemic treatment w/ ceftriaxone. Erythromycin syrup should also be provided 2 cover 4 possible concurrent Chlamydial disease (failure to treat Chlamydial conjunctivitis can lead 2 Chlamydial pneumonia)
Microscopic View
N. Gonorrhea Gram-negative coffee bean-
shaped diplococci bacteria
Gram's stain of urethral discharge from a male patient with gonorrhea shows gram-negative intracellular monococci and diplococci. (From the Public Health Agency of Canada.)
C. Trachomatis- gram-negative bacteria that lack mechanisms for
the production of metabolic energy and cannot synthesize ATP
Urethritis
Neisseria Gonorrhea- yellowish discharge from the penis,
associated with painful, and sometimes frequent, urination
C. Trachomatis-Male patients may develop a white, cloudy or watery discharge from the tip of
the penis
Vaginosis
Neisseria Gonorrhea- vaginal discharge that may be thin &
watery or thick & yellow/greenChlamydia Trachomatis- Mild,
milky or yellow mucus-like vaginal discharge
Cervicitis
N. Gonorrhea- Infection of the lower genital tract occurs through direct inoculation of columnar epithelial cells of
mucous membranes in the cervix and the urethraC. Trachomatis- Chlamydial cervicitis
with ectopy, discharge, bleeding.
Eye Infection
N. Gonorrhea- baby's eyes are contaminated during passage through the birth canal from a
mother infected with either Neisseria gonorrhoeae
C. Trachomatis- infection due to Chlamydia (trachoma) can be
spread from eye to eye by fingers, shared towels or cloths, coughing and sneezing and eye-
seeking flies