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IUPUI MICR J210 - Pathogenic Bacteria/Sexually Transmitted Diseases

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MICR J210 1st Edition Lecture 18Outline of Last Lecture I. Impact of VaccinesII. Types of VaccinesIII. Herd ImmunityIV. Bordetella pertussisV. Corynebacterium diphtheriaVI. Clostridium tetaniVII. DTap VaccineOutline of Current Lecture I. Sexually Transmitted DiseasesII. Neisseria gonorrhoeaeIII. Chlamydia trachomatis IV. Treponemapallidum (Syphilis)V. Mycobacterium tuberculosis VI. Vector-born Lyme borelliosis (Lyme disease)VII. Heliocbacter pyloriCurrent LectureSexually Transmitted Disease - General to this group of diseases; transmitted by mixing and matching of mucus membranes (MMMM)o Which microbes? Representatives of all 4 groups of microbes can cause STD- Bacteria: eg. Chlamydia, Gonorrhea, Syphilis - Viruses: eg. Herpes simplex type II, HIV, Papilloma virus- Fungi: eg. Candida albicans- Parasites: eg. TrichomonasvaginalisThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.o Lethality Generally not lethal. More morbidity than mortality (except HIV & HBV/HCV)o Impact: Both economical and socialo Transmission of STD 1. Direct sexual contact, genital to genital or genital to oral 2. Depends on type and frequency of intercourse and # of partners 3. Asymptomatic carriers are silent transmitters of STD 4. Infection occurs in packs (individual may have multiple infections)o Sites of primary infection: Port of entry; Genital organ Females; - Vulvovaginitis: Inflammation of all or part of the external vulva - Vagina: Vaginitis- Cervix: Cervicitis- Uterus: Endometritis; PID (pelvic inflammatory disease)- Fallopian tubes: Salpingitis- Peritoneal cavity: Peritonitis- Female Reproductive systemo Vulva; External genital organs of the femaleo Vagina; The stretchable passage that connects a woman's outer sex organs with the cervix and uterus. Males; - External genitalia- Urethra (urethritis)- Prostatitis and involvement of the testes can also occuro Sequelae at other sites There is concern for spreading from primary site to other organs such as heart, brain, eye, joints. Spread through bacteremiao Geographic prominence Worldwide epidemic or pandemic  Pandemic stage is normal for usNeisseria gonorrhoeae- Biologyo Gram (-), bean-shaped diplococci. o Grow in chocolate agaro Oxidase test; Oxidase (+)- Virulence factorso Fimbriae (Pili): Mediate attachment and is antiphagocytico Outer membrane proteins (help invade mucosal epithelial cells) Intracellular pathogens can hide from immune systemo Lipopolysaccharide; induces overt inflammation and tissue damageo IgA protease; protects microorganism from mucosal antibody IgAo Serological diversity; More that million types in nature- Prevalence of Gonorrhea (CLAP)o Human is the only natural host Can only be transmitted through sexual activityo Gonorrhea is second most commonly reported infectious disease in the US. 150 million cases per year in the world- Pathology; Starts with superficial infection and then goes deepero Surface infections Urethritis: NGU: mostly symptomatic in men (cuased by chlamydia)- 2-8 day incubation period- Dysuria, purulent discharge (drip) Cervicitis : 50% asymptomatic (women) Pharyngitis (oral sex) and proctitis (rectal gonorrhea) Conjunctivitis; In newborns of infected mother- Ophthalmianeonatorium- May lead to blindness- Can treat with silver nitrate or Erythromycin drop at birtho Preventative measure- Invasive/systemic disease;o Happens in 10% if infected women who do not get treatmento Mostly in women Pelvic inflammatory disease (PID); Infection of the female reproductive organs More than one million women are affected by PID each year (really common), and the rate is highest amongst teenagers Yearly, about 50,000 women become infertile in the US from PID  May be asymptomatic two-thirds of the time. PID can cause scarring inside the reproductive organs leading to infertility- Permanent damage Salpingitis (inflammation of fallopian tubes)- Symptoms (Fever, Flank pain, painful sex, discharge, abnormal bleeding)- Increased risk for ectopic pregnancy-egg is imbedded inside the fallopian tube instead of the uterus (women can bleed out and it’sa medical ermergency)o Disseminated gonococcal infection (DGI) DGI occurs following gonococcal bacteremia resulting in- Arthritis; o Most reported arthritis in the sexually-active young individuals- Dermatitis; Skin lesionso Papule shape, pus- Conjunctivitis; inflammation of conjunctivao Can happen in adults…not just infants If untreated- N. gonorrhoeae may spread to the blood- stream and, thereby, throughout the body. The most common symptoms are then rash, joint pain which may lead to deformity, and conjunctivitis, but other generalized symptoms may occur.- Diagnosiso Based on symptoms (i.e. discharge); Gram stain the dischargeo More difficult in females (need additional tests. i.e. Oxidase test)o Gram stain of the urethral discharge showing Gram (-) diplococci- Therapy of Neisseria gonorrhea infectionso For the treatment of uncomplicated urogenital and anorectal gonorrhea, CDC now recommends a single intramuscular dose of Ceftriaxone (cephalosporin) or oral doses of other types of Cephalosporineso Persons with gonorrhea should be tested for possible coinfection with Chlamydiatrachomatis Or other types of STDso If positive, treat with a single dose of Azithromycin 1 g by mouth or with Doxycycline 100 mg twice a day, by mouth for 7 days - History of Gonorrhea treatmento Gonorrhea was an easily treatable disease however, the estimated cost of treating gonorrhea in the United States is $56 million each year (CDC Update, 2000). o Small amounts of penicillin, and later on tetracycline, was the standard treatment for gonorrhea since the emergence of antibiotics in the 1940s. o During the Vietnam War, the use of penicillin and tetracycline used to treat uncomplicated gonorrhea became more and more resistant as new strains mutated (WebMD, 1999). o In 2000, The CDC recommended fluoroquinolone (ciprofloxacin) to treat uncomplicated gonorrheao N. gonorrhoeae'sresistance to ; fluoroquinolones was documented in Canada, Australia, United Kingdom, Hong Kong, and the United States starting at year 2000 and it is not treatment of choice anymore.o April 12, 2007 -- The CDC announced today that it no longer recommends treating gonorrhea with fluoroquinolone antibiotics such as


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IUPUI MICR J210 - Pathogenic Bacteria/Sexually Transmitted Diseases

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