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mkofos's version from 2015-12-15 05:54

Section 1

Question Answer
HSVPainful, itchy lesions
Ulcerative lesions on ectocervix
Treponema pallidum --Syphilis--Enlarged, firm painless lymph nodes

Primary: Chancre
Secondary: Skin rash
Tertiary: neuro, cardio, gummatous, bone
Human Papillomavirus (HPV) --Genital Warts--Painless swellings (warts)
Haemophilus ducreyi --Chancroid--Painful lesion (bleeds easily)
Klebsiella granulomatis --Donovanosis--Painless deep-red, velvety lesions (bleeds easily)
Chlamydia trachomatis --Lymphogranuloma Venereum (LGV)--Primary: Small, painless papules or herpetic-type ulcers (Generally not noticed and heals in 1 week w/o a scar)
Secondary: Inguinal lymphadenopathy (most characteristic)
Tertiary: elephantitis
Molluscum Contagiosum Virus (MCV) --Molluscum Contagiosum--Painless pearly to flesh-colored round (dome-shaped) nodules w/ dimples
May have a “cheesy”, off-white/yellow material protruding from the lesions
Phthirus pubis --Crab Lice or Pediculosis Pubis--Itching and/or Burning of Pubic Area (esp. at night)
Neisseria gonorrhoeae (Gonococcus) --Gonorrhea--Painful Urination (+/- Urethral or Vaginal Discharge)
Trichomonas vaginalis --Trichomoniasis (“Trich”)--Vaginal itching, redness and/or tenderness
“Strawberry” cervix
“Frothy” discharge
Candida albicans --Vulvovaginal Candidiasis (VC)--cottage cheese discharge no odor
--Bacterial Vaginosis (BV)--Gardnerella vaginalis, and Prevotella spp. are the most common
"Fishy" odor
Clue cells
memorize

Section 2

Question Answer
HSVEnveloped dsDNA virus
Treponema pallidum --Syphilis--Gram-negative Spirilla
Human Papillomavirus (HPV) --Genital Warts-- (Types 6 and 11)Naked dsDNA virus
Haemophilus ducreyi --Chancroid--Gram-negative pleomorphic bacilli
Klebsiella granulomatis --Donovanosis--Gram-negative pleomorphic encapsulated bacilli
Chlamydia trachomatis --Lymphogranuloma Venereum (LGV)--Gram-negative membrane structure w/o peptidoglycan but WILL NOT show up on gram stain!
Molluscum Contagiosum Virus (MCV) --Molluscum Contagiosum--Enveloped dsDNA virus (“Oval” or “brick” shape)
Phthirus pubis --Crab Lice or Pediculosis Pubis--Ectoparasite
Neisseria gonorrhoeae (Gonococcus) --Gonorrhea--Gram-negative nonmotile coccus
Trichomonas vaginalis --Trichomoniasis (“Trich”)--Flagellated protozoa
Candida albicans --Vulvovaginal Candidiasis (VC)--Yeast (latent) hyphal & pseudohyphal fungus (active)
--Bacterial Vaginosis (BV)--Clue Cells
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Section 3

Question Answer
HSVHSV-2 DNA in vesicular lesion scrapings (PCR)
Staining of scrapings of base of ulcer lesions Wright, Giemsa or Papanicolaou stains
Observe for giant cells and/or intranuclear inclusions
Culture of HSV in human cells (48-96 h)
Observe for giant cells or intranuclear inclusions
Treponema pallidum --Syphilis--Cutaneous & Mucocutaneous lesions:
Direct IF, PCR, Darkfield microscopy

Serology:
Nontreponemal reaginic tests.....use for primary and secondaryinfections (Rapid Plasma Reagin (RPR) & Venereal Disease Research Lab (VDRL))
Specific treponemal tests...use for tertiary/latent (FTA-ABS TP-PA)
Human Papillomavirus (HPV) --Genital Warts--Histology: Look for Koilocytosis
Haemophilus ducreyi --Chancroid--Gram stain: Predominance of Gram-negative coccobacilli or long filaments
Klebsiella granulomatis --Donovanosis--“Bipolar” density – produces “safety pin” appearance upon staining w/ Giemsa (Donovan bodies)
Chlamydia trachomatis --Lymphogranuloma Venereum (LGV)--Cell culture: Stain w/ Giemsa (or use C. trachomatis-specific fluorescent Ab) to visualize cytoplasmic inclusions
Serology: Use complement fixation test or IF to detect anti-chlamydial IgG response
Molluscum Contagiosum Virus (MCV) --Molluscum Contagiosum--Histology: Observe for molluscum bodies......PCR for MCV DNA
Phthirus pubis --Crab Lice or Pediculosis Pubis--Demonstration of live adult lice, nymphs & viable eggs (nits)
Neisseria gonorrhoeae (Gonococcus) --Gonorrhea--Cytochrome oxidase-positive
Lipooligosaccharide (LOS) rather than LPS in cell membrane
Trichomonas vaginalis --Trichomoniasis (“Trich”)--Rapid test: Red-Ig-Ag captured (band = positive)
Culture: commertial media and look for motility
Candida albicans --Vulvovaginal Candidiasis (VC)--Vaginal swab (secretions, discharge): Examine for budding yeast or hyphae
Negative Whiff test Vaginal secretion + KOH = NO odor
Culture: Gram stain sample for budding yeast
--Bacterial Vaginosis (BV)--Amsel Criteria (3 of 4):
1. Vaginal swab (secretions, discharge) shows “clue cells”
2. Positive Whiff test Vaginal secretions + KOH = “Fishy” odor
3. Vaginal pH ABOVE 4.5
4. Homogenous grayish vaginal discharge
memorize

Section 4

Question Answer
HSVImmediate-Early genes: Regulates transcription of viral genes
Delayed Early genes: DNA replication Viral thymidine kinase
Late genes: Make structural proteins
Can infect/reside in non-dividing cells
Treponema pallidum --Syphilis--Extracellular Replication
Human Papillomavirus (HPV) --Genital Warts--Nuclear replication
Haemophilus ducreyi --Chancroid--colocalizes w/ PMN & macrophages but avoid phagocytosis
Klebsiella granulomatis --Donovanosis--Cytoplasmic replication
Chlamydia trachomatis --Lymphogranuloma Venereum (LGV)--Replicates inside monocytes and macrophages
Molluscum Contagiosum Virus (MCV) --Molluscum Contagiosum--Cytoplasmic replication by vDNA polymerase
Phthirus pubis --Crab Lice or Pediculosis Pubis--Mate & lay eggs (attached to hair shaft)
Neisseria gonorrhoeae (Gonococcus) --Gonorrhea-- Replicates inside neutrophils
Trichomonas vaginalis --Trichomoniasis (“Trich”)--Replicates in lumen & on epithelial surface
Candida albicans --Vulvovaginal Candidiasis (VC)--Replicates in epithelial tissue
--Bacterial Vaginosis (BV)--clue cells
memorize

Section 5

Question Answer
Complaint: Lesions on the genitals or groin region1. Herpes Simplex Virus (HSV) --Genital Herpes--
2. Treponema pallidum --Syphilis--
3. Human Papillomavirus (HPV) --Genital Warts--
Complaint: Itching and/or Burning of Pubic Area (esp. at night)1. Neisseria gonorrhoeae (Gonococcus) --Gonorrhea--
2. Trichomonas vaginalis --Trichomoniasis (“Trich”)--
3. Candida albicans --Vulvovaginal Candidiasis (VC)--
4. --Bacterial Vaginosis (BV)--
Complaint: Cervical Discharge1. HSV (Ulcerative lesions on ectocervix)
2. Chlamydia trachomatis (Thin, mucoid discharge with endocervical bleeding upon gentle swabbing)
3. Neisseria gonorrhoeae (Purulent discharge with Gram(-) diplococci in endocervical mucus)
4. Trichomonas vaginalis (Nonpurulent -clear mucoid- to purulent discharge with “Strawberry” cervix. May have “frothy” discharge from cervix.)
memorize

Section 6

Question Answer
Most difinitve test for HSVMost difinitive test
Most difinitve test for Treponema pallidum --Syphilis--Nontreponemal reaginic tests...use for primary and secondary infections
1. Rapid Plasma Reagin (RPR)
2. Venereal Disease Research Lab (VDRL)

Specific treponemal tests...use for tertiary/latent
1. FTA-ABS
2. TP-PA
Most difinitve test for Human Papillomavirus (HPV) --Genital Warts--Koilocytosis
Most difinitve test for Haemophilus ducreyi --Chancroid--Gram stain: Gram-negative coccobacilli or long filaments
Most difinitve test for Klebsiella granulomatis --Donovanosis--Graim stain: Donovan bodies
Most difinitve test for Chlamydia trachomatis --Lymphogranuloma Venereum (LGV)--Will NOT show up on a gram stain
Most difinitve test for Molluscum Contagiosum Virus (MCV) --Molluscum Contagiosum--Histology: Observe for molluscum bodies
PCR for MCV DNA
Most difinitve test for Phthirus pubis --Crab Lice or Pediculosis Pubis--Demonstration of live adult lice, nymphs & viable eggs (nits)
Most difinitve test for Neisseria gonorrhoeae (Gonococcus) --Gonorrhea--Transcription-Mediated Amplification (TMA) and add to modified Thayer-Martin media
Most difinitve test for Trichomonas vaginalis --Trichomoniasis (“Trich”)--
Most difinitve test for Candida albicans --Vulvovaginal Candidiasis (VC)--Culture: Gram stain sample for budding yeast
Most difinitve test for Bacterial Vaginosis (BV)--Amsel Criteria (3 of 4):
1. Vaginal swab (secretions, discharge) shows “clue cells”
2. Positive Whiff test Vaginal secretions + KOH = “Fishy” odor
3. Vaginal pH ABOVE 4.5
4. Homogenous grayish vaginal discharge
memorize

Section 7

Question Answer
HSVMedicine to treat
Treponema pallidum --Syphilis--Meds
Human Papillomavirus (HPV) --Genital Warts--Meds
Haemophilus ducreyi --Chancroid--Meds
Klebsiella granulomatis --Donovanosis--Meds
Chlamydia trachomatis --Lymphogranuloma Venereum (LGV)--Meds
Molluscum Contagiosum Virus (MCV) --Molluscum Contagiosum--Meds
Phthirus pubis --Crab Lice or Pediculosis Pubis--Meds
Neisseria gonorrhoeae (Gonococcus) --Gonorrhea--Meds
Trichomonas vaginalis --Trichomoniasis (“Trich”)--Meds
Candida albicans --Vulvovaginal Candidiasis (VC)--Meds
--Bacterial Vaginosis (BV)--Meds
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Section 8

Question Answer
Why is HPV persistant?Downregulates HLA class I molecules. (via E5 protein that traps peptide-loaded HLA class I molecules in the Golgi)
*Although a loss of HLA class I on the cell surface activates NK cells, there are few NK cells are in this cell layer. So we need out T cells to kill it, which takes time.
What are the steps to HPV replication?1. Entry requires minor trauma
2. Stratum basale: uncoats
3. Stratum spinosum: Active replication with acanthosis - thickening of skin
4. Stratum granulosum: Keratohyaline granules
5. Stratum corneum: Excess keratin produced & virus released
What does Haemophilus ducreyi --Chancroid-- need for growth?Requires hemin (X factor) and nicotinamide adenine dinucleotide (NAD, V factor) for growth
What does Chlamydia trachomatis --Lymphogranuloma Venereum (LGV)-- need for growth?Require host cell for ATP and NAD+ regeneration – “Energy parasites”
What are the two life cycle forms of Chlamydia trachomatis --Lymphogranuloma Venereum (LGV)?1. Elementary body (EB)......Extracellular infectious stage
2. Reticulate body (RB)........Intracellular replicative stage
How does the Molluscum Contagiosum Virus (MCV) bind to the host cell surface?IMV & EEV can bind to host cell surface glycosaminoglycans (GAGs)

EEV (Exocytosis/budding Extracellular enveloped virus)....Cell lysis
IMV (Intracellular mature virus)
How does Neisseria gonorrhoeae (Gonococcus) bind to host cells?Attachment to columnar/cuboidal epithelia by pili & Opa (opacity proteins)
LOS, peptidoglycan causes cytokines (epithelial cells)
PMN recruited/activated
TNF drives inflammation
What might cause Non-Gonococcal Urethritis (NGU)?50% of NGU cases are due to Chlamydia trachomatis serovars D-K
What is the most common curable STD (and is non-reportable)?Trichomonas vaginalis --Trichomoniasis (“Trich”)--
What kind of enviornment does Trichomonas vaginalis prefer? Alkaline (Vaginal fluid pH ABOVE 4.5)
What does Trichomonas vaginalis release?1. ECM proteases (host cells detach from basal lamina)
2. Pore-forming proteins (can lyse host cells)
What causes the “fishy” odor in Bacterial Vaginosis (BV)?Amines
Endocervicitis
1. Damaged cells
2. Type of discharge
3. Organisms responsible
Columnar epithelial damage
Yellow-Green, Purulent, Mucoid discharge

1. N. gonorrhoeae
2. C. trachomatis
3. M. genitalium
4. T. vaginalis
5. HSV
Ectocervicitis

1. Damaged cells
2. Organisms responsible
Stratified squamous epithelium damage

1. Candida vulvovaginitis
2. Trichomonas vaginitis
3. HSV (causes endocervicitis at the same time)
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Section 9

Question Answer
HSVUlcerative lesions on ectocervix
Chlamydia trachomatisThin, mucoid discharge with endocervical bleeding upon gentle swabbing
Neisseria gonorrhoeaePurulent discharge with Gram(-) diplococci in endocervical mucus
Trichomonas vaginalis“Strawberry” cervix.
Nonpurulent -clear mucoid- to purulent discharge
“frothy” discharge
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Section 10

Question Answer
Anything ElseAnything Else
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