SEXUALLY TRANSMITTED BACTERIAL DISEASES
PLAN • Morphology • Culture • Antigenic structure • Virulence factors • Pathogenesis • Immunity • Clinical syndromes • Epidemiology • Laboratory diagnosis • Treatment • Prevention
• A 28 -year-old hair dresser complained of a painless small ulcer on the penis during the last 2 weeks. When asked, he said he had repeated sexual relation with a female sexual worker approximately many months back. On examination, the pus exudate from the smear did not reveal any Treponema. Serum sample was found to be positive for syphilis by the VDRL test. ELISA for HIV was negative
TREPONEMA PALLIDUM: MORPHOLOGY
TREPONEMA PALLIDUM : ANTIGENIC STRUCTURE • Cardiolipin antigen • T. pallidum group-specific antigen • T. pallidum species-specific antigen
TREPONEMA PALLIDUM : VIRULENCE FACTORS Virulence factors Outer membrane proteins Enzyme hyaluronidase Fibronectin Biological functions Promote adherence of T. pallidum to the surface of host cells Facilitates perivascular infiltration Prevents phagocytosis of T. pallidum by macrophages
TREPONEMA PALLIDUM : PATHOGENESIS
TREPONEMA PALLIDUM : CLINICAL SYNDROMES 1. Venereal syphilis (transmitted by sexual contact) 2. Nonvenereal syphilis (congenital syphilis and occupational syphilis)
TREPONEMA PALLIDUM : EPIDEMIOLOGY
TREPONEMA PALLIDUM : LABORATORY DIAGNOSIS • Microscopy • Direct antigen detection • Serodiagnosis: • Nontreponemal tests (standard tests of syphilis: STS): • • Wasserman complement fixation test Kahn’s tube flocculation test VDRL test Rapid plasma reagin (RPR) test • Treponema-specific tests: • • • T. pallidum immobilization test T. pallidum agglutination test T. pallidum immune adherence test Fluorescent treponemal antibody test TPHA test Enzyme immunoassay
TREPONEMA PALLIDUM : LABORATORY DIAGNOSIS
• A 6 -year-old boy attended the Ophthalmology OPD with symptoms of conjunctivitis of the right eye. Examination showed follicular hypertrophy with diffuse inflammation that had affected the entire conjunctiva along with pannus formation. Iodine staining of conjunctival scrapings demonstrated inclusion bodies of Chlamydia trachomatis. The condition was diagnosed as trachoma.
CHLAMYDIA TRACHOMATIS: MORPHOLOGY
CHLAMYDIA TRACHOMATIS: CULTURE
CHLAMYDIA TRACHOMATIS: ANTIGENIC STRUCTURE • Genus-specific antigen • Species-specific antigen • Serotype-specific antigen • Typing of species • trachoma biovar causing trachoma and inclusion conjunctivitis (TRIC) – 13 serotypes, • lymphogranuloma venereum (LGV) biovar causing LGV – 5 serotypes, and • serovars causing mouse pneumonitis
CHLAMYDIA TRACHOMATIS: VIRULENCE FACTORS • The ability to multiply intracellularly in the infected cell is the key mechanism of virulence of C. trachomatis. • The bacteria prevent fusion of phagolysosome with cellular liposomes, thereby preventing intracellular killing of the bacteria by the host cell. • Repeated infections caused by C. trachomatis contribute to pathology seen in the infected eye in trachoma.
CHLAMYDIA TRACHOMATIS: PATHOGENESIS
CHLAMYDIA TRACHOMATIS: CLINICAL SYNDROMES • Lymphogranuloma venereum • Ocular LGV • Trachoma • Adult inclusion conjunctivitis • Neonatal conjunctivitis • Infant pneumonia • Urogenital infections
CHLAMYDIA TRACHOMATIS: CLINICAL SYNDROMES
CHLAMYDIA TRACHOMATIS: LABORATORY DIAGNOSIS • Microscopy • Culture • Antigen detection • Serodiagnosis • Frei’s skin test
• A 22 -year-old female complained of lower abdominal pain on and off for the last 3 months. She complained of a feeling of heaviness in the pelvis and pain during sexual intercourse. On examination, a tender mass was found to the right side during examination. Gram staining of cervical swab showed plenty of pus cells and a few Gram-negative cocci. She gave a history of allergy to penicillins.
NEISSERIA GONORRHOEAE: MORPHOLOGY
NEISSERIA GONORRHOEAE: CULTURE
NEISSERIA GONORRHOEAE: VIRULENCE FACTORS
NEISSERIA GONORRHOEAE: PATHOGENESIS
NEISSERIA GONORRHOEAE: CLINICAL SYNDROMES a) b) c) d) gonorrhea, disseminated gonococcal infections (DGI), ophthalmia neonatorum, and other gonococcal diseases
NEISSERIA GONORRHOEAE: LABORATORY DIAGNOSIS • Microscopy • Culture • Antigen detection • Serodiagnosi. S
NEISSERIA GONORRHOEAE: CLINICAL SYNDROMES a) b) c) d) gonorrhea, disseminated gonococcal infections (DGI), ophthalmia neonatorum, and other gonococcal diseases
NEISSERIA GONORRHOEAE: LABORATORY DIAGNOSIS • Microscopy • Culture • Antigen detection • Serodiagnosi. S
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