MIC205A – Microbiology – Exam 4 Questions and Answers
Genitourinary Tract Infections -Often uncomfortable, can have serious consequences
-Urinary tract infections (UTIs) most frequent healthcare-associated infections -> main origin of
fatal, bacterial blood-stream infections
-Healthcare-associated uterine infections require attention -> puerperal fever from childbirth
-Sexually transmitted infections (STIs) widespread -> US has highest reported incidence of STIs
among economically developed countries; about 85% of students have had intercourse, about
1/3 of these with >/= 6 partners; bout 70% of these report rarely or never using condoms
Bacterial Cystitis -Signs and symptoms: sudden onset, burning pain on urination, frequent
need to urinate, cloudy or red-colored urine that smells bad; fever, chills, back pain, and
vomiting with pyelonephritis
-Bladder infection, most common type of UTIs
-Often caused by normal microbiota (about 80% by E. coli)
-Upward movement of pathogens can cause pyelonephritis, an infection of kidneys
-Predisposing factors: women (short urethra, use of a diaphragm, and sexual intercourse), men
(enlargement of prostate gland partially obstructs urethra; catheterization often results in
infection)
-Treatment and prevention: short-term antimicrobial medication usually sufficient; longer
treatment for pylonephritis; prevention includes drinking enough liquid to urinate at least four
to five times daily, wiping from front to back; low daily dose of antibiotic may help prevent
recurrent bacterial cystitis in women
Vulvovaginal Candidiasis -Caused by Candida albicans, a yeast and a member of normal
microbiota
-Often associated with disturbance of normal microbiome by antibiotics, contraceptives,
menstruation, and pregnancy
-Signs and symptoms: itching, burning, thick and white vaginal discharge, redness and swelling
-Not contagious, usually not sexually transmitted
,-Treatment: intravaginal antifungal medications usually effective
-Prevention: minimizing antibiotic use and treating known predisposing conditions
Sexually Transmitted Infections (STIs, STDs) Global Situation -More than 1 million people
acquire an STI/day
-Each year, about 357 million people become ill with one of 4 STIs: chlamydia, gonorrhoea,
syphilis, and trichomoniasis
-Over 530 million people have HHV2
-Over 290 million women have an HPV infection
-Genital herpes and syphilis can increase the risk to HIV
-STIs can cause infertility and mother to child transmission
Snapshot: STDs in the US, 2015 -Despite recent declines, 2015 was the second year in a row
in which increases were seen in all three nationally reported STDs (chlamydia, syphilis, and
gonorrhea)
-The approximately 1.5 million cases of chlamydia represent the highest number of annual
cases of any condition ever reported to CDC
-Substantial increases were also seen among reported cases of gonorrhea and syphilis. While
young people and women are most severely affected by STDs, increasing rates among men
contributed to the overall increase in 2015 across all diseases
STIs -Unprotected sex with multiple partners
-Preventable by: abstinence, monogamous relationship, condom use
-Bacterial infections are treatable with antibiotics
-Herpes infections can be lessened with acyclovir
-Papillomavirus infection can be prevented by vaccine; linked to cervical cancer; some types
cause warts on skin
-Person who gets one STI may have acquired others (may not know, needs to be tested)
,-STIs widespread: US has highest reported incidence of STIs among economically developed
countries
-Signs and symptoms often overlooked: require clinical evaluation even if go away (a number of
STIs can cause few or no signs or symptoms; can produce serious effects and are transmissible)
-Signs and symptoms that suggest an STI: abnormal discharge from the vagina or penis; pain or
burning sensation with urination; sore or blister (painful or painless) on the genitals or nearby;
swollen lymph nodes in the groin; abnormal vaginal bleeding or unusually severe menstrual
cramps; itching in the vagina or rectal area; pain in the lower abdomen in women; pain during
sexual intercourse; skin rash or mouth lesions
Gonorrhea -Caused by Gonococcus (GC) Neisseria gonorrhoeae, a fastidious, Gram-negative
diplococcus that requires rich medium (for example, chocolate agar) -> some produce pili
(fimbriae) and Opa for attachment on non-ciliated epithelial cells; produces membrane proteins
that take iron from transferrin and lactoferrin
-Outer membrane of GC has general structure of Gram-negative LPS membrane, except
membrane lipid has highly branched oligosaccharide structure: Lipooligosaccharide (LOS) ->
plays role in GC virulence and pathogenicity
-Colonize and infect non-ciliated columnar epithelia cells (urethra, rectum, cervix opening,
fallopian tubes, vagina wall, mouth, pharynx, anus, conjunctiva)
-Cannot colonize squamous epithelium such as that lining adult vagina, or ciliated cells
-Entry via endocytosis, mediated by porin protein in LOS
-LOS and peptidoglycan released by autolysis of cells cause complement activation, triggers
inflammatory response that leads to most symptoms, also release of proteases, phospholipases
that damage cells and tissues
-Avoid innate immunity: inactivate C3b by binding to complement regulatory proteins; use host
sialic acid to make capsule-like structure to avoid opsonization; lipooligosaccharides similar to
host red blood cells (similarity to "self" prevents effective immune response); produces outer
membrane porin proteins that prevents phagolysosome formation and allows survival inside
-Avoiding adaptive immunity: protease to destroy IgA of mucosa; surface antigen variations and
phase variation (LOS, Pilins, and Opa proteins); Opa proteins prevent CD4+ T-cell proliferation
by attaching to lymphocytes, preventing their activation and proliferation; phase variation (may
not produce any LOS, pilins, Opa)
, -Human-specific pathogen; survives poorly in environment
-Iron-binding proteins, phospholipases
-Among mo
Gonorrhea signs and symptoms -Often asymptomatic (about 60% women, about 20% men)
-Men: painful urination and discharge of pus; inflammation can produce scar tissue that
obstructs urethra, slows urination, increases risk of UTIs; infection may spread to prostate gland
and testes -> produce prostatic abcesses and orchitis -> infertility can result from blockage or
tissue destruction
-Women: fewer symptoms but possible complications if untreated, such as pelvic inflammatory
disease, sometimes infertility; may have painful urination, vaginal discharge; scarring of
fallopian tube can lead to ectopic pregnancy
-Bacteria grows in cervix and fallopian tubes, in glands in vaginal wall, and other areas of genital
tract, causing inflammation, pain, possible scarring
-Infection occasionally spreads into abdominal cavity (unclear how since N. gonorrhoeae is non-
motile)
-Disseminated gonococcal infection (DGI)
-Ophthalmia neonatorum infection in newborns -> prevented by prophylactic treatment of eyes
of all newborns within 1 hour (required by law in US)
-Anal gonorrhea, pharyngeal gonorrhea
-If untreated, may result in endocarditis, meningitis, arthritis, phthalmia neonatorum
-Highest incidence of any reportable bacterial disease other than Chlamydia
-Treatment: Cephalosporin (frequently resistant to many antibacterial medications -> CDC
considers "Urgent Threat"), (Fluoroquinolones); current combination treatment is
Cephalosporin and Azithromycin or doxycycline
-Prevention: abstinence, monogramous partner, consistent and correct condom use
-Incubation period 2-5 days
-Noticeable, unpleasant: men who have usually seek treatment
-Rapid identification and treatment
Genitourinary Tract Infections -Often uncomfortable, can have serious consequences
-Urinary tract infections (UTIs) most frequent healthcare-associated infections -> main origin of
fatal, bacterial blood-stream infections
-Healthcare-associated uterine infections require attention -> puerperal fever from childbirth
-Sexually transmitted infections (STIs) widespread -> US has highest reported incidence of STIs
among economically developed countries; about 85% of students have had intercourse, about
1/3 of these with >/= 6 partners; bout 70% of these report rarely or never using condoms
Bacterial Cystitis -Signs and symptoms: sudden onset, burning pain on urination, frequent
need to urinate, cloudy or red-colored urine that smells bad; fever, chills, back pain, and
vomiting with pyelonephritis
-Bladder infection, most common type of UTIs
-Often caused by normal microbiota (about 80% by E. coli)
-Upward movement of pathogens can cause pyelonephritis, an infection of kidneys
-Predisposing factors: women (short urethra, use of a diaphragm, and sexual intercourse), men
(enlargement of prostate gland partially obstructs urethra; catheterization often results in
infection)
-Treatment and prevention: short-term antimicrobial medication usually sufficient; longer
treatment for pylonephritis; prevention includes drinking enough liquid to urinate at least four
to five times daily, wiping from front to back; low daily dose of antibiotic may help prevent
recurrent bacterial cystitis in women
Vulvovaginal Candidiasis -Caused by Candida albicans, a yeast and a member of normal
microbiota
-Often associated with disturbance of normal microbiome by antibiotics, contraceptives,
menstruation, and pregnancy
-Signs and symptoms: itching, burning, thick and white vaginal discharge, redness and swelling
-Not contagious, usually not sexually transmitted
,-Treatment: intravaginal antifungal medications usually effective
-Prevention: minimizing antibiotic use and treating known predisposing conditions
Sexually Transmitted Infections (STIs, STDs) Global Situation -More than 1 million people
acquire an STI/day
-Each year, about 357 million people become ill with one of 4 STIs: chlamydia, gonorrhoea,
syphilis, and trichomoniasis
-Over 530 million people have HHV2
-Over 290 million women have an HPV infection
-Genital herpes and syphilis can increase the risk to HIV
-STIs can cause infertility and mother to child transmission
Snapshot: STDs in the US, 2015 -Despite recent declines, 2015 was the second year in a row
in which increases were seen in all three nationally reported STDs (chlamydia, syphilis, and
gonorrhea)
-The approximately 1.5 million cases of chlamydia represent the highest number of annual
cases of any condition ever reported to CDC
-Substantial increases were also seen among reported cases of gonorrhea and syphilis. While
young people and women are most severely affected by STDs, increasing rates among men
contributed to the overall increase in 2015 across all diseases
STIs -Unprotected sex with multiple partners
-Preventable by: abstinence, monogamous relationship, condom use
-Bacterial infections are treatable with antibiotics
-Herpes infections can be lessened with acyclovir
-Papillomavirus infection can be prevented by vaccine; linked to cervical cancer; some types
cause warts on skin
-Person who gets one STI may have acquired others (may not know, needs to be tested)
,-STIs widespread: US has highest reported incidence of STIs among economically developed
countries
-Signs and symptoms often overlooked: require clinical evaluation even if go away (a number of
STIs can cause few or no signs or symptoms; can produce serious effects and are transmissible)
-Signs and symptoms that suggest an STI: abnormal discharge from the vagina or penis; pain or
burning sensation with urination; sore or blister (painful or painless) on the genitals or nearby;
swollen lymph nodes in the groin; abnormal vaginal bleeding or unusually severe menstrual
cramps; itching in the vagina or rectal area; pain in the lower abdomen in women; pain during
sexual intercourse; skin rash or mouth lesions
Gonorrhea -Caused by Gonococcus (GC) Neisseria gonorrhoeae, a fastidious, Gram-negative
diplococcus that requires rich medium (for example, chocolate agar) -> some produce pili
(fimbriae) and Opa for attachment on non-ciliated epithelial cells; produces membrane proteins
that take iron from transferrin and lactoferrin
-Outer membrane of GC has general structure of Gram-negative LPS membrane, except
membrane lipid has highly branched oligosaccharide structure: Lipooligosaccharide (LOS) ->
plays role in GC virulence and pathogenicity
-Colonize and infect non-ciliated columnar epithelia cells (urethra, rectum, cervix opening,
fallopian tubes, vagina wall, mouth, pharynx, anus, conjunctiva)
-Cannot colonize squamous epithelium such as that lining adult vagina, or ciliated cells
-Entry via endocytosis, mediated by porin protein in LOS
-LOS and peptidoglycan released by autolysis of cells cause complement activation, triggers
inflammatory response that leads to most symptoms, also release of proteases, phospholipases
that damage cells and tissues
-Avoid innate immunity: inactivate C3b by binding to complement regulatory proteins; use host
sialic acid to make capsule-like structure to avoid opsonization; lipooligosaccharides similar to
host red blood cells (similarity to "self" prevents effective immune response); produces outer
membrane porin proteins that prevents phagolysosome formation and allows survival inside
-Avoiding adaptive immunity: protease to destroy IgA of mucosa; surface antigen variations and
phase variation (LOS, Pilins, and Opa proteins); Opa proteins prevent CD4+ T-cell proliferation
by attaching to lymphocytes, preventing their activation and proliferation; phase variation (may
not produce any LOS, pilins, Opa)
, -Human-specific pathogen; survives poorly in environment
-Iron-binding proteins, phospholipases
-Among mo
Gonorrhea signs and symptoms -Often asymptomatic (about 60% women, about 20% men)
-Men: painful urination and discharge of pus; inflammation can produce scar tissue that
obstructs urethra, slows urination, increases risk of UTIs; infection may spread to prostate gland
and testes -> produce prostatic abcesses and orchitis -> infertility can result from blockage or
tissue destruction
-Women: fewer symptoms but possible complications if untreated, such as pelvic inflammatory
disease, sometimes infertility; may have painful urination, vaginal discharge; scarring of
fallopian tube can lead to ectopic pregnancy
-Bacteria grows in cervix and fallopian tubes, in glands in vaginal wall, and other areas of genital
tract, causing inflammation, pain, possible scarring
-Infection occasionally spreads into abdominal cavity (unclear how since N. gonorrhoeae is non-
motile)
-Disseminated gonococcal infection (DGI)
-Ophthalmia neonatorum infection in newborns -> prevented by prophylactic treatment of eyes
of all newborns within 1 hour (required by law in US)
-Anal gonorrhea, pharyngeal gonorrhea
-If untreated, may result in endocarditis, meningitis, arthritis, phthalmia neonatorum
-Highest incidence of any reportable bacterial disease other than Chlamydia
-Treatment: Cephalosporin (frequently resistant to many antibacterial medications -> CDC
considers "Urgent Threat"), (Fluoroquinolones); current combination treatment is
Cephalosporin and Azithromycin or doxycycline
-Prevention: abstinence, monogramous partner, consistent and correct condom use
-Incubation period 2-5 days
-Noticeable, unpleasant: men who have usually seek treatment
-Rapid identification and treatment
