Institute for Microbiology, Medical Faculty of Masaryk University     and St. Anna Faculty Hospital
                                              in Brno





                              Agents of classical venereal infections









                                   Classical venereal infections

•       Gonorrhoea (rudely: the clap)

    Neisseria gonorrhoeae

•       Syphilis (in Central Europe also: lues)

    Treponema pallidum

•       Chancroid (soft chancre, ulcus molle)

    Haemophilus ducreyi

•       Lymphogranuloma venereum

    Chlamydia trachomatis L[1], L[2], L[2a], L[3]



                                   Clinical forms of gonorrhoea

•                 Infections of lower parts of urogenital tract

•                 Infections of upper parts of urogenital tract

•                 Other localized infections



•                  Rare gonococcal infections: disseminated ones (skin, arthritis, meningitis,
endocarditis)

                                     GO: infections of the UGT

♂



•                  Urethritis

•                  Epididymitis



♀



•                  Cervicitis

•                  Urethritis

•                  Bartholinitis

•                  Endometritis

•                  Salpingitis, adnexitis (PID, pelvic inflammatory disease) → sterility!



                                  GO: other localized infections

♂ and ♀:

proctitis

pharyngitis

blenorrhoea neonatorum



♀:

peritonitis (Fitz-Hugh syndrome)

perihepatitis (Curtis syndrome)





                                         GO: complications

♂:

prostatitis

periurethral abscesses



♀:

cervicitis chronica

tuboovarial abscess

adnexitis chronica → sterility

                                     graviditas extrauterina

                                  GO: laboratory diagnostics – I

Direct detection only:

microscopy

culture

molecular biology tests



Sampling places:

♂ urethra

♀ cervix, urethra, rectum, pharynx (if necessary)

                                  GO: laboratory diagnostics – II

Way of sampling:

•                 always 2 swabs

      the first one inoculate directly on media (warmed, not from the fridge), or put it into a
transport medium, transport it at ambient temperature, from the second one make a film on the slide



Microscopy (Gram):                         important in acute gonorrhoea in males,

      symptomatic gonorrhoea in females



                                 GO: laboratory diagnostics – III

Media for gonococci:

Combine non-selective chocolate agar

      with a selective medium with antibiotics

Always fresh (moist), with added CO[2] (candle jar),[ ] read after 24 and 48 hrs



Identification:

•                 biochemistry (oxidase +, glucose +, maltose -)

•                 serology (slide agglutination)

•                 molecular biologic confirmation tests



                                            GO: therapy

Ceftriaxone or ciprofloxacin                       usually in a single
dose,                            because of potential concurrent Chlamydia trachomatis infection:
in a combination with doxycycline or azithromycine



Nowadays, many strains of N. gonorrhoeae are resistant to penicillin & tetracyclines



                                         Syphilis: course

From the very beginning: syphilis = systemic disease!



Early syphilis: primary (ulcus durum)

                     secondary (mostly rash)

                     early latent

Late syphilis: latent

                   terciary (gummas, aortitis,

                                      paralysis progressiva,

                                      tabes dorsalis)

Congenital syphilis: early and late

                                         Syphilis: therapy

„One night with Venus, the rest of life with Mercury“



Ehrlich and Hata: preparation No 606 – salvarsan

von Jauregg: malaria (because of high fever)



                            Nowadays, the drug of choice is penicillin



Primary syphilis:

benzathin penicillin (2,4 MIU) 1 dose



Secondary and late syphilis:

benzathin penicillin (2,4 MIU) 3 times after 7 days



                                    Syphilis: laboratory dg – I

Direct detection

From exudative lesions only (mostly from ulcus durum)

      darkfield examination
PCR                                        immunofluorescence



Indirect detection (serology)

= mainstay of laboratory diagnostics of syphilis



Two types of serologic tests:

      with nonspecific antigen (cardiolipin)

      with specific antigen (Treponema pallidum)



                                   Syphilis: laboratory dg – II

Tests with cardiolipin (nontreponemal):

     RRR, VDRL, RPR

     fast, cheap, positive early, reflecting the activity, but often falsely positive

Treponemal tests:

     TPHA, ELISA, WB, FTA-ABS, TPIT

     sensitive, more expensive, more specific, but positive later, remaining positive for life





                                     Soft chancre (chancroid)

Agent of ulcus molle: Haemophilus ducreyi

Occurrence: the tropics



Course: genital ulcerations (easier transmission of HIV) & purulent lymphadenitis



Dg: only culture on enriched media    (chocolate agar with supplements),         3 days at 33 °C in
10% CO[2]



                                     Lymphogranuloma venereum

Agent of LGV: Chlamydia trachomatis serotypes L[1], L[2], L[2a], L[3][]

[ ]

Occurrence: the tropics and subtropics



Course: purulent lymphadenitis (tropical bubo) & lymphangoitis with fistulae & scars devastating
the pelvic region in females



Dg: mostly serology – CFT with the common antigen of chlamydiae







                                       Homework 4 – solution
                         Gerrit van Honthorst (1590-1656): Dentist (1622)

 Homework 5