Group A6: Brown, Carrier, Cronin, Hayat, Hyman
Clinical Manifestations of Gonorrhea, Syphilis, and Chlamydia.
A 32y/o businessman comes into your office.
He was well until yesterday,
when he admits he experienced dysuria accompanied by yellowish urethral
discharge. He also admits that he had intercourse with a prostitute 5 nights ago. You
perform a gram stain on
a specimen of the discharge and see gram
diplococci within neutrophils.
Given this characteristic finding, you know right
away that the most likely cause of this infection is?
Neisseriae are gram
positive cocci that resemble
paired kidney beans.
causes gonorrhea, neonatal co
PID. Gonorrhea in men is characterized primarily by urethritis accompanied by
dysuria and a purulent discharge. In women, infection is located primarily in the
endocervix, causing a purulent vaginal discharge and intermenstrual bleeding
The most common complication in women is ascending infection into
the uterine tubes, causing salpingitis/PID, which can result in sterility or ectopic
Disseminated infections commonly manifest as arthritis, tenosynovitis,
In men, the finding of gram
negative diplococci within PMNs is
sufficient for diagnosis. In women, the use of gram stain alone can be difficult to
interpret, so cultures should be done additionally.
is a spirochete, which is a thin
shaped, motile rod.
They are so thin that they are seen only by darkfield microscopy, silver
impregnation, or immunofluorescence.
are obligate intracellular bacteria, and thus, the gram stain is not useful.
is a common cause of NGU, which may progress to
epididymitis, prostatitis, or proctitis. In women, cervicitis develops and may
progress to PID or salpingitis.
Source: Ex Master USMLE
style Question Bank
old, sexually active woman has had
a mucopurulent vaginal discharge
for 1 week. On pelvic examination, the
cervix appears reddened around the os, but
no erosions or mass lesions are present. A Pap smear shows numerous neutrophils,
but no dysplastic cells. A cervical biopsy specimen shows m
cervicitis. Which of the following infectious agents is most likely to produce these
The redness of the cervix, the inflammatory cells in the cervical
discharge, and the biopsy findings indicate that the
patient has cervicitis.
is the most common cause of cervicitis in sexually active women.
gonorrhea, and trichomoniasis also are common. Candidiasis often
produces a scant, white, curdlike vaginal discharge; gonorrhea may have an
associated urethritis; and
may produce a profuse homogeneous,
frothy, and adherent yellow or green vagin
is found in
bacterial vaginosis, a common condition caused by overgrowth of
infection produces a moderate, homogeneous, low
adherent vaginal discharge that is white or gray and has a characteristic
odor; “clue” cells are seen on a wet mount. Herpetic infections are more likely to
manifest as clear vesicles on the skin in the perineal region. Infection with human
papillomavirus is associated with condylomata, dysplasias, and carcinoma.
: Robbins & Cotran Review of Pathology, 3
old man who has had progressive dementia for the past 6 years dies
of bronchopneumonia. Autopsy shows that the thoracic aorta has a dilated root and
ng the intimal surface a “tree
bark” appearance. Microscopic examination
of the aorta shows an obliterative endarteritis of the vasa vasorum. Which of the
following laboratory findings is most likely to be recorded in this patient's medical
A. High double
stranded DNA titer
ANCA positive 1:1024
C. Sedimentation rate 105 mm/hr
D. Ketonuria 4+
E. Antibodies against Treponema pallidum
(E) This description is most suggestive of syphilitic
aortitis, a c
omplication of tertiary syphilis, with characteristic
involvement of the thoracic aorta. Obliterative endarteritis is not a
feature of other forms of vasculitis. High
titer doublestranded DNA
antibodies are diagnostic of systemic lupus erythematosus, and a
result for P
ANCA is positive in various vasculitides, including
microscopic polyangiitis. A high sedimentation rate is a nonspecific
marker of inflammatory diseases. Ketonuria can occur in individuals
with diabetic ketoacidosis.
Source: Robbins & C
otran Review of Pathology, 3rd ed, Ch.11
A sexually active, 26
old man has had pain on urination for the past 4 days.
On physical examination, there are no lesions on the penis. He is afebrile. Urinalysis
shows no blood, ketones,
protein, or glucose. Microscopic examination of the urine
shows few WBCs and no casts or crystals. What infectious agent is most likely to
produce these findings?
C. Herpes simplex virus
This patient has urethritis. The most common cause of nongonococcal
urethritis in men is
. The condition is a
the behavior that led to the infection can place the patient at risk of other sexually
transmitted diseases. Tuberculosis of the urinary tract is uncommon. Herpes
simplex can produce painful vesicles on the skin.
in immunocompromised patients or in patients receiving long
therapy. A syphilitic chancre on the penis is an indicator of
Source: Robbins & Cotran Review of Pathology, 3
old man who has multiple sexual partners and does not use barrier
precautions comes to the physician complaining of a nontender ulcer on the penis
that has been present for 1 week. On physical examination, the 0.6
cm lesion has a
tous base and sharply demarcated borders. The lesion is scraped, and
darkfield examination is positive for spirochetes consistent with
. Which of the following is most likely to be seen microscopically in the
atous inflammation with suppuration
B. Granulomatous inflammation with caseation
C. Acute inflammation with abscess formation
D. Perivascular inflammation with plasma cells
E. Gummatous inflammation
Syphilitic chancres occur in the primary
stage of syphilis and are
characterized by lymphoplasmacytic infiltrates and by an obliterative endarteritis.
Similar lesions also may appear with secondary syphilitic mucocutaneous lesions.
Suppurative granulomas are typical of cat
scratch disease. Casea
inflammation is more characteristic of tuberculosis or fungal infections. Acute
inflammation with abscess formation is characteristic of bacterial infections such as
gonorrhea. Gummatous inflammation can be seen in adults with tertiary s
in congenital syphilis.
Source: Robbins & Cotran Review of Pathology, 3