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Pathophysiology of Gonorrhea and Syphilis, and Related Conditions

Key Concepts Exam 4 Pathophysiology of Gonorrhea Gonorrhea is associated with the gram-negative diplococcus Neisseria gonorrheae In gonorrhea, disease transmission occurs through contact with exudates from the mucous membranes of infected persons, usually by direct contact. The gonococcus then attaches and penetrates columnar epithelium and produces a patchy inflammatory response in the submucosa. Although usually asymptomatic in women, gonorrhea may produce purulent vaginal discharge, dysuria painful urination, and abnormal vaginal bleeding The most commonly affected areas in women are the cervix and urethra. This can manifest in other area commonly found in surface urethra skin and Bartholin glands Pathogenesis of Syphilis- specifically the vasculature During all changes of the syphilis invasion of tissue by Treponema pallidum results in pathologic changes in the vascular system. The inflammatory response in endothelial tissue causes the infiltration of lymphocytes and plasma cells, with subsequent endothelial swelling. The terminal arterioles and small arteries may become obliterated and no longer functional. Finally, long term inflammation of vascular tissue results in the formation of hardened, fibrous thickening in the blood vessels and eventually tissue necrosis. Primary-canchre Secondary-rashes aches and pains flu like symptoms Tertiary- major organ system failure-neurosyphilis Damage of the cardiovascular system may include aortic necrosis and subsequent aortic insufficiency, damage to the central nervous system may be progressively and widespread with degeneration of cortical neurons and eventually paresis, blindness and mental deterioration Predominate bacteria causing PID and clinical findings Neisseria gonorrhoeae and chlamydia trachomatis are the most common causative agents Abdominal tenderness and tenderness or pain of the cervix or adnexa (ovaries fallopian tubes, and ligaments that secure the female reproductive organs) on pelvic abscess or inflammatory mass may be present on physical examination or ultrasound and purulent vaginal discharge may be noted. Newborn complication of Chlamydia Chlamydia trachomatis Ophthalmia Neonatorum-ophthalmic ointment to protect child incase undiagnosed Neonatal Pneumonia *HPV communicability 21-year-old women should get pap smear HPV can develop into cervical cancer oropharyngeal cancers in women and men. Can remove warts but virus is still there no cure high transmission rate can still be transmitted Soft pink or brown colors HSV : NO CURE : Can be in remission with meds transmitted trough vaginal delivery Causative bacteria and labs in Epididymitis Neisseria gonorrhoeae and chlamydia trachomatis are the most common causative agents. s/s: Swelling , fever enlarged hot red scrotum Laboratory testing usually reveals an elevated white blood cell count or leukocytosis and urine culture may reveal the infecting organ. BPH disease manifestations (what is happening in a functional level) Benign tumor constriction of urethra occurs Urinary retention, decrease stream, frequency or urgency, interruption of stream, nocturia, dribbling, difficulty emptying bladder. Decrease in the urine force in the urinary stream Hesitancy or difficulty in initiating a urinary stream, and interruption of the stream may occur. Possible etiology of Fournier's gangrene-gangrenous necrosis of the scrotum Medical emergency Usually, an underlying cause such as diabetes, alcoholism, smoking, or another general debility predisposes the patient to such an aggressive infection. Manifestations: pain, swelling, necrosis and can