Bakteri penyebab STD / PHS

Riyani Wikaningrum Bagian Mikrobiologi FKUY

Top Ten STD

Organism Papillomaviruses (types 6 and 11 associated with visible genital warts) Chlamydia trachomatis (D-K serotypes) C. trachomatis (L1, L2, L3 serotypes) Candida albicans Disease Genital warts, dysplasias Comment The commonest of all STDs, associated with cancer of cervix, penis, etc. Increasing incidence Mainly tropical countries Treatment Podophyllin, cryotherapy

Non-specific urethritis Lymphogranuloma venereum Vaginal thrush, balanitis

Doxycycline, azithromycin Doxycycline, tetracycline, erythromycin

Very common; Nystatin, predisposing factors fluconazole

Top Ten STD

Organism Trichomonas vaginalis Herpes simplex virus types 1 and 2 Neisseria gonorrhoeae Disease Vaginitis, urethritis Genital herpes Comment Very common; can be asymptomatic Treatment Metronidazole Increasing; problem Aciclovir, of latency and valaciclovir, reactivation famciclovir Decreasing incidence in resource-rich countries Incidence increasing worldwide Ceftriaxone, ciprofloxacin

Gonorrhea

HIV

AIDS

Nucleoside, nucleotide and non-nucleoside reverse transcriptase inhibitors; fusion inhibitors; protease inhibitors

Top Ten STD

Organism Treponema pallidum Disease Syphilis Comment Decreasing incidence in resource-rich countries 350 million carriers worldwide Mainly tropical Treatment Penicillin

Hepatitis B virus

Hepatitis

Lamivudine, adefovir, interferon alpha Erythromycin, ceftriaxone

Haemophilus ducreyi

Chancroid

Other STD
Organism Disease Comment Treatment

Calymmatobacterium Granuloma inguinale granulomatis

Sarcoptes scabiei Phthirus pubis Mycoplasma Ureaplasma (T strains) Gardnerella vaginalis Genital scabies Pediculoses pubis Non-specific urethritis Vaginitis

Tropical
Common Common Less important than chlamydia Acts together with anaerobes

Doxycycline, azithromycin
Permethrin cream Permethrin cream/shampoo Doxycycline, azithromycin Erythromycin Metronidazole

Microbes to combat host defenses

Host defenses Complement Microbial strategies C3d receptor on microbe binds C3b/d and reduces C3b/d-mediated polymorph phagocytosis Examples Candida albicans

Inflammation

Induce strong Gonococcus, C. albicans, inflammatory response, yet HSV, chlamydia evade consequences Produce IgA protease Antigenic variation; allows re-infection of a given individual with an antigenic variant Poorly understood factors cause ineffective cellmediated immune response Gonococcus Gonococcus, Chlamydia, Papillomaviruses (not HSV or T. pallidum) T. pallidum, HIV

Antibodies (especially IgA) Cell-mediated immune response (T cells, lymphokines, natural killer cells, etc.)

Host defenses Integrity of mucosal surface Urine flow (for urethral infection)

Microbial strategies Specific attachment mechanism Specific attachment; induce own uptake and transport across urethral epithelial surface in phagocytic vacuole Infection of urethral epithelial or subepithelial cells

Examples Gonococcus or Chlamydia to urethral epithelium Gonococcus

Herpes simplex virus (HSV), Chlamydia

Phagocytes (especially polymorphs)

Induce negligible inflammation

Treponema pallidum, mechanism unclear, perhaps poorly activates alternative complement pathway due to sialic acid coating
Gonococcus (capsule) T. pallidum (absorbed fibronectin)

Resist phagocytosis

SIFILIS

Spiral Organisms
Family Genus Species pallidum pallidum carateum Borrelia Leptospiraceae Leptospira recurrentis Subspecies Pallidum Pertenue Disease Syphilis Yaws Pinta Relapsing fever Spirochaetaceae Treponema

burgdorferi
Interrogans

Lyme disease

(Serovar) Leptospirosis Icterohaemorrha (Weil's disease) giae

Introduction
Pathogenic members of this genus include: - T pallidum

- T pertenue - T carateum

Introduction
Pathogenic treponemes are associated with 4 diseases : 1. Venereal syphilis -T pallidum pallidum 2. Yaws -T pallidum pertenue 3. Endemic syphilis (bejel) - T pallidum

endemicum 4. Pinta - T carateum

The treponemes responsible for these diseases cannot be distinguished serologically, morphologically, or by genome analysis, and they have not been successfully cultivated on artificial media.

Treponema Pallidum
Thin Motile Extremely fastidious Survive only briefly outside host Not cultivated successfully on artificial media

Transmission
Direct sexual contact with ulcerative lesions of skin or mucous membranes Trans placental:
- Typically during second half of pregnancy - As early as 6 weeks of gestation - Pregnant with primary or secondary syphilis are more likely to transmit the disease than those with latent (not clinically apparent) disease
Cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils

Spirochetes
Gram negative
long, thin, helical, motile

axial filaments
locomotion between peptidoglycan layer/outer membrane * runs parallel

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T. pallidum

Natural History of Untreated Syphilis

Clinical Presentation of Syphilis

Treponema pallidum
transmission genital/genital in utero or during birth

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Syphilis
chronic slowly progressive

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Syphilis Primer

 primary lesion - chancre 10 to 60 days

area of ulceration/inflammation many organisms

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Syphilis Secunder

 Secondary (2-10 weeks later) systemic spread flu-like symptoms skin, particularly many organisms

mouth muosa

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Latent syphilis
Patients are asymptomatic Serologic testing positive Early latent disease
Patients are potentially infectious <1 year

Late latent disease

Patients no longer infectious >1 year Longer duration of therapy recommended

Syphilis Tertier

Diagnosis Laboratorium
Mikroskopis:
Sample: kerokan lesi, biopsi, LCS Langsung Mikroskop lapangan gelap Pewarnaan:
impregnansi perak Imunofluoresens

Serologi:
Non - Treponemal test (VDRL; RPR; WR) Treponemal test (FTA-ABS; TP-PA; TPHA)

Microbiological diagnosis
not culturable dark field microscopy actively motile organisms brightly lit against dark backdrop light shines at an angle reflected from thin organisms enters objective conventional light microsrcopy light shines through NOT visualized fluorescence microscopy antibody staining

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Tes Serologi untuk Sifilis

Test
Non-specific (non-treponemal)
VDRL RPR Viral infection, collagen vascular disease, acute febrile disease, post-immunization, pregnancy. leprosy, malaria, drug misuse Diseases associated with increased or abnormal globulins, lupus erythematosus, Lyme disease, autoimmune disease, diabetes mellitus, alcoholic cirrhosis, viral infections, drug misuse, and pregnancy Conditions associated with false-positive results

Specific (treponemal)
FTA-ABS TP-PA TPHA

RPR

A definite clumping of the charcoal particles is reported as reactive (R).

No clumping is reported as non-reactive (N).

Secondary and Tertiary Syphilis - serology

screening method antibodies to cardiolipin specific diagnosis antibodies to treponemal antigen

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Autoimminty
cardiolipin
self antigen

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Treatment & Prevention:

no vaccine antibiotics (e.g. penicillin) effective

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NEISSERIA

Neisseria gonorrhoeae
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Neisseria
Gram negative diplococci (pairs of cocci) oxidase positive
culture Thayer Martin. selective chocolate agar * heated blood (brown)
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N. gonorrhoeae
the Gonococcus"
found only in man gonorrhea second most common venereal disease

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Infeksi GO

Manifestasi klinis infeksi Gonokokus

Opthalmia neonatorum

Smear
polymorphonuclear cell Gram negative cocci
many in cells

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Sediaan langsung sekret

Dissemination -gonococci
gonoccocal arthritis septic arthritis dermatitis

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Antibiotic therapy
lactamase-resistant cephalosporin e.g. ceftriaxone resistant strains common produce lactamases destroy penicillin

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Virulence Factor of Gonococcus

Pathogensis
adhesion to genital epithelium outer membrane pili *Antigenicity highly variable among strains no vaccine

IgA protease also N. meningitidis

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N. gonorrhoeae
Tissue injury lipopolysaccharide peptidoglycan

Infeksi pada feminina: Cervisitis Asimtomatik Berlanjut menjadi PID Infeksi pada maskulina: Urethritis Berlanjut menjadi epididimitis
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CHLAMYDIA TRACHOMATIS

Pendahuluan
Bakteri Gram (-), tdk mampu memproduksi enersi untuk metabolisme, tdk dapat mensintesa ATP parasit intrasel obligat atau parasit enersi Spesies:
Chlamydia trachomatis Chlamydia pneumoniae Chlamydia psittaci

C. pneumoniae dan C. psittaci digolongkan pada Genus Chlamydophila

 Mempunyai dua bentuk:

Elementary body (300 3250nm)
bentuk ekstraseluler dari chlamydia Infeksius Metabolisme tidak aktif

Reticulate body (800 1000nm)

Bentuk intrasel Chlamydia Non-infeksius Metabolisme sangat aktif

Siklus Chlamydia

 Bakteri berukuran kecil, dapat diwarnai dengan pewarnaan GIEMSA Hasil pewarnaan GIEMSA
C. trachomatis badan inklusi yang matur berwarna ungu, masa padat dekat nukleus. Pewarnaan untuk glikogen (+) Glycogen inclusion (+) C. psittaci badan inklusi merupakan agregat intrasel yang merata

Intracellular Inclusions of C. trachomatis

Serovarian
C. trachomatis 15 serovar
A, B, Ba, C K, L1 L3

C. psittaci beberapa serovar C. pneumoniae satu serovar

Infeksi Chlamydia pada Manusia

TRAKTUS GENITAL:
Laki-laki:
Urethritis, epididymitis, proctitis C. trachomatis (D K)

Perempuan
Urethritis, cervicitis, proctitis, PID C. trachomatis (D K) Aborsi, lahir mati C. psittaci

Laki-laki & Perempuan

Limfogranuloma venereum C. trachomatis (L1 L3)

Infeksi genital
Penyebab STD / PHS yang penting Disebabkan oleh C. trachomatis serovar D K Mengakibatkan sterilitas dan kehamilan ektopik Sekret genital orang dewasa yang terinfeksi self-inoculation inclusion conjunctivitis

Limfogranuloma Venereum
Disebabkan oleh C. trachomatis L1 L3 Merpakan STD, inkubasi beberapa hari s/d beberapa minggu Klinis: Papul/vesikel pad genital externa sembuh spontan limfadenopati regional lnn. Pecah discharge mukopurulen, bersifat kronis fibrosis

Lymphogranuloma Venereum

Cara penularan Chlamydia

C. trachomatis A, B, Ba, C

Manusia
C. trachomatis D - K Laki-laki

Lalat Tangan

Manusia

Perempuan

Neonatus

Cara penularan Chlamydia (lanj)

C. pneumoniae Manusia C. psittaci Manusia Burung Burung Manusia Manusia Manusia

Diagnosis Laboratorium
Sediaan langsung pewarnaan GIEMSA Kultur biakan sel dan telur berembrio Deteksi Antigen immunofluoresensi Serologi

Terapi dan Kontrol

Drug of choice:
Tetrasiklin Eritromisin Penisilin dan chloramphenicol chlamydiostatic

Pembuatan vaksin belum berhasil

HAEMOPHILUS DUCREYI

Chancroid

 Bakteri berbentuk batang kecil, pleomorfik, Gram (-), membutuhkan faktor pertumbuhan khusus untuk isolasinya Faktor pertumbuhan darah atau derivatnya Spesies penting:
H. influenzae H. aegyptius H. ducreyi H. parainfluenzae; H. aphrophilus; H. paraaphrophilus

Berdasarkan kebutuhan faktor X dan V

Spesies H. influenzae H. aegyptius Faktor X Faktor V Hemolisa + + -

H. parainfluenzae H. ducreyi
H. haemolyticus
H. parahaemolyticus

+
+ -

+ + + -

+ + -

H. aphrophilus

H. ducreyi
Penyebab penyakit menular seksual (PMS) cahncroid (soft chancre)
Ulkus yang sakit pada penis disertai limfedenitis (bubo) DD: sifilis, herpes simpleks, limfogranuloma venereum

Bakteri bentuk batang, Gram (-), membutuhkan faktor X Terapi:

Ceftriaxon im Trimetoprim, eritromisin oral 2 minggu