CHANCROID

Epidemiology of Chancroid
Chancroid occurs especially in tropical countries. Very rare in Europe or North America.

Pathogenesis
The pathogenesis of chancroid is poorly understood, but the organism is thought to gain access through minute breaks in the mucosal epithelium. The organism is drained to the regional lymph nodes but does not disseminate further in the body. The organisms remain localized in the superficial layers of the ulcer.
Complications list for Chancroid: The list of complications that have been mentioned in various sources for Chancroid includes:

Abscess Scarring Complications and sequelae of Chancroid from the Diseases Database include:

Genital ulcers Inguinal lymphadenopathy VDRL positive Gram negative bacilli / rods Sexually transmissable disease

Complications include urethral fistulas and scars on the foreskin of the penis in uncircumcised males.

CHLAMYDIA

EPIDEMIOLOGY:

Trachoma is prevalent in Africa and Asia, generally in hot and dry areas. The organisms are very persistent. Their habitat is similar to that of Neisseria and Haemophilus.

Infection can occur via swimming in unchlorinated pools, sharing towels or by passage through the birth canal.

Chlamydia causes more than 250,000 cases of epididymitis in the U.S. each year. Chlamydia causes 250,000 to 500,000 cases of PID every year in the United States. Women infected with chlamydia are up [21] to five times more likely to become infected with HIV, if exposed.

PATHOGENESIS:

C. trachomatis is spread via the fingers to the urogenital area and vis versa. In contrast, C. psittaci is acquired from infected birds, usually via the respiratory route. Trachoma is an infection of the epithelial cells of the conjunctiva, producing inclusion bodies. Vascularization and clouding of cornea along with trichiasis (inward growth of eyelashes) can produce scarring that may lead to blindness. Inclusion conjunctivitis is a milder form that occurs in both children and adults. This form generally heals without scarring or blindness. Sexually transmitted nongonococcal urethritis (NGU) is similar to gonorrhea and occurs with greater frequency. In 1997, approximately 320,000 cases were reported to the Centers for Disease Control. In men, a condition termed lymphogranuloma venereum (LGV) involving inguinal lymphadenopathy ("buboes") can occur. Psittacosis is a respiratory disease ranging from influenza-like to pneumonia-like and is generally acquired from infected birds.

Chlamydia Complications
Chlamydia complications typically affect women more than men. In women, untreated infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease. This may cause permanent damage to the fallopian tubes, uterus, and surrounding tissues, which can ultimately lead to chronic pelvic pain, infertility, and ectopic pregnancy. Chlamydia complications among men are uncommon, but may include pain, fever, and, in rare cases, sterility.

Prevention: All sexually active persons should consider being tested for Chlamydia in order to stop transmitting it and to decrease the likelihood of complications such as pelvic inflammatory disease. Latex condoms used consistently and correctly are an effective means for preventing disease (and pregnancy). Talk openly with your partner about STDs, HIV, and hepatitis Binfection, and the use of contraception.
Chlamydia prevention can include abstaining from sex, using protection during intercourse (such as a condom), and getting tested for sexually transmitted diseases at least once a year. Know the symptoms of chlamydia as well, such as burning during urination or discharge. Recognition of the symptoms may also be beneficial in chlamydia prevention and understanding.

GONORRHEA

EPIDEMIOLOGY:

N. gonorrhoeae normally colonizes mucosal surfaces. Humans are the only host and transmission is via sexual contact. The probability of acquiring disease from a single exposure varies: in men, the probability is about 25%; in women, the probability is about 40%; in women taking oral contraceptives, the probability is about 100%. Gonorrhea occurs worldwide and generally affects persons aged 15-29.

N. meningitidis inhabits the human nasopharynx. There is a 3-30% normal carrier state lasting days to months that provides the reservoir for infection of susceptible persons. Attack rates are highest in children (usually less than one year old) and sporadic epidemics do occur.

PATHOGENESIS:

Gonorrhea is a sexually transmitted disease. The sites of infection include the urethra (in men) and the cervix (in women). Fimbriae (pili) are very important for the gonococcus to attach to host cells. N. gonorrhoeae lacking fimbriae are avirulent. A substance called Protein I makes up 66% of the outer membrane protein of N. gonorrhoeae. This protein is antigenic and is used as the basis of some serological tests. N. gonorrhoeae produce cytotoxic substances that damage ciliated epithelial cells in fallopian tubes; the LPS endotoxin may be partly responsible. N. gonorrhoeae also produce an extracellular protease that cleaves a proline-threonine bond in immunoglobulin IgA. This causes loss of antibody activity. Approximately 9-15% of affected women contract Pelvic Inflammatory Disease (PID) as a consequence of gonorrhea. This is often a polymicrobic infection involvingBacteroides and other anaerobes. The virulence of N. meningitidis is associated with its antiphagocytic capsule. The meningococcal LPS is as toxic as Escherichia or Salmonella and causes suppression of leukotriene B4 (a chemokinetic/chemotactic factor) synthesis in PMNs. Untreated, meningococcal meningitis has a mortality approaching 85%. N. meningitidis produces proline-threonine and proline-serine proteases, but any particular isolate will only produce one or the other.