Question

BIOL 2267 Ch. 21- Genitourinary Tract Infections The patient was a 15 year-old male who was brought to the emergency room by his sister. He gave a 24-hour history of dysuria and noted some "pus-like" discharge in his underwear and from the tip of the penis. His urine appeared to be clear, and a urine culture was negative, although urinalysis was positive for leukocyte esterase and multiple WBC upon microscopic examination of the urine sample. He gave a history of being sexually active with 5 or 6 female partners over the past six months. He claimed that he and his partners were free of STIs. His physical examination was significant for a yellow urethral discharge and tenderness at the tip of the penis. A Gram stain of the discharge is shown in Figure 1. He was given antimicrobial agents and scheduled for a follow-up visit one week later. He did not return Figure 1: Gram stain of the penile discharge form the patient obtained upon admission.

Answer 1

1. In my view, the patient is infected with the HIV virus and the gram staining is not only reliable in detecting the organism and the gram staining is not only helpful in diagnosing the organism from the cervical specimen of the women.

2. Due to the HIV infection mostly the patient shows a negative urine culture and as well as the urinalysis shows a positive for leukocyte esterase and the presence of WBC in microscopic examination.

3. The patient is being sexually active with a 5-6 female sexual partner and one of the women is in the window period of HIV infection and the patient has got an infection with the partner who is in window period of infection.

4. The virulence factors that are responsible for his symptoms are depletion in CD4+ T-cells and exhausted immunity.

5. According to history, he is a 15-year old male and during the past 6 months he is sexually active with 5-6 females and he is at risk for infection with HIV virus. He is advised for a follow-up visit why because the organism is not detected at the initial period of infection. For the confirmation of the diagnosis and to detect the organism he is advised for the follow-up.

6. In the emergency room, he was given or initial with the antiviral agents.

Over the last 30 years, clinicians, researchers and policymakers have debated the ideal CD4 threshold for starting ART. During the late 1990s, treatment was expensive and associated with significant drug toxicity. Most drug combinations were less robust, carrying a higher risk of causing drug resistance, there were fewer treatment options and the decision about when to start treatment needed to balance benefits against the significant risks. The prevailing view during this period was that rates of disease progression and death were low at a CD4 cell count greater than 200 cells/mm3, and any drug exposure above this threshold could result in severe and unnecessary side-effects or development of drug resistance at a time when alternative treatment options were limited.

7. No. There is currently no vaccine available that will prevent HIV infection or treat those who have it. Vaccines against HIV are being developed, and they are in various stages of the clinical trial.