45 - Genitourinary Infections Flashcards
What genus is predominant in normal vaginal flora during childbearing years?
Lactobacillus
Lactobacillus features
Gram-positive, microaerophilic/anaerobic rods
Cannot grow in urine (no UTIs)
How does Lactobacillus affect the conditions of the vagina?
Metabolize glycogen into lactate, resulting in vaginal pH of ~4-5
Factors that can alter normal vaginal flora
Age
Menstruation
Hysterectomy
Hysterectomy affects on normal vaginal flora
Particular increase in prevalence of Bacteroides fragilis
Also increase in E. coli and Enterococcus
Bacterial vaginosis (BV) cause
Overgrowth of anaerobic bacterial species
BV symptoms
May be asymptomatic
Discharge
Odor
Pain
Itching
Burning
BV diagnosis
Discharge
Clue cells
Positive “whiff test”
Elevated vaginal pH
Nugent score
Whiff test
Volatile amines produced by anaerobic metabolism
KOH added results in a strong, fishy odor
Nugent score
0-3 = normal (Lactobacillus dominant) 4-6 = intermediate (mixed)
7-10 = BV (absence of Lactobacillus, predominance of two other morphotypes)
Complications associated with BV
STD-susceptible
Increased transmission of HIV
More likely to develop other infections
Effects on baby during pregnancy
BV treatment
Oral metronidazole
Clindamycin
Recurrence is common
Vulvovaginal candidiasis (VVC) symptoms
Common fungal infection in women of childbearing age
Thick, odorless, white vaginal discharge
Two classifications of VVC
Uncomplicated
Complicated
Uncomplicated VVC
Sporadic or infrequent mild-to-moderate symptoms in otherwise healthy patient
Complicated VVC
Recurrent or severe
Non-albicans candidiasis
Uncontrolled diabetes, debilitation, or immunosuppression
Candida species features
Oval, yeastlike forms
Produce buds, pseudohyphae, and hyphae (GERM TUBES diagnostic for C. albicans)
Common symptoms of C. albicans
Vaginitis
Diaper rash
Oral thrush
When are C. albicans infections most common?
After taking antibiotics
C. albicans diagnosis and treatment
KOH microscopy reveals hyphae and budding yeast
1-3 days of topical azole for uncomplicated VVC
7-14 days of topical, or two doses of oral fluconazole for complicated VVC
Trichomoniasis symptoms
Most women are asymptomatic
Symptoms range from vaginitis, painful urination, yellow-green, frothy, foul-smelling discharge
Men are primarily asymptomatic carriers, but can have some UT problems
Trichomonas vaginalis features
Small, pear-shaped protozoa
Motile
Rigid axostyle (attachment)
Anaerobic
ONLY exists in trophozoite form
Pathogenesis of T. vaginalis
Squamous epithelium of GU tract results in epithelial cell destruction, neutrophil influx, and petechial hemorrhages
T. vaginalis diagnosis and treatment
Detection of T. vaginalis in exudate or Pap smear
Metronidazole - treat both partners
