Genital Pathogens and STI's Flashcards
Sexually transmitted infections (STI’s)
- spread via person-to-person sexual contact
- some can be transmitted mother to baby during birth or blood products
CDC reccomendations
- yearly chlamydia and gonorrhea screenings for at risk women
- annual chlamydia screening for women age 25
- annual screening of men who have sex with men for syphilis, gonorrhea, chlamydia, and HIV
Normal urethral flora
CoNS, Corynebacteria, Anaerobes, Lactobacillus, non-hemolytic strep, Neisseria
Normal vulva and foreskin flora
Mycobacterium smegmatis, Gram-positive organisms
Prepubescent and postmenopausal female genital flora
- CoNS, Corynebacteria
- varies with pH and estrogen
Normal genital flora of reproductive age females
Enterobacteriaceae, Strep, Staph, Anaerobes (Lactobacillus), Clostridium, transient yeast
Endogenous Genital infections
result from organisms that are normal flora
Exogenous Genital infections
STI’s, result from instrumentation or foreign bodies
Primary Genital Pathogens
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Treponema pallidum
- Human papilloma virus
- Gardnerella vaginalis: bacterial vaginosis, premature labor
- Trichomonas vaginalis
- Haemophilus ducreyi
- Klebseilla granulomatis
- Mycoplasma hominis
- Ureaplasma urealyticum
- cervicitis with mucus
- PID leading to infertility
- Preterm births
Chlamydia trachomatis
- may be #1 STI
- penile malignancy, cervical carcinoma
- genital warts
Human papilloma virus (HPV)
Gardnerella vaginalis
bacterial vaginosis, premature labor, low birth rates
Trachomonas vaginalis
vaginitis
- questionable role in genital infection
- PID, pyelonephritis
- postpartum fever with morbidity and still births
Mycoplasma hominis
- acute non-gonococcal urethritis
- acute urethral syndrome in females with reproductive failure
Ureaplasma urealyticum
Organisms associated with homosexual practice
- Protozoa: Giardia, Entamoeba
- Bacteria: Salmonella, Shigella, Campylobacter, N. meningitidis
- Viruses: CMV, Hepatitis, HIV
Genital tract pathogens
- Fungi: Candida, yeast
- Viruses: CMV, HPV, Herpes
- Protozoa: Trichomonas vaginalis, scabies, lice
Genital tract infections (clinical manifestations)
- women asymptomatic
- discharge, dysuria, skin lesions
Vaginosis and Vaginitis
- inflammation of vaginal mucosa
- discharge and odor
- Trichomonas vaginalis and Candida albicans
Bacterial vaginosis
- polymicrobial or Gardnerella vaginalis
- most common vaginal infection in women of child-bearing age
Cervicitis
- inflammation of cervix
- increased number of PMN’s
- N. gonorrhoeae, C. trachomatis
HPV
- most common sexually transmitted viral disease in US
- genital warts, cervical cancer
anorectal lesions
- HPV, HSV, viruses, parasites, N. gonorrhoeae, C. trachomatis
- itching, discharge, anal pain
- proctitis: N. gonorrhoeae and C. trachomatis
- due to HIV in ICP’s
Batholinitis
- infection of glands on either side of vaginal orifice
- N. gonorrhoeae and C. trachomatis
- polymicrobial infections (commonly)
Pelvic Inflammatory Disease (PID)
- cervical microorganisms travel to endometrium, fallopian tubes and other pelvic structures
- N. gonorrhoeae and C. trachomatis
- associated with IUD’s (Actinomyces)***
Post-gyneclogic surgery infections
pelvic cellulitis or abscesses, usually from own flora
Pregnancy-associated infections
- bloodborne or ascending routes from mom to baby
- Chorioamnionitis: infection of uterus and contents during pregnancy; anaerobes, genital mycoplasmas, Group B strep, E. coli
Epididymitis
- inflammation of epididymis
- complication of gonorrhea or chlamydia
Proctitis
inflammation of rectal lining
Specimen collection
- discharge for Neisseria and Chlamydia (males and females)
- discharge for yeast, beta-hemolytic strep, Gardnerella (females)
- discharge for ureaplasma and chlamydia (males)
- urethral swab for ureaplasma, chlamydia, trichomonas (Dacron swab)
Urine specimen (organisms)
Chlamydia (males), Trichomonas (males), Neisseria gonorrhoeae
Cervical swab (organisms)
Neisseria gonorrhoeae, Trichomonas vaginalis, yeast, beta-hemolytic strep, herpes simplex
Transport
- gonococci: Stuart’s or Amie’s charcoal media
- Chlamydia and Mycoplasma: specific transport media
Gram-stain dipplococci
N. gonorrhoeae
Wet prep
T. vaginalis
10% KOH prep
yeasts (hyphae plus odor)
Clue cells
- epithelial cells surrounded by gram-positive coccobacilli
- Gardnerella vaginalis (bacterial vaginosis) is clue cell +
Gonococci media
Modified Thayer Martin, New York City agar, JEMBEC
Yeast media/serology
CNA, BAP
Hybridization assay
Gardnerella media/serology
CNA, V agar
Hybridization assay
Beta-hemolytic media/serology
CNA, BAP
Rapid antigen tests
Mycoplasma/ureaplasma media
A8 agar
Chlamydia media
Cell culture on McCoy media
Trichomonas
Diamond’s media
DFA, Hybridization assay
Hepes Simplex Virus (HSV)
- genital herpes
- extensive painful vesicles
- culture and look for cytopathogenic effect
- DFA, EIA, PCR
Syphilis (lab diagnosis)
- Darkfield microscopy and DFA
- nontreponemal antibody tests
- treponemal specific antibody tests
Chancroid
- Haemophilus ducreyi
- painful genital ulceration, bubo formation
- pleomorphic, gram-negative coccobacilli, school of fish
Lymphogranuloma venereum (LGV)
- C. trachomatis serovars L1, L2, L2a, L2b, L3
- secondary stage spreads to lymph nodes
Donovanosis
Klebsiella granulomatis
Infections of neonates
- transmitted via birth canal
- HSV, CMV
- Group B streptococcal sepsis
- Gonorrhea
- Chlamydia conjunctivitis and pneumonia
- E. coli
