GYN Infections Flashcards
Classification of Infections
- Lower genital tract infections
- Common infections not typically linked to STDs
- Vulvovaginal candidiasis
- Bacterial vaginosis
- Common STIs
- Trichomonas vaginalis
- Molluscum contagiosum
- Herpes simplex infections
- Neisseria gonorrheae
- Common infections not typically linked to STDs
- Lower & upper genital tract infections
Most common fungal species associated with human disease
Candida albicans
Candida
Clinical Diseases
C. albicans grows best on warm, moist surfaces
* Oral thrush: most common candidiasis; superficial infection of oral mucosa
* Candida esophagitis: common in AIDS patients; Sx: dysphagia & retrosternal pain; leukoplakia & pseudomembranes on endoscopy
* Candida vaginitis: common vaginal infection; frequent in diabetics, pregnant or on oral contraceptives
* Cutaneous candidiasis: diabetics & burn patients at-risk
- Common GYN infection in US
- 3/4 of women experience at least 1 episode
- 1/2 of women experience >1 episode
- In smaller % of women, condition becomes chronic with multiple relapses over several years
- Uncommon before menarche; rapidly increasing incidence in late 20s, peaking in 30s-40s
Epidemiology
Vulvovaginal Candidiasis (VVC)
- Uncontrolled DM
- Immunosuppression
- Steroid / antibiotic use
- Oral contraceptive use
Predisposing Factors
Vulvovaginal Candidiasis (VVC)
- Intense vulvar pruritis
- Dysuria
- Erythema
- Edema
- White vaginal discharge with curd-like appearance
Signs & Symptoms
VVC
White curd-like discharge = hallmark; “candidus” = dazzling white
VVC
Approach to Diagnosis
- KOH wet prep / Pap smear
- Culture
- Branching pseudohyphae & yeast forms
- “Shish kabob” appearance
Pap smear
Candida
“Shish kabob”: tangles of squamous cells around pseudohyphae
Bacterial vaginosis (BV)
Complex change in normal vaginal flora
* Decreased: lactobacilli
* Increased:
* G. vaginalis
* Mobiluncus spp.
* Mycoplasma hominis
* Anaerobic Gram-negative belonging to genera Prevotella, Porphyromas, Bacteroides
* Peptostreptococcus spp.
- Frothy gray vaginal discharge with pH > 4.5
- Foul, “fishy” odor that is more noticeable following intercourse & during menses
Signs & Symptoms
BV
Most common cause of vaginal discharge
BV
Approach to Diagnosis
- Vaginal pH: >4.5
- Wet prep / Pap smear: clue cells; absence of lactobacilli & WBCs
Dense, evenly distributed collections of bacterial rodlike forms in squamous cells
Pap smear
BV
- Clue cells
- Fishy odor when KOH is added
Wet prep
BV
* Clue cells = epithelial cells entirely covered with bacteria, giving cell a “furlike” appearance
* Fishy odor: due to release of amines by anaerobic bacteria (whiff test)
- Purulent yellow-green discharge
- “Strawberry cervix”
Trichomonas vaginalis
“Strawberry cervix” = fiery red vaginal & cervical mucosa
Trichomonas vaginalis
Approach to Diagnosis
- Microscopy of vaginal secretions: low sensitivity
- Wet prep
- Pap smear
- Culture: most sensitive commercially available method
Rapid movement & flagella
Wet prep
Trichomonas vaginalis
- Indistinct, ghostly appearance
- Pale oval nucleus
- Faint red granules
Trichomonas vaginalis
Discrete, dome-shaped, pink-colored papules
Signs & Symptoms
Molluscum contagiosum
Molluscum contagiosum
Approach to Diagnosis
- Clinical appearance is diagnostic in most cases
- Diagnosis can be confirmed via biopsy or cytologic inspection of debris expressed from center of lesion
- Epithelial hyperplasia with formation of a cup-shaped lesion
- Large, roiunded, homogenous cytoplasmic inclusions
- Peripheral pyknotic nuclei
Histology
Molluscum contagiosum
Most common STD worldwide
HS
HSV-2 (genital herpes)
- Red papules that progress to vesicles and then painful coalescent ulcers
- Vulvar lesions: clinically apparent
- Cervica / vaginal lesions: present with severe purulent discharge & pelvic pain
- Urethral lesions: painful uirination & urinary retention
HSV
HSV
Approach to Diagnosis
- Usually clinically apparent
- Confirmatory tests:
- Serology
- Tissue culture
- Direct immunofluorescene
- Molecular rechniques
- Reliable & rapid identification can be made using smears of vesicles (Tzanck preparation) & immunofluorescence mAbs
- Multinucleation
- Miolding of nuclei
- Margination of chromatin
- Ground glass nuclei
- Eosinophilic intranuclear inclusions
Histology
HSV
Triple M
- Urethritis
- Purulent urethral discharge
Signs & Symptoms
Neisseria gonorrheae
Men
- Blindness
- Pharyngitis
- Sepsis
Signs & Symptoms
Neisseria gonorrheae
Neonates
- Endocervical infection with urethritis
- Bartholin’s & Skene’s glands inections
- Pharyngeal & rectal infections
- Spontaneous abortion; placental abruption
Signs & Symptoms
Neisseria gonorrheae
Women
- Septic arhritis (asymmetric)
- Low grade fever
- Rash of hemorrhagic papules & pustiules
- Tenosynovitis
- Migratory arthralgies
Signs & Symptoms
Neisseria gonorrheae
Disseminated
Neisseria gonorrheae
Approach to Diagnosis
- Direct detection: microscopt
- Antigen detection
- Nucleic acid-based methods
- Culture
