Introduction to the Female Genital Tract (Embryo, Anatomy, STI) Flashcards
What is the female reproductive system derived from?
- Mesoderm
- Primordial germ cells
- Coelomic epithelium
- Mesenchyme
What are the three main groups of the female reproductive system?
- Gonads
- Reproductive ducts
- External genitalia
When does the uterus form?
- During Müllerian organogenesis accompanied by the development of the upper third of the vagina, cervix, and both fallopian tubes
Which duct is the ovary derived from?
- Mesonephric duct (Wolffian duct)
- Mesonephros
Which duct is the upper third of the vagina, cervix, both fallopian tubes, and the uterus derived from?
- Paramesonephric duct
- Müllerian duct
What are some anomalies that occur due to Müllerian duct fusion?
- Bicornuate uterus
- Uterus didelphys
What is Mayer-Rokitansky-Küster-Hauser syndrome?
- A disorder that occurs in females and mainly affect the reproductive system
- Causes the vagina and uterus to be underdeveloped or absent although external genitalia are normal
What is the karyotype of someone with MRKH syndrome?
- 46XX (normal)
Why does someone with MRKH syndrome still develop external genitalia?
- The ovaries are working allowing for hormones to still be produced
What does the vulva include?
- Mons pubis
- Labia majora
- Labia minora
- Clitoris
- Urethral opening
- Vaginal opening
- Perineum
Who can infectious diseases affect?
- Elderly
- Immunocompromised
- Debilitating chronic diseases
- Inadequate access to health care
- Malnutrition
What are the different types of inflammatory responses to infection?
- Suppurative (purulent) inflammation
- Mononuclear and granulomatous inflammation
- Cytopathic-cytoproliferative (viral change)
- Tissue necrosis
- Chronic inflammation and scarring
How are infectious agents diagnosed?
- Gold standard has been culture
- Now it is biologic or serologic identification
- PCR
- Molecular methods
Who is most likely to be infected with HSV2?
- Women more than men due to it being easier to transmit from men to women during penile-vaginal sex
- More common among non-hispanic blacks
What systemic symptoms show up in a HSV infection?
- Fever
- Malaise
- Tender inguinal lymph nodes
When do the systemic symptoms show up in a HSV infection?
- Only 1/3 of individuals are symptomatic
- Show up 3 to 7 days after transmission
What is the earliest lesion in HSV infection?
- Red papules that progress to vesicles and then to painful coalescent ulcers
- Easily visible on vulvar skin and mucosa, while cervical and vaginal lesions present with severe purulent discharge and pelvic pain
What is a simple screening test for HSV?
- Tzanck Smear test
What is important to remember about HSV?
- It is a latent virus meaning that it will persist indefinitely
- Any decrease in immune function as well as stress, trauma, UV radiation, and hormonal changes can trigger reactivation of the virus and recurrence of the skin and mucosal lesions
What is the neonatal transmission of HSV associated with?
- High mortality
What does HHV-1 cause?
- Herpes simplex type 1
What does HHV-2 cause?
- Herpes simplex type 2
What does HHV-3 cause?
- Varicella-Zoster
What does HHV-4 cause?
- Epstein-Barr
What does HHV-5 cause?
- Cytomegalovirus
What does HHV-6/7 cause?
- Exanthem subitum
- Roseola infantum
What does HHv-8 cause?
- Kaposi sarcoma
What is CMV and what are some modes of transmission?
- Variety of manifestations depending on age of the host and immune status
- Transplacental transmission (congenital)
- Neonatal transmission (perinatal)
- Genital transmission
What is the characteristic histologic appearance for CMV?
- Prominent intranuclear basophilic inclusions spanning half the nuclear diameter
- Owl eye appearance
What does disseminated CMV cause?
- Focal necrosis with minimal inflammation in virtually any organ
What is congenital CMV?
- 95% are asymptomatic
- If primary maternal infection, it causes cytomegalic inclusion disease that looks clinically like erythroblastosis fetalis
How does an infant with congenital CMV look?
- Intrauterine growth retardation
- Hepatosplenomegaly and jaundice
- Anemia
- Bleeding due to thrombocytopenia
- Encephalitis/microcephaly
What are some ways of vertical transmission for CMV?
- Placental-fetal transmission
- Transmission during birth (birth canal)
- Postnatal transmission (breast milk)
How will patients present with infectious diseases?
- Asymptomatic
- Rash
- Pruritus
- Odor
- Discharge
- Pain
- Mass/lesion
- History of recurrence or medical condition, infertility
What is chlamydial infections due to?
- C. trachomatis
- A small gram negative bacterium that is an obligate intracellular pathogen
- Exists in two forms
What is the infectious form of chlamydia called?
- The elementary body which differentiates into a metabolically active form called the reticulate body
What are the diseases caused by C. trachamatis infection associated with?
- Different serotypes of the bacteria
What serotypes cause urogenital infections and inclusion conjuctivitis?
- D to K
What serotypes cause Lymphogranuloma venereum?
- L1, L2, and L3
What serotypes cause ocular infections of children and trachoma?
- A, B, and C
What is the most common bacterial STI in the world?
- Genital infection by C. trachomatis
What is an elementary body?
- Metabolically inactive infectious form in endosome
What is a reticulate body?
- Metabolically active form
What is the clinical presentation of C. trachomatis?
- Usually asymptomatic in women
- PID major complication
What are the best tests for C. trachomatis?
- Urine or swabs for nucleic acid amplification test (NAATs)
What is Neisseria gonorrhoeae?
- Aerobic bacteria with stringent growth requirements
- Organisms adhere to and invade non-ciliated epithelial cells
How does Neisseria gonorrhoeae present?
- Women are often asymptomatic
- Untreated women may develop PID
- Also can infect anus/rectum and pharynx
What are some complications of PID?
- Cervicitis
- Vulvovaginal abscess
- Fitz-Hugh-Curtis syndrome
What is Fitz-Hugh-Curtis syndrome?
- PID causes bowel obstruction, bacteremia/sepsis, peritonitis
- Common symptoms include: severe pain in RUQ, fever, chills, headaches, and malaise
What can disseminated gonorrhea cause?
- Septic arthritis accompanied by a rash
What is dissemination of gonorrhea associated with?
- Lack of complement proteins that form the MAC
What is syphilis?
- A “chronic” sexually transmitted disease with varied clinical and pathological manifestations
- Treponema pallidum is too slener to be seen on gram staining but can be visualized by silver stains and immunofluorescence techniques
What lesion is associated with syphilis?
- Chancre
- Occurs on the penis or scrotum in 70% of men and on the vulva or cervix in 50% of women
What does a chancre look like?
- Nontender, slightly elevate firm, reddened papule, up to several centimeters in diameter, that erodes to create a clean based shallow ulcer
- Leads to a button like mass adjacent to the chancre
What is seen on histologic exam for syphilis?
- Proliferative endarteritis affecting small vessels with a surrounding plasma cell-rich infiltrate is characteristic of all stages of syphilis
- Regional nodes are usually enlarged due to nonspecific acute or chronic lymphadenitis, plasma cell-rich infiltrates, or granulomas
What is seen in primary syphilis?
- Chancre
What is seen in secondary syphilis?
- Palmar rash
- Lymphadenopathy
- Condyloma latum
- Neurosyphilis (asymptomatic)
What is the stage after secondary syphilis?
- Latent syphilis
What is seen in tertiary syphilis?
- Neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, general paresis
- Aortitis: aneurysms, aortic regurgitation
- Gummas: Hepar lobatum, skin, bone, others
What is seen in the infantile form of syphilis?
- Rash
- Osteochondritis
- Periostitis
- Liver and lung fibrosis
Shat is seen in the childhood form of syphilis?
- Interstitial keratitis
- Hutchinson teeth
- Eighth nerve deafness
What are some ulcerative sexually transmitted infections?
- Treponema pallidum
- Chancroid
- Granuloma inguinale
- Chlamydia serovars L1-L3 –> Lymphogranuloma venereum
What is a chancroid (soft chancre) caused by?
- Haemophilus ducreyi
- Found in the tropics and subtropics
Who usually has a chancroid?
- People of lower socioeconomic groups
- Men who have sex with prostitutes
When does the chancre develop in chacroid?
- 4 to 7 days after inoculation
What does the chancre look like in chancroid?
- Tender erythematous papule involving external genitalia
- In males, primary lesion is on the penis
- In females, most lesions occur in the vagina or the periurethral area
What happens to the primary lesion in chancroid?
- It erodes and produces an irregular, painful ulcer
- Base of the ulcer is covered by shaggy, yellow-gray exudate
What happens 1 to 2 weeks after inoculation of chancroid?
- Regional lymph nodes enlarge and become tender
What can happen if chanroid is not treated?
- Enlarged nodes may erode the overlying skin to produce chronic, draining ulcers
What is granuloma inguinale?
- Sexually transmitted chronic inflammatory disease caused by Klebsiella granulomatis (minute, encapsulated coccobacilli)
What happens in untreated cases of granuloma inguinale?
- Development of extensive scarring
- Often associated with lymphatic obstruction and lymphedema of the external genitalia
How is diagnosis of granuloma inguinale made?
- Microscopic examination of smears or biopsy samples of the ulcer
What is lymphogranuloma venereum?
- L serotypes
- Sporadic in US, endemic in Africa, Asia, South American, Caribbean
What does lymphogranuloma venereum look like?
- Starts as small papule on genital mucosa or skin
- 2-6 weeks later draining swollen nodes
- Can cause fibrosis and strictures in anogenital tract
What is vulvobaginal candidias?
- Intense vulvovaginal pruritus, erythema, swelling, pain/dysuria/dyspareunia
- Thick white vulvovaginal discharge described as “curd-like or cottage cheese-like”
How is diagnosis made for vulvovaginal candidias?
- Inspection
- KOH test
- Pap smear
What is the pathogenesis of candidias?
- It is normally there
- When you change the ecosystem (like lose the lactobacilli), it allows the yeast to infiltrate
Where else is a candida infection seen?
- Most common fungal infection in patients with AIDS and infection of the oral cavity, vagina, and esophagus are it most common clinical manifestations
What causes trichomonas vaginalis?
- Large flagellated ovoid protozoan
What is the presentation of someone with trichomonas vaginalis?
- Asymptomatic or,
- Frothy yellow vaginal discharge
- Dysuria
- Dyspareunia
What will be seen on exam with trichomonas vaginalis?
- Fiery red vaginal and/or cervical mucosa (strawberry cervix)
What is Gardnerella vaginalis?
- Gram negative coccobacillus
- Main cause of bacterial vaginosis
How do patients with gardnerella vaginalis present?
- Thin, green-gray malodorous (fishy) vaginal discharge
What doe pap smears reveal in gardnerella vaginalis?
- Superficial and intermediate squamous cells covered with a shaggy coat of coccobacilli
What is molluscum contagiosum?
- Cutaneous or mucosal lesion caused by poxvirus
How is molluscum contagiosum transmitted?
- In children 2-12, through direct contact or shared articles and most commonly affects the trunk, arms, or legs
- In adults, sexually transmitted and affect the genitals, lower abdomen, buttocks, and inner thighs
How is diagnosis made for molluscum contagiosum?
- Characteristic clinical appearance of pearly, dome-shaped papules with a dimpled center
What are the TORCH infections?
- Toxoplasma
- Other (syphilis, HIV, listeria, VZV, parvovirus B19)
- Rubella
- Cytomegalovirus
- Herpes
What are the clinical presentations of the TORCH infections?
- Fever
- Encephalitis
- Chorioretinitis
- Hepatosplenomegaly
- Pneumonitis
- Myocarditis
- Hemolytic anemia
- Skin lesion
