Lec 3 Vulvovaginal

Question 1

What type of genital ulcer is associated with dysuria in a US patient?

Answer 1

herpes –> cause urethritis

Question 2

What type of genital ulcer is associated with patients from 3rd world countries?

Answer 2

hemophilus ducreyi = chancroid

Question 3

What kind of tissue line vagina?

Answer 3

stratified squamous mucosa with overlying muscular wall and outer adventitia

Question 4

What is outer labia?

Answer 4

made of skin

Question 5

What is role of glycogen in vagina?

Answer 5

synthesized by vaginal epithelium –> thickens epithelium and is main nutrient for normal vaginal flora [lactobacilli]

Question 6

What is normal vaginal pH?

Answer 6

3.8-4.2

Question 7

What should you think if mucopurulent discharge with bleeding?

Answer 7

vaginal cancer

Question 8

What are causes of chemical vaginitis?

Answer 8

• sanitary supplies
• feminine hygiene supplies
• excessive sexual ativity

Question 9

What is most common cause of bacterial vaginitis?

Answer 9

gardnerella vaginalis

Question 10

What is morphology of gardnerella vaginalis?

Answer 10

facultative gram variable anaerobe

normally comprises small percent of vaginal flora

Question 11

What are symptoms of gardnerella vaginosis?

Answer 11

itching and burning

scant grayish to milky white, fishy discharge

Question 12

What do you see on histology in gardnerella?

Answer 12

• on saline wet mount of secretions see clue cells = epithelial cells w/ bacteria studding the surface

Question 13

What bug is associated wtih clue cells?

Answer 13

gardnerella vaginosis

Question 14

What test can you do to diagnose gardnerella?

Answer 14

amine test = add KOH to discharge and reaction will release fishy odor

Question 15

What is pH of gardnerella discharge?

Answer 15

higher [alkaline] = 5.0 - 5.5 [normal 3.8 - 4.2]

Question 16

What is treatment for gardnerella vaginosis?

Answer 16

metronidazole or clindamycin

Question 17

What are clinical symptoms of candida vanigitis?

Answer 17

• erythematous skin, normal cervix
• dysuria = burning w/ urination
• thick cheesy discharge

Question 18

When do you get candida vanititis?

Answer 18

when you have systemic disorder, pregnancy, use of antibiotics/oral contraceptives

Question 19

What do you see on histology in candida vaginitis?

Answer 19

fungal hyphae in discharge on silver, methylene blue, or PAS stain
wet mount + KOT –> can see hyphae

Question 20

What are clinical symptoms of trichomonas vaginalis?

Answer 20

• profuse froth green smelly discharge

- cervical-vaginal petechial lesions = strawberry cervix

Question 21

What is treatment for trichomoniasis?

Answer 21

metronidazole + TREAT PARTNER

Question 22

What is pH of vagina in trichomoniasis?

Answer 22

pH > 4.5 ~ 6

Question 23

What is morphology of trichomonas?

Answer 23

uniflagellar protozoans

Question 24

What do you see on wet mount wtih trichomoniasis?

Answer 24

pear shaped motile organisms = can see them darting back and forth

Question 25

What bug causes anogenital warts?

Answer 25

HPV

Question 26

What 2 types of infections cause mucopurulent endocervicitis?

Answer 26

- neisseria gonorrhea | - chlamydia trachomatis D-K

Question 27

What is clinical presentation of gonorrhea?

Answer 27

can be asymptomatic can cause urethritis w/ copious pus-like discharge = more visible in males than females inflammation, redness, dysuria, burning in urination

Question 28

What is a potential adverse effect of untreated gonorrhea in females?

Answer 28

can ascend and cause pelvic inflammatory disease leading to infertility [from scarring of fallopian tubes]

Question 29

What is pathogenesis of gonorrhea?

Answer 29

produces IgA protease that promotes virulence

Question 30

What test to diagnose gonorrhea?

Answer 30

gram stain shows gram negative diplocci | culture or DNA test

Question 31

What is treatment for gonorrhea?

Answer 31

ceftriaxone or cephalosporins

Question 32

What two diseases associated with chlamydia?

Answer 32

chlamydia D-K: mucopurulent cervicitis, PID chlamydia L1-L3: lymphogranuloma venereum = painless papule followed by inguinal lymphadenopathy

Question 33

What is lymphogranuloma venereum?

Answer 33

small painless ulcers on genitals from chlamydia L1-L3 --> leads to swollen painful inguinal lymph nodes that ulcerate

Question 34

What is morphology of chlamydia trachomatis?

Answer 34

obligate intracellular bacteria

Question 35

What is effect of neonatal chlamydia infection?

Answer 35

trachoma [eye infection] and pneumonia --> can lead to blindness

Question 36

What are some complications of untreated chlamydial infection?

Answer 36

can lead to PID --> fallopian tube scarring, increased risk ectopic pregnancy, adhesion formation

Question 37

What are some complications of untreated lymphogranuloma venereum?

Answer 37

ulceration and hypertrophy of genitalia, fistula formation

Question 38

What is primary lesion in syphillis?

Answer 38

painless chancre

Question 39

How does secondary syphilis prsent?

Answer 39

diffuse rash of trunk + palms of hands and soles of feet; conyloma latum = broad whiteish wart like lesion w/in 4-10 weeks of primary infection

Question 40

How does tertiary syphilis present?

Answer 40

gummas, neuro, or cardiac signs [aortic aneurysm formation]

Question 41

How do you test for syphilis?

Answer 41

non-treponemal test [VDRL] and RPR

Question 42

What is treatment for syphilis?

Answer 42

intramuscular penicillin

Question 43

What are clinical symptoms of chancroid?

Answer 43

painful papule that ulcerates inguinal lymph nodes may swell and break through skin = buboes usually occurs in 3rd world country

Question 44

What does chancroid look like on histology?

Answer 44

school of fish appearance

Question 45

What is morphology of hemophilus ducreyi?

Answer 45

gram negative streptobacillus

Question 46

What is granuloma inguinale?

Answer 46

donovanosis = chronic bacterial infection see in tropics and subtropics due to klebsiella granulomatous infection

Question 47

Who is more likely to get granuloma inguinale?

Answer 47

same sex oriented men

Question 48

What is clinical presentation of granuloma inguinale?

Answer 48

painless gentical nodules that may ulcerate | no inguinal lymphadenopathy

Question 49

What is test to diagnose granuloma inguinale?

Answer 49

biopsy with wright-giemsa stain = gold standard | see macropahges that contain intracellulra red bacilli = donovan bodies

Question 50

What is the most common cause of genital ulcers in the US?

Answer 50

HSV-2

Question 51

How do you diagnoses HSV?

Answer 51

scrape lesion and do tzanck stain --> see multinucleated giant cells

Question 52

What is clinical presentation of herpes?

Answer 52

painful penile, vulvar, or cervical vesicles or ulcers | can have systemic symptoms -- fever, malaise, headache, myalgia

Question 53

What are the low risk vs high risk types of HPV?

Answer 53

low risk = 6, 11 | high risk = 16, 18 --> integrate into host DNA

Question 54

What two viral genes get disrupted when HPV integrates into host genome? effect?

Answer 54

E6 --> degrades p53 | E7 --> interferes w/ cyclin A and p105 RB = regulators of cell cycle progression

Question 55

What do you see on histology with HPV?

Answer 55

koilocytes = perinuclear cytoplasmic clearing [halo] with raisinoid nucleus

Question 56

What do you see clinically with HPV?

Answer 56

condylomata acuminata = cauliflowerlike lesions

Question 57

What is lichen sclerosus?

Answer 57

type of vulvular dystrophy --> itchy patchy white, thin skin = parchement paper

Question 58

What is treatment for lichen sclerosus?

Answer 58

corticosteroids for symptom relief

Question 59

What does vulvar/vaginal dysplasia suggest?

Answer 59

suggests HPV infection