Lecture 7: Infections of the Lower Genital Tract Flashcards
HSV-2 infection in the neonate may be mild, but more commonly what course does it follow and what’s affected?
- More commonly is fulminating
- Generalized LAD, splenomegaly, and necrotic foci throught the lungs, liver, adrenals and CNS
With STD can cause cervical dysplasia and cancer; as well as vuvlvar cancer in females?
HPV
Lymphogranuloma venereum is caused by what organism?
Chalmydia trachomatis
HPV and herpes virus are associated with what type of inflammatory response?
Cytopathic-cytoproliferative reactions
What is the major infectious cause of corneal blindness in the United States?
HSV-1
What is the major cause of fatal sporadic encephalitis in the US?
HSV-1
Infection by which organism increases the risk of HIV transmission by 4-fold and increases the risk of HIV acquisition by 2-3 fold?
HSV-2
Which congenital infection may resemble erythroblastosis fetalis; infants w/ intra-uterine growth retardation, jaundice, hepatosplenomegaly, anemia, thrombocytopenia and encephalitis?
CMV –> Cytomegalic inclusion disease
L. monocytogenes infection during pregnancy can lead to what complications?
Amnionitis —> abortion, stillbirth, or neonatal sepsis
Which infection in neonates involves the formation of pyogenic granulomas distributed over the whole body; what organism is responsible?
- Granulomatosis infantiseptica
- Listeria monocytogenes
Finding of gram-positive, most intracellular bacilli in CSF is virtually diagnostic for which organism?
Listeria monocytogenes
Infants born with L. monocytogenes sepsis often have what clinical finding and what will be seen in the placenta?
- Papular red rash over the extremities (Granulomatosis infantiseptica)
- Listerial abscesses can be seen in the placenta
Untreated N. gonorrheae infection in a woman can lead to pelvic inflammatory disease which may can what 2 complications?
- Ectopic pregnancy
- Inferitility
Neonatal N. gonorrheae infection causes what?
Conjunctivitis which may lead to blindness
Which organism is responsible for causing chancroid (soft chancre) in both males and females; what is its morphology and gram stain?
Haemophilus ducreyi = Gram negative coccobacillus
Where is Haemophilus ducreyi seen most commonly?
- Tropical and subtropical areas
- Most common cause of genital ulcers in Africa and SE Asia
Who is Haemophilus ducreyi most commonly seen in?
People of lower socioeconomic status and men who have frequent sex with prostitutes
Where do most ulcers associated w/ H. ducreyi develop in females; are they painful or painless?
Vagina or periurethral area; PAINFUL erythematous papule
*Haemophilusducreyi(it’s so painful, you “do cry”)
How does the ulcer of H. ducreyi differ from that of syphillis; what is seen morphologically at the base of the ulcer?
- Ulcer is NOT indurated, and multiple lesions may occur
- Base of ulcer is covered by shaggy, yellow-gray exudate
What is seen in 50% of patients with H. ducreyi within 1-2 weeks following primary infection?
Regional LN’s become large and tender
Microscopically how does the ulcer of chancroid (H. ducreyi) appear?
Superficial zone of neutrophilic debris + fibrin w/ underlying zone of granulation tissue containing areas of necrosis and thrombosed vessels
Which organism is associated with granuloma inguinale (donovanosis) in both males and females; what is its gram stain and morphology?
Klebsiella granulomatis = Encapsulated,gramnegativecoccobacillus
Which organism endemic in rural areas of some developing countries can lead to extensive scarring, often assoc. w/ lymphatic obstruction and lymphedema (elephantitis) of the external genitalia?
Klebsiella granulomatis (aka donovanosis)
How does the lesion of granuloma inguinale begin and how does it progress over time?
- Raised papular lesion on moist stratified squamous epithelium of genitalia
- Eventually ulcerates and develops abundant granulation tissue, manifesting grossly as a protuberant, soft, PAINLESS mass
Which cause of genital ulcers if left untreated is sometimes associated with urethral, vulvar and anal strictures?
Klebsiella granulomatis
What is one major difference about the pathogenesis of H. ducreyi and K. granulomatis?
- H. ducreyi often has regional LN involvement; become large and tender
- K. granulomatis typically spares the regional LN’s
Which stain of a culture can be useful in identifying K. granulomatis; what is characteristically seen?
- Giemsa-stain shows minute, encapsulated coccobacilli (Donovan bodies) inside macrophages
- Silver stains may also be used
What is the microaerophilic spirochete that causes syphillis?
T. pallidum
What is the gram stain and unique shape of spirochetes?
Flagellated, gram negative, slender corkscrew-shaped (or spiral)
T. pallidum is too slender to be gram stained so what is used for visualization?
Silver stain and immunofluorescence techniques
Which pathological process is characteristic of all stages of syphillis?
Proliferative endarteritis of small vessels w/ surrounding plasma cell-rich infiltrate
Primary syphillis occurs about 3 weeks after infection and is characterized by what?
Single, firm, nontender, raised, red lesion (hard chancre) at site of treponemal invasion of the penis, cervix, vaginal wall, or anus
2-10 weeks after untreated primary syphilis the pt enters second stage of syphillis which is characterized by what?
- Palmar rash (palms or soles of feet) that may be maculopapular, scaly, or pustular
- Moist areas of skin i.e., anogenital region, inner thighs and axillae may have condyloma lata = broad-based, elevated plaques
- Mild fever + LAD + malaise + weight loss = common
- Asymptomatic neurosyphillis may develop
How long is the typical latent period between secondary syphillis and tertiary syphillis?
5+ years
What are the main manifestations of tertiary syphillis that may occur alone or in combination?
- Cardiovascular syphillis
- Neurosyphillis
- Benign tertiary syphillis (aka gummas)
What is the most common clinical manifestation of tertiary syphillis and what is seen?
- Cardiovascular syphillis
- Aortitis —> progressive dilation of aortic root and arch, which may cause aortic valve insufficiency and aneurysms of prox. aorta
What is the characteristic finding of benign tertiary syphillis and what are the signs/sx’s?
- Gummas in bone, skin, and mucous membranes of upper airway and mouth = nodular lesions
- Skeletal involvement causes pain, tenderness, and swelling + pathologic fractures
- Skin/mucous membranes w/ nodular or, rarely, destructive, ulcerative lesions
What are the clinical manifestations of infantile syphillis?
- Nasal discharge and congestion (snuffles) in first few months of life
- Desquamating or bullous rash –> sloughing skin, particularly of the hands and feet and around the mouth + anus
- Hepatomegaly and skeletal abnormalities = common
What is seen on histological examination of a gumma associated with tertiary syphillis?
Centers of coagulated, necrotic material and margins composed of plump, palisading macrophages and fibroblasts surrounded by large numbers of mononuclear leukocytes, mainly plasma cells
The later manifestations of congenital syphillis inculde what distinct triad?
- Interstital keratitis
- Hutchinson teeth
- CN VIII deafness
Syphillitic osteochondritis and periostitis affect all bones, but lesions of which 2 areas are most distinct and what is classically seen?
- Nose –> destruction of vomer causes collapse of bridge, later on saddle-nose deformity
- Legs –> periostitis of the tibia leads to excessive new bone growth on anterior surfaces and anterior bowing, or SABER SHIN
What is the gram stain and special feature of Chlamydia trachomatis?
Small gram-negative, obligate intracellular parasite
What are the 2 forms that Chlamydia trachomatis exists in during its life cycle and characteristic of each?
- Elementary body = infectious, metabolically inactive form, which is taken up by the host cell
- Reitculate body = metabolically active form, uses host ATP and AA’s to replicate
Lymphogranuloma venereum caused by which serotypes of C. trachomatis?
L serotype (L1-L3)
Lymphogranuloma venereum is endemic where?
Parts of Asia, African, the Caribbean region, and S. America
Characteristics of the genital ulcers and LAD seen in lymphogranuloma venereum?
PAINLESS genital ulcers, PAINFUL LAD (i.e., buboes)
Urethritis causes by C. trachomatis is characterized by what?
Mucopurulent discharge containing predominance of neutrophils
What is the characteristic morphology of the lesions and regional LN’s involvement in lymphogranuloma venereum?
- Mixed granulomatous and neutrophilic inflammatory response
- Regional LAD within 30 days, granulomatous rxn assoc. w irregular shaped foci of necrosis containing neutrophils (stellate abscesses)
- Over time extensive fibrosis + local lymphatic obstruction + lymphedema + strictures
Candida vaginitis is common in which settings?
Women who are diabetic, pregnant, or on oral contraceptives
Which sign’s and sx’s are common to Candida vaginitis?
Intense itching, erythema, swelling and a thick, curdlike discharge (“cottage cheese-like”)
What is the characteristic morphology of Candida?
Pseudohyphae and budding yeast
How is the diagnosis of Candida vaginitis made; which stain and what’s seen?
Pseudospores or filamentous fungal hyphae in wet KOH mounts of discharge or on pap smear
How do the lesions of HSV-2 on genital mucosa appear early on and describe their progression; cervical and vaginal lesions present with what?
- Red papules —> vesicles —> painful coalescent ulcers
- Cervical or vaginal lesions present w/ severe purulent discharge and pelvic pain
Smears of the inflammatory exudate of HSV-2 show what characteristic cytopathic changes?
Multinucleated squamous cells containing eosinophilic to basophilic viral inclusions w/ “ground-glass” appearance
Detection of anti-HSV antibodies in the serum is indicative of what?
Recurrent/latent infection
Which type of Molluscum contagiosum virus is most often sexually transmitted?
MCV-2
What family of viruses is Molluscum contagiosum; what is unique about its replication?
- Poxvirus; dsDNA and linear virus
- ONLY DNA virus to replicate in the cytoplasm
What is the characteristic appearance of the papules seen w/ Molluscum contagiosum infection?
- Pearly, dome-shaped w/ dimpled umbilicated center
- Central waxy core contains cells w/ cytoplasmic viral inclusion bodies
What is the morphology of Trichomonas vaginalis?
Large, flagellated ovoid protozoan
What are the common presenting signs and sx’s of Trichomonas vaginalis?
- Yellow-green, foul-smelling, frothy vaginal discharge
- Vulvovaginal discomfort + dysuria
- Dyspareunia (painful intercourse)
Which STI is associated with a fiery-red vaginal and cervical mucosa, with marked dilation of cervical mucosal vessels resulting in the characteristic “strawberry cervix” appearance?
Trichomonas vaginalis
Diagnosis of Trichomonas vaginalis is made how; use what stain?
Motile trophozoites in methylene blue wet mount, present w/ corkscrew motility
What is the gram-stain and shape of Gardnerella vaginalis?
Pleomorphic, Gram-variable bacillus
What is the typical presentation of Gardnerella vaginalis?
Present w/ thin, green-GRAY, vaginal discharge w/ fishy smell
What will a pap smear of pt with Gardnerella vaginalis show?
Superficial and intermediate squamous cells covered with shaggy coatin of coccobacilli (clue cells)
Which test for Gardnerella vaginalis will enhance the fishy odor?
Amine whiff test: mix discharge w/ 10% KOH
Pelvic inflammatory disease arising after spontaneous/induced abortions and normal or abnormal deliveries are referred to as what; most commonly caused by what organisms?
- Puerperal infections
- Typically polymicrobial: staphylococci, streptococci, coliforms, and Clostridium perfringens
How does PID causes by gonococcal infections differ from that caused by staphylococcis, streptococci, and other puerperal invaders; which is more often assoc. w/ bacteremia?
- Gonococcal shows marked acute inflammation of mucosal surfaces; spread upward to involve fallopian tubes and tubo-ovarian region
- Puerperal invaders have less mucosal involvement and more inflammation of deeper layers; spread via lymph and veins; bacteremia is a more frequent complication
What are the common signs/sx’s of PID?
- Pelvic pain + adnexal tenderness
- Fever
- Purulent cervical discharge
Which part of the female genital tract is usually spared in Gonococcal infections?
Endometrium
What are the acute vs. chronic complications which may arise from PID?
- Acute = peritonitis and bacteremia —-> endocarditis, meningitis, and suppurative arthritis
- Chronic = infertility and tubal obstruction, ectopic preg., pelvic pain, and intestinal obstruction
Which infection is associated with strikingly enlarged cells and intranuclear basophilic “owl eye” inclusions?
CMV
Lesions of genital HSV infection develop 3-7 days after transmission and are often accompanied with what systemic sx’s?
Fever + malaise + tender inguinal LAD
What is the gravest consequence of HSV infection?
Transmission to the neonate during birth (active and primary/initial infection) is assoc. w/ high mortality rate
What is a rare complication of PID that occurs almost exlusively in women?
Fitz-High Curtis Syndrome
