Other genitourinary tract infections Flashcards
What is the primary vaginal bacteria genus during childbearing years?
Lactobacillus
What is the gram stain for lactobacillus?
Gram positive
What is the oxygen requirement for lactobacillus?
Microaerophilic or anaerobic rods
What is the shape of lactobacillus?
Rods
Why doesn’t lactobacillus cause UTIs?
Cannot grow in presence of urine
How does lactobacillus create an intravaginal environment of pH 4-5?
Metabolizes glycogen to lactic acid
Which bacteria are found in women who develop pelvic infections following a hysterectomy?
- Bacteroides fragilis 2. E. coli 3. Enterococcus spp.
Overgrowth of what type of bacteria is seen in bacterial vaginosis?
Anaerobic
Reduction in what bacteria is seen in bacterial vaginosis?
Lactobacillus
What are the symptoms of BV?
- Discharge, odor, pain, itching, burning 2. Can by asymptomatic
What are the Amsel criteria for BV diagnosis?
- Discharge - white or gray 2. Clue cells in microscopy 3. Positive whiff test - fishy amines upon KOH prep4. pH > 4.5
What are complications of BV?
- HIV infection and transmission risk increase 2. Post-op infection 3. Preterm delivery, miscarriage, post-partum infection4. Susceptibility to other STIs
What is the treatment for BV?
- Oral metronidazole (anaerobes, parasites) 2. Clindamycin (gram+ cocci, anaerobes)
What is the discharge for vulvovaginal candidiasis?
Thick, odorless, white (cottage cheese)
What is the identification of candida species in VVC?
Yeast form producing buds, pseudohyphae, and phyphae (gram stain or KOH)
VVC is generally seen in what populations?
- Local or generalized immunosuppression, or favorable overgrowth conditions 2. Oral contraceptives, pregnancy, diabetes, systemic corticosteroids, HIV infection, antibiotic use
What is the diagnosis for VVC?
- Microscopy with KOH - visualization of hyphae and budding yeast 2. Cultures with Nickerson medium if candida is suspected but not demonstrated
What is the treatment for VVC?
- UNCOMPLICATED: 1-3 day regimen of topical azole 2. COMPLICATED: 7-14 day topical regimen or 2 doses of oral fluconazole 3 days apart
What is the discharge for trichomoniasis?
- Symptomatic - yellow-green, frothy, foul smelling 2. Asymptomatic / mild - scant, watery discharge
What are the symptoms of trichomoniasis?
Mild to severe vaginitis, itching, burning, dysuria
Are men typically symptomatic or asymptomatic for trichomoniasis?
Asymptomatic
What is the shape / appearance of trichomonas vaginalis?
Small pear-shaped protozoa with 4 anterior flagella and an undulating membrane for motility
What is the oxygen requirement for trichomonas vaginalis?
Anaerobic
In what form(s) does trichomonas vaginalis exist?
Only trophozoite
What is the pathogenesis for trichomonas vaginalis?
- Contact with epithelium of GU tract then destruction of epithelial cells 2. Neutrophil influx and petecchial hemorrhages
What is the appearance of the cervix during a trichomonas vaginalis infection?
“Strawberry cervix”
Which infection presents with a “strawberry cervix”?
Trichomonas vaginalis
Does trichomonas vaginalis infection confer immunity?
No
What is the diagnosis for trichomonas vaginalis?
- Detection of swimming T. vaginalis in exudate 2. Pap smear for asymptomatic individuals
What is the treatment for trichomonas vaginalis?
Metronidazole for BOTH partners
What is the cause of toxic shock syndrome?
S. aureus
What is the gram staining for S. aureus?
Gram positive
What is the catalase rating for S. aureus?
Positive
What is the coagulase rating for S. aureus?
Positive
What is the shape of S. aureus?
Cocci in clusters
What is responsible for the systemic effects of toxic shock syndrome?
TSST-1
What is the virulence of TSST-1 in toxic shock syndrome?
- Heat- and proteolysis-resistant exotoxin 2. Superantigen
What is responsible for the hypotension and shock associated with toxic shock syndrome?
TNFa and TNFb release
What is released by macrophages in response to TSST-1?
IL-1B and TNFa
What is released by T cells in response to TSST-1?
IL-2, IFNy, TNFb
What is responsible for the fever associated with toxic shock syndrome?
IL-1B
What are the main /common symptoms associated with toxic shock sydrome?
Diarrhea, general ill-feeling, high fever / occasional chills, nausea, vomiting
What are the major criteria for toxic shock syndrome diagnosis?
Hypotension, orthostatic syncope, systolic BP 38.8C, late skin desquamation on hands, and feet, very high creatine phosphokinase levels
What is the treatment for toxic shock syndrome?
- B-lactamase-resistant penicillin or vancomycin 2. Supportive - fluids
