STI’s Flashcards
1
Q
A woman is brought to the clinic complaining of vaginal discharge and RUQ abdominal pain. On history, the patient reports having many sexual partners. Pelvic exam reveals cervical motion tenderness and labs of vaginal discharge detect numerous polymorphonuclear leukocytes but no organisms on gram stain. The doctor makes a diagnosis based on these findings and administers doxycycline and ceftriaxone. Later, surgeons, concerned about the patient’s abdominal pain, perform alaparoscopy and find adhesions around the patient’s liver
capsule.
A
Chlamydia trachomatis
2
Q
Urethritis Cervicitis
Pelvic Inflammatory Disease
Whose the culprit of theses STI’s
A
Neisseria gonorrhea
Chlamydia trachomatis
Mycoplasma
Ureaplasma
3
Q
Pain with urination (dysuria) Feeling urge to urinate frequently Pain during sex (dyspareunia) Discharge from the urethral opening or vagina. In men, blood in the semen or urine
A
Urethritis
4
Q
Urethritis Causal organisms
A
Gonococcal Neisseria gonorrhea
Non-gonococcal Chlamydia and Mycoplasma Trichomonas vaginalis Herpes simplex virus Escherichia coli
5
Q
What are the symptoms for Cervicitis?
A
unusual vaginal discharge Frequent, painful urination
Pain during sex
Bleeding between menstrual periods Vaginal bleeding after sex, not associated with a menstrual period
6
Q
Cervicitis Causal organisms
A
Gonococcal Neisseria gonorrhea
Non-gonococcal Chlamydia, Trichomonas
7
Q
Pelvic inflammatory disease PID symptoms
A
Pain in the lower abdomen; Fever
unusual, foul smelling vaginal discharge
Pain and/or bleeding during sex Burning micturition Bleeding between periods.
8
Q
Pelvic inflammatory disease PID Causal organisms
A
Gonococcal Neisseria gonorrhea
Non-gonococcal Chlamydia
9
Q
Which three STI’s has casual agent gonorrhea
A
Cervicitis
Urethritis
PID
10
Q
How is gonorrhea transmitted
A
almost exclusively by sexual contact with an infected person including vaginal, oral, and anal intercourse
11
Q
Can gonorrhea spread from mother to child during brith and if so what is most affects the ______ called
A
Yes,
Eyes called ophthalmia neonatorum
12
Q
What are the complication of gonorrhea
A
PID(salpingitis, endometritis)
Disseminated gonococcal infection
13
Q
Risks for getting gonorrhea which there are many give the one that was highlighted in the PPT
A
Terminal complement deficiency
14
Q
What is the morphology of gonorrhea
A
Gram -ve diplococci
Coffee bean shaped
No capsule
Oxidase +
Ferment glucose
NG=glucose +
Grow on Thayer martin , chocolate agar
Selective medium with antibiotics (vancomycin, Colsitin, Nystatin)
15
Q
What is the VF for gonorrhea
A
Pilus
Pro protein
Opa proteins
LOS
Rpm proteins
IgA protease
Iron binding proteins(siderophores)
16
Q
Why do some patients present with repeated gonococci infection and no immunity?
A
Surface structures like pili, Opa proteins and LOS indigo Antigenic variation
Genes coding for pili switched off or on
17
Q
Neisseria gonorrhea
Primarily infects
A
mucus membranes of the urethra and cervix
may infect mucus membranes of rectum, oropharynx and conjunctivae
Does not infect post pubertal vaginal epithelium
18
Q
Pre puberty STIs
A
Non keratinized vaginal epithelium (Not keratinized in the absence of estrogen) is susceptible Vulvovaginitis in a child maybe indicative of (sexual abuse)
19
Q
Post Puberty STI’s
A
Gonococcal infection limited to
columnar epithelium of urethra, cervix, rectum, pharynx and conjunctiva
Keratinized Squamous epithelium (under the influence of estrogen) is not susceptible in post pubertal women (vagina not infected)
20
Q
What is the incubation period for symptoms of gonorrhea
A
2-5 days after exposure
21
Q
What are the symptoms of men with gonorrhea
A
• painful urination (dysuria)
• yellow or greenish pus discharge
from the tip of the penis
• swelling or pain in the testicles or
scrotum (epididymitis)
• swelling or redness at the
opening of the penis
22
Q
What are the symptoms for women with gonorrhea
A
• Increased vaginal discharge watery, creamy or greenish yellow
• painful sexual intercourse (dyspareunia)
• painful or frequent urination
• abdominal or pelvic pain
• vaginal bleeding between periods
• Bleeding after intercourse
23
Q
Gonorrhea symptoms in extragenital sites
A
• Anal itching
• straining during a bowel movement
• pus like discharge from the rectum
• tissue stained with blood
• eye pain
• pus like discharge from one or both eyes
• sensitivity to light
• sore throat this is usually acquired from
performing an oral sex on an infected partner
• Swollen inflamed lymph nodes in the neck
24
Q
Infections caused by N. gonorrheae
A
25
Complication caused by N. gonorrhea
26
Infections that ascends from the cervix or vagina to involve fallopian tubes and endometrium
Pelvic inflammatory disease
27
DGI result of gonococcal bacteremia presents with a triad of
Fever bacteremia
Tenosynovitis arthritis
Pustular necrotic skin lesions(dermatitis)
28
What are lab diagnosis tests
NAAT(nucleic acid amplification test
PCR-polymerase chain reaction
Urine sample
Bacterial culture on selective medium NYC medium
Gram stain
29
What is the treatment of gonorrhea
Single dose of Ceftriaxone injection
30
What is the treatment for urethritis/ cervicitis
Ceftriaxone injection +doxycycline
31
Prevention/ reducing the risk of gonorrhea
Barrier protection
32
non gonococcal urethritis
Most prevalent bacterial STI in the USA
Chlamydia trachomatis
33
silent disease
Chlamydia trachomatis
34
untreated chlamydia can lead to significant complications such as –
• pelvic inflammatory disease in women 40% ( salpingitis, endometritis)
• infertility women (scarring of reproductive structures)
• Ectopic pregnancy
• Reitters syndrome
35
Risks for getting Chlamydia infection
• having oral, anal or vaginal sex with a person who is infected
• multiple sex partners
• younger age (teenage or young adult)
• previous chlamydia diagnosis
• having other sexually transmitted infections
• new sex partners
• Men who have sex with men
• Use of alcohol or illicit drug use
36
Obligate intracellular bacteria (antimicrobial and immune response) ?
Chlamydia trachomatis- bacteria
37
Chlamydia trachomatis- bacteria morphology
Obligate intracellular bacteria (antimicrobial and immune response) ?
• Depend on host cell for ATP, NAD. Energy parasite
• No peptidoglycan (antimicrobial and immune response)
• Cannot be stained by Gram stain, so demonstrated by Iodine, Giemsa and
Fluorescent stain
• Cytoplasmic membrane, double layered outer membrane
• Outer membrane has weak LPS/ endotoxin like activity
• MOMP major outer membrane protein
• Undergo unique development in the host cytoplasm as inclusions
38
Obligate intracellular bacteria Undergo unique development in the host cytoplasm as inclusions
Chlamydia trachomatis
39
Larger intracellular form, metabolically active and replicates within target cell.
No ATP; depend on target cell
RB- reticulate body ( seen as cytoplasmic inclusions) (4)
40
Smaller extracellular infectious form metabolically inert and resistant
EB- elementary body
41
Obligate intracellular bacteria
• No peptidoglycan
• Cannot be stained by Gram stain
• Cytoplasmic Inclusions
(reticulate bodies) are demonstrated by Iodine, Giemsa and Fluorescent stain
Giemsa stain
Chlamydia trachomatis- demonstration
42
Chlamydia trachomatis- pathogenesis
Tropism for epithelial cells of the
endo-cervix and upper genital tract of women
urethra, rectum and conjunctiva
Infect non ciliated columnar epithelial cells of mucous membrane which have receptors for EB (elementary body)
43
Infect non ciliated columnar epithelial cells of mucous membrane
Release of proinflammatory cytokines (IL-1, IL-6,IL-8,IL-12, TNF-a attract
neutrophils, macrophages, lymphocytes, plasma cells and eosinophils persistent infections leads to
aggregates of lymphocytes and macrophages (lymphoid follicles in the sub mucosa)
chronic sequelae of progressive inflammation with scarring and fibrosis seen in the genital tract and conjunctiva
Blocked fallopian tubes-infertility
Chlamydia trachomatis- pathogenesis
44
Cervicitis, urethritis, proctitis, conjunctivitis, pneumonia (in neonates) which serotype of chlamydia trachomatis
D-K
45
Lymphogranuloma venereum what is the serotype
L1, L2, L3
46
Chlamydia urethritis- cervicitis symptoms men
• painful urination (dysuria)
• Clear or purulent discharge from
the tip of the penis
• swelling or pain in the testicles or
scrotum (epididymitis)
• swelling or redness at the
opening of the penis
47
Chlamydia urethritis- cervicitis symptoms women
• Increased vaginal discharge watery, creamy or greenish yellow
• painful sexual intercourse (dyspareunia)
• painful or frequent urination (dysuria)
• abdominal or pelvic pain
• vaginal bleeding between periods
• Bleeding after intercourse
48
symptoms in extragenital sites Chlamydia trachomatis
• Anal itching
• straining during a bowel movement
• pus like discharge from the rectum
• tissue stained with blood
• eye pain
• pus like discharge from one or both eyes
• sensitivity to light
• sore throat this is usually acquired from
performing an oral sex on an infected partner
• Swollen inflamed lymph nodes in the neck
49
Infections caused by Chlamydia trachomatis D-K
50
Chlamydia trachomatis D-K infections in females
51
Chlamydia trachomatis D-K infections in males
52
Chlamydia trachomatis D-K infections complications
53
Autoimmune condition
Urethritis- conjunctivitis- asymmetric arthritis
May occur during or shortly after a genital chlamydial infection Clinical findings: mainly urethritis, conjunctivitis, asymmetric polyarthritis may include oral ulcers, uveitis, rashes, inflammation of the sacroiliac joints, cardiac and neurologic complications. Reactive arthritis occurs more commonly in men linked to the HLA-B27 genotype; persons with HLA-B27 may have a more aggressive clinical course.
Reiter’s syndrome SARA- Sexually Acquired Reactive Arthritis
54
Laboratory diagnosis- tests Chlamydia
NAAT nucleic acid amplification test
PCR- polymerase chain reaction
Urine sample
swab
Fluorescent antibody
Giemsa stain
Iodine stain
Chlamydia antigen test
Gram stain ( only inflammatory cells no organisms seen) important clue
55
Treatment for Chlamydia trachomatis D-K
Doxycycline 100mg or Azithromycin 500mg
56
Treatment for urethritis/ cervicitis Treatment for Chlamydia trachomatis D-K
Ceftriaxone injection 500 mg + doxycycline 100mg
57
Non gonococcal urethritis (NGU) Mycoplasma
58
VF for Chlamydia
Virulence: obligate intracellular, use host ATP EB (infective) and RB (inclusions)
No peptidoglycan-not gram stained
59
Sexually transmitted genital ulcers
60
Caused by bacteria called Treponema pallidum
A Spirochete Spiral bacteria
Syphilis
61
_________ is a chronic, systemic infectious disease that is sexually transmitted or by other intimate contact
The ________ bacteria can remain dormant in the body for decades if not treated. It can then become active again.
If left untreated, ________ can severely damage the heart, brain and other organs and even be life threatening.
Who am I?
Mr. Syphilis
62
Syphilis- transmission
most common mode of transmission is through sexual contact with the infected person. intimate contact of skin-skin or mucus membrane to mucus membrane bacteria can enter the body through compromised skin, such as through minor cuts or abrasions in the skin. Thus, transmissible through direct contact with an active lesion during kissing
also be transmitted from a mother to her fetus, resulting in congenital syphilis
63
Syphilis- increased risk transmission
• having oral, anal or vaginal sex with a person who is infected
• multiple sex partners
• younger age (teenage or young adult)
• having other sexually transmitted infections
• Having HIV infection
• new sex partners
• Men who have sex with men
• Use of alcohol or illicit drug use
64
Treponema pallidum characteristics
Morphology - thin, spiral shaped
Motility - corkscrew motility, internal endo-flagella(axial filament)
Cell wall- cannot be stained seen in Gram stain
Cannot be cultured on artifical media
65
the great imitator Clinical manifestation changes frequently and easily Protean manifestation
If left untreated, syphilis is a chronic disease that spreads through out the body hematogenously and can produce manifestations in virtually every organs system
Syphilis- the great imitator
66
Syphilis- symptoms
characterized by 4 stages- 1. Primary
2. Secondary 30-90 days after exposure
3. Latent 4-10 weeks after initial infection
4. Tertiary - 3-15 years after initial infection
with varied symptoms associated with each stage
67
presents with a firm, painless, small, and highly infectious sore called chancre
chancre appears at the spot where the bacteria enters the body ( vagina, penis, mouth, rectum, anus)
usually develops 3 weeks after exposure
Primary chancre on tongue with clean base and rolled up edges
Syphilis- primary stage symptoms
68
Syphilis- secondary stage symptoms
presents with a non-itchy, coppery rash that begins on the trunk and eventually spreads to the entire body, including the palms and soles
Flat, moist, lesions on mucus membranes (condylomata latum) highly infectious
may also be accompanied by hair loss (alopecia), muscle aches, a fever, sore
throat (pharyngitis), and swollen lymph nodes (lymphadenopathy)
symptoms can resolve a few weeks after they appear, or repeatedly come and go for as long as a year
69
Syphilis- latent stage symptoms
W/o symptoms
70
Damage due to chronic inflammation of multiple organs including the brain, nerves, eyes, liver, bones, heart, and joints.
blindness, deafness, mental illness (general paresis of the insane), memory loss, destruction of soft tissue and bone (gumma- granuloma), neurological disorders such as stroke, heart disease (aortitis, endarteritis) meningitis, neurosyphilis (tabes dorsalis)
Syphilis- tertiary stage symptoms
71
Syphilis- tertiary stage symptoms
72
Syphilis- pathogenesis
Adhere to mucosal membrane (fibronectin, laminin)
Organism coated with fibronectin,
Resist phagocytosis and immune recognition
Multiply at the initial site to large numbers
Produce hyaluronidase facilitates tissue invasion
Spread to other organs through blood stream; skin, endothelium, cartilage, bones, joints, mucosa
73
Syphilis-pathogenesis
Granulomatous infections who are the immnune cells
Chancres and rash have intense inflammatory infiltrate of lymphocytes (TH1 CD4 & CD8), macrophages and plasma cells surrounding the bacteria in all stages of syphilis
74
Syphilis Laboratory diagnosis-tests
Serology
PCR
Direct microscopy
75
What two types of antibodies are produced Syphilis
Non treponemal antibodies -produced in response to tissue damage from inflammation; useful in prognosis of tx; become negative after tx
Treponemal antibodies -produced against bacteria, useful in confirming dx, remain positive after tx
76
Which test use cardiolipin as antigen
Non treponemal test
VDRL, RPR test
77
Which test use FTA-ABS
Treponemal test for specific test and confirmatory test
78
Dark field microscopy is use from which casual antigen
Primary Syphilis due to they do not stain by gram stain
Secondary syphilis use DFA-TP
79
What are the laboratory diagnosis-sensitivity of various test for Syphilis
80
Treatment for syphilis
Penicillin injections
If allergic to penicillin Doxycycline
or Azithromycin
81
Soft, tender ulcers
Deep punched out ulcers, irregular edge, red margin, not indurated
Painful inguinal lymphadenopathy
Chancroid – soft chancre- Hemophilus ducreyi
82
Chancroid – soft chancre- Hemophilus ducreyi is seen where and in which population the most common
Seen in Africa, Asia, Caribbean, South America, southern states of N. America
Mostly seen among men who have sex with men (MSM)
Increased risk of getting HIV infection
83
Gram-negative coccobacilli in railroad track or school of fish pattern
Chancroid – soft chancre- Hemophilus ducreyi
84
Morphology: gram negative rods Grows on chocolate agar
Chancroid – soft chancre- Hemophilus ducreyi
85
Virus characteristics DNA virus
Enveloped Herpesviridae family Alphaherpes subfamily
Genital herpes herpes simplex virus-2
86
Genital herpes-transmission
Easily pass from person to person through contact with the moist skin of the mouth and genitals (vesicle/ulcer fluid).
• spread through contact with other areas of the skin and the
eyes.
• The virus is most contagious between the time when
symptoms first appear and when they heal.
• Less commonly, a person can transmit the virus when
symptoms are not present (asymptomatic).
• If a woman with genital herpes has sores while giving birth,
the virus can pass on to the baby (congenital transmission).
• The tissue in a woman's vagina is more prone to small tears,enabling the virus to enter easily
87
Herpes simplex virus-2 pathogenesis
Enters through break in skin or mucus membrane
• Multiplies locally in the tissue
• Lytic infection of host cells
• Retrograde transport along nerve
axons
• Remains latent/ dormant in the
dorsal ganglion ( not whole virus
only DNA)
• Later, certain triggers, such as
stress, illness, exposure to sunlight, and menstruation can make the virus active again (reactivation)
• virus return down (anterograde) the
axons to skin causing another
88
Giant cells syncytium in Tzank smear
Herpes simplex virus-2
89
Presents as painful vesicular lesions, and ulcers on mucus
membrane and skin of the penis, around or inside the vagina, on the thighs, buttocks or the anus
Pain, tingling, and itching, burning micturition, vaginal discharge swollen lymph nodes, fever, malaise and fatigue
Genital herpes symptoms
90
Genital herpes symptoms incubation period
Incubation period- 2-12 days
91
Genital herpes laboratory diagnosis
PCR- polymerase chain reaction (gold standard)
Vesicle/ ulcer fluid collected with a swab
Blood sample
Look for virus antigen by immunofluorescence
Tzank smear for HSV infected multinucleated giant cells
92
Genital herpes treatment
Acyclovir (nucleoside analog) 400mg Inhibits DNA polymerase can prevent the virus from multiplying and thus reducing the severity of symptoms.
Valacyclovir 500 mg
93
Genital ulcer- lymphogranuloma venereum (LGV) cause? Symptoms
C. trachomatis L1, L2, L3
• Africa, SEAsia, South America, India and
Caribbean
• Painless primary lesion on genitals
• Fever, headache, myalgia
• Inflammation, swelling of inguinal lymph nodes (suppurative inguinal adenitis; buboe)
94
Genital ulcer- lymphogranuloma venereum (LGV)
Complications
• Ulcers, multiple draining fistula, genital elephantiasis,
• Proctitis, proctocolitis, perirectal abscess (MSM)
• Doxycycline
95
Donovanosis- granuloma inguinale caused by
Caused by
Klebsiella granulomatis formerly Calymmatobacterium granulomatosis
96
Donovanosis- granuloma inguinale
Clinical manifestation
Morphology
Epidemiology
97
Gram negative cocco bacilli seen within cytoplasmic vacuole of monocyte from granulation tissue of genital lesion
Klebsiella granulomatis
98
• Most common sexually transmitted disease
• Cervical dysplasia and neoplasia
• Benign ________
• Anogenital ___________ (condylomata _________)
• Laryngeal papilloma
Genital warts Human papilloma virus (HPV)
99
Human papilloma virus characteristics
• Double stranded DNA virus
• Circular DNA
• Non enveloped
• Encode proteins that promote cells growth (E6 to p53), (E7 to p105RB)
• Lytic infection and Oncogenic transformation
100
Serotypes Human papilloma virus
• Cervical neoplasia and cancer (16,18)
• Condyloma acuminatum (6, 11)
• Laryngeal papilloma (6,11)
• Benign skin warts (1,2,3,4,5, 8,10)
101
Transmission Genital warts Human papilloma virus (HPV)
Direct contact
• Through abrasions on skin and mucus membrane
• Sexual contact
• Passage through genital tract (laryngeal papilloma)
Who is at risk Pathogenesis
102
Who is at risk HPV
• Sexually active
• Early age sexually active
• Multiple sexual partners/number
• Co-factors: smoking, oral contraceptives, folate deficiency
103
Pathogenesis HPV
• Cervical neoplasia and cancer (16,18)
• Condyloma acuminatum (6, 11)
• Laryngeal papilloma (6,11)
• Benign skin warts (1,2,3,4,5, 8,10)
104
Virus replicates in stratum granulosum and stratum corneum
HPV
105
Virus reach stratum basale (basal keratinocytes )
HPV
106
HPV assembly and release in the
Stratum corneum
107
HPV Vision genome amplification initiation of late gene expression initiation of virion assembly
Stratum granulosum
108
HPV induced hyperplasia where
Stratum spinosum
109
Where does HPV infection uncoating early transcription establish and maintence of viral genome take place
Stratum basale
110
Benign papillomatous, pedunculated, sessile growth throughout the anogenital area
Appear weeks to months after contact
Flesh to gray colored, hyper- pigmented, erythematous and in groups
Large perianal warts in HIV/AIDS patients
Laryngeal papilloma
Benign epithelial tumor of larynx
Infection occurs during birth
Life threatening if it obstructs airways
Condylomata acuminata
111
Flesh to gray colored, hyper- pigmented, erythematous and in groups
Large perianal warts in HIV/AIDS patients
HPV
112
Cervical dysplasia micro
Cytological changes indicating HPV infection
Koilocyte and superficial desquamated epithelial cells on a Papanicolau smear
Koilocyte: Cell with perinuclear halo (vacuolated cytoplas
113
Histo HPV
Histology: hyperplasia of prickle cells
Hyperkeratosis
PAP smear: Koilocyte
Molecular: DNA probe
PCR of cervical swabs, tissue
114
HPV Tx
Podophyllin
Imiquimod (immunology)
Interferon Cidofovir Cryotherapy
115
HPV Prevention
Human recombinant vaccine:
Gardasil-9v (HPV- 6,11,16,18, 31,33,45,52, 58)
Cervarix (HPV-16,18)
For girls, boys before sexual activity
116
Molluscum contagiosum is a________
• Pox viridae
• Double stranded DNA
• Enveloped
• Replicates in the cytoplasm
• Carries its own DNA polymerase enzyme
117
Molluscum contagiosum Poxvirus transmission
• Infection occurs after breakage of skin
• Sexual contact
• Wrestling
• Sharing of fomites, towels
118
Pathogenesis Molluscum contagiosum
• Virus replicates in lower layers of epidermis, extends upwards
• Epidermis hypertrophies
• Characteristic inclusions
(Henderson-Paterson bodies, or molluscum bodies) are formed in the cytoplasm of the prickle cell layer and gradually enlarge as cells age and migrate to the surface
119
Pearl like, umblicated nodules 2-10mm diameter with a central caseous plug which can be squeezed out
Trunk, genitalia, thighs, extremities
AIDS disseminated lesions
Molluscum contagiosum Poxvirus
120
• Intracytoplasmic inclusions
• Replicates in the cytoplasm
Histo _____________?
Molluscum contagiosum Poxvirus
121
Lesions: Pearl like, umbilicate nodules 2-10mm diameter with a central caseous plug which can be squeezed out
Seen on trunk, genitalia, thighs, extremities
MOLLUSCUM CONTAGIOSUM
122
Double stranded DNA
Enveloped
Replicates in the cytoplasm
Carries its own DNA polymerase enzyme
MOLLUSCUM CONTAGIOSUM
123
Transmission: through breakage of skin Sexual contact
Wrestling
Sharing of fomites, towels
MOLLUSCUM CONTAGIOSUM
124
Histopathology: hypertrophied epidermal cells, cytoplasm occupied by a large acidophilic granular inclusion mass (the molluscum body), project above the skin to appear as a wart like lesion
MOLLUSCUM CONTAGIOSUM
125
Serotypes: Cervical neoplasia and cancer (16,18) Condyloma acuminatum (6, 11)
Laryngeal papilloma (6,11)
Benign skin warts (1,2,3,4,5, 8,10)
Lytic infection and Oncogenic transformation
GENITAL WARTS Human papilloma virus
126
DNA Virus
Non enveloped Squamous cell Carcinoma
Human papilloma virus
DNA Virus
127
Transmission: Direct contact through abrasions on skin and mucus membrane
Sexual contact
Passage through genital tract (laryngeal papilloma)
Human papilloma virus
128
At risk: Early age sexually active
Multiple sexual partners/number
Co-factors: smoking, oral contraceptives, folate deficiency
Human papilloma virus
129
PAP smear: Koilocyte cell with perinuclear halo (vacuolated cytoplasm)
Human papilloma virus
130
Who keeps the vagina acidic
Lactobacilli
131
A decline in lactobacilli causes
Vaginosis
132
Gram positive anaerobic rods
Gardnerella vaginalis
Bacterial vaginosis- cause
133
Bacterial vaginosis- symptoms
Presents as excessive malodorous, thin white, grey white discharge with fishy odor
Milky clings to vaginal walls
Odor worsens after sexual intercourse
Vaginal itching, burning during urination
Vaginal pH> 4.5
Vaginal epithelium appear normal
134
Bacterial vaginosis- risk factors
Reduced lactobacilli ( antibiotics) Multiple sex partners
Unprotected sex
Vaginal douching
Intrauterine device
Higher incidence among women who
have sex with women (increased risk by 60%)
135
Bacterial vaginosis- diagnostic criteria
1. Presence of Clue cells ( at least 1in 5 vaginal epithelial cells with edges
obscured by bacteria )
2. Vaginal pH > 4.5
3. Whiff test positive: Amine odor spontaneously or after addition of 10% KOH to vaginal fluid
4. Thin homogenous discharge
136
Gram stain of clue cell (vaginal epithelial cell whose margins are obliterated with numerous
Gardnerella bacteria causing vaginosis
137
Bacterial vaginosis- treatment
Clindamycin 150 mg
Metronidazole 250 mg
138
Vulvovaginits whose the culprit
Trichomoniasis
Trichomonas vaginalis
139
Vulvo vaginitis- Trichomonas vaginalis symptoms
Malodorous, frothy, purulent, greenish yellow vaginal discharge
Vaginal itching, burning Dysuria
Pain during intercourse
Asymptomatic infection common
Infection often seen mixed with gonorrhea and chlamydia
140
Vulvo vaginitis- Trichomonas vaginalis symptoms
Erythematous vaginal epithelium Fiery red cervix
Strawberry cervix
Marked dilation of cervical mucosal vessels
141
Trichomonas vaginalis risk factors
Multiple sexual partners
A history of other sexually
transmitted infections (STIs)
A previous episode of trichomoniasis Sex without a condom
142
Trichomonas vaginalis complications
Increased risk of getting and spreading HIV and other STI
Pregnant women deliver too early (prematurely)
Have a baby with a low birth weight
Give the infection to the baby as the baby passes through the birth canal
Increased risk of cervical or prostate cancer.
Untreated, trichomoniasis infection can last for months to years.
143
Morphology: Protozoan, Flagellate
Trophozoites: Ovoid, leaf like, anterior tuft of 4 flagella Undulating membrane
No cyst stage
Who am I?
Vulvo vaginitis Trichomonas vaginalis characteristics
144
Trichomonas vaginalis laboratory diagnosis tests
Vaginal discharge swab
NAAT- (Nucleic acid amplification technique PCR- polymerase chain reaction
Urine sample
145
Wet mount of vaginal fluid mixed with saline
Move with a jerky motion
Trichomonas vaginalis laboratory diagnosis
146
Trichomonas vaginalis Treatment
Metronidazole 250 mg
Tinidazole Treat both partners
147
Vaginal thrush Candidiasis predisposing factors
Candida albicans
148
Candidiasis symptoms
Intense pruritis: vaginal itching Thick, curdy, cottage cheese like or white- creamy, odorless discharge
Erythematous vaginal mucosa Excoriated mucosa
Pain during urination or sex
149
Candida albicans Morphology
Oval yeast like budding cells Buds called blastospores
Elongated buds with constriction called pseudohyphae
Elongated buds without constrictions- true hyphae- germ tubes at 37C in serum
150
Candida albicans laboratory diagnosis
Gram stain
Vaginal discharge
Culture on Sabourauds agar
151
Candida albicans treatment
Oral ketoconazole Oral itraconazole
Oral fluconazole Topical- Miconazole Clotrimazole Nystatin
152
Females: malodorous thin yellowish green frothy discharge
Numerous pus cells
pH >4.4
Vaginal erythema
Straw berry cervix
Microscopy of discharge: Motile flagellates seen Lab: NAAT
Treatment: Metronidazole
TRICHOMONAS VAGINALIS
153
Females: Malodorous fishy odor vaginal discharge
Milky- greyish and clings to the vaginal wall Homogenous adherent
Vaginal pH alkaline pH >4.4
Microscopy: Clue cells with numerous bacteria Test: Positive whiff test: Fishy amine odor add 10% KOH to the vaginal fluid; release volatile amines; fishy odor)
GARDNERELLA VAGINALIS
154
Pruritic, cheesy, curdy discharge Erythema and burning
Normal pH 4.3 or less
Predisposing factors Antibiotics use Immunosuppression Diabetes
Elderly
Morphology: Budding yeast cells and pseudohyphae seen
Treatment: Azoles
CANDIDA ALBICANS VAGINAL THRUSH
155
Pruritic dermatitis caused by Itch mite (Sarcoptes scabei) that live on within skin
Female Mite burrows, tunnels through the stratum corneum and lays eggs
Transmitted through skin to skin contact, clothing
Scabies - itch mite - ectoparasite infection
Sarcoptes scabei
156
Scabies - itch mite - ectoparasite infection
Manifestation
Pruritic tracks or papules seen on web of palms, wrists, axillary folds and genitals.
Rash and itching due to delayed type hypersensitivity to mite, eggs and excreta
157
Scabies - itch mite - ectoparasite infection
Treatment
Permethrin Crotamiton Ivermectin (oral)
