UG Tract Flashcards
Normal vaginal flora varies according to what changes at different ages?
Hormonal influences
What is the primary bacteria in the vaginal flora in the childbearing years?
Lactobacillus
What is the morphology and gram stain of lactobacillus? Aerobic?
Gram positive, microaerophilic rods
Does lactobacillus causes UTIs? Why/why not?
No, b/c they cannot grow in urine
What causes the low pH found in the vagina?
Lactic acid fermentation by lactobacilli
Why is lactobacillus the main organism in the vagina?
Lowers pH, killing off other bacteria
What happens to lactobacillus as women age?
Becomes less prominent
How much does menstruation change normal vaginal flora?
Transient changes
What happens with a hysterectomy in regard to the normal vaginal flora? (3 species increase)
Increase in bacteroides fragilis, E.coli, and enterococcus species
What is BV?
Dysbiosis of bacterial vaginal flora, with overgrowth of anerobic species
What happens to [Lactobacillus] in BV infections?
Lowers
What are the symptoms of BV?
Asymptomatic
Burning, itching, pain, odor
Is BV an STD?
No
What are the risk factors for BV?
Oral sex
Douching
Smoking
Sex during menses
How do you diagnose BV?
Clue cells in vaginal prep
What is the discharge associated with BV?
White-grey milky appearance
What is the whiff test?
Adding KOH and smelling Fishy odor d/t release of amines
What do clue cells look like?
Granular looking epithelial cells
Clue cells are diagnostic for what?
BV
A vaginal pH above 4.5 is indicative of what? Why?
BV d/t lack of lactobacillus
What is the Nugent score?
Numerical score based on quantifying the types of bacteria present
What are the components of an amsel criteria?
- Discharge
- Clue cells
- Whiff test
- pH test
A lower Nugent score is (normal/abnormal)?
Normal
What are the complications of BV?
- Increases the risk for HIV/other STDs
- Sepsis post surgery
- Miscarriage
What is the treatment for BV?
Oral metronidazole or clindamycin
What is vulvovaginal candidiasis caused by?
Yeast
What are the symptoms of vulvovaginal candidiasis?
Thick, odorless white vaginal discharge
Pruritus
What is the discharge associated with vulvovaginal candidiasis?
Cottage-cheese like appearance
What is the criteria for complicated candidiasis?
more than 4 in one year
What does candida look like under the microscope?
Oval, yeast like from
Pseudohyphae and aseptate hyphae
What does a germ tube indicate?
Candida albicans
What does the india ink stain indicate?
Cryptococcus neoformans
What is the most common yeast found in candidiasis?
Candida albicans
True or false: Candida albicans is normal host flora
True
What usually predisposes someone to candidiasis?
Recent Abx use
What else does Candida albicans cause? (4)
Diaper rash
Oral thrush
What are the two infections that can occur with Candida albicans in immunocompromised patients?
Esophagitis and disseminated if immunocompromised
What are the factors associated with increased susceptibiliy of candidiasis?
- Oral contraceptive use
- prego
- DM
- HIV
- Abx
How do you diagnose candidiasis?
Microscope
What is the treatment for Candidiasis?
1-3 days of topical azole
7-14 days of oral fluconazole if complicated
What is trichomoniasis?
Gross parasite that does not produce cysts
What are the symptoms of trichomoniasis? Discharge?
Yellow-green frothy, foul smelling
itching, dysuria
Men are asymptomatic or symptomatic with trichomoniasis infections? Women?
Men primarily asymptomatic
Women more often display symptoms, but still usually not
Is trichomoniasis motile?
Yes, has undulating membrane
Is trichomoniasis aerobic?
Anaerobic
Does trichomoniasis have a cyst form? What is the consequence of this?
No, only protozoa/trophozoite form
Can only spread via sexual contact
What is the pathogenesis of trichomoniasis?
Petechial hemorrhages on the cervix
Strawberry cervix is associated with what?
trichomoniasis
How do you diagnose trichomoniasis?
Seeing swimming organisms on a wet mount of discharge
Do you develop immunity to trichomoniasis?
No
What is the treatment for trichomoniasis? Who else should be treated?
Metronidazole (BOTH partners)
What is menstrual toxic shock syndrome? What is it caused by?
S. Aureus toxin production d/t tampons or wound
What is the gram stain and morphology of S. Aureus?
Gram positive cocci
Is staph catalase positive or negative? Coagulase?
Both positive
Is S. Aureus intracellular or not?
Intracellular
Does S. Auerues produce toxins? Is this relevant in toxic shock syndrome?
Yes, and yes
What is the toxin that S. Aureus produces in menstrual toxic shock? What type of toxin is it?
TSST-1
Superantigen (attaches to MHC class II)
What is the MOA of superantigens?
Binds to MHC class II, causing T cell acitvation and release of proinflammatory cytokines
What are the cytokines released in toxic shock syndrome?
TNFbeta, TNF-alpha
IL-2
What are the symptoms of toxic shock syndrome? (5)
n/v/d
Malaise
Fever
What are the signs of TSS?
Hypotension
Conjunctival erythema
Sunburn rash
Myalgias
How do you diagnose TSS?
Culture vaginal tract but NOT blood
What is the treatment for TSS?
Remove tampon
Beta-lactamase resistant PCN or vanco
What percent of pts fail to mount an antibody response to TSS? What is the consequence of this?
50%
High likelihood for recurrence, so should avoid tampon use
What are the characteristic features of trichomonas vaginalis?
Undulating membrane
Flagella
Can trichmonas vaginals survive on fomites?
No
Which gram positive cocci grows in grapes? Which smells like grapes?
S. Aureus
Smell = pseudomonas
What is erythroderma? Which disease that we discussed is associated with this?
Diffuse erythema, particularly on the soles and palms
Toxin shock syndrome by Staph Aureus toxin
