9. Robbins: Chapter 22 Vulva, Vagina and Cervix Flashcards
(85 cards)
Embryologically, how are fallopian tubes formed?
Upper portions of mullerian ducts do not fuse.
When the LOWER portion of the mullerian ducts fuse, what does this form?
- uterus
- cervix
- upper vagina
- Endometriosis is a _______-derived lesion
Mullerian
Persistance of the mesonephric ducts form what?
- Gartner duct cysts = Epithelial inclusions in the cervix and vagina t
- Paratubal cysts = Epithelial inclusions next to the ovaries, tubes, and uterus;
What type of epithelium lines the female genital tract and the surface of the ovary?
Coelomic epithelium (mesothelium)
Buzzwords for the following common CURABLE STIs (include types in discharge, if possible)
- Chlamydia trachomatis
- Neisseria gonorrhea
- Trichomonas vaginalis
- Gardnerella vaginalis
- Ureaplasma urealyticum, mycoplasma hominis
- Chlamydia trachomatis =
- pelvic inflammatory disease;
- Serous discharge
- Neisseria gonorrhea =
- Pelvic inflammatory disease (most serious complication of gonorrhea in women);
- Purulent discharge
- Gram (-) diplococci within neutrophils (PMNs)
- Trichomonas vaginalis
- Large, ovoid protozoa w flagella;
- Yellow, frothy discharge;
- “Strawberry cervix”
- Gardnerella vaginalis
- Gram (-) baccili
- Main cause of bacterial vaginosis
- Thin grey/green fishy discharge
- Ureaplasma urealyticum, mycoplasma hominis
- Seen in pre-term deliveries
Which infections of the female genital tract cause:
- Discomfort, without serious complications
- Infertility
- Occur if bb is delivered pre-term
- Candida, Trichomonas, Gardnerella
- Gonorrhea and chylamydia
- Ureaplasma urityiculum and mycoplasma homonis
Herpes Simplex Virus (HSV)
- Commonly involves: _______
- _____ => oropharyngeal infection
- _____ => infection in the genital mucos and skin.
- Cervix > vagina > vulva
- HSV1 => oropharyngeal infection
- HSV2 => infection of the genital mucosa and skin
How does HSV (herpes simplex virus) present?
- Lesions on cervix > vagina > vulva
- 1/3 of newly infected females show painful red papules 3-7 days after infection with fever, malaise, and tender inguinal lymph nodes
- => vesicles
- => coalesce into painful ulcers
- If on cervix or vagina: + purulent discharge & pain
- If on vulva: easily seen
- If next to urethra: dysuria
- => spontaneously in 1-3 weeks
- => however, infection remains latent in lumbosacral ganglia
- => reactivated due to stress, trauma, UV light, hormonal changes (skin & mucosal lesions
- Purulent discharge
- Pelvic pain

ALL males with HSV are _____.
Symptomatic
HSV
- Contains what intranuclear inclusions?
- Morphology?
- Cowdry bodies
- Morphology
- Ulcer is often biopsied
- Desquamated (peeling) of epithelium with acute inflammation at the ulcer bed
- Multinucleated squamous cells
- “Ground glass” eosinophilic to basophilic viral inclusions (viral cytopathic effect)
Recurrences of HSV is MUCH more common in who?
Immunocompromised → meningitis, hepatitis, pneumonitis
Detection of anti-HSV antibodies to (Smith antigen) in the serum = _______
recurrent/latent infection
- _______ have higher susceptibility to HSV
- Previous infection with HSV-1 ___ risk of infection with HSV-2
- HSV-2 infection enhances acquisition and transmission of ____
- Females
- ↓
- HIV-1
HSV1 is a major cause of what in the US?
- Corneal blindness
- Fatal sporadic encephalitis
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
What can be used to ID herpes simplex virus (HSV)?
- Tzank smear, look for cytopathic effect (multinucleation).

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 Molluscum contagiosum virus?
Which type is most often prevelent and sexually transmitted?
- Poxvirus of the skin and mucus membranes with 4 subtypes
- Most prevelant = MCV1
- Most sexually trasnmitted = MCV2
What family of viruses is Molluscum contagiosum; what is unique about its replication?
- Poxvirus; linear dsDNA 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 has cells w/ cytoplasmic viral inclusion bodies (Guarnieri bodies)

How is Molluscum contagiosum (poxvirus) diagnosed in children (2-12) and adults?
- Children (2-12 years old): Direct contact or shared items (towels) and is most common on the trunk, arms & legs. Think of sexual abuse if seen in genitals in kids.
- Adults: sexually transmitted and seen on genitals, lower abdomen, buttocks, inner thighs
Vulvovaginal candidiasis is common in who?
- T2DM**
- Pregnant
- ABX
- Defects in NADPH or MPO
- Burn patients or indwelling cartheter
- Neutroptenia/TH17 defects
- HIV
Which sign’s and sx’s are common to Candida vaginitis?
-
Yeast infection (not a STI)
- Thick, curd like discharge (“cottage cheese-like”)
- Intense itching, erythema, swelling
- If severe=> ulcerate








