other genitourinary tract infections Flashcards
(28 cards)
Lactobacinnus
- present predominantly during the child bearing years as part of normal biota
- gram pos, microaerophilic or anaerobic rods
- DO NOT CAUSE UTI BECAUSE THEY CAN’T GROW IN URINE
- glycogen metabolized to lactic acid by lactobacilli RESULTING in a vaginal pH of 4 to 5- THIS IS OPTIMINAL FOR GROWTH AND SURVIVAL OF LACTOBACILLI AND INHIBITS GROWTH OF OTHER ORGANISMS!
What populations are least likely to have large amounts of lactobaccili?
non-child bearing age women
what does hysterectomy with removal of cervix do to the normal vaginal biota
- increase in bacteroides fragilis and Escherina colia and enterococcus spp
- most often found in pt that develop pelvic infections post-hysterectomy
what is bacterial vaginosis
- change in normal vaginal flora
- abnormal overgrowth of anaerobic species
- reduction of lactobaccilus (b/c other organisms can grow)
symptoms: itchiness, discharge, odor, pain, burning-can be asymptomatic
what are some risk factors for bacterial vaginosis
- oral sex, douching, smoking, sex during menses, IUD, early sexual intercourse, new/multiple partners, sex with other women
- still not considered STD
how do you diagnose bacterial vaginosis
three of the 4 must be met:
1) -DISCHARGE- MILKY-WHITE OR GREY
2) -CLUE CELLS!- (be able to recognize) -granular epithelial cells covered by microbiota
3) - fishy-odor due to volatile amines released during anaerobic metab: whiff test
4) vaginal pH>4.5
what is the whiff test
-KOH used on sample of vaginal discharge to see whether a strong fishy odor is present
what is the nugent score
-scores whether pt has bacterial vaginitis-another way to diagnose
- 1 point- large gram pos- lactobacillus
2- small gram variable rods- (G. vaginalis or bacteroides spp) and
3) curved gram-variable rods (mobiluncus spp)
0-3: normal, lactobac present
4-6: intermediate; mixed morphotypes
7-10: Bacterial vaginosis! - no lactobac and predominance of 2 other morphotypes
what does bacterial vaginosis make a woman more susceptible to?
- contracting and infecting someone with HIV
- contracting other STD like chlamydia, gonorrhea and HSV
- infection after surgical procedures
- during pregnancy- complications like preterm delivery, miscarriage, infection post delivery
how is bacterial vaginosis treated
- oral metronidazole
-clindamycin
= recurrence is common
Vulvovaginal candidiasis
- common FUNGAL INFECTION in women of childbearing age
- yeast infection
- discharge: THICK ODORLESS, WHITE VAGINAL DISCHARGE
- caused by candida species
classifications of vulvocandidiasis
- complicated and uncomplicated-
uncomplicated- healthy pt with sporadic infection and mild to moderate symptoms
-complicated (4+) episodes or severe VVC, non-albicans candidiasis or the pt has uncontrolled DM, debilitation or immunosuppression
what is the structure of candida species
- oval yeastlike forms that produce buds with pseudohyphae and hyphae
- PRODUCE ELONGATED GERM TUBE FROM HYPHAE AT 37C
candida albicans
-part of the normal flora of vagina but can cause yeast infections
other than yeast infections (vulvocandidiasis) what else can candida albicans cause?
oral thrush and diaper rash as well as esophagitis and disseminated cervical candidiasis
what are some things that can cause valvulocandidiasis?
-oral contraceptives, hiv, pregnancy, DM, systemic corticosteroids, antibiotic use
diagnosis and treatment for vulvulocandidiasis
- microscope with KOH to reveal hyphae and budding yeast
- treatment-1-3 day topical azole for uncomplicated VVC, 7-14 topical reg or two doses oral fluconazole 3 days apart for complicated VVC
trachomoniasis
symptoms- women and men
-STD
-women can be asymptomatic or scant watery discharge
- mild to severe vaginitis with inflammation associated with itching, burning and painful urination
-discharge- yellow, green, foul smelling, frothy
men- usually asymptomatic and serve as reservoirs-occasional prostatitis, uthritis or UTIs
what causes trachomoniasis and what is it’s shape and special features
- trachomonas vaginalis
- pear-shaped (pears are green) PROTOZOA!!!! (PARASITE)
- 4 ANTERIOR FLAGELLA- and membrane allow for MOTILITY
- only have trophozoic form-strict parasite and can’t live outside host; reservoir is human urogenital tract
what is the pathogenesis of trachomonas vaginalis
- contact of it with epithelial cells results in destruction of the cells and neutrophil influX causing petechial hemorrhages that lead to STRAWBERRY CERVIX (strawberries and pears)
what’s important to note about immunity and trachomonas vaginalis
no immunity- reinfection possible
diagnosis and treatment of trachomonas vaginals
- diagnosis: see swimming T. vaginalis in exudate
- asymptomatic -pap smear
treat: metronidazole- treat both partners
menstrual toxic shock syndrome
bacteria that causes it, characteristics of bacteria and symptoms
- bacteria s. aureus buildup as tampons left in too long
- catalase positive, gram pos, coagulase positive in clusters
- symptoms: HYPOTENSION AND SHOCK, diarrhea,high fever, nausea, red rash that looks like SUNBURN ON PALMS OF HANDS AND BOTTOM OF FEET-PEEL 2 WKS
pathogenesis of menstrual toxin syndrome
-caused by S. aureus
- s. aureus has TSST-1 exotoxin that is heat resistant and can penetrate the mucosal barrier- bringing about systemic effects
-super antigen-stimulates T-cell activation and release of cytokines
-> macrophages release IL-1beta and TNFalpha
T cell release IL-2, IFN gamma, TNF beta.
-TNF alpha and beta release is associated with HYPOTENTION AND SHOCK
IL-1beta =fever
