What parts of female reproductive tract have microbes?
Anterior urethra and vagina are permanently colonized.
What bacteria is predominating in the female reproductive system during childbearing years:
Lactobacillus
**Features of Lactobacillus:
Gram (+) rod. Microaerophilic or anaerobic
Lactobacillus and UTIs:
Cannot cause UTIs because they cannot grow in urine.
**Lactobacillus and Vaginal pH:
Glycogen is metabolized to lactic acid by lactobacillus resulting in a vaginal pH of 4-5 = optimal for lactobacilli growth and inhibits other organisms
**Alterations in Normal Microbiota of the Vagina are due to (3):
Due to: Age, Menstruation, Hysterectomy with removal of cervix
*How does Hysterectomy with removal of cervix change vaginal microbiota (3):
Increase in prevalence of Bacteroides Fragilis, E. Coli and Enterococcus (BEE)
Bacterial vaginosis results from:
an overgrowth of ANAEROBIC species. Lactobacillus is typically reduced with BV.
**Amsel Criteria: Diagnosis of Bacterial Vaginosis (4):
**Discharge usually WHITE or GREY. Presence of CLUE CELLS in vaginal secretion, (+)Whiff test, Vaginal pH > 4.5 ** MUST HAVE 3 of 4
**Whiff Test:
KOH added to discharge > strong FISHY ODOR= POSITIVE for Bacterial Vaginosis
Nugent Score of 0-3 in Diagnosis of Bacterial Vaginosis:
Normal, Lactobacillus dominant
Nugent Score of 4-6 in Diagnosis of Bacterial Vagninosis
Intermediate; mixed morphotypes
Nugent Score of 7-10 in Diagnosis of Bacterial Vagninosis:
+ Bacterial Vaginosis; absence of lactobacilli, predominance of 2 other morphotypes
Complications of Infection with Bacterial Vaginosis (4):
Increased susceptibility to HIV infection + other STDs, Increased risk of passing HIV to partners. post-surgical infection, preterm delivery, miscarriage
**Treatment of Bacterial Vaginosis:
Oral Metronidazole or Clindamycin
Vulvovaginal candidiasis is what type of infection:
A common FUNGAL infection found in women of childbearing age
**Discharge present with Vulvovaginal Candidiasis:
Thick, ODORLESS, white vaginal discharge (“COTTAGE CHEESE-LIKE”)
Definition of Complicated Vulvovaginal Candidiasis:
Four or more episodes in 1 year
Vulvovaginal candidiasis caused by C. Albicans Gram stain and KOH prep:
Exists as oval yeastlike forms that produce budding with pseudohyphae or hyphae
At 37 C Candida Albicans rapidly form:
hyphae called GERM TUBES
Most commonly isolated specimen during Vulvovaginal Candidiasis:
Candida Albicans. Is part of normal flora
Diagnosis of Vulvovaginal Candidiasis:
Microscopic exam reveals hyphae and budding yeast
**Treatment of VVC:
1-3 day regimen of topical azole for uncomplicated VVC
C. Albicans causes what other diseases:
Vaginitis (MORE FREQUENT AFTER ABX) Diaper Rash, Oral Thrush
VVC is generally seen in what type of patients:
Pregnant. Corticosteroids. Contraceptives. HIV. Abx use Diabetes
Most common, curable sexually transmitted disease:
Trichomoniasis
Most women infected with Trichomoniasis will present with:
70% asymptomatic
Symptoms of Trichomoniasis:
Mild to severe vaginitis with itching and dysuria and DISCHARGE.
Discharge with Trichomoniasis infection:
Yellow-green, frothy, foul-smelling discharge
Men and Trichomoniasis:
Primarily asymptomatic carriers
Features of Trichomonas Vaginalis:
Small, pear shaped protozoa, They are MOTILE exist only in TROPHOZOITE form
Pathogenesis of T. Vaginalis (3):
Contact results in destruction of epithelial cells, neutrophil influx, petechial hemorrhages (strawberry cervix)
Strawberry Cervix
Present in infection with T. Vaginalis due to petechial hemorrhages
Diagnosis of T. Vaginalis:
Detecting SWIMMING T. Vaginalis in exudate
**Treatment of Trichomoniasis:
Metronidazole
Immunity to T. Vaginalis:
There is NONE. Reinfection is possible.
Menstrual Toxic Syndrome was first linked to:
Hyperabsorbant TAMPONS that allow S. AUREUS to multiply and release TOXIN
Causative Agent of Menstrual Toxic Syndrome:
S. Aureus
Staph Aureus Features:
Catalase (+). Coagulase (+). Gram (+) cocci in grape-like clusters
S. Aureus Toxin:
TSST-1
Features of TSST-1 (2):
Can penetrate mucosal barrier and lead to systemic effects. Is a SUPERANTIGEN = stimulates T-cell activation and release of cytokines
Symptoms of Menstrual Toxic Syndrome (5):
Diarrhea. Nausea and vomiting. High fever. Hypotension Widespread red rash with possible desquamation of palms and soles
4+/1+ Culture from Vagina/Blood:
4+ from Vagina= More than 90% positive cultures > TSS 1+ from Blood= Less than 10% positive > TSS
Treatment of MTSS:
Penicillin or Vancomycin
Immunity to Menstrual Toxic Shock Syndrome:
50% of TSS patients fail to mount Ab-response to TSST > RISK OF RECURRENCE
Case Presentation of TSS:
Pharyngitis. Vaginitis. Vomiting + diarrhea. Febrile. HYPOTENSIVE. DIFFUSE ERYTHEMATOUS RASH. PEELING OF PALMS AND SOLES CAN OCCUR (1-2 weeks after)
Major Criteria for MTSS Diagnosis (3):
Hypotension. Fever. Diffuse Erythroderma (with late skin desquamation)