Female Genitourinary Pathology

What is endometriosis?

presence and growth of endometrial tissue outside the uterus

History consistent with endometriosis

- chronic pelvic pain

- dysmenorrhea

- dyspareunia (pain during vaginal penetration)

- dyschezia (painful bowel movements, particularly during menses)

- infertility

What are condyloma acuminatum (genital warts)?

- warty lesions due to STI with HPV

- painless, may be unnoticed

How do condyloma acuminatum appear on exam?

flesh-colored, pointed papules; singular or cauliflower patch

What is a syphilitic chancre?

small, solitary silvery papule that erodes to a red superficial ulcer; painless

What most commonly causes genital herpes?

herpes simplex virus type 2 (HSV-2)

How does genital herpes present?

local pain, dysuria, fever

How does genital herpes appear on exam?

small clusters of shallow vesicles with surrounding erythema, often associated with inguinal adenopathy

What history and physical exam is consistent with a Bartholin's cyst/abscess?

Hx: pain and swelling

Exam: swelling/fluctuance overlying gland

How is vulvar carcinoma classified?

by the type of tissue from which it arises

- squamous cell (~90%)

- adenocarcinoma

- melanoma

- basal cell

Hx consistent with vulvar carcinoma

- persistent vulvar pruritus

- persistent (> 1 mo) vulvar lesion

- pain, burning, or lesion

What are the vaginal infections?

- Bacterial vaginosis (Gardnerella vaginalis)

- Candida vulvovaginitis (Candida albicans)

- Trichomoniasis (Trichomonas vaginalis)

- Gonorrhea (Neisseria gonorrhoeae)

- Chlamydia (Chlamydia trachomatis)

- Foreign body

Hx consistent with candidiasis

intense pruritus, thick, white discharge

Physical exam consistent with candidiasis

vulva and vagina erythematous

- "cottage cheese" like discharge, not malodorous

Testing for candidiasis

KOH prep - shows branched hyphae

Hx consistent with trichomonas

pruritus, watery malodorous discharge

Physical exam consistent with trichomonas

- vaginal mucosa inflamed and speckled with petechial lesions (strawberry cervix)

- frothy green, foul-smelling discharge

Test for trichomonas

Wet prep - flagella, pH > 4.5

Hx consistent with bacterial vaginosis

diffuse milky/creamy discharge with fishy odor

Physical exam consistent with bacterial vaginosis

thin, gray-white discharge

Test for bacterial vaginosis

Wet prep - clue cells (+ Whiff test)

Hx consistent with chlamydia

minimal to no symptoms; may have dysuria or postcoital bleeding (70-80% asymptomatic)

Exam findings consistent with chlamydia

may have yellow/green mucopurulent discharge

- friable cervix

- CMT

- subtle, often mistaken for gonorrhea

How do you test for chlamydia?

urine nucleic acid amplification test (NAAT)

Hx consistent with gonorrhea

vaginal discharge, dysuria, abnormal bleeding (~50% are asymptomatic or have mild symptoms)

Exam findings consistent with gonorrhea

often no signs apparent; may have purulent d/c

How do you test for gonorrhea?

positive culture

What causes Chadwick's sign?

hyperemia of the cervix due to increased blood flow

How does Chadwick's sign appear?

a bluish discoloration of the cervix, vagina, and labia

When can Chadwick's sign be observed?

as early as 6 to 8 weeks after conception, and its presence is an early sign of pregnancy

What are the two main types of cervical cancer?

squamous cell carcinoma and adenocarcinoma (named for the cell type from which the cancer arises)

Hx consistent with cervical carcinoma

- can be asymptomatic

- abnormal vaginal bleeding/discharge, pain with intercourse

Physical exam consistent with cervical carcinoma

- visible cervical lesion that is often irregular, friable, or ulcerated

- bimanual exam = enlarged, firm, immobile cervix

Hx consistent with cystocele

feeling of pressure vaginally, associated with stress incontinence

Exam findings consistent with cystocele

anterior bulge that is soft and round (posterior = rectocele)

What is uterine prolapse?

descent or herniation of the uterus into or beyond the vagina

What are common, benign uterine tumors?

myomas (leiomyomas, fibroids)

What are ovarian cysts?

fluid-filled sac in an ovary

What is a tubal (ectopic) pregnancy?

pregnancy occurring outside the uterus

What is pelvic inflammatory disease (PID)?

- infection of the uterus, fallopian tubes, and other reproductive organs

- common and serious complication of some STIs

What is salpingitis?

inflammation or infection of the fallopian tubes, often associated with PID