Genital Tract Infections
Genital Tract Infections Lecture Notes
Introduction
Focus of the lecture: infections of the genital tract.
Reference: Chapter 72 of the textbook for further reading.
Anatomy of the Reproductive System
Female Reproductive System:
Major components: uterus and ovaries.
Functions of the uterus:
Provides vaginal and uterine secretions.
Area for fetal growth and development.
Connects to the vaginal opening via the cervix.
Function of ovaries:
Produce female eggs.
Connect to the uterus and fallopian tubes.
Male Reproductive System:
Includes penis and testes.
Normal Genital Flora
Urethra Flora:
Includes coagulase-negative staphylococci, corynebacteria, and anaerobes.
Female Genital Tract Flora:
Varies with pH and estrogen levels.
Predominantly lactobacilli found in vaginal secretions.
Prepubescent and postmenopausal women may have staphylococci and corynebacteria.
Reproductive-age women harbor facultative bacteria and anaerobes.
Some women carry group B streptococci, which can be transmitted to neonates during childbirth.
Genital Infections Overview
Sexually Transmitted Diseases (STDs):
Major causes of lower genital tract infections.
Modes of transmission:
Intimate person-to-person sexual contact (vaginal, oral, anal sex).
From mother to child during pregnancy/childbirth.
Blood products and tissue transfer.
Asymptomatic carriers can infect others.
Screening Recommendations:
CDC recommends annual chlamydia screening for women by age 25.
Annual screening for sexually active men having sex with men, including tests for syphilis, gonorrhea, chlamydia, and HIV.
Common STDs
Surface epithelial infections caused by:
Herpes simplex virus
Haemophilus ducreae
Treponema pallidum
Common Causes of STDs:
Chlamydia
Gonorrhea
Trichomonas
Syphilis
Viruses: HIV, HPV
Statistics (South Dakota, 2019-2020):
Chlamydia rates increased since late 1980s, with a slight drop between 2019 and 2020.
Gonorrhea and syphilis cases increased during the same time.
Note: Statistics may change in recent years.
Laboratory Analysis for STDs
Gonorrhea:
Diagnosis via Gram stain of male urethral exudate.
Diagnostic criteria: presence of white blood cells with gram-negative intracellular diplococci in symptomatic males.
Culture needed for symptomatic females.
Coinfection with chlamydia is common.
Urethritis
Definition: Inflammation of the urethra.
Causes:
Mechanical injury (e.g., catheterization)
Chemical irritation (e.g., antiseptics)
Infectious agents (commonly STDs)
Common Causative Agents:
Neisseria gonorrhoeae
Symptoms: dysuria, urethral discharge without urinary frequency or urgency.
Chlamydia - most commonly reported infectious disease in the US; Gonorrhea is second.
Infection Mechanism:
Neisseria gonorrhoeae specifically binds to columnar epithelial cells of the genitourinary tract.
Effected sites include urethra, cervix, endocervix, Bartholian glands, anal canal, pharynx, conjunctiva.
Symptoms:
95% of males experience purulent urethral discharge.
Women often asymptomatic but may have urethritis with cervicitis.
Cervicitis
Definition: Inflammation of the columnar and subepithelial cells of the endocervix.
Causative Agents:
Chlamydia
Gonorrhea
Mycoplasma
Ureaplasma
Herpes
HPV
Symptoms:
Increased neutrophils
Purulent discharge
50% of women will develop cervicitis at some point in their lives.
Risk Factors:
Early sexual activity, high-risk sexual behaviors, history of STDs, multiple partners.
Non-Infectious Causes:
Injury from foreign objects (e.g., birth control devices, douches).
Testing often includes bacterial vaginosis and trichomoniasis evaluation.
Vulvovaginitis
Definition: Inflammation of the vagina's mucosal lining.
Causes:
Bacterial, yeast, viruses, chemical/mechanical irritants (e.g., soaps, hygiene products).
Symptoms:
Vaginal discharge, itching, irritation, and odor.
Bacterial Vaginosis:
Most common vaginal infection in women of childbearing age.
Caused by overgrowth of specific organisms (e.g., Gardnerella vaginalis) after loss of normal lactobacilli.
Often presents with a fishy odor resembling rotting fish.
Risk Factors for Bacterial Vaginosis:
Early sexual activity, multiple anonymous partners, ethnicity (higher risk in African American and Mexican American women), frequent douching.
Diagnosis:
Gram stain (gold standard), examination of vaginal discharge, presence of clue cells, and pH testing.
Trichomoniasis
Causative Organism:
Trichomonas vaginalis (protozoan).
Clinical Signs/Symptoms:
Itching, burning, dysuria, lower abdominal pain, genital redness/soreness, smelly discharge (clear, white, yellowish, greenish).
Punctate papilla on cervix (known as "strawberry cervix").
Laboratory Diagnosis:
Visualization of motile trichomonads in saline preparation of vaginal fluid or urine.
Antigen tests or PCR can also be used.
Candidiasis
Causative Organism:
Candida albicans (fungal infection).
Risks:
Often develops after use of broad-spectrum antibiotics, disrupting normal flora.
Signs/Symptoms:
Itching, burning, redness, abnormal discharge (may be thick, white, and curd-like).
Laboratory Tests:
Culture, potassium hydroxide prep, Gram stain, or BD affirm VP3 microbial identification.
Lymphogranuloma Venereum (LGV)
Causative Agent:
Chlamydia trachomatis (virulent strains).
Clinical Presentation:
Small genital/rectal ulcers, rectal inflammation, regional lymphadenopathy (buboes).
Phases:
Primary, secondary, tertiary (chronic inflammation can result).
Diagnosis:
Based on clinical presentation, exclusion of other etiologies, bubo aspirates, tissue culture, DFA, ELISA, or nucleic acid testing.
Genital Warts
Causative Agent:
Human papillomavirus (HPV).
Types of HPV:
Separate genotypes for genital warts and cervical cancer.
Signs/Symptoms:
Small bumps (raised/flat), single/grouped, some cauliflower shape.
Found in moist or dry areas (vulva, vagina, anus, cervix, penis, scrotum, groin).
Diagnosis:
Physical examination, tissue biopsy for confirmation.
No cure; prevention through vaccination.
Pelvic Inflammatory Disease (PID)
Definition:
Group of diseases affecting female reproductive organs.
Commonly follows cervicitis, particularly from chlamydia or gonorrhea.
Incidence:
Estimated 750,000 women develop PID annually; over 100,000 may become infertile.
Diagnosis Challenges:
Lack of specific symptoms, based on physical examination and clinical findings.
Laboratory tests essential for confirming causative agents.
Symptoms:
Lower abdominal pain, fever, vaginal discharge, painful intercourse, painful urination, irregular menstrual bleeding.
Genital Ulcers
Genital Herpes:
Causative organism: herpes simplex virus (HSV).
Transmission through direct sexual contact; virus intermittently shed between outbreaks.
Two serotypes: HSV-1 (oral) and HSV-2 (genital).
Signs/Symptoms of Genital Herpes:
Painful vesicles, fever, malaise, dysuria, inguinal lymphadenopathy.
Syphilis
Causative Agent: Treponema pallidum (spirochete).
Stages:
Primary: initial chancre.
Secondary: systemic infection with organ involvement, skin rash, mucocutaneous lesions, lymphadenopathy.
Tertiary: neurological symptoms, cardiovascular effects, gummas.
Transmission:
Congenital spread can cause severe deformities, rash, jaundice, meningitis, deafness, blindness in neonates.
Diagnosis:
Various tests available (nontreponemal like RPR and VDRL, treponemal like FTA ABS and treponema pallidum particle agglutination).
Chancroid
Causative Agent:
Haemophilus ducreyi (gram-negative bacteria).
Clinical Signs/Symptoms:
Painful genital ulcerations (ragged edges, gray/yellow purulent exudate), inflammatory inguinal adenopathy (buboes).
Laboratory Diagnosis:
Gram stain showing pleomorphic gram-negative coccobacilli in characteristic formations.
Culture performed on specialized media (GC agar, Mueller Hinton agar).
Conclusion: The lecture provides a comprehensive overview of genital infections, their symptoms, causes, laboratory diagnosis, as well as implications for both males and females. Understanding the anatomy, normal flora, and potential infections is crucial for effective diagnosis and treatment.