Bacterial Genital Infections Gonococcal Infection Urethritis/ Mucopurulent Cervicitis Gonorrhea Chlamydial Infection Non-Gonococcal Infection Coinfection with N.gonorreha and C.trachomatis Ureaplasma Urealyticum Infection Primary Syphilis Chancre Skin rashes Condylomata Lata Bacterial Genital Infections Syphilis Secondary Syphilis Mucous Patches in mouth Chancroid Latent Syphilis Genital Ulcer Lymphgranuloma Venereum Granuloma Inguinale Bacterial Vaginosis Vaginal Discharge Candida Vulvovaginatis Generalized Lymphadenopathy Tertiary Syphilis Bacterial Genital Infections with Urethritis and Mucopurulent Cervicitis Diseases Clinical Features Gonorrhoea Gonorrhoea  Urethritis and/or Cervicitis Clinical presentations o Vaginal discharge  Acute/chronic Gonorrhoea  Gonococcal Vulvovaginitis  Sub-infections always noticed by women with Proctitis (in female and  Throat and Rectum may get children) infected  Gonococcal Opthalmia o Often asymptomatic Neonatorum (in Neonate)  Ascending infection (minor) o Prostatitis Causative agent o Epididymitis  Neisseria gonorrhoea o Salpingitis  Characteristics o Perihepatitis o Gram negative Gonococcal Bactereamia Diplococci  Arthritis of both knees o Oxidase test positive o Joint swollen and edematous o Glucose fermenter o Joint is painful o Intra/extracellular o Effusion organism  Fever o Agar  Painful vesicles  Thayer Martin Complications  Chocolate agar  Reinfection o 5-10% CO2 with high  Male humidity o Urethral stricture o Some strains produce o Prostatic damage Beta Lactamase o Chronic inflammation  Female o Tubal damage and obstruction o Infertility o Pelvic Inflammatory Disease Laboratory Investigations Specimen  Affected part o Discharge o Pus o Secretion  Blood o Systemic infection Microscopic Examination  Gram staining o Intra/extracellular Gram Negative Diplococci o Pus cells Culture  Thayer Martin/ Chocolate Agar o Small o Translucent o Glistening colonies Biochemical Test  Oxidase test positive  Glucose fermentation Serological Tests  ELISA o Gonococcal antigen detection  DNA Probe Assay o Gonococcal Ribosomal Gene detection Treatment Non-PPNG  Gonorrhoea o Ampicillin + Probenecid o Cefuroxime  Systemic Gonorrhoea o Benzyl Penicillin PPNG  Gonorrhoea o Ceftriazone o Ciprofloxacin o Spectinomycin o Azithromycin  Systemic Gonorrhoea o Cefuroxime Bacterial Genital Infections with Urethritis and Mucopurulent Cervicitis Diseases Chlamydial Infections Causative Agents Chlamydia thracomatis Characteristics o Obligate intracellular organism  Uses host ATP o Lack of cell wall o Serotypes  Ocular Trachoma  A,B,Ba and C  Oculogenital and Neonatal Infection  D-K  Lymphogranuloma Venereum  L1, L2, L3 Morphology  Elementary Bodies o Extracellular o Highly infectious form  Reticulate Bodies o Intracellular o Replicative form   Ureaplasma urealyticum Infection Causative Agent  Ureaplasma urealyticum  Characteristic o Lack rigid cell wall Clinical Features Men  Urethritis  Dysuria  Urethral and Meatal soreness  Urethral discharge  Prostatitis Women  Cervicitis  Urethritis  Soreness  Dysuria  Mucoid Vaginal discharge  Salpingitis Both Gender  Proctitis  Perihepatitis Neonate  Inclusion Conjunctivitis  Pneumonitis     Non-Gonococcal Urethritis Reiter’s Syndrome o Urethritis o Conjunctivitis o Arthritis Presents with o Prolonged Synovitis o Connective tissues inflammation Affecting mainly men with HLA B27 Laboratory Investigations Specimens  Swabs from o Urethra o Cervix o Rectum Culture  Cell lines o McCoy cells o HeLa cells  Results o Giemsa staining o Purple – Elementary Bodies o Blue – Reticulate Bodies Serological Tests  Antigenic detection o ELISA o Immunoflourescent Assay  Chlamydial DNA detection o PCR  Appearance of colony on Agar o Fired egg colony Treatment  First DOC o Doxycycline  Alternative o Erythromycin o Azithromycin  Systemic infection o Erythromycin IV   Resistant of Penicillin Sensitive to Erythromycin Bacterial Genital Infections with Genital Ulcer Syphilis Causative Agent o Treponema pallidum o Characteristic  Thin wall  Flexible  Spiral shaped Spirochete Clinical Presentation  Acquired Syphilis – Sexual contact  Congenital Syphilis – Transplacental spread  Pathogenesis  T. pallidum will penetrate through o Intact mucous membrane o Break in the Epidermis  It will then multiply locally at the site of entry  Some can further multiply at the regional lymph nodes  Then it is disseminated across the body through blood Laboratory Investigations Demonstration of Causative Organism Specimen o Exudate from Primary Lesion  Chancre  Affected Lymph Nodes o Exudate from Secondary Lesion  Mucous patches  Condylomata  Skin rashes  Affected Lymph Nodes  Microscopic Examination o Under Dark Ground Illumination o Stain  Giemsa  Silver Impregnation o Findings  Spiral shape  Regular and evenly placed coils  Movements  Undulating  Rotation  Flexion  Slow backward/forward movement  Culture o Can’t be cultured on any media o Can propagate if inoculated in the Rabbit Testis  Demonstration of Antibodies Production  Standard Test for Syphilis (STS) – no confirmatory o Venereal Disease Research Laboratory Test (VDRL Test) o Rapid Plasma Reagin Test (RPR Test) o Kahn Test (KT) o Wassermann Reaction (WR)  Serological Test for Treponema Pallidum Antibody – confirmatory o Fluorescent Treponemal Antibody Absorbed Test (FTA-ABS) o Treponema Pallidum Immobalization Test (TPI) o Treponema Pallidum Passive Heamagglutination (TPHA) Diseases Clinical Features   Primary Syphilis    Secondary Syphilis   Congenital Syphilis  Both Primary and Secondary Syphilis lesions o Rich with Spirochetes o Highly infectious Multisystem infection  Systemic manifestation Presentation of Gumma (Gummatous o CNS Necrosis)  Meningovascular Meningitis o Indolent granulomatous lesion  Tabes Dorsalis o May undergo central mucoid  General Paresis of the Insane degeneration o CVS o Can be little bit painful or painless  Aortitis o Affecting  Mycotic Aneurysm  Skin, bone, liver, testis and tongue  Aortic insufficiency  Transmitted to from infected mother to fetus through placenta – 10-15 weeks of Gestation  Can lead to o Abortion or still birth during term o Born with Congenital Anomalies  Saddled nose  Hutchison’s teeth  Bow legs   Tertiary Syphilis Incubation period o 10 days, 10 weeks or more Chancre/ Hard Sore o Painless ulcer o With border and a base of induration o Affecting  Genital  Foreskin, coronal sulcus, vulva, uterus, cervix and fourchette  Extragenital  Lips, mouth and nipple o Heals spontaneously Painless enlargement of regional Lymph Nodes Develops 6-8 weeks after Primary Syphilis 4 Cardinal signs o Skin Rashes  Symmetrical  Generalized Maculopapular/popular  Extend from Palm to Sole o Condylomata Lata  Flat warty lesion o Mucous patches at the mouth o Generalized Lymphadenopathy Other presentation o Arthritis, Arthralgia, Iritis and Retinitis o CNS involvement – 20% of cases  Meningitis, cranial nerve palsies The lesion subside spontaneously Treatment Penicillin is the DOC for all kind of Syphilis Bacterial Genital Infections with Genital Ulcer Diseases Chancroid  Causative Agent o Haemophilus ducreyi o Characteristics  Incubation period of 25 days  Gram Negative Bacillus  Requires only Factor X in the Blood Agar Lymphogranuloma Venereum  Causative Agent o Chlamydia trachomatis  Serotype L1, L2 and L3 o Characteristic  Incubation period of 2-30 days  o o o o  o o o    Clinical Features Typical soft sore lesion Large Irregular PAINFULL Almost always affecting the Genetalia Localized Lymphadenopathy Painful Enlarged Inflamed Small shallow ulcer at the Genitalia Bilateral Inguinal Lymphadenopathy Suppuration is common with draining sinuses Laboratory Investigations  o o  o o  o  o o o  o o  o o  o  o o o Granuloma Inguinale  Causative Agent o Kliebseilla granulomatis o Characteristic  Gram Negative Anaerobe Bacilli  Lactose Fermenter Indolent progressive ulcerating condition o Painless ulcer  Confined to Genital and Subcutaneous tissue  Due to sexual contact   o  o o Specimen Scrapping from the lesion Discharge from the Lymph Nodes *inoculate into Rabbit’s blood Microscopic Examination Gram Negative Bacillus School of fish appearance Culture Blood Agar with Factor X only Ducreyi Skin Test Delayed hypersensitivity skin test Positive after 1-2 weeks of infection Used for specific diagnosis Specimen Discharge from ulcer Tissue slough from Lymph Node Microscopic Examination Giemsa staining Intracytoplasmic Inclusion Culture Yold sac of Embryonated egg Frei Test Delayed hypersensitivity skin test Intradermal injection of LGV infection Antigen is group antigen; not specific Specimen Tissue biopsy Microscopic Examination Giemsa staining Donovan Bodies (Pathognomonic)  Rod shape organism inside the cytoplasm of Phagocyte/Histiocytes  Deep purple intracellular inclusions are the encapsulated Gram Negative Bacilli   Treatment Sulfamethopyrazine Cotrimoxazole (Bactrim®)  Tetracycline Standard treatment o Ampicillin – 12 weeks  Other o Tetracycline o Erythromycin o Bactrim  Diseases Bacterial Vaginosis  Causative Agents o Gardnerella vaginalis o Characteristics  Not sexually transmitted  Facultative Anaerobe Gram Variable Bacilli Pathogenesis  Lactobacillus spp. insufficiently produces Lactic Acid and Hydrogen Peroxide  This will impair the inhibition of growth of Anaerobes  Multiplication of G. vaginalis Vulvovaginitis  Causative Agents o Candida albican o Characteristic  Normal yeast of the female genitalia     Bacterial Genital Infections with Vaginal Discharge Clinical Features Laboratory Investigations Greyish fishy vaginal 3 out of 4 of the following criteria  discharge 1. Presence of thin homogenous gray-white non-inflammatory discharge  2. Vaginal discharge pH >4.5 (normal is <4.5) 3. Presence of Clue Cells a. Epithelial cells with indistinctive border due to adherent of bacteria 4. Amine fishy odor a. Before/after KOH b. Positive i. Amine test ii. Whiff test Vulva itching Burning pain at the end of urination Voluminous cheesy vaginal discharge with little odor Predisposing factors  Diabetes Mellitus  Antibiotic therapy  Steroid therapy Specimen o Vaginal discharge  Microscopic Examination o Budding yeasts  Culture o Media  SDA  Blood agar o Colony appears Star-shaped      Treatment Metronidazole o Cream o Oral Clindamycin o Oral o Cream Bactrim vaginal tab/cream Econazole passeries Nystatin passeries Fluconazole