Bacterial Genital Infections

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