Bacterial Vaginosis (BV)

• It is caused by alteration of the normal flora, with over-

growth of anaerobic bacteria
• It is cause by ↑ PH of the vagina
• Recurrences are common
• May present with Fishy odor (especially after
intercourse)
• Increases risk for:
 -in pregnant women (endometritis and postpartum
fever)
 -Postabortal infection
 -Acquiring other STDs, especially HIV
 Bacterial vaginosis is the most common cause of abnormal vaginal odour
and discharge.
 It is caused by a change in the type of bacteria found in the vagina.
Normally, bacteria belonging mostly to the (Lactobacillus family ):
o live harmlessly in the vagina.
o And produce chemicals that keep the vagina mildly acidic.
In bacterial vaginosis, Lactobacillus bacteria are replaced by other types of
bacteria that normally are present in smaller concentrations in the vagina.
 Bacterial Vaginosis (BV)
• Diagnosis: Amstel Criteria( must have at least 3
of the following finding):
1) Homogenous, grayish-whitish discharge
2) Presence of clue cells
3) PH >4.5
4) +ve whiff test(amine test) (adding KOH to the
vaginal secretions will give a fishy odor) in 70-
80% of cases
• “Clue cells are the most reliable predictor of BV”
Clue cells
• Treatment:
• Flagyl 500mg one week
• Clindamycin cream
• Treatment of the partner is not recommended
 Non-Venereal Genital System Diseases
• A)

• B) Candida albicans
• C) Candida albicans is

• D)
• In case of over-growth of the yeast this will lead to

 the majority of infection is going to be due to Candida

albicans 90% , remain 10% is caused by Candida glabrata.

 Candida albicans is really more severe, while Candida

glabrata is mild infection
 Candidiasis Predisposing factors:
• Antibiotics: disrupting the normal flora by ↓
lactobacilli
• Pregnancy (↓ cell-mediated immunity)
• Diabetes
• Vaginal itching is the most common symptom of

Candidia vaginitis.

• - a thick, whitish (cheese-like ) discharge;

• - burning;

• - pain during urination (dysuria).

 • Can a man infected with Candidiasis?
• Although Uncommon, men can get infection by having
unprotected sex with a woman with Candidiasis.

• It usually appears as small white spots, redness, or a dry,

peeling rash on the penis accompanied by itching, irritation,
or burning.
• Diagnosis:
• PH of discharge: 4-5 .

• Wet mount: Saline( KOH 10%)

• Gram stain.

• Culture: Only when microscopy is not diagnostic .

• Kits: slide agglutination test is rapid diagnostic test.

• .
• Antifungal medications.
• Topical Imidazole (E.g.clotrimazole cream or pessaries).

• Oral imidazole (e.g. fluconazole).

• Vaginal nystatin.
Bacterial STDs
 Chlamydia trachomatis
 Chlamydia is one of the first most important sexually transmitted
bacterial infections.
 Cause disease to the genitourinary tract and the eye (non-gonococcal
urethritis and ocular infections).
 Chlamydia Can cause infection in:
men, women, and newborn babies

 Chlamydia is an obligate intracellular

bacteria with elements of bacteria but
no rigid cell wall.
 Fail to grow on artificial media
 Uses host cell metabolism for growth and replication.
 Chlamydia trachomatis

• Two morphological forms

– Elementary body
– Reticulate body
 Chlamydia species

• SPECIES • DISEASE
 C. trachomatis
 A,B,C  Trachoma
 D–K  Inclusion conjunctivitis,
genital infection
 L1, L2, L3
 Lymphogranuloma venerum
(LGV)

 C.Psittaci  Psittacosis

 C.pneumoniae,  Respiratory infections

Symptoms:-
It is known as the infectious (silent disease )
because it is Asymptomatic in ¾ of infected women and ½infected men.
 Male: Usually Asymptomatic, may be cause Discharge from the penis (thin
gray-white discharge) Burning on urination
 Complications, if not treated(epididymitis)
 Female: Usually asymptomatic may be cause Abnormal vaginal discharge
and Pain during sex
 Complications, if not treated: Pelvic inflammatory disease (PID)

- Repeated or chronic infection can lead to sterility and ectopic

pregnancy.

Treatment :
Antibiotics: Tetracycline Penicillin Erythromycin
Can be treated, but no immunity develops – a person can
become infected again!
 Diagnosis of Chlamydia genital infections
 Polymerase chain reaction (PCR) is the most sensitive
method of diagnosis. Performed on vaginal ,cervical , urethral
swabs, or urine .
 Isolation on tissue culture ( McCoy cell line) but rarely done.

 C.tracomatis inclusions can be seen by iodine or Giemsa

stained smear.
 Treatment
Antibiotics: Tetracycline, Penicillin, Erythromycin
Can be treated, but no immunity develops – a person can
become infected again!

Prevention and control

• through early detection of Asymptomatic cases ,
screening women under 25 years to reduce
transmission to the sexual partner.
 Neisseria gonorrhoeae
Gram –ve diplococci. Classified as pyogenic cocci because the infection
is characterized by the production of purulent (pus like) material
comprised largely of WBCs. Can cause infections in men, women, and
new babies
The disease is often called Gonorrhea.

Incubation period: 1 – 14 days.

Transmision: sexual contact or during

delivery (ophthalmia neonatorum)
whichcan cause blindness to the baby if
not treated.
 Symptoms:
are more acute and easier to diagnose in male.
- Male: yellow, purulent urethral discharge, painful urination.
- Complications in Men : (epididymitis)

- Female: greenish-yellow discharge, bleeding, endocervicitis. If it

progresses to the uterus, it may lead to tubal scarring and infertility,
and fibrosis can occur.
- Complications in Women Pelvic inflammatory disease (PID)
- Disseminated gonococcal infection (DGI)

- Rectal infection (in homosexuals), and pharyngitis (oral-genital

contact).
 Diagnosis of Gonorrhea

 Transport media required unless transfer to the lab. is immediate.

 Direct smear for Gram stain of urethra and cervical specimens to
see Gram negative intracellular diplococci , more sensitive in men .
 Culture on Thayer-Martin or other selective medium.
 Isolates identified by sugar fermentation of glucose only ( does not
ferment maltose or sucrose) or Coagglutination test.
 Treatment of Gonorrhea
 Ceftriaxone IM (or oral Cefixime recommended).
 Ciprofloxacin or Ofloxacin
 Azithromycin, Doxycycline ( orally for 7 days) both cover
C.trachomatis infection as well .
 Syphilis

• A chronic systemic infection , sexually transmitted , caused

by a spiral organism called:
Treponema pallidum subsp. pallidum .
• The organism grow on cultured mammalian cells only , not
stained by Gram stain but readily seen only by
immunoflurescence (IF), dark filed microscopy or silver
impregnation histology technique.
Transmission by contact with mucosal
surfaces or blood, less commonly by non-
genital contacts with a lesion, sharing
needles by IV drug users, or
transplacental transmission to fetus.
Early disease is infectious.
Late disease is not infectious .
 STAGES OF SYPHILIS
Syphilis can present in one of four different stages: primary, secondary,
latent, and tertiary. It may also occur congenitally.
I. Primary Syphilis: (3–90 days after the initial exposure)
A skin lesion appears at the point of contact called a chancre (single
firm, painless, non itchy skin ulceration). Lesions outside of the genitals
may be painful. Lesion heals spontaneously after 4-6 weeks.
II. Secondary Syphilis: (4-10 weeks after the primary infection)
Reddish-pink non-itchy rash on the trunk and extremities including the
palms and soles. Other symptoms may include fever, sore throat, weight
loss, hair loss, and headache.
III. Tertiary Syphilis: (3-15 years after the initial infection)
Divided into three different forms: late neurosyphilis, cardiovascular
syphilis, and gummatous syphilis (soft, tumor-like balls of
inflammation).
IV. Congenital Syphilis: May occur during pregnancy or during the birth
process. Common symptoms include: Fetal loss or congenital syphilis
result. Rhinitis ,rash and bone changes ( saddle nose) anemia
thrombocytopenia, and liver failure.
 Clinical findings
Multistage disease
1. Primary syphilis.

2. Secondary syphilis.

3. Tertiary syphilis.
 Diagnosis of syphilis
 Dark field microscopy of smear from primary or
secondary lesions.
 Serologic tests: commonly used .
A. Nontreponemal tests: antibody to cardiolipin
(lipid complex extracted from beef heart) called
reagin . The tests are called rapid plasma reagin
(RPR). Become positive during the primary
stage, antibody peak in secondary syphilis.
Slowly wane in later stages.
• Used for screening and titer used to follow up
therapy.
• B. Treponemal tests:
treponemal antigen used.
Detects specific antibody to T.pallidum eg.:
i. Fluorescent treponemal antibody ( FTA-ABS)
ii. Microhemagglutination test(MHA-TP)
(antigen attached to erythrocytes)
Positive results confirm RPR.
IgM used to diagnose congenital syphilis.
 Summary of syphilis serology
Test Stage
• Non-treponemal • POSITIVE during primary
tests(RPR) stage ,screening, follow
up therapy

• Treponemal tests( • POSITIVE at all stages ,

FTA-ABS)&( MHA-TP ) confirm RPR & VDRL

• IgM antibody • Congenital syphilis

 Treatment

• Treponema is sensitive to Penicillin.

• Hypersensitive patients treated with
Tetracycline, Erythromycin or Cephalosporins
 Viral: HIV
1. Human immunodeficiency virus
2. Slowly destroys immune system causing AIDS
(acquired immune deficiency syndrome)
3. Incurable and MOST deadly STD
4. Early Symptoms: fatigue, fever, chills, night
sweats, swollen lymph nodes, diarrhea, weight
loss AND Increased susceptibility to disease
5. Asymptomatic stage may last years!
6. Death caused by failure of immune response
 Viral: genital herpes
1. Caused by Herpes symplex virus 2
2. Over 15% population infected
3. Symptoms: Genital blisters, painful urination,
swollen lymph nodes of groin, fever
4. Incurable [virus shed when blistering]
 Anti-viral medications suppress active stage
1. May cause blindness in infants if left untreated
 Viral: genital warts
ARE ON THE RISE
• Most common STD - Approximately 20 million
people currently infected with HPV.
• Caused by Human papilloma virus (HPV)
• Symptoms: Warts on penis, labia, vagina, cervix,
or anus
• Treated by: laser surgery, freezing, drugs:
reoccurrence common NO REAL CURE!!!
• Increased risk of cancer [especially cervical
cancer]
 Trichomonas Vaginalis

• Trichomoniasis is the most common protozoal urogenital tract

infection of humans.
• It can live for 24 hrs in urine sample, or semen, or even
• a water sample. It can live on a wet surface for 1-2 hrs.
• Transmission: It is largely sexually transmitted.
• In very rare cases it can be transmitted
by using infectedp erson towels
• Symptoms:
• - Male: usually asymptomatic carriers (if symptomatic white
discharge).
• - Female: fishy odor yellow or green discharge AND hemorrhages
on the cervix known as colpitis macularis or strawberry
Frothy vaginal discharge Strawberry cervix
 Metronidazole tablets 500mg twice daily for 5_7 days.

 Treat sexual partner.