GTI

Vaginal Defeces:

Normal vaginal flora: lactobacillus spp….leads to production of H202, lactic acid, etc inhibits yeasts.
Maintains PH 4 to protect against infections. Lactobacili keeps vagina healthy. Occupies the ecological
niche and does not allow space for pathogenic organism.

Effect of hormonal level fluctuation: colonization begins during birth process as lactobacilli transferred
from mothers vagina as a result of residual maternal estrogen.

At puberty: VVI

baseline level of estrogen increases → increase in intracellular glycogen in vaginal mucosa →

stimulation of proliferation of vaginal epithelial cells → increased lactic acid producing microbes in
vagina → lactobacilli metabolizes glycogen → increased lactic acid concentration → vaginal pH lowered
to 4-4.5 → inhibition of colonization by other bacterial spp

Pregnancy: increased level of estrogen(estriol)

Menopause: opposite to puberty

Layers of vaginal epithelium: Superficial Intermediate Parabasal Basal. Vaginal Maturation Index uses
first 3 layers

Causes of Vaginitis:

7 Candidates try but money calls nonspecific agenst7 Candidates try but money calls
nonspecific agensts:

 Candidiasis/ Moniliasis/Monilial vaginitis

 Trichomoniasis- Trichomonas vaginalis

 Bacterial vaginosis/vaginitis- Gardnerella vaginalis

Minor:

 Moniliasis

 Chlamydia trachomatis

 Nonspecific vaginitis

 Atrophic vaginitis
Vaginitis Candidiasis (candida albicans (85%) +VE Trichomoniasis +VE
(trichomonas vaginalis)
Morpholog Yeast, pseudo hyphae Pear shaped protozoal
y Obligate parasite parasite, flagellated (4+1)
involvement of squamous
epithelium cells.
Trophozoite in secretion=
diagnostic
Trophozoite in vagina=
Causes strawberry mucosa.
Chicken like epithelium
Clinical Pruritis, Erythema, Dysuria, Dyspareunia similar
Features
Discharge Odorless, thick curdy white. KOH odor Purulent frothy white grey
negative ≤4.5 yellow. Acetic acid gives
strawberry cervix 4.7
Lab Specimen: Discharge Specimen: Vaginal Discharge
Direct Microscopy to view yeast: KOH prep, Transport medium
gram stain Amines medium if delayed
Culture: SDA giving creamy white colony anticipated
Direct microscopy
Wet mount
PMN; polymorphonuclear
cells
Actively motile trichomonads
Gram stain
Culture
Diamond’s or Kupferberg
medium
Bac. Vaginosis -VE
(Gardenella Vagninalis)/
Haemophilus vaginalis
Amsel’s 4 diagnostic criteria:
Homogeneous vaginal discharge.
Vaginal pH >4.5 (litmus paper
test).
Positive whiff tests
Presence of clue cells (> 20% of
cells).
homogenous, white, grey, ≥4.7
adherent, foul smelling, adherent
to vaginal wall. Amine test positive
Specimen: Vaginal Discharge
Direct microscopy
Wet mount/Gram stain: clue cells
Culture: HBT AGAR ; β Hemolytic
colony
Whiff test: Upon application of
10% KOH to a vaginal swab sample
a fishy odor is released suggesting
trichomoniasis or bacterial
vaginitis.
Gram stain:
Grade 1 :(normal): Vaginal
epithelium with lactobacilli
Grade 2: (indeterminate): Vaginal
epithelium with few lactobacilli
and gram-negative bacilli
Grade 3:(Bacterial vaginosis):
Vaginal epithelium with Gram+ve,
Gram-ve and Gram variable rods.
ECTO CERVITIS= HERPER SIMPLEX VIRUS

ENDO CERVITIS Neisseria gonorrhoeae -VE. O+ Chlamydia trachomatis -VE

C+
Morphology Virulence factors: Obligate intracellular parasite
Pili or fimbriae- composed of
pilin proteins
Outer membrane proteins:
Porin (protein 1)
Opacity associated protein
(protein 2)
IgA 1 protease
Lipopolysaccharide

Clinical Features Complications: Acute salpingitis, Salpingitis, endometritis,PID

pelvic inflammatory diseases
Discharge Mucopurulent
LAB Specimen: Endocervical swab Specimen: Cervical Discharge
Transport media: Stuarts, Microscopy:
Amines transport media Grams stain:>30PMN/HPF
Microscopy: Gram stain Giemsa Stain: Inclusion bodies
Culture: New York City Medium Culture: HeLA
Martin Lewis medium
Thayer Marin Medium
Chocolate Agar

PID: Pelvic Inflammatory Disease (PID) : Transport of bacteria from vagina to upper part of the female
reproductive parts. Involves: Endometritis, Salpingitis, Pelvic peritonitis, Tub ovarian abscess.

Etiological agents: Neisseria gonorrhea, Chlamydia trachomatis, Mycoplasma hominis, Urea plasma

Urethritis : urethral discharge. Meatus: expressed material. Platinum loop.

Host defenses of lower male genital tract: flushing action of urine and ejaculation, zinc. Longer length
urethra

Gonococcal Urethritis Non-Gonococcal Urethritis

Onset 2 days 7 days
Discharge Purulent Mucopurulent
Complications Polyarthritis, endocarditis Reiter’s Syndrome: ACU:
Arthritis Conjunctivitis Urethritis
Diagnosis Culture yeta uti mathi table ko Chlamydia, Trichomonas,
Candida mathi tabale ko
cultures
 Acute Prostatitis
Acute inflammation of prostate
Normal lymphocytes
Tender prostate on DRE
Culture shows bacteria
Chlamydia trachomatis, N.
gonorrhoeae (young adults)
Chronic Prostatis
Chronic inflammation of prostate
Lymphocytes increment
No tender prostate on DRE
Culture doesn’t show bacteria

E.coli. Pseudomonas (older adult)

Epididymitis: Male genital TB- tuberculous epididymitis, pseudomonas, bacteremia, scrotal swelling with
beadlike enlargement of vas deferens