Reproductive System Laboratory

Activity
Case Discussion
Case 1
● A 54-year old woman presented to clinic with complaint of thick whitish
vaginal discharge along with pruritis.
● On examination the vaginal walls as well as vulva were found erythematous
and with white patches (cheese curd-like).

● Questions:
1. What is your diagnosis? What is the common etiologic agent of your suspected diagnosis?
-> VVC (vulvo vaginal candidiasis)-Candida Albicans (jamur)
2. How do you confirm the diagnosis? List routine examinations may be necessary to rule out
differential diagnosis!
-> keluhan dischare putih kental,gatal atau pruritus,gram stainingnya gram (+),pseudohyfae (+)
3. How do you collect the specimen?
-> menggunakan transport media suburoud dextrose agar
Case 1
Case 1
● Questions:
4. Describe your finding based on gram staining! Gram (+)
5. What is pseudohyphae? Please draw or find a picture of pseudohyphae! What is its role in this
case?untuk menenempelnya candida Pada lateral vaginal wall
6. Which medium should be used to culture the microorganism for routine examination? PCR
Case 2
● A 34-year old woman presented to clinic with complaint of malodorous vaginal
discharge for 3 weeks.
● The vaginal malodor was very obvious after sexual intercourse.
-> sperma mengandung alkalin (basa) sudah bau ditambah malodors pada vaginal
● There is no associated vaginal itching or pain.
● She is married and monogamous. No sexual trandmitted disease
● She admit to douching about once per month to prevent odor, but this time it
is not working. Dapat mematikan lactobacillus
● On examination, her discharge was visible. It was thin, off-white, and
homogenous.
● The doctor then taken the sample from mid vaginal wall and did several
examinations to exclude differential diagnosis.
Case 2
● Questions
1. List several tests the doctor should perform to conclude the etiology!
-> whiff test and clue cells test

2. Why do vaginal malodor present after sexual intercourse? What metabolites caused the odor?
-> vaginal fluid >4.5

3. Refer to the microscopic preparation! What kind of staining it is? What is the specific finding from this prep related with the
case? Explain your finding!
-> clue cells,gram (+)

4. The doctor may diagnose the patient based on Amsel’s criteria and Nugent Score. Explain how to perform nugent score!
-> 1. homogenous white to grey adherent discharge
2. a vaginal fluid ph>4.5
3. fishy odors
4. clue cells (+)
Case 2
Case 3
● A 30-year old woman presented to clinic with complaint of vaginal discharge for 5
days.
● She also complained pain during sexual intercourse and sometimes accompanied
by bleeding.
● She had history of multiple sexual partner and did not use condom during
intercourse.
● On vaginal speculum examination, her discharge was found mucopurulent.
● The cervix was erythematous.
● No abnormality was found in vaginal wall.
● On bimanual examination, pain was absent. But cervical tenderness was present.
Case 3
The doctor then taken the discharge sample and did several examinations to exclude differential diagnosis.

Questions:
1. Refer to microscope in your bench! What staining was used to determine the etiologic agent! N.gonorrhea , gram
staining -> gram (-) diplococcus
2. What is your diagnosis? Cervicitis e.c Neisseria Gonorrhoeae
3. What complication might develop if the patient is left untreated?
● Female : salphingitis,endometritis,Bartholin abcess,lymphangitis,tubo-ovarian abcess,ectopic pregnancy,infertility
● Male : penile edema,Tyson’s gland abcess,cowper’r glands abcess,seminal vesiculitis,epydidimitis,infertility(rare)

4. What are the differential diagnosis?

● BV (bakteri)
● VVC (fungi)
● Trichomoniasis (parasite)
Case 3
Case 4
● A 30 year old pregnant women, 36-37 weeks of pregnancy.
● She came to the doctor to perform a screening for colonization of bacteria.

Questions:
1. Observe the gram stain prep. Explain your finding!menggunakan sheep blood agar Gram (-)
streptococcus,grup B-> S.agalatiae
2. On your bench is CAMP test. Explain what is CAMP test? Catalase test negative,bacitracin
resistant,positive CAMP test
3. What kind of microorganism might be important for screening in pregnant women to prevent ascending
infection or prevent transmission to baby during vaginal delivery? ,di screening pada usia 35-37 minggu
Antibiotik prophylaxis,1-2%
4. What possible complication might be happened if the bacteria transmitted to baby?
->meningitis,dan sepsis
Case 4