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36 Cards in this Set
- Front
- Back
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COmmon clinical syndrome characterized by alterations in vaginal flora
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bacterial vaginosis
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Where is prevalence highest for BV?
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STD clinics and sex workers (although not exclusively sexual problem)
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Changes in BV flora
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absence of lactobacilli
Large number of gram- or gram variable coccobacilli Epithelial cells studded with bacteria: clue cells |
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2 changes for BV
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Garnderella vaginalis (gram-variable, facultative anaerobes) and mobiluncus spp. (gram- anaerobes)
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Clinical signs and symptoms of BV
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odor from anaerobes, elevated pH, changes in vaginal discharge
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criteria for diagnosis of BV
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at least 3 of:
-presence of clue cells -vaginal pH >4.5 -Homogenous adherent discharge -fishy odor with addition of KOH on slide |
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BV associations
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Acquisition and transmission of HIV
Other STIs Developing PID from gonococcal or chlamydial infections |
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Recommended tx for BV
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metronidazole or clindamycin (anaerobes)
-only moderately effective, high relapse |
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Potential tx for BV down the road
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probiotics for Lactobacilli
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What causes bacterial vaginosis?
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No specific bacteria, disappearance of Lactobacillus
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What goes on with vulvovaginal candidiasis?
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vaginal yeast infection (lactobacilli eliminated by antibiotics)
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What does candida normally exist as?
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yeast
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What is vulvovaginal candidiasis prevalence higher in?
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Pregnant women
Women with uncontrolled diabetes Women with impaired immunity |
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Common complaint with VVC
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Vulvar itching or irritation
-discharge often absent, but when present is thick |
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Pathogenesis of VVC
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hyphae associated with active disease
allergic reaction may cause severe symptoms |
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How do you diagnose VVC?
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Culture/wet mount
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Tx of VVC
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Uncomplicated: Short course of oral antifungals
Complicated: Culture to confirm, longer antifungals |
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How is VVC different from other STIs discussed thus far?
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Candida is sometimes part of normal flora; organisms causing STIs are not.
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Main classifications of UTIs
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Lower (cystitis) vs. Upper (acute pyelonephritis)
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Symptoms of cystitis
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frequency
dysuria urgency strangury (muscle spasms) hematuria suprapubic pain Change in smell of urine |
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Symptoms of acute pyelonephritis
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fever
rigors vomiting loin pain or tenderness (rapid onset) |
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Anti-adherence protein in urogenital tract
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Tamm-Horsfall protein (binds uropathogenic E. coli UPEC, comp inhibitor of binding)
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Reason why women are more suscetible to UTIs
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shorter urethra
anus and urethra close by pregnancy inc risk inc with common behaviors |
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Recurrent UTIs occur when: (4)
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greater density of receptors for binding of UPEC
Structural abnormality resulting in reflux Urinary tract stones (site to adhere) Conditions affecting nerve supply (like spinal cord injury) |
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Main two causes of UTI
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Uropathogenic E.coli (UPEC) (have fimbrial adhesins)
Staphylococcus saprophyticus |
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Movement of UPEC during UTI
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intestine -> periurethra -> urethra -> bladder
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What causes the inflammatory response for UPEC UTIs?
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LPS (received by TLR4)
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How do UPEC usually start the infection of the bladder?
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Form biofilm and "pods"
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What is the key to the UPEC virulence?
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Pili (recurrent bind more)
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What aspect of UPEC is responsible for establishing cystitis? It also binds to Tamm-Horsfall protein.
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Type 1 pili
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What role do Tamm-Horsfall proteins play in UTIs?
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Anti-UTI factor b/c it binds some Type I pili because it binds mannose
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These types of pili are required to cause pyelonephritis. What do they bind?
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Pap pili; galactose-containing glycolipid R on kidney epithelial cells
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What forms on urinary catheters?
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biofilms
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Dx of UTI
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Quantitative urine culture, but usually signs, symptoms, urine dipstick
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Tx of UTIs
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3 days of antibiotics for cystitis, long course for pyelonephritis (watch out for yeast infection in women)
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Preventing UTIs?
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Goal: Block adherence
Vaccines: Tamm-Horsfall protein like to block binding |
