Chlamydia trachomatis, Mycoplasma, Ureaplasma, and other Non-Gonococcal urethritis: Chlamydia trachomatis: Microscopy and culture: -Small unicellular round-to-ovoid bacteria that cannot stained by Gram’s stain. -Some inclusion bodies retain Iodine or the counter stain safranin. -Rigid Cell wall. -The cell envelope has two lipid bilayers with cell wall material resembles a gram-negative (but not peptidoglycan nor muramic acid).

n -Obligatory intracellular parasite. -It depends on the host cellular energy compounds ATP, and NAD. -Cultivated in yolk sac of embryonated egg or tissue culture. Chlamydia inclusion :R. bodies. Chlamydia inclusion.

Pathogenesis and life cycle: -Transmission: Sexual route. -Infectious part: The elementary body. -The elementary bodies taken by phagocytosis into susceptible host cell. -Once inside the cell, the elementary body prevents fusion of the phagosome and lysosomes. -It will converted into metabolically active dividing Reticulate body. (non-infectious body). -Inclusion bodies. -After 48 hours, rupture of infected cell to release many elementary bodies. -Host cell death.

Chlamydia life cycle: N

Clinical picture of Chlamydia trachomatis: Annually, more than four million urogenital Chlamydia trachomatis infections occur in the USA in young individuals. 1-Nongonococcal urethritis: -Caused by Serovars: D,E, F,.., to K. - In male : Urethritis, infection could extend to epididymitis. and orchitis. - In Female: Pelvic inflammatory disease. Urethritis, Cervicitis, Endometritis, Salpingitis. 2-Lymphogranuloma venereum:(LGV): more invasive infection -Caused by Serovars: L1, L2, and L3. -Papules in the external genitalia.(for one to two months). - Painful swelling of inguinal and perirectal lymph nodes.

Clinical picture of Chlamydia trachomatis: N

Urethral discharge : (more mucoid with fewer pus cell). Chlamydial Cervicitis.

Laboratory diagnosis: Clinical specimens: Urethral discharge, urine, and Scraping of infected epithelial cells. 1- Direct microscopy: A-Immunofluorescent microscopy. B-Electron microscopy. 2-Detection of Chlamydia genetic material by PCR. 3-Serology: Serologic testing for specific antibodies is not helpful except in suspected Lymphogranuloma venereum.

Laboratory diagnosis: Immunofluorescent staining of inclusion body. Electron microscopy and immuno-electrone microscopy for inclusions.

Mycoplasma hominis and Ureaplasma urealyticum: -The smallest prokaryotic microbe with no peptidoglycan cell wall. -Because of their extremely small size( micrometer), Mycoplasma species pass through sterilization filters. -Lacking cell walls, all species are enclosed instead by lipid bilayer membrane containing sterols. -Due to the absence of Cell walls: 1-The bacteria are plastic, pleomorphic in nature, and cannot be classified as either cocci or rods. 2-The bacteria are resistance to penicillin and cephalosporins.

n -Double-stranded DNA genomes measure less than one million Kilodaltons. Cultural characteristics and colony morphology : -Facultative anaerobes, and some species are strict anaerobes. -Fastidious for external source of cholesterol (serum). -Given appropriate supplementation, they can be grown in cell- free media. -Colonies are visualized microscopically by 30 to 100 x magnification. -Colonies show a characteristics (fried egg) appearance.

Biochemical activities and clinical picture: -Mycoplasma hominis and Ureaplasma urealyticum grow more rapidly than Mycoplasma pneumoniae. -They can be distinguished by their carbon utilization patterns; M. hominis degrades arginine. U. urealyticum hydrolyses urea. In female: - The major clinical condition associated with M. hominis is postabortal fever. -M. hominis is recovered locally in cases of Pelvic inflammatory disease. -All M. hominis species are Erythromycin resistance.

n -The drug of choice for treatment is tetracycline (for M. hominis). -Ureaplasma urealyticum is associated with cases of Endometritis and vaginitis. In male: -Ureaplasma urealyticum is associated with cases of Urethritis. -The infection could be disseminated to other tissue in immunocompromised patients.

Candidiasis: - Most commonly encountered opportunistic mycoses worldwide. - Cellular immunity protects against mucocutaneous candidiasis, neutrophils protect against invasive candidiasis - They are members of the normal flora. - More than 150 species of Candida known. - Only ten species cause disease in humans. - The most common species of medical significance are: 1-Candida albicans. 2-Candida tropicalis.

Morphology and cultural characteristics: Candida is thin-walled, small yeasts (4 to 6 microns) that reproduce by budding. Microscopically: Candida albicans is dimorphic, in addition to budding yeast cells, pseudohyphae, it also can produce true hyphae. Asexual Germination of Candida occurs by production of Blastospores or Chlamydiospores.

n -Macroscopically: on agar media they produce creamy colonies within 24 hours at 37  C or room temperature. -Candida species produce a small,white, rounded colonies with feet projection and regular margin. Germ tube test: -Candida species must be incubated with serum for 90 minutes at 37  C; -yeast cells of C. albicans will produce true hyphae or germ tube.

Clinical picture of Candida albicans: -Candida albicans causes almost 100% of cases of oropharyngeal candidiasis and at least 90% of cases of Candida vulvovaginitis. -Vaginal candidiasis presents as itching and burning pain of the vulva and vagina. -Thick or thin white discharge. -Vaginal swab and discharge should be examined for differential diagnosis. -Candida albicans can cause urethritis in male.

Trichomoniasis: Trichomonas vaginalis: Classification: urogenital Mastigophora. Morphology: um,oval or pyriform in shape,with short undulating membrane, axostyle and four free flagellae. Transmission: sexual intercourse,and contaminated clothes. Pathology and Clinical picture: Vaginitis - itching, copious- yellowish offensive discharge. Urethritis in male and female. Prostatitis and seminal vesiculitis in male. Diagnosis: by finding the trophozoites in smears from vaginal or urethral discharge.

Trichomoniasis: n