1. Genital Tract Infection1

2. Normal flora in the urethra of female depends on the age:
Normal flora in the urethra of Male are, Staphylococcus Coagulase negative, Diphtheroid, Mycobacterium smegmatis.
Normal flora in the urethra of female depends on the age:
Before puberty
Staphylococcus Coagulase negative
Diphtheroid
During puberty :
Lactobacillus
Gardnerella vaginalis
Streptococcus group B
Streptococcus, beta, alpha, and gamma hemolytic Streptococci.
Enterobacteriaceae 2

3. Actually, all of STD “Sores” (ulcers) Syphilis :Treponema pallidum
Background
Actually, all of STD
“Sores” (ulcers)
Syphilis :Treponema pallidum
Genital herpes (HSV-2, HSV-1)
Chancroid - Hemophilus ducreyi

4. STDs of Concern (continued)
Background
“Drips” (discharges)
Gonorrhea
Chlamydia
Trichomonas vaginitis / urethritis
Candidiasis (vulvovaginal, less problems in men)
Bacterial vaginosis

5. Procedure of collection sample from a patient with Urethritis
Urethral specimen without external discharge .
Profuse urethral discharge
Vaginal swab 5

6. Cervical swab: is a swab which is taken from the cervix).6

7. Culturing:
When the samples received in the lab (Urethral swab or vaginal swab or cervical swab), we search for the most common causative agents (Haemophilus ducreyi, Candida albicans, and N. gonorrhea). 7

8. Therefore we used the following media as primary plates: Blood Agar
Chocolate Agar
Sabouraud dextrose agar.
MacConkey Agar
Incubate all media for 24 hours at 35°C. For chocolate agar media used 5-10% CO2 condition.

9. NON-ULCERATIVE GENITAL INFECTIONS
Cervicitis/urethritis most common
Neisseria gonorrhoeae
Chlamydia trachomatis
Patients infected with Neisseria gonorrhoeae or Chlamydia trachomatis in the genital tract may complain of:
urethral discharge
vaginal discharge
dysuria
nothing at all

10. These organisms result in similar clinical presentations although with Neisseria gonorrhoeae,the incubation period tends to be shorter and the symptoms tend to be more severe, but not always.

11. Neisseria gonorrhoeae
Gram negative diplococci ( intra and extra cellular)
Fastidious
Requires supplements to media (X, V factors)
May take 48 – 72 hours to grow in culture
Not part of normal flora

12. Diagnosis
For gonorrhea Urethral discharge may be examined by Gram stained 12

13. Small, gray Translucent, raised
Colony morphology on modified Thayer-Martin (MTM) agar
Small, gray
Translucent, raised

14. Oxidase test (+) Identification
Yellow is a positive result on carbohydrate utilization tests

15. Chlamydia Trachomatis
Obligate intracellular parasite
Cell wall components similar to gram negatives, but not seen with gram stain
Requires tissue culture in laboratory
inclusions seen in infected cells
Not part of normal flora

16. Chlamydia trachomatis: prepare a smear from either urethral swab or cervical swab16

17. Trichomonas vaginalis Budding cells
Wet mount preparation of vaginal discharge is the most useful for rapid diagnostic test for:
Trichomonas vaginalis
Budding cells 17

18. For identification Candida albicans we used germ tube method18

19. Procedure For Germ Tube Test
A small amount of an isolated colony is suspended in a test tube containing 0.5 ml of rabbit or human plasma or serum.
The test tube in incubated at 35°C for no longer than 2 hours.
A drop of the yeast-serum or plasma suspension is placed on a clean slide, covered with a cover slip and examined it under microscope (40x)for the presence of germ tubes.
The test is not valid if examined after 2 hours. 19

20. Trichomonas vaginalis
Trophozite is the only stage present in the life cycle.
They are 7-32µm long by 5-12µm wide.

21. Symptoms
Usually none.
Particularly in males. They don’t show symptoms.
In females it ranges from: itching, fishy smell frothing/clear/greenish discharge that is profuse from vagina (leukorrhea).

22. Bacterial Vaginosis Characterized by
(polymicrobial) (due to overgrowth of anaerobes and loss of lactobacilli. Gardnerella may be a marker but not the sole cause of disease)
Clue cells
Homogenous gray discharge.
An amine or fishy odor
The PH is greater than 4.5
Absence of a predominance of Lactobacillus on Gram stain slide 22

23. BV Clinical Characteristics (cont.)
Clue cells – vaginal epithelial cells so coated with bacteria that the cell borders are obliterated. Were originally described on wet mount

24. Normal Vaginal Gram Stain

25. BV 25

26. ULCERATIVE GENITAL INFECTIONS
Herpes Simplex Virus
Syphilis
Chancroid

27. In ulcer swab we suspect Haemophilus ducreyi and Treponema pallidum ( wet mount preparation under dark field microscope) 27

28. Treponema Pallidum Spirochaetes Diagnosis depends on
- dark field examination (1o and 2o stages) of material from the skin lesions
- serology to look for antibodies

29. SEROLOGIC TESTS FOR SYPHILIS
Non-treponemal antibody tests
- uses cardiolipin antigen, not Treponema Pallidum
- VDRL (Venereal Diseases Research Lab)
- RPR (Rapid Plasma Reagin, also ART)
Used as screening tests ,simple, cheaper
False positives common, must be confirmed by a specific test

30. Treponemal tests
use whole treponemes or treponemal extracts to detect antibodies
TPHA: Treponemal Pallidum Heamagglutination Test.