MICROBIOLOGY LABORATORY FAC.

OF MEDICINE BRAWIJAYA UNIVERSITY

May caused by: Bacteria Viruses Fungi Parasites Others (ToRCH agents)

Gonorrhoea Non gonococcal urethritis (NGU) Pelvic inflammatory disease (PID) Syphilis (Lues) Lymphogranuloma venereum (LV) Chancroid (Ulcus molle) Bacterial vaginosis

Caused by gram negative cocci Neisseria gonorrhoeae (gonococcus). The name is given by Galen (AD 150) gon = semen + rhea = flow. To infect, the gonococci must attach to the mucosal cells of the epithelial wall by means of fimbriae. It invades the spaces separating columnar epithelial cells, which are found in the:

 oral-pharyngeal area eyes, rectum urethra opening of the cervix external genitals (of prepubertal

The invasion sets up an inflammation leukocytes move into the area pus formation. In male: single unprotected exposure 20-35%; whereas in female: 6090%.

females)

Males will aware of gonococcal infection by painful urination and copious discharge from the urethra.
In females this disease is more insidious; only the cervix which contains columnar epithelial cells is infected. In both, untreated GO can disseminate and become a systemic and serious infection. Complications may involve the joints, heart, meninges, or other part of the body.

Ophthalmia neonatorum a condition found in infant infected by this bacteria in their eyes which can result in blindness. There is no adaptive immunity to GO, because of its extraordinary antigenic variability; and this bacteria are capable of producing several different Opa proteins which is required for adherence. Opa

proteins bind to receptors on host cells on CD4 lymphocytes prevent activation and turn off proliferation. This blocks immunologic memory against the bacteria.

Penicillin has been effective, but the dosage have to be increased, because of penicillin-resistant bacteria. PPNG (Penicillinase-producing N. gonorrhoeae) 1st appear in 1976, highest incidence in special populations.

CDCs recommendation: fluoroquinolone.

Usually caused by Chlamydia trachomatis, or Ureaplasma urealyticum.

Smears from specimen shows absence of gram negative diplococci. Pelvic inflammatory disease (PID) or salpingitis is the inflammation of the uterus, uterine tubes, and adnexal tissue; mostly caused by gonococcal and C. trachomatis infection. Other bacteria may also cause PID - enteric gramnegative bacilli and anaerobic bacteria.

Natural infection with Treponema pallidum is limited to the human host.

Transmitted by sexual contact; infectious lesions on the skin or mucous membrane of genitalia.
The spirochetes multiply locally at the of entry some spread to lymph nodes blood stream.

In 2-10 after infection papule ulcer (hard chancre), characterized by lymphocytes and plasma cells response.

The primary lesion heals spontaneously, but 3-10 weeks later secondary lesion will appear, consist of red maculopapular rash in the body.
Both lesions are highly infectious. The secondary lesions subside spontaneously.

The tertiary stage characterized by gumma (granulomatous lesions) in skin, bone, liver; degenerative changes in CNS (meningovascular syphilis, paresis, tabes); cardiovascular lesions (aortic aneurysm, insuff). In this stage, the bacteria are rare, and tissue response is caused by hypersensitivity.

Some person suffer miscarriage ; others are stillbirth; others born alive with the sign of congenital syphilis: interstitial keratitis, Hutchinsons teeth, saddlenose, periostitis, and several CNS anomalies. Diagnostic laboratory: STS (serologic test for syphilis), using treponemal & nontreponemal antigens.

Pregnant women may transmit this bacteria to the fetus through the placenta in the 10th to 15th weeks of gestation.

STS:
Nontreponemal test: antigens used are cardiolipin VDRL (Venereal Disease Research Laboratory) and RPR (Rapid plasma reagin) will be positive after 2-3 weeks. May revert to negative in 6-18 months after effective therapy. This test are subject to false positive in some diseases (MH, malaria, measles, SLE, rheumatic disorders, etc). Treponemal tests:

These test remain positive for years, even after effective treatment.

TPHA (T. pallidum hemagglutination test) FTA-Abs (fluorescent treponemal antibody)

Treatment: long-acting penicillin (benzathine penicillin G); in latent syphilis is given 3x weekly intervals. Other antimicrobial drugs: tetracycline or erythromycin. A typical Jarisch-Herxheimer reaction may occur within hours after treatment, due to the release products from killed bacteria.

A common condition of women of reproductive age, associate with PRM (premature rupture of the membrane) and preterm labor.

Caused by 2 microbes: Gardnerella vaginalis and Mobiluncus species. In wet smears clue cells which are vaginal epithelial cells covered with many gramvariable bacilli. Vaginal discharge has a distinct fishy odor. Treatment: metronidazole.

Caused by Chlamydia trachomatis (serovar L1-L3), characterized by suppurative inguinal adenitis. Days-weeks after exposure, small papule or vesicle develops on external genital and ulcerate; regional lymph nodes enlarge and painful suppurate and discharge pus through multiple sinus.
In females and homosexuals, perirectal nodes are primarily involved and proctitis.

There are systemic symptoms: fever, headache, conjunctivitis, skin rash, nausea & vomiting, arthralgia. Chronic inflammatory process fibrosis, lymphatic obstruction and rectal strictures. The lymphatic obstruction may lead to elephantiasis of the penis, scrotum, or vulva.

Diagnosis: suspected material is inoculated into McCoy cell culture, and identify by morphology and serologic test.
Treatment: sulfonamides and tetracyclines.

Caused by Hemophilus ducreyi. Lesion consist of ulcer with swelling and tenderness; regional lymph nodes are enlarged and painful. Diagnosis: inoculate scrapings from the ulcer base into IsoVitaleX agar and incubate in 10% CO2.
Treatment: ceftriaxone, cotrimoxazole or erythromycin.

Herpes genitalis Genital warts AIDS

Fungal Infection:

Candidiasis (Vulvovaginal thrush)

Caused by Herpes simplex virus 2 (HSV2)

Characterized by vesiculoulcerative lesions of the penis, cervix, vulva, vagina, and perineum
The virus must encounter mucosal surfaces in order for an infection to be initiated Viral replication occurs first at the site of infection then invades local nerve endings and is transported by retrograde axonal flow to dorsal root ganglia and after further replication, latency is established.

Genital HSV2 infections lead to latently infected sacral ganglia.

Viral persistence in latently infected ganglia lasts for the lifetime of the host; provocative stimuli can reactivate virus from the latent

state, including axonal injury, fever, physical or emotional stress and exposure to uv light.

HSV infection of the newborn may be acquired inutero, during, or after birth; in 75% of cases neonatal herpes is transmitted by contact with lesions in birth canal cesarean section. Treatment: acyclovir, vidarabine.

Caused by human papillomavirus (HPV).

This virus are highly tropic for epithelial cells of skin and mucous membrane.

Cause several different kinds of warts: plantar warts, genital condylomas, laryngeal papilloma.
HPV are also accepted as the cause of anogenital cancers, especially cervical cancer (HPV type 16 and 18). Cervical cancer is the second most frequent cancer in women. Prevention: vaccination.

Characterized by irritation, pruritus, burning sensation, redness, and vaginal discharge creamy white, curdlike.
Is often preceded by factors as diabetes, pregnancy, or antibacterial drugs that alter the microbial flora, local acidity, or secretions.

Diagnosis: pseudohyphae (+) from specimen.

Treatment: topical antifungal drugs.

Toxoplasma Rubellavirus Cytomegalovirus Herpesvirus agents that infect pregnant women and can cause congenital defects in fetus.

Maternal viremia associated with rubella infection during pregnancy may result in infection of the pllacenta and fetus. Timing of fetal infection determines the extent of teratogenic effect; the earlier infection occurs, the greater damage to the fetus. Birth defect are uncommon if maternal infection occurs after 20th week of gestation.

The classic triad: cataract, cardiac anomalies, and deafness.

Prevention: vaccination.

Is a member of Herpesviridae family. Cytomegalic inclusion disease is a generalized infection of infants caused by intrauterine or early postnatal infection with CMV. The infection may be severe. Fetal damage rarely results from reactivation maternal infections.

A high percentage of babies with this disease will exhibit developmental defects and mental retardation.