1. Laboratory diagnostic of STDs

11. Clinical aspects of BV

12. Clue cells

14. Gardnerella vaginalis - Clue Cells Pap Smear X10
imagecache6.allposters.com/.../3040/EDPBF00Z.jpg

15. improved by a standardized method of gram stain interpretation”
Normal vaginal flora
A: 4+ morfotipuri lactobacili, fara bacterii gram negative – scor 0;
B: 3+ morfotipuri lactobacili, 1+ Garnerella spp – scor 2;
Nugent RP, Krohn MA, Hillier SL (1991). "Reliability of diagnosing bacterial vaginosis is
improved by a standardized method of gram stain interpretation”

16. improved by a standardized method of gram stain interpretation”BV
E: lactobacili absenti, 4+ bacili gram negativi; prezente “clue cells” – scor 8;
F: lactobacili absenti, 4+ bacili gram negativi; prezente “clue cells” si Mobiluncus spp. – scor 10.
Nugent RP, Krohn MA, Hillier SL (1991). "Reliability of diagnosing bacterial vaginosis is
improved by a standardized method of gram stain interpretation”

18. Figure A – a patient with exophytic genital condyloma acuminatum
Figure B – the initial form of Buschke Lowenstein tumor
Figure C – verrucous carcinoma
Figure D – perianal Buschke Lowenstein tumor

23. STD: normal flora and causative agents
Anatomic site
Normal flora
Causative agents
STDs non STDs
Distal urethra
Enterobacteriaceae, alpha streptococci, enterococci, coagulase negative staphylococci, anaerobs
Chlamydia trachomatis
Neisseria gonorrhoeae
Mycoplasma genitalium
Ureaplasma urealyticum
Extern genital organs
coagulase negative staphylococci, diphtherimorf, yeasts, Enterobacteriaceae
HSV, HPV, Treponema pallidum, Haemoplilus ducrey, C. trachomatis, Candidas pp.
HSV type 1,
Candida spp,
S. pyogenes
Vagina
Lactobacillus, Enterobacteriaceae, alpha streptococci, enterococci, coagulase negative staphylococci
HPV,
Trichomonas vaginalis
Candida,
Trichomonas vaginalis.

24. Anatomic site Normal flora Causative agents STDs non STDs
Cervix
Normal sterile
HPV, HSV,
N. gonorrhoeae, C. trachomatis
HSV type 1, CMV
Endometrium, Fallopian tube, ovary
Mixt ascending infections,
S. pyogenes,
L.monocytogenes, B group streptococci, Actinomyces israelii

25. Diseases:
Urethritis: N. gonorrhoeae
- non gonococcal – C. trachomatis
- Ureaplasma urealyticum
- Mycoplasma genitalium
- Trichomonas vaginalis
- HSV type 2
- post gonococcal – re infection
- failure treatment
- double infection
( C. trachomatis, U. urealyticum has longer incubation than gonococcal infection)
Vulva infection :
– T. pallidum
- HSV, 1
- HPV (6,11)
- Sarcoptes scabiei

26. Vaginitis – vaginal discharge
- specific – Candida albicans
- T. vaginalis
Vaginosis - Gardnerella vaginalis, Bacteroides, Peptococcus,
Mobiluncus, Mycoplasma hominis
girls – vulva - vaginitis – N. gonorrhoeae
- C. trachomatis
- S. pyogenes
Cervicitis – T.vaginalis
- Candida albicans
- Treponema pallidum
- Papillomavirus
- N. gonorrhoeae
- HSV, 2

27. Laboratory diagnostic
Sampling and transport of the pathologic products
Urethral discharge:
at least 2 hours after micturition
Spontaneous / swab
Smears (3), culture – preferable
Vaginal discharge: through aspiration /swab
Endocervicitis: the cervix is scrape with 2 – 3 sterile compress, and then sampling of 3 swabs – gram staining, culture, Giemsa.

28. genital ulcers: swab
syphilis – dark field examination
- fluorescent antibody examination
Herpes ulcers: - Giemsa, Papanicolau smear for giant cells.
IF for viral antigens in epithelial cell.
- serology: syphilis confirmation, C. trachomatis
- genital warts – biopsy – genotyping HPV

29. Case 1
Man, 22 years old, after a holiday in Turkey, present dysuria and purulent urethral discharge.
Presumptive diagnostic: gonococci urethritis
Sampling: urethral discharge, 3 smears, cultivation, ELISA for Chlamydia
Diagnosis: gonococcal urethritis
Treatament :
First intention…
What do you prescribe to the patient?

30. Case 2
Professional driver request a medical examination for legs pain, walking difficulty.
History: painless penille lesion which cured spontaneous, without treatment.
Probably diagnosis: tertiary syplilis
Laboratory findings:
serum – VDRL positive (titer 512), TPHA positive, FTA-abs positive.
CSF – VDRL positive (titru 512), TPHA şi FTA-abs – positive.
Therapeutic behavior:
Hospitalization
Penicilin,
Repeat the serologic tests and lumbar puncture after 3 – 6 month.

31. Case 3
New – born, caesarian section; the mother is HIV positive since 4 years ago.
The gynecologist found about the history of the patient after delivery; the mother came at the hospital in the last moment.
Laboratory findings: child - antibody anti HIV type IgG (ELISA, Western-blot).
After 4 month: the child doesn’t grow, present oral candidiasis, generalized lymphadenopathy, persistent diarrhea. ARN / HIV is present in the blood. Diagnostic – AIDS.
Treatment: anti retroviral – after some month the symptomatology disappeared.

32. Case 4
Man, 25 years old, detect on a wart lesion on the penis, before 4 month ago. Quickly after, his wife present genital warts, also.
The dermatologyst confirm the diagnostic. Advise the women to perform a gynecologic exam.
Questions:
When and how was the husband contaminated?
Is the wife infected? What are the clinical consequences?
How can the diagnosis be confirmed ?