Laboratory diagnostic of STDs

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Clinical aspects of BV

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Clue cells

Gardnerella vaginalis - Clue Cells Pap Smear X10

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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”

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”

• 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

STD: normal flora and causative agents

Anatomic site

Normal flora Causative agentsSTDs non STDs

Distal urethra Enterobacteriaceae, alpha streptococci,

enterococci, coagulase negative

staphylococci, anaerobs

Chlamydia trachomatisNeisseria gonorrhoeaeMycoplasma genitaliumUreaplasma 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.

Anatomic site Normal flora Causative agentsSTDs non STDs

Cervix Normal sterile HPV, HSV, N. gonorrhoeae,

C. trachomatis

HSV type 1, CMV

Endometrium, Fallopian tube,

ovary

Normal sterile N. gonorrhoeae, C. trachomatis

Mixt ascending infections,

S. pyogenes, L.monocytogenes,

B group streptococci, Actinomyces

israelii

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

Vaginitis – vaginal discharge - specific – Candida albicans - T. vaginalisVaginosis - 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

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.

- 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

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?

Case 2Professional 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.

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.

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 ?