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Download Normal flora in the urethra of Male are, Staphylococcus Coagulase
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• 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 – Staphylococcus Coagulase negative – Streptococcus, beta, alpha, and gamma hemolytic Streptococci. – Enterobacteriaceae Background • Actually, all of STD • “Sores” (ulcers) – Syphilis :Treponema pallidum – Genital herpes (HSV-2, HSV-1) – Chancroid - Hemophilus ducreyi Background STDs of Concern (continued) • “Drips” (discharges) – Gonorrhea – Chlamydia – Trichomonas vaginitis / urethritis – Candidiasis (vulvovaginal, less problems in men) – Bacterial vaginosis Procedure of collection sample from a patient with Urethritis • Urethral specimen without external discharge . • Profuse urethral discharge • Vaginal swab •Cervical swab: is a swab which is taken from the cervix). 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). • 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. 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 • 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. 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 Diagnosis • For gonorrhea Urethral discharge may be examined by Gram stained • Colony morphology on modified Thayer-Martin (MTM) agar – Small, gray – Translucent, raised • Identification – Oxidase test (+) 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 •Chlamydia trachomatis: prepare a smear from either urethral swab or cervical swab • Wet mount preparation of vaginal discharge is the most useful for rapid diagnostic test for: –Trichomonas vaginalis –Budding cells • For identification Candida albicans we used germ tube method 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 Trichomonas vaginalis • Trophozite is the only stage present in the life cycle. • They are 7-32µm long by 5-12µm wide. 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). 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 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 Normal Vaginal Gram Stain BV ULCERATIVE GENITAL INFECTIONS • Herpes Simplex Virus • Syphilis • Chancroid • In ulcer swab we suspect Haemophilus ducreyi and Treponema pallidum ( wet mount preparation under dark field microscope) Treponema Pallidum • Spirochaetes • Diagnosis depends on - dark field examination (1o and 2o stages) of material from the skin lesions - serology to look for antibodies 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 • Treponemal tests • use whole treponemes or treponemal extracts to detect antibodies • TPHA: Treponemal Pallidum Heamagglutination Test.
