Transcript Normal flora in the urethra of Male are, Staphylococcus Coagulase

• 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.