Female genital tract infections/inflammations

Female genital tract infections/inflammations

Updated: 07/20/2022

© Jun Wang, MD, PhD

General features

• Virus: Herpes, Human papillomavirus (HPV), molluscum contagiosum virus
• Bacteria: Gardinerella, Actinomycete (IUD), Syphilis, Gonorrhea, etc
• Chlamydia trachomatis: Most common STD
• Fungi: Candida
• Parasites: Trichomonas
• Pelvic inflammatory disease

Bartholin cyst

• Blockage of Bartholin gland duct
• May be infected by chlamydia, gonorrhea, E. coli, etc
• Swelling
• Squamous and urothelial epithelium lined cysts with inflammation

Herpes

• Associated with HSV1 and HSV2
• Neonatal herpes associated with vaginal delivery in women with third trimester genital herpes
• Commonly asymptomatic
• Painful vesicular lesions until rupture and ulceration, usually heal in a few weeks
• Pathological findings: Multinucleation, Molding of nuclei, Margining of chromatin, ground glass appearance
• Diagnosis: Pathological finding and HSV detection (PCR)

Condyloma acuminatum

• Sexually transmitted infection by human papillomavirus (HPV)
• Spread through oral, anal and genital sexual contact
• Vertical transmission and autoinoculation may occur
• Associated with increased risk of HPV associated neoplasms
• May have abnormal cervical changes
• Risk factors: Multiple sexual partners, unprotected intercourse, history of sexually transmitted infections, smoking
• Clinical presentations: Pearly, filiform, fungating, cauliflower, or plaquelike growth
• Pathological findings: Koilocytes with raisin-like nuclei and cytoplasmic halo, may have dysplasia or squamous carcinoma

Candida

• May be asymptomatic, or pruritus, erythematous changes, swollen vulva, dysuria, etc
• Thick white discharge
• Associated with immunosuppression, antibiotics, due to changes in vaginal pH, glycogen or flora
• Pathological findings: acute inflammation and fungal pseudohyphae (Pap or KOH wet mount)
• Treatment aims to relieve symptoms
  

Trichomoniasis

• Caused by Trichomonas vaginalis
• Increased risk for transmission and acquisition of HIV in women
  
• Primary risk factor: Multiple sexual partners
• Asymptomatic or burning, pruritus, etc
• Copious yellow-green or gray-white vaginal discharge
• Strong odor
• Pathological findings: Pear-shaped, oval, or round cyanophilicprotozoa with four anterior flagella, inflammation
• Diagnostic approaches
• Motile trichomonads on saline wet mount
• Nucleic acid amplification test
• Rapid antigen or nucleic acid probe test

Bacterial vaginosis

• Most common vaginal infection for reproductive age women
• Likely sexually transmitted
• Alteration of flora due to elevated pH associated with various causes
• Gardnerella vaginalis and other bacteria
• Fishy odor, thin, greyish-white vaginal discharge, vulvar irritation
• Diagnosis: Clinical presentations, wet mount finding of clue cells (squamous cells covered by coccobacilli), Whiff test (fishy odor produced by adding KOH to discharge)
• Treatment: Symptom relief, prevent postoperative infections, antibiotics (metronidazole, clindamycin, etc

Pelvic inflammatory disease

• Infectious and inflammatory disorder of the upper female genital tract
• Common causes: Gonorrhea and chlamydia
• Chronic inflammation/scarring
• Risk for infertility or ectopic pregnancy (esp. gonococcal infections)
• Presumptive diagnosis: sexually active young women, pelvic or lower abdominal pain, evidence of cervical motion, uterine, or adnexal tenderness 
• Other findings: Scarring of pelvic organs per image studies (thickening of tubules etc), laparoscopic findings of pelvic inflammation (erythematous changes, edema, adehesion, etc), histologic evidence of endometriosis
• Treatment: Antibiotics (against gonorrhea, chlamydia, etc) 

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