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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