Diseases of female reproductive system: Lecture 1
Viral vaginal infections:
Genital herpes simplex virus:
- HSV 2 infections
- Painful red lesions
- Virus can travel to the lumbosacral ganglion latent infection
- Dx: multinucleated giant cells (Tzanck smear)
- Rx: acyclovir (block DNA synthesis)
Molluscum contagiosum:
- Poxvirus infection of the skin and mucous membranes
- Affect 1) small children 2) adults via sexual transmission
- Gross: multiple little papules on the skin, dome shaped papules with dimpled center
- In Adults:
o Biopsy and histology: epithelial cells overloaded w/ virus (molluscum bodies)
- Tx: local destruction
Vaginitis:
- Inflammation of the vagina
- Bacterial, candida, trichomonas vaginalis
- Bacterial Gardnerella vaginalis MCC, risk factor = pregnancy, IUD, douching
- Candida MCC in diabetics and immunocompromised, seen in chronic Ab use
- Trichomonas vaginalis sexual transmission, protozoa
Gardnerella vaginalis:
- Malodorous fishy smell discharge from vagina
o After adding KOH
- Pap smear clue cells = epithelial cells with shaggy coat/granulation of bacteria
- Dangerous in pregnant patients = premature labor
- Rx: metronidazole
Candidiasis:
- Erythema in labial areas, very rare to give white film
- Risk factors diabetes and antibiotics
- Pap smear treat with KOH to melt human cells and leave fungal cells
o Yeast and true hyphae/pseudohyphae
Trichomonas vaginalis:
- Amoeba
- C/F: strawberry colored mucosa of cervix on colonoscopy
- Risk sexual transmission, males are asymptomatic
- Dx: trophozoites with tail (motile flagellates)
- Tx: metronidazole
Chlamydia trachomatis:
- Causes inflammation of the cervix, uterus, fallopian tubes, and lymph nodes
o Follicular cervicitis and lymphogranuloma venerum + conjunctivitis in babies
- Inguinal lymph node enlargement
- Biopsy: necrotizing granuloma + neutrophils + macrophages with inclusion bodies
, - Can cause infertility
- Tx: azithromycin, doxycycline + for babies with trachoma give erythromycin
Pelvic inflammatory disease (PID):
- Combination of inflammation of vagina, cervix, uterus, and fallopian tube (entire FRT)
o MC problem is in the fallopian tubes and ovaries
- C/F: pelvic pain, adnexal tenderness, fever, vaginal discharge
- Causes Neisseria and Chlamydia (staph aureus in patients who use tampon – sepsis)
- Acute suppurative salpingitis:
o Inflammation of the fallopian tube (neutrophils, plasma cells, lymphocytes)
- Consequences of PID:
o Infertility
o Ectopic pregnancy
o Sepsis
Diseases of vulva:
- External genitalia
Bartholinitis:
- Obstruction of ducts of Bartholin glands can cause abscess or cysts
- Cysts filled with transudate, abscess filled with exudate
- Tx: surgical removal
Caruncle:
- Fibroepithelial polyps of the urethra
- Result of chronic inflammation granulation tissue that looks like a polyp
o Excessive proliferation of CT of urethra
Vulvar vestibulitis associated with vulvodynia:
- Vulvodynia burning discomfort, itching, throbbing, and tenderness in vulva
Leukoplakia:
- White plaques in the walls of vulva
- Can be caused by variety of diseases:
o Inflammatory dermatitis, psoriasis
o Invasive carcinoma
o Lichen sclerosis and Lichen simplex
LSA and LS can cause leukoplakia
Lichen sclerosis (LSA) autoimmune atrophic skin LSA = ATROPHY
- Thinning of epidermis, superficial keratosis
- Increased chance of developing squamous cell carcinoma
- Whitish plaques + rough skin = discomfort and painful
- Biopsy: mucosal atrophy + fibrosis + inflammation
Lichen simplex autoimmune hypertrophic skin squamous cell hyperplasia
- Rough skin and hyperplastic epidermis NOT atrophic
Condyloma acuminatum:
- Sexually transmitted HPV 6 and 11 (not precancerous)
- Spiked shape of condyloma unlike flat condyloma of syphilis
- Morphology koilocytic atypia
o epithelial cells look round, nucleus shrink, clear cytoplasm
Vulvar intraepithelial neoplasia (VIN):
Viral vaginal infections:
Genital herpes simplex virus:
- HSV 2 infections
- Painful red lesions
- Virus can travel to the lumbosacral ganglion latent infection
- Dx: multinucleated giant cells (Tzanck smear)
- Rx: acyclovir (block DNA synthesis)
Molluscum contagiosum:
- Poxvirus infection of the skin and mucous membranes
- Affect 1) small children 2) adults via sexual transmission
- Gross: multiple little papules on the skin, dome shaped papules with dimpled center
- In Adults:
o Biopsy and histology: epithelial cells overloaded w/ virus (molluscum bodies)
- Tx: local destruction
Vaginitis:
- Inflammation of the vagina
- Bacterial, candida, trichomonas vaginalis
- Bacterial Gardnerella vaginalis MCC, risk factor = pregnancy, IUD, douching
- Candida MCC in diabetics and immunocompromised, seen in chronic Ab use
- Trichomonas vaginalis sexual transmission, protozoa
Gardnerella vaginalis:
- Malodorous fishy smell discharge from vagina
o After adding KOH
- Pap smear clue cells = epithelial cells with shaggy coat/granulation of bacteria
- Dangerous in pregnant patients = premature labor
- Rx: metronidazole
Candidiasis:
- Erythema in labial areas, very rare to give white film
- Risk factors diabetes and antibiotics
- Pap smear treat with KOH to melt human cells and leave fungal cells
o Yeast and true hyphae/pseudohyphae
Trichomonas vaginalis:
- Amoeba
- C/F: strawberry colored mucosa of cervix on colonoscopy
- Risk sexual transmission, males are asymptomatic
- Dx: trophozoites with tail (motile flagellates)
- Tx: metronidazole
Chlamydia trachomatis:
- Causes inflammation of the cervix, uterus, fallopian tubes, and lymph nodes
o Follicular cervicitis and lymphogranuloma venerum + conjunctivitis in babies
- Inguinal lymph node enlargement
- Biopsy: necrotizing granuloma + neutrophils + macrophages with inclusion bodies
, - Can cause infertility
- Tx: azithromycin, doxycycline + for babies with trachoma give erythromycin
Pelvic inflammatory disease (PID):
- Combination of inflammation of vagina, cervix, uterus, and fallopian tube (entire FRT)
o MC problem is in the fallopian tubes and ovaries
- C/F: pelvic pain, adnexal tenderness, fever, vaginal discharge
- Causes Neisseria and Chlamydia (staph aureus in patients who use tampon – sepsis)
- Acute suppurative salpingitis:
o Inflammation of the fallopian tube (neutrophils, plasma cells, lymphocytes)
- Consequences of PID:
o Infertility
o Ectopic pregnancy
o Sepsis
Diseases of vulva:
- External genitalia
Bartholinitis:
- Obstruction of ducts of Bartholin glands can cause abscess or cysts
- Cysts filled with transudate, abscess filled with exudate
- Tx: surgical removal
Caruncle:
- Fibroepithelial polyps of the urethra
- Result of chronic inflammation granulation tissue that looks like a polyp
o Excessive proliferation of CT of urethra
Vulvar vestibulitis associated with vulvodynia:
- Vulvodynia burning discomfort, itching, throbbing, and tenderness in vulva
Leukoplakia:
- White plaques in the walls of vulva
- Can be caused by variety of diseases:
o Inflammatory dermatitis, psoriasis
o Invasive carcinoma
o Lichen sclerosis and Lichen simplex
LSA and LS can cause leukoplakia
Lichen sclerosis (LSA) autoimmune atrophic skin LSA = ATROPHY
- Thinning of epidermis, superficial keratosis
- Increased chance of developing squamous cell carcinoma
- Whitish plaques + rough skin = discomfort and painful
- Biopsy: mucosal atrophy + fibrosis + inflammation
Lichen simplex autoimmune hypertrophic skin squamous cell hyperplasia
- Rough skin and hyperplastic epidermis NOT atrophic
Condyloma acuminatum:
- Sexually transmitted HPV 6 and 11 (not precancerous)
- Spiked shape of condyloma unlike flat condyloma of syphilis
- Morphology koilocytic atypia
o epithelial cells look round, nucleus shrink, clear cytoplasm
Vulvar intraepithelial neoplasia (VIN):
