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Bacterial Vaginosis & Gonococcal infection.pptx

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Shan Damrolien
Shan Damrolien

Bacterial Vaginosis is caused by an imbalance in the normal vaginal flora with an overgrowth of anaerobic bacteria like Gardnerella vaginalis and fewer lactobacilli. It can occur due to risk factors like other STIs, douching, or preterm labor. Diagnosis involves Amsel's criteria of vaginal discharge and pH as well as clue cells on microscopy. Nugent's score on Gram stain is also used. Neisseria gonorrhoeae causes gonorrhea, manifesting as cervicitis, urethritis, or conjunctivitis. It is a gram-negative diplococcus with pili and outer membrane proteins helping adhesion and virulence. Diagn

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Bacterial Vaginosis & Gonococcal Infection. Dr Shan
Bacterial Vaginosis ? Bacterial vaginosis affects women of reproductive age. This condition is associated with an alteration of the normal vaginal flora, which is as follows: ? ? Increase in the concentrations of: - ? Gardnerella vaginalis: It is normally isolated from the female genital tract in low numbers; but in bacterial vaginosis, it outnumbers other organisms ? - Mobiluncus (motile, curved, gram-variable or gramnegative, anaerobic rods) ? - Several other anaerobes (Prevotella and some Peptostreptococcus) ? - Mycoplasma hominis ? Decrease in the concentrations of lactobacilli (lactobacilli maintain the acidic pH of the vagina
Risk Factors ? Bacterial vaginosis can occur in presence of the following risk factors: ? ? Coexisting other infections such as HIV, Chlamydia trachomatis, and Neisseria gonorrhoeae ? ? Recent unprotected vaginal intercourse ? Vaginal douching ? ? Premature rupture of membranes and preterm labor.
Diagnosis ? Bacterial vaginosis is so named because there is no associated inflammation. Amsel¡¯s Criteria Bacterial vaginosis is diagnosed if any 3 of the following 4 findings are present: 1. Slight to moderately increased thin (low viscous), white homogeneous vaginal discharge uniformly coated on vaginal wall 2. pH of vaginal discharge more than 4.5 3. Whiff test +ve : Accentuation of distinct fishy odor immediately after vaginal secretions are mixed with 10% solution of KOH 4. Clue cells: They are vaginal epithelial cells coated with coccobacilli, which have a granular appearance and indistinct borders observed on a wet mount
Bacterial Vaginosis & Gonococcal infection.pptx
Laboratory Diagnosis ? ? Nugent¡¯s score: It is a scoring system followed for the diagnosis of bacterial vaginosis; done by counting the number of G.vaginalis, Mobiluncus and lactobacilli present in the Gram stained smear of vaginal discharge. ? A score of more than or equal to 7 is diagnostic Score Lactobacillus Score 0-4 Gardnerella Score 0-4 Mobiluncus Score 0-2 0 > 30 / OIF 0 0 1 5-30 / OIF < 1 / OIF 1-4 /OIF 2 1-4 / OIF 1-4 / OIF > 5 /OIF 3 < 1 / OIF 5-30 / OIF 4 0 > 30 / OIF
? Culture: G. vaginalis requires enriched media such as chocolate agar, BHI broth with serum, etc. ? - It is gram-negative (appears gram-variable in smears), nonmotile, small pleomorphic rod, which shows metachromatic granules ? - It produces minute hemolytic colonies on blood agar, incubated aerobically under 5% CO2 for 24¨C48 hours - Identification from colonies is made either by conventional biochemical tests or by automated identification systems such as MALDI-TOF or VITEK
Gonococcal Infection
Neisseria gonorrhoeae ? Noncapsulated, gram- negative kidney-shaped diplococcus. ? It causes ¡®gonorrhea¡¯, a sexually transmitted infection (STI) which commonly manifests as cervicitis, urethritis and conjunctivitis.
Virulence Factors 1.? Pili or fimbriae: Help in adhesion to host cells and prevent bacteria from phagocytosis ? 2. Outer membrane proteins: ? ? Porin (protein I): ? Transmembrane channels (pores) which help in exchange of molecules across gonococcal surface ? There are two major serotypes: PorB.1A and PorB.1B serotypes. ? Opacity-associated protein (Protein II): Helps in adhesion to neutrophils and other gonococci. 3. Transferrin-binding and lactoferrinbinding proteins, 4. IgA1 protease 5. lipo-oligosaccharide (LOS) with endotoxin
Laboratory Diagnosis ? Specimen Collection: - Urethral swab in men and cervical swab in women are the preferred specimens. - Dacron or rayon swabs are preferred, as cotton and alginate swabs are inhibitory to gonococci ? Transport Media: Stuart¡¯s transport medium or Amies medium. ? Microscopy: Gram staining of urethral exudates reveals gram- negative intracellular kidney-shaped diplococci ? Culture: Thayer Martin medium ? Identification: Gonococci are catalase and oxidase positive ? They ferment only glucose, but not maltose and sucrose ? Automated systems such as MALDI-TOF can be used. ? Molecular Method: PCR targeting 16s or 23s rRNA gene.

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Bacterial Vaginosis & Gonococcal infection.pptx

  • 1. Bacterial Vaginosis & Gonococcal Infection. Dr Shan
  • 2. Bacterial Vaginosis ? Bacterial vaginosis affects women of reproductive age. This condition is associated with an alteration of the normal vaginal flora, which is as follows: ? ? Increase in the concentrations of: - ? Gardnerella vaginalis: It is normally isolated from the female genital tract in low numbers; but in bacterial vaginosis, it outnumbers other organisms ? - Mobiluncus (motile, curved, gram-variable or gramnegative, anaerobic rods) ? - Several other anaerobes (Prevotella and some Peptostreptococcus) ? - Mycoplasma hominis ? Decrease in the concentrations of lactobacilli (lactobacilli maintain the acidic pH of the vagina
  • 3. Risk Factors ? Bacterial vaginosis can occur in presence of the following risk factors: ? ? Coexisting other infections such as HIV, Chlamydia trachomatis, and Neisseria gonorrhoeae ? ? Recent unprotected vaginal intercourse ? Vaginal douching ? ? Premature rupture of membranes and preterm labor.
  • 4. Diagnosis ? Bacterial vaginosis is so named because there is no associated inflammation. Amsel¡¯s Criteria Bacterial vaginosis is diagnosed if any 3 of the following 4 findings are present: 1. Slight to moderately increased thin (low viscous), white homogeneous vaginal discharge uniformly coated on vaginal wall 2. pH of vaginal discharge more than 4.5 3. Whiff test +ve : Accentuation of distinct fishy odor immediately after vaginal secretions are mixed with 10% solution of KOH 4. Clue cells: They are vaginal epithelial cells coated with coccobacilli, which have a granular appearance and indistinct borders observed on a wet mount
  • 6. Laboratory Diagnosis ? ? Nugent¡¯s score: It is a scoring system followed for the diagnosis of bacterial vaginosis; done by counting the number of G.vaginalis, Mobiluncus and lactobacilli present in the Gram stained smear of vaginal discharge. ? A score of more than or equal to 7 is diagnostic Score Lactobacillus Score 0-4 Gardnerella Score 0-4 Mobiluncus Score 0-2 0 > 30 / OIF 0 0 1 5-30 / OIF < 1 / OIF 1-4 /OIF 2 1-4 / OIF 1-4 / OIF > 5 /OIF 3 < 1 / OIF 5-30 / OIF 4 0 > 30 / OIF
  • 7. ? Culture: G. vaginalis requires enriched media such as chocolate agar, BHI broth with serum, etc. ? - It is gram-negative (appears gram-variable in smears), nonmotile, small pleomorphic rod, which shows metachromatic granules ? - It produces minute hemolytic colonies on blood agar, incubated aerobically under 5% CO2 for 24¨C48 hours - Identification from colonies is made either by conventional biochemical tests or by automated identification systems such as MALDI-TOF or VITEK
  • 9. Neisseria gonorrhoeae ? Noncapsulated, gram- negative kidney-shaped diplococcus. ? It causes ¡®gonorrhea¡¯, a sexually transmitted infection (STI) which commonly manifests as cervicitis, urethritis and conjunctivitis.
  • 10. Virulence Factors 1.? Pili or fimbriae: Help in adhesion to host cells and prevent bacteria from phagocytosis ? 2. Outer membrane proteins: ? ? Porin (protein I): ? Transmembrane channels (pores) which help in exchange of molecules across gonococcal surface ? There are two major serotypes: PorB.1A and PorB.1B serotypes. ? Opacity-associated protein (Protein II): Helps in adhesion to neutrophils and other gonococci. 3. Transferrin-binding and lactoferrinbinding proteins, 4. IgA1 protease 5. lipo-oligosaccharide (LOS) with endotoxin
  • 11. Laboratory Diagnosis ? Specimen Collection: - Urethral swab in men and cervical swab in women are the preferred specimens. - Dacron or rayon swabs are preferred, as cotton and alginate swabs are inhibitory to gonococci ? Transport Media: Stuart¡¯s transport medium or Amies medium. ? Microscopy: Gram staining of urethral exudates reveals gram- negative intracellular kidney-shaped diplococci ? Culture: Thayer Martin medium ? Identification: Gonococci are catalase and oxidase positive ? They ferment only glucose, but not maltose and sucrose ? Automated systems such as MALDI-TOF can be used. ? Molecular Method: PCR targeting 16s or 23s rRNA gene.