Normal pH of vagina
Disruption of the normal balance of bacteria in the vagina
List 3 clinical features of bacterial vaginosis.
creamy discharge (unpleasant "fishy" odor, may be thin, white or gray)
pain, itching, or burning outside vagina
*Most women report no signs or symptoms.
Most common vaginal infection in childbearing aged women
*not considered a true STI
Describe vaginal pH change seen in bacterial vaginosis.
Bacterial vaginosis leads to a decrease of which normal flora?
What cell, seen upon microscopic examination of vaginal discharge, is associated with bacterial vaginosis?
*unusual vaginal cell with punctate pattern; 1
Candida albicans primary site of colonization
List 3 parts of the body in which Candida albicans exists as a commensal (normal microflora).
skin (under the nails)
List 3 conditions that may put a woman at risk for genital Candidiasis.
use of broad-spectrum antibiotics and/or corticosteroid medications
What environmental factor plays an important role in the pathogenesis of Candida albicans?
Patient presents with thick, curd-like, cottage cheese-like discharge in the vagina.
*pH does not rise (as seen in bacterial vaginosis and trichomoniasis)
Most common site of trichomoniasis in women and men
Describe the virulence factors of trichomonas that give it its characteristic motility.
4 flagella and short undulating membrane
Trichomoniasis transmission (2)
sexual intercourse (primary)
Describe vaginal pH change seen in trichomoniasis.
Are the first or subsequent outbreaks of HHV-1/2 more severe?
1st outbreaks are more severe.
Patient presents with an odorous and frothy discharge in the vagina.
Patient presents with strawberry cervix.
Describe primary symptoms of HHV-1/2 infection.
1+ blisters on or around the genitals or rectum. Itching and vaginal discharge may be present.
What is the relationship between genital herpes and increased chance of HIV infection?
at least a 2 fold increase in HIV infection in patients with genital herpes
HHV-1/2 envelope, shape, and nucleic acid
large, enveloped icosahedral dsDNA virus
In what type of cells do HHV-1 and HHV-2 initially replicate?
HHV-1/2 inclusion bodies
Cowdry bodies type A
In which 2 immune cells do HHV-1 and 2 establish persistent infection?
lymphocytes and macrophages
In which cells do HHV-1 and 2 establish latent infection?
List 3 cytopathic effects of HHV-1 and 2.
Cowdry bodies type A
syncytial giant cells
Which cytokine is blocked by HHV-1 and 2?
*prevents CD8 T cell recognition of infected cells, escapes antibody neutralization and clearance by going into "hiding" during latent infection
visual inspection if the outbreak is typical
test a sample from the sore(s)
HSV outbreaks can also be diagnosed between outbreaks by the use of a blood test to detect antibodies to HHV-1 or 2 infection.
*virus isolation is gold standard
What is the lifetime cumulative risk of acquiring HPV in sexually active persons?
Which 2 strains of HPV cause 70% of all cervical cancers?
Which 2 strains of HPV cause 90% of anogenital warts?
Gardasil is active against which 4 HPV strains?
16, 18, 6, 11
Cervarix is active against which 2 HPV strains?
What is condylomata acuminata?
Peak prevalence of anogenital warts in women
20-24 years of age
Peak prevalence of anogenital warts in men
25-29 years of age
Which viral strain is found in oral tumors of 72% of cancer patients?
Does HPV pr smoking pose a greater risk in contracting oral cancer?
HPV nucleic acid
Cancer associated with HPV
cervical intraepithelial neoplasia
2 oncoproteins associated with HPV and the oncogenes affected
*low-risk strains have these proteins, but do not bind as well to their respective oncogenes
Which layer of the epithelium is infected by HPV?
What happens to the HPV life cycle once it integrates into the host chromosome?
termination of the life cycle
Review mechanism of human papillomavirus-associated carcinogenesis.
CIN stage: mild dysplasia; includes condyloma
CIN stage: moderate dysplasia
CIN stage: severe dysplasia; includes cervical cancer in situ
Review mechanisms of HPV-associated carcinogenesis.
HPV Dx (4)
genital warts diagnosed by visual inspection
routine Pap tests
HPV typing by PCR
HPV typing by nucleic hybridization assay