Genital Tract Infections

Resident Microbial Flora

Normal urethral flora - coagulase-negative staphylococci and corynebacteria
Vulva and penis (foreskin) – Mycobacterium smegmatis
Lactobacilli are the predominant organisms in secretions from normal, healthy vaginas.
Yeast – not considered as normal flora.
Sexually Transmitted Diseases and MOT
Genital and anal warts; Cervical Dysplasia; Cancer – HPV
Vaginitis - Gardnerella/Mobiluncus, Trichomonas vaginalis, Candida albicans
Urethritis/Cervicitis - Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum
Herpes genitalis – HSV Type 2
AIDS – HIV
Hepatitis – HBV
Lymphogranuloma venereum - C. trachomatis
Granuloma inguinale - Calymmatobacterium granulomatis (Donovania)
Syphilis - Treponema pallidum
Chancroid - Haemophilus ducreyi
Molluscum contagiosum - Poxlike virus

Intestinal protozoa that are significant causes of STDs, especially among homosexual populations:
1. Giardia lamblia
2. Entamoeba histolytica
3. Cryptosporidium spp.
Often transmitted sexually:
Salmonella, Shigella, Campylobacter and Microsporidium

Oral-Genital Practices – N. meningitidis colonizes and infects the genital tract

Laboratory Diagnosis
Urethral Specimen
Suspected organism: N. gonorrhoeae, T. vaginalis, Ureaplasma urealyticum (male)
Use: Dacron or rayon swabs on plastic shaft inserted approx. 2 cm into the urethra
Notes:
 Separate swabs for cultivation of gonococci, chlamydiae, and ureaplasma are required.
 Swab for T. vaginalis must be placed directly into a tube with 0.5 mL of sterile physiologic
saline or in InPouch TV Diagnostic System.
 InPouch TV Diagnostic System – for wet mount examination and culture of T. vaginalis
***The swab collected from the patient is inserted into liquid medium in the upper chamber
of the plastic pouch and swirled. The top of the pouch is folded over and then sealed with the
tabs. Once received in the laboratory, the upper chamber is examined for motile organisms; if
no motile organisms are seen by microscopy, the upper chamber material is inoculated into
the lower chamber and then incubated for up to 5 days. The lower chamber is similarly
examined daily by microscopy for the presence of motile T. vaginalis.
 Few drops of first morning urine can detect: gonococci and T. vaginalis in males.

Cervical/Vaginal Specimen
Suspected organism (purulent discharge): T. vaginalis, gonococci, beta-hemoytic streptococci (rare)
Use: Dacron or rayon swabs on plastic shaft inserted into the cervical canal and rotated for 30
seconds
Notes:
 Remove mucus using cottonballs.
 Infected Bartholin glands should be aspirated with needle and syringe after careful skin
preparation, and cultures should be evaluated for anaerobes and aerobes.

Transport
 Swabs collected for isolation of gonococci may be transported to the laboratory in
modified Stuart’s or Amie’s charcoal transport media and held at room
temperature until inoculated to culture media.
 Good recovery of gonococci is possible if swabs are cultured within 12 hours of
collection.
 Specimen for Chlamydia should be inoculated within 15 minutes of collection.

Storage
 4oC – up to 24 hours
 >24 hours - quick-frozen in a dry ice and 95% ethanol bath and stored at –70 0C until cultured.

Direct Microscopic Examination

1. Gram negative intracellular diplococcic

- Diagnostic for gonorrhea in males
- Presumptive for gonorrhea in females (Normal flora, Veillonella, may resemble gonococci)
2. Clue cells in vaginal discharge suggestive of bacterial vaginosis .