Genital Skin and Mucous Membrane Lesions

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External genital lesions are usually either vesicular or ulcerative. Causes of lesions can be determined by physical examination, histologic/cytologic examination, or microscopic examination and/or culture of exudate. Because any genital lesion may be highly contagious, clinicians should wear gloves when carrying out all manipulations of lesion material.

Vesicles in the genital area are almost always attributable to viruses, and herpes simplex is the most common cause. Epithelial cells from the base of a vesicle may be spread onto the surface of a slide and examined for the typical multinucleated giant cells of HSV or stained by immunofluorescent antibody stains for viral antigens. Additionally or alternatively, the material may be transported for culture of the virus, as outlined in Procedure 58-2.

Several commercial fluorescein-conjugated monoclonal and polyclonal antibodies directed against herpetic antigens of either type 1 or 2 are available. When fluorescent-antibody-stained lesion material containing enough cells is viewed under ultraviolet light the diagnosis can be made in 70% to 90% of patients. Laboratories that routinely process genital material for herpes

Figure 58-10 Affirm VP III Microbial Identification Test used to differentiate the three major causes of vaginitis/bacterial vaginosis from a single sample within 1 hour. (Courtesy Becton Dickinson Microbiology Systems: Affirm is a trademark of Becton Dickinson and Company.)

Figure 58-10 Affirm VP III Microbial Identification Test used to differentiate the three major causes of vaginitis/bacterial vaginosis from a single sample within 1 hour. (Courtesy Becton Dickinson Microbiology Systems: Affirm is a trademark of Becton Dickinson and Company.)

should be using immunofluorescent staining reagents when a rapid answer is desired; otherwise, culture, which is generally positive in 2 days, is the method of choice. Nonfluorescent markers, such as biotin-avidin-horseradish peroxidase or alkaline phosphatase, have also been conjugated to these specific antibodies, often allowing earlier detection of herpes-infected cells in tissue culture monolayers. Such reagents have been developed for use direcdy on clinical material, although their sensitivity is not great enough to forego culture if a definitive diagnosis is necessary.

Material from lesions suggestive of syphilis should be examined by dark-field or fluorescent microscopy. These procedures are described in Chapter 48.

All lesions suspected of infectious etiology may be Gram stained in addition to the procedures described. The smear of lesion material from a patient with chancroid may show many small, pleomorphic, gram-negative rods and coccobacilli arranged in chains and groups, characteristic of H. ducreyi. However, culture has been shown to be more sensitive for diagnosis of this agent. Material collected on cotton or Dacron swabs may be transported in modified Stuart's medium. Specimens should be inoculated to culture media within 1 hour of collection. A special agar, consisting of chocolate agar enriched with 1% IsoVitaleX (BBL Microbiology Systems) and vancomycin (3 mg/mL) has yielded good isolation if cultures are incubated in 5% to 7% carbon dioxide in a moist atmosphere, such as a candle jar. H. ducreyi grows best at 33° C.2-10

Granuloma inguinale is diagnosed by staining a crushed preparation of a small piece of biopsy tissue obtained from the edge of the base of the ulcer with Wright's or Giemsa stain and finding characteristic Donovan bodies {bipolar staining rods intracellularly within macrophages). Cytologists or pathologists usually examine such specimens rather than microbiologists. No acceptable media for isolation of C. granulomatis are available.

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Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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