Tuyển tập các báo cáo nghiên cứu về sinh học được đăng trên tạp chí sinh học Clinical Microbiology đề tài: Genital tuberculosis in a tamoxifen-treated postmenopausal woman with breast cancer and bloody vaginal discharge...
Clinical Presentation and Staging Patients with cervix cancer generally are asymptomatic, and the disease is detected on routine pelvic examination. Others present with abnormal bleeding or postcoital spotting that may increase to intermenstrual or prominent menstrual bleeding. Yellowish vaginal discharge, lumbosacral back pain, lower-extremity edema, and urinary symptoms may be present.
The staging of cervical carcinoma is clinical and generally completed with a pelvic examination under anesthesia with cystoscopy and proctoscopy.
This syndrome (formerly termed nonspecific vaginitis, Haemophilus vaginitis, anaerobic vaginitis, or Gardnerella-associated vaginal discharge) is characterized by symptoms of vaginal malodor and a slightly to moderately increased white discharge, which appears homogeneous, is low in viscosity, and evenly coats the vaginal mucosa. An interesting observation is that new genital HPV infection in young women is associated with increased subsequent risk of developing bacterial vaginosis.
Gonococcal Infections in Females
Gonococcal Cervicitis Mucopurulent cervicitis is the most common STI diagnosis in American women and may be caused by N. gonorrhoeae, C. trachomatis, and other organisms. Cervicitis may coexist with candidal or trichomonal vaginitis. N. gonorrhoeae primarily infects the columnar epithelium of the cervical os. Bartholin's glands occasionally become infected.
Women infected with N. gonorrhoeae usually develop symptoms. However, the women who either remain asymptomatic or have only minor symptoms may delay in seeking medical attention.
Risk assessment is followed by clinical assessment (elicitation of information on specific current symptoms and signs of STDs). Confirmatory diagnostic tests (for persons with symptoms or signs) or screening tests (for those without symptoms or signs) may involve microscopic examination, culture, antigen detection tests, genetic probe or amplification tests, or serology. Initial syndrome-based treatment should cover the most likely causes. For certain syndromes, results of rapid tests can narrow the spectrum of this initial therapy (e.g.
Abnormal Vaginal Discharge If directly questioned about vaginal discharge during routine health checkups, many women acknowledge having nonspecific symptoms of vaginal discharge that do not correlate with objective signs of inflammation or with actual infection. However, unsolicited reporting of abnormal vaginal discharge does suggest bacterial vaginosis or trichomoniasis. Specifically, an abnormally increased amount or an abnormal odor of the discharge is associated with one or both of these conditions. Cervical infection with N. gonorrhoeae or C.
Other Causes of Vaginal Discharge or Vaginitis
In the ulcerative vaginitis associated with staphylococcal toxic shock syndrome, Staphylococcus aureus should be promptly identified in vaginal fluid by Gram's stain and by culture. In desquamative inflammatory vaginitis, smears of vaginal fluid reveal neutrophils, massive vaginal epithelial-cell exfoliation with increased numbers of parabasal cells, and gram-positive cocci; this syndrome may respond to treatment with 2% clindamycin cream.
Leukorrhea is a usually whitish vaginal discharge that may occur at any age and affects virtually all women at some time. Although some vaginal discharge (mucus) is physiologic and nearly always present, when it becomes greater or abnormal (bloody or soils clothing), is irritating, or has an offensive odor, it is considered pathologic. Pathologic discharge is often coupled with vulvar irritation. Commonly, the pathologic conditions are due to infection of the vagina or cervix.
This book is aimed specifically at medical practitioners in primary
care who require a quick guide to help diagnose and manage
genital problems. As such this is not a comprehensive text
but a prompt to “what to do next” when faced with a patient presenting
with a genital complaint. A list of reference textbooks is
provided in Further Reading and I would suggest you have at
least one of these available for perusing at a more leisurely pace
at a later time.
Numerous misconceptions surround endogenous infections. For example, many women
believe, or are mistakenly told by medical practitioners, that their symptoms result from much
more serious sexually transmitted infections. This can occur if the presence of inflammation or
discharge caused by endogenous infections is confused with discharge produced by STIs such
as gonorrhea or chlamydia. Indeed, many studies show that even experienced clinicians cannot
reliably distinguish between vaginal discharge caused by sexually transmitted or endogenous
Inspection of the vulva and perineum may reveal tender genital ulcerations (typically due to HSV infection, occasionally due to chancroid) or fissures (typically due to vulvovaginal candidiasis) or discharge visible at the introitus before insertion of a speculum (suggestive of bacterial vaginosis or trichomoniasis).
Because there is significant variation and overlap in the appearance of dif-
ferent etiologies of vaginitis, objective testing should always be undertaken.
Any symptomatic, colored, or foul-smelling discharge should be sampled
from the lateral vaginal wall for microscopic examination. Such specimens
usually are obtained before other testing to decrease the presence of red blood
cells. Secretions are mixed with a small amount of normal saline either in a
test tube or on a slide with a protective cover slip to prevent air-drying.