Pathogenesis

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Normally, C. albicans causes no symptoms. The interaction between large numbers of the normal vaginal lactobacilli and

Epithelial cells

Epithelial cells

Cell nucleus Bacteria

25 mm

Figure 25.4 Clue Cell in an Individual with Bacterial Vaginosis The cells in the photograph are epithelial cells that have sloughed from the vaginal wall, one of which, the clue cell, is completely covered with adherent anaerobes.

Cell nucleus Bacteria

25 mm

Figure 25.4 Clue Cell in an Individual with Bacterial Vaginosis The cells in the photograph are epithelial cells that have sloughed from the vaginal wall, one of which, the clue cell, is completely covered with adherent anaerobes.

Table 25.3 Bacterial Vaginosis

Symptoms

Gray-white vaginal discharge and unpleasant fishy odor

Incubation period

Unknown

Causative agent

Unknown

Pathogenesis

Uncertain. Marked distortion of the normal flora. Increased sloughing of vaginal epithelium in the absence of inflammation. Odor due to metabolic products of anaerobic bacteria. Association with complications of pregnancy, including premature births

Epidemiology

Associated with many sexual partners or a new partner, but can occur in the absence of sexual intercourse. Probably not a sexually transmitted disease

Prevention and treatment

No proven preventive measures.Treatment with metronidazole is effective

Yeast cell, budding

Yeast cell, budding

Pseudomycelium Cell Epithelial i_

nucleus cell

20 mm

Figure 25.5 Candida albicans in the Vaginal Discharge of a Woman with Vulvovaginal Candidiasis

Pseudomycelium Cell Epithelial i_

nucleus cell

20 mm

Figure 25.5 Candida albicans in the Vaginal Discharge of a Woman with Vulvovaginal Candidiasis small numbers of these fungi results in a balance between them probably based on competition for nutrients. When this balance is upset, however, as occurs during intensive antibacterial treatment, C. albicans multiplies without restraint, causes an inflammatory response, and the symptoms of vulvovaginitis occur. Other predisposing factors to Candida infection are late pregnancy, the use of oral contraceptives, and uncontrolled sugar diabetes when glucose is excreted in the urine. Most patients, however, have no known predisposing factors.

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