Complete activities 1-3. Activity #1: Click on the STD fact-sheet link under activity 1 to complete the information on the STD tables. Write the information on the lab worksheet. Activity #2: Complete the alteration in the reproductive system matching exercise on the lab worksheet. Activity #3: Complete the reproductive case studies on the lab worksheet. Use the graphics from the patho webpage as indicated.
STDs Bacterial Vaginosis (BV) Chlamydia Genital Herpes Genital Warts Describe disease Infectious agent Incidence Symptoms Diagnosis Complications Treatment
Describe the disease Gonorrhea HIV/AIDS Syphilis Trichomoniasis Infectious agent Incidence Symptoms Diagnosis Complications Treatment
Disorders Matching Match the description on the left with the reproductive disorder on the right. 1. Peyronie disease a. Excessive female prostaglandin secretion 2. Fibrocystic disease b. Inflammation of upper genital tract by STD 3. Orchitis c. Cyst between epididymis and testis 4. Polycystic ovarian syndrome d. Female inflammatory conditions often caused by STD s 5. Prostatic hyperplasia e. Carcinoma from high levels of androgens 6. Human papilloma virus f. Fluid causes scrotal swelling 7. Varicocele g. Fibrous penile plaques 8. Phimosis h. Many cysts on enlarged ovaries 9. Endometriosis i. Possible complication of mumps 10. PID j. Spermatic cord vein inflammation 11. Secondary amenorrhea k. Leading cause of cervical cancer 12. Hydrocele l. Compression causing bladder obstruction 13. Primary dysmenorrhea m. Palpable lumps in breast 14. Spermatocele n. Penile foreskin too tight to move over the glans 15. Testicular cancer o. Linked to cytotoxic T cell suppression 16. Vaginitis, cervicitis, vulvitis, urethritis p. Stop of menstruation for 3 or more cycles
Case Studies Case 1 A 32 year-old woman had a sensation of pelvic heaviness and a mucinous vaginal discharge which had persisted for months. She has recently experienced dysuria and blood in her urine. A pelvic examination revealed the uterus to be enlarged, and a thick, creamyyellow discharge to be exuding from the cervix. What is the primary reproductive disorder? What do you suspect the cause of this disorder is? Immunoassay tests were positive for C. trachomatis. What are possible complications from this infection? Case 2 A 34 year-old woman complained of severe dysmenorrhea and irregular bowel movements. She had two children during her early twenties, but had been unable to conceive since then. At laparoscopy, multiple "powder-burn" lesions were noted on the pelvic peritoneum, uterine wall, left fallopian tube, and left ovary. A small mass was visible in the wall of the sigmoid colon. See slide 2a The surface of a uterus from a woman with a similar disease process shows a few focal small darkly discolored lesions. See slide 2b Upon closer inspection, the lesions on surface of the uterus have the appearance of small "powder burns".
See slide 2c Microscopically, the lesions on the serosal surfaces are composed of both endometrial glands and stroma with hemorrhage. What condition do you suspect is occurring here? What does ectopic endometrium refer to? How does the menstrual cycle affect the ectopic endometrium? Case 3 A 24 year-old male reports to his physician that he has been experiencing painful urination, a cloudy penile discharge, and has been achy, especially in his knees. He has been feverish and feels like he might have the flu. Physical exam indicates epididymitis, enlarged prostate, and swollen lymph glands and joints. A penile discharge is cultured as well as synovial fluid from the knee joints. Both cultures are positive for intracellular gram-negative diplococci. Use the following link for slide 3: http://www.med.sc.edu:85/fox/neisseria-ml.jpg Your diagnosis is? Why are the joints affected? Can this disorder be treated?
Case 4 A 45-year-old woman visits her obstetrician after noticing a discharge from her right nipple. The physician palpates a large irregular firm fixed mass in the right breast as well as overlying skin with a rough, reddened appearance. Mammographically, the mass has irregular borders. A fine needle aspirate is performed of the mass, followed by a mastectomy See slide 4a There is a large mass lesion with irregular borders in this mastectomy specimen. The mass has a central irregular whitish scar. There are scattered foci of yellow to white necrosis and calcification. See slide 4b In the skin overlying the breast, the dermal lymphatics are dilated and contain small clusters of malignant cells. See slide 4c Microscopically at medium power, the breast lesion is shown here. Explain the diagnosis and current treatment methods. The patient had a familial history of breast cancer. An aunt had a double mastectomy with a different form of cancer in each breast. The patient s sister was diagnosed with breast cancer at age 35. Explain the significance of the family history. What other factors increase the risk of breast cancer? Case 5 A 35-year-old woman calls her physician asking for an antibiotic for a urinary tract infection. The receptionist arranges an appointment for her to be seen. The woman complains of painful urination and vaginal itching. She also indicates she has been experiencing pain following
intercourse. The physician requests a urine sample and also swabs the vagina for culture. He notes a gray-green vaginal discharge. The urine sample is unremarkable except for the following organism observed on microscopic examination. The organism is also noted on a vaginal gram stain, along with many white blood cells. See slide 5. Can you make a diagnosis? Is this a bacterial, viral, or parasitic infection? For a microscopic video clip, use this URL. http://www.dpd.cdc.gov/dpdx/html/trichomoniasis.asp?body=frames/ S-Z/Trichomoniasis/body_Trichomoniasis_mic1.htm Case 6 A 55-year-old man complains of increased urinary frequency and nocturia 2-3 times each night. He has a history of hypertension and diabetes. His physical exam is unremarkable except for a firm, large, prostate. Urinalysis results are normal. A DRE (digital rectal exam) indicated prostrate induration with nodularity. A PSA test was markedly elevated at 40 ng/ml (normal is < 4.0 ng/ml). Your diagnosis is? What are treatment options for this patient?
Case 7 A pregnant 18 year-old woman came an urgent-care clinic with a lowgrade fever, malaise, and headache. She was sent home with a diagnosis of influenza. She again sought treatment 7 days later with a macular rash on her trunk, arms, hands, and feet. Further questioning of the patient when serology results were known revealed that 1 month previously, she had a painless ulcer on her vagina that healed spontaneously. What STD do you suspect? Use the following link for an image of the organism. (http://www.med.sc.edu:85/trepo.jpg). What is the causative organism? What complications can occur if left untreated?
ANSWERS TO MATCHING WORKSHEET Match the description on the left with the reproductive disorder on the right. 1. g_ Peyronie disease a. Excessive female prostaglandin secretion 2. m_ Fibrocystic disease b. Inflammation of upper genital tract by STD 3. i_ Orchitis c. Cyst between epididymis and testis 4. h_ Polycystic ovarian syndrome d. Female inflammatory conditions often caused by STD s 5. l_ Prostatic hyperplasia e. Carcinoma from high levels of androgens 6. k_ Human papilloma virus f. Fluid causes scrotal swelling 7. j_ Varicocele g. Fibrous penile plaques 8. n_ Phimosis h. Many cysts on enlarged ovaries 9. o_ Endometriosis i. Possible complication of mumps 10. b_ PID j. Spermatic cord vein inflammation 11. p_ Secondary amenorrhea k. Leading cause of cervical cancer 12. f Hydrocele l. Compression causing bladder obstruction 13. a Primary dysmenorrhea m. Palpable lumps in breast 14. c_ Spermatocele n. Penile foreskin too tight to move over the glans 15. e_ Testicular cancer o. Linked to cytotoxic T cell suppression 16. d_ Vaginitis, cervicitis, vulvitis, urethritis p. Stop of menstruation for 3 or more cycles ANSWERS TO CASE STUDIES Case 1 A 32 year-old woman had a sensation of pelvic heaviness and a mucinous vaginal discharge which had persisted for months. She has recently experienced dysuria and blood in her urine. A pelvic examination revealed the uterus to be enlarged, and a thick, creamyyellow discharge to be exuding from the cervix.
What is the primary reproductive disorder? THE PRIMARY CONDITION IS CERVICITIS. What do you suspect the cause of this disorder is? THE VAGINIAL DISCHARGE SUGGESTS AN STD Immunoassay tests were positive for C. trachomatis. What are possible complications from this infection?. CHLAMYDIAL INFECTIONS CAN BE PASSED TO THE NEWBORN AS CONJUNCTIVITIS AND/OR PNEUMONIA, IT IS ALSO THE LEADING CAUSE OF PELVIC INFLAMMATORY DISEASE. Case 2 A 34 year-old woman complained of severe dysmenorrhea and irregular bowel movements. She had two children during her early twenties, but had been unable to conceive since then. At laparoscopy, multiple "powder-burn" lesions were noted on the pelvic peritoneum, uterine wall, left fallopian tube, and left ovary. A small mass was visible in the wall of the sigmoid colon. See slide 2a: The surface of a uterus from a woman with a similar disease process shows a few focal small darkly discolored lesions. See slide 2b: Upon closer inspection, the lesions on surface of the uterus have the appearance of small "powder burns". See slide 2c: Microscopically, the lesions on the serosal surfaces are composed of both endometrial glands and stroma with hemorrhage. What condition do you suspect is occurring here? ENDOMETRIOSIS What does ectopic endometrium refer to? ECTOPIC ENDOMETRIUM IS FUNCTIONING ENDOMETRIAL TISSUE THAT IMPLANTS OUTSIDE THE UTERUS.
How does the menstrual cycle affect the ectopic endometrium? IF BLOOD SUPPLY IS SUFFICIENT, THE ECTOPIC TISSUE PROLIFERATES, BREAKS DOWN, AND BLEEDS IN CONJUNCTION WITH THE NORMAL MENSTRUAL CYCLE. Case 3 A 24-year-old male reports to his physician that he has been experiencing painful urination, a cloudy penile discharge, and has been aching, especially in his knees. He has been feverish and feels like he might have the flu. Physical exam indicates epididymitis, enlarged prostate, and swollen lymph glands and joints. A penile discharge is cultured as well as synovial fluid from the knee joints. Both cultures are positive for intracellular gram-negative diplococci. Link here for slide 3: http://www.med.sc.edu:85/fox/neisseria-ml.jpg Your diagnosis is? THE GRAM-NEGATIVE DIPLOCOCCI ARE INDICATIVE OF NEISERRIA GONNORHEA, THE BACTERIA THAT CAUSES GONORRHEA. Why are the joints affected? THE FEVER, SWOLLEN LYMPH GLANDS AND JOINTS INDICATE THE BACTERIA HAS DISSEMINATED Can this disorder be treated? THE CONDITION IS TREATABLE WITH ANTIBIOTICS Case 4 A 45-year-old woman visits her obstetrician after noticing a discharge from her right nipple. The physician palpates a large irregular firm fixed mass in the right breast as well as overlying skin with a rough, reddened appearance. Mammographically, the mass has irregular
borders. A fine needle aspirate is performed of the mass, followed by a mastectomy See slide 4a. There is a large mass lesion with irregular borders in this mastectomy specimen. The mass has a central irregular whitish scar. There are scattered foci of yellow to white necrosis and calcification. See slide 4b. In the skin overlying the breast, the dermal lymphatics are dilated and contain small clusters of malignant cells. See slide 4c. Microscopically at medium power, the breast lesion is shown here. Explain the diagnosis and current treatment methods. THIS IS BREAST CANCER, DIAGNOSED BY BIOPSY AS INFILTRATING DUCTAL CARCINOMA. TREATMENT DEPENDS UPON THE TYPE OF CANCER AND HOW FAR IT S PROGRESSED. TREATMENT METHODS INCLUDE SURGERY, RADIATION, CHEMOTHERAPY, HORMONE THERAPY, BIOLOGIC THERAPY, AND BONE MARROW TRANSPLANTATION The patient had a familial history of breast cancer. An aunt had a double mastectomy with a different form of cancer in each breast. The patient s sister was diagnosed with breast cancer at age 35. Explain the significance of the family history. What other factors increase the risk of breast cancer? THE RISK OF BREAST CANCER IS INCREASED IF A FIRST DEGREE RELATIVE, SUCH AS A MOTHER, OR AUNT, HAS A HISTORY OF BREAST CANCER. THE LIFETIME RISK FOR BREAST CANCER WITH AFFECTED FIRST DEGREE RELATIVES IS AS FOLLOWS: Number Age Risk One relative less than 50 years 13-21% One relative greater than 50 years 9-11%
Two relatives less than 50 years 35-48% Two relatives greater than 50 years 11-24% Other risk factors include race (black higher incidence under 40, whites over 40), previous medical history, estrogen exposure (early menstruation, late menopause, estrogen therapy, oral contraceptives), pregnancy after age 35, radiation exposure, obesity, and alcohol abuse. Case 5 A 35-year-old woman calls her physician asking for an antibiotic for a urinary tract infection. The receptionist arranges an appointment for her to be seen. The woman complains of painful urination and vaginal itching. She also indicates she has been experiencing pain following intercourse. The physician requests a urine sample and also swabs the vagina for culture. He notes a gray-green vaginal discharge. The urine sample is unremarkable except for the following organism observed on microscopic examination. The organism is also noted on a vaginal gram stain, along with many white blood cells. See slide 5. Can you make a diagnosis? TRICHOMONAS VAGINALIS Is this a bacterial, viral, or parasitic infection? PARASITE For a microscopic video clip, use this URL. http://www.dpd.cdc.gov/dpdx/html/trichomoniasis.asp?body=frames/ S-Z/Trichomoniasis/body_Trichomoniasis_mic1.htm
Case 6 A 55-year-old man complains of increased urinary frequency and nocturia 2-3 times each night. He has a history of hypertension and diabetes. His physical exam is unremarkable except for a firm, large, prostate. Urinalysis results are normal. A DRE (digital rectal exam) indicated prostrate induration with nodularity. A PSA test was markedly elevated at 40 ng/ml (normal is < 4.0 ng/ml). Your diagnosis is? PROSTATE CANCER What are treatment options for this patient? TREATMENT DEPENDS ON THE STAGE OF THE TUMOR AND THE PATIENT S AGE, GENERAL HEALTH, AND LIFE EXPECTANCY. TREATMENT INCLUDES SURGERY, RADIATION THERAPY, HORMONE THERAPY, OR CHEMOTHERAPY OR ANY COMBINATION OF THESE Case 7 A pregnant 18-year-old woman came an urgent-care clinic with a lowgrade fever, malaise, and headache. She was sent home with a diagnosis of influenza. She again sought treatment 7 days later with a macular rash on her trunk, arms, hands, and feet. Further questioning of the patient when serology results were known revealed that 1 month previously, she had a painless ulcer on her vagina that healed spontaneously. What STD do you suspect? (See slide 7 for a picture of the organism). THIS IS A CASE OF SECONDARY STAGE SYPHILIS What is the causative organism? THE CAUSATIVE ORGANISM IS TREPONEMA PALLIDUM What complications can occur if left untreated? IF LEFT UNTREATED SYPHILIS CAN PROGRESS TO TERTIARY
SYPHILIS. IN THIS STAGE PATIENTS EXHIBIT NEUROLOGICAL, CARDIAC, AND CUTANEOUS INVOLVEMENT.