OG26.1-2,OG27.1-3 | Genital Trauma and Infections — Glossary

A bacterium (including M. tuberculosis) that retains carbol fuchsin dye after acid-alcohol decolourisation in the Ziehl-Neelsen stain; identified by characteristic red rods against a blue background on ZN-stained smears.

Intrauterine adhesions (synechiae) obliterating part or all of the uterine cavity, causing amenorrhoea, hypomenorrhoea, or recurrent miscarriage; in genital TB, caused by endometrial fibrosis from the granulomatous process; confirmed and treated by hysteroscopy.

The combination drug regimen used to treat tuberculosis; first-line regimen = 2RHEZ + 4RH (rifampicin, isoniazid, ethambutol, pyrazinamide for 2 months, then rifampicin + isoniazid for 4 months = 6 months total) for drug-sensitive TB.

Overgrowth of anaerobic bacteria (Gardnerella, Mobiluncus, Prevotella) in the vagina, replacing normal Lactobacillus flora; associated with PID risk because these anaerobes are the co-pathogens that ascend once the cervical barrier is disrupted.

A long-acting intramuscular penicillin preparation used as first-line treatment for syphilis; 2.4 MU IM single dose for primary/secondary/early latent syphilis; the only agent proven effective for treating congenital syphilis when given to the mother.

A form of necrosis specific to tuberculous granulomas in which the central area liquefies to a pale, cheese-like (caseous) material; macroscopically white and amorphous; histologically shows a granular, eosinophilic, acellular zone surrounded by epithelioid cells.

A rapid cartridge-based molecular test that detects M. tuberculosis DNA by PCR and simultaneously identifies rifampicin resistance; endorsed by WHO and RNTCP for TB diagnosis; provides results in approximately 2 hours.

The CDC 2021 threshold for empirical PID treatment: uterine tenderness OR adnexal tenderness OR CMT in a sexually active woman at risk for STIs, with no other cause identified; intentionally low-threshold to prevent under-treatment.

A second-generation cephamycin antibiotic with activity against N. gonorrhoeae, gram-negative rods, and anaerobes; used in inpatient PID regimen A (CDC 2021) as IV cefoxitin 2 g every 6 hours, combined with doxycycline.

Pain on gentle lateral movement of the cervix during bimanual examination; indicates peritoneal irritation from ascending pelvic infection; one of the three CDC minimum diagnostic criteria for PID; also called chandelier sign.

The primary lesion of syphilis — a painless, indurated, clean-based ulcer with firm rolled edges at the site of inoculation; heals spontaneously in 3–6 weeks; highly infectious.

Soft sore caused by Haemophilus ducreyi; characterised by a painful, non-indurated genital ulcer with ragged undermined edges and purulent base, often with ipsilateral tender inguinal lymphadenopathy (bubo).

An alternative term for cervical motion tenderness (CMT) in PID — referring to the dramatic pain response ('reaching for the chandelier') when the cervix is gently moved; indicates peritoneal involvement.

The 'strawberry cervix' appearance in Trichomonas vaginalis infection — punctate haemorrhagic spots on the cervical mucosa caused by sub-epithelial haemorrhage; best seen on colposcopy; classic but not universal finding.

Syphilis acquired transplacentally from an infected mother, particularly in secondary/early latent syphilis; causes stillbirth, hydrops, and a range of neonatal and late stigmata (Hutchinson's triad); prevented by antenatal VDRL screening and benzathine penicillin treatment.

Instillation of 1% silver nitrate or antibiotic eye drops (erythromycin 0.5% or tetracycline 1% ointment) into the conjunctival sac of the newborn at birth to prevent gonococcal ophthalmia neonatorum.

A microscopy technique using oblique illumination to visualise unstained spirochaetes; used to identify T. pallidum directly from primary syphilitic chancre exudate — the most sensitive test for primary syphilis before serological tests become positive.

The current NACO-recommended treatment for gonorrhoea combining ceftriaxone 500 mg IM with azithromycin 1 g oral to cover both N. gonorrhoeae (ceftriaxone) and co-infecting chlamydia (azithromycin); mandated due to widespread fluoroquinolone resistance.

Inflammation of the endometrium — an early step in ascending PID; histopathological confirmation by endometrial biopsy showing plasma cells in the stroma is one of the additional CDC diagnostic criteria for PID.

A focal collection of activated macrophages (epithelioid cells) surrounding a pathogen or irritant; in tuberculosis, granulomas contain Langhans giant cells and central caseous (cheese-like) necrosis — the hallmark of TB histopathology.

Perihepatitis complicating PID — infection spreads from the fallopian tube via the peritoneal cavity to the hepatic capsule (Glisson's capsule), causing right upper quadrant pain and perihepatic 'violin-string' adhesions visible at laparoscopy.

Infection of the female genital tract by Mycobacterium tuberculosis, almost always by haematogenous spread from a primary pulmonary or lymph node focus; principally affects the fallopian tubes and endometrium; a leading cause of tubal-factor infertility in India.

A syndrome comprising one or more ulcers on the external genitalia; the differential includes syphilis (painless, indurated), chancroid (painful, soft), herpes (painful, multiple vesicles), LGV, and donovanosis.

A diagnostic test for ureterovaginal fistula: indigo carmine is injected intravenously, and orange-stained vaginal swabs at 10–20 minutes confirm ureteric leakage.

A radiological investigation using intravenously administered iodinated contrast to opacify the renal collecting systems and ureters; mandatory when ureterovaginal fistula is suspected to assess for ureteric obstruction or ectopic opening.

Tissue death resulting from sustained compression of the soft tissue (vesicovaginal septum) between the fetal skull and the bony pelvis during prolonged obstructed labour, leading to sloughing of the compressed tissue and fistula formation.

Administration of isoniazid (INH) alone for 6 months to individuals with latent TB infection (positive TST/IGRA) who are at risk of progression to active disease; reduces the risk of active TB by approximately 60-90%.

Assisted reproductive technique in which oocytes are retrieved, fertilised in the laboratory, and resulting embryos are transferred into the uterus; the appropriate management for bilateral tubal TB where natural conception is not possible.

A VVF located near the cervix (high in the vagina), typically large and obstetric in origin; may involve one or both ureteric orifices and carries a more complex surgical approach.

A multinucleated giant cell formed by fusion of epithelioid macrophages in granulomatous inflammation; characterised by peripheral arrangement of nuclei in a horseshoe or 'crown' pattern; named after Theodor Langhans; diagnostic of TB when seen with caseation.

The gold standard investigation for PID diagnosis — allows direct visualisation of salpingitis (red, swollen, exudate-covered tubes), peritoneal fluid, TOA, and Fitz-Hugh-Curtis perihepatic adhesions; not required before starting empirical treatment in typical cases.

A stage of syphilis in which the patient is seropositive (reactive VDRL/TPHA) but has no clinical signs; divided into early latent (<1 year from infection — more infectious) and late latent (≥1 year or unknown duration); treatment duration differs.

An extraperitoneal vaginal surgical technique for repair of post-hysterectomy VVF, in which the vaginal epithelium surrounding the fistula is excised and the vaginal vault is partially closed to eliminate the fistulous tract.

A pedicled flap of labial fat pad used as a vascularised tissue interposition layer during VVF repair to provide an additional blood supply between the bladder and vaginal suture lines, reducing the risk of breakdown.

A bedside test for VVF: methylene blue dye is instilled into the bladder, and vaginal swabs are inspected — blue staining of the uppermost swab confirms a vesicovaginal communication.

A molecular diagnostic method (including PCR) that amplifies pathogen-specific nucleic acid; the gold standard for detecting Chlamydia trachomatis and N. gonorrhoeae with high sensitivity and specificity from genital swabs or urine samples.

Obstetric Anal Sphincter Injuries — 3rd and 4th degree perineal tears involving the external anal sphincter (EAS), internal anal sphincter (IAS), or anorectal mucosa; associated with risk of faecal incontinence if not repaired correctly.

A fistula (usually VVF) resulting from ischaemic pressure necrosis of the vesicovaginal septum following prolonged obstructed labour; the major cause of urogenital fistulae in low-resource settings.

Acute purulent conjunctivitis in the newborn, acquired during passage through the infected birth canal; gonococcal type appears within 2–5 days (most severe, risk of blindness); chlamydial type at 5–14 days; prevented by Credé prophylaxis.

A form of TB in which the number of mycobacteria in the specimen is very low, making smear microscopy and culture less sensitive; genital TB is characteristically paucibacillary, explaining why CBNAAT and histopathology are required and a single negative test does not exclude the diagnosis.

Pelvic Inflammatory Disease Evaluation and Clinical Health trial — randomised controlled trial comparing outpatient with inpatient treatment for mild-to-moderate PID; found no significant difference in long-term fertility outcomes, validating outpatient management with close follow-up.

An ascending polymicrobial infection of the upper female genital tract — endometrium, fallopian tubes, ovaries, and surrounding peritoneum — usually initiated by sexually transmitted pathogens (N. gonorrhoeae, C. trachomatis) with amplification by endogenous anaerobes.

The fibromuscular node at the centre of the perineum to which multiple muscles converge (bulbospongiosus, superficial and deep transverse perinei, EAS, puborectalis); injury during delivery disrupts pelvic floor integrity.

A characteristic hysterosalpingographic or laparoscopic appearance of fallopian tubes in genital TB — rigid, non-peristaltic, straight tubes (resembling a lead pipe) due to fibrosis and loss of normal tubal flexibility.

An infection caused by multiple organisms simultaneously; PID is polymicrobial — initiated by STI pathogens and amplified by endogenous anaerobes, aerobic gram-negative rods, and facultative organisms from vaginal flora.

Endometrial curettage performed on days 21–25 of the menstrual cycle (pre-menstrual phase) to obtain endometrial tissue for TB diagnosis; this timing is chosen because the bacillary load in the endometrium is maximal in the secretory phase before shedding.

An abnormal communication between the rectum and the posterior vaginal wall, resulting in passage of flatus and faeces through the vagina; causes include obstetric (4th degree tear breakdown), surgical, radiation, and Crohn's disease.

Revised National Tuberculosis Control Programme (now called National TB Elimination Programme — NTEP), India's national programme for TB diagnosis and treatment; provides free first-line ATT under DOTS to all TB patients.

Inflammation of the fallopian tube caused by ascending infection; the principal site of damage in PID; characterised by red, oedematous, exudate-covered tubes on laparoscopy; repeated episodes cause progressive tubal scarring and occlusion.

An approach to STI treatment in which empirical antibiotic regimens covering all likely pathogens are prescribed based on the clinical syndrome at first presentation, without waiting for laboratory confirmation; adopted by NACO/India for resource-limited settings.

A fundamental surgical principle requiring that suture lines are placed without tension on the edges — achieved by adequate tissue mobilisation and dissection; tension leads to ischaemia and suture-line breakdown.

A treponemal-specific confirmatory test for syphilis that detects antibodies to T. pallidum antigens; remains positive for life after infection; not used for treatment monitoring.

Infertility caused by structural damage to the fallopian tubes (occlusion, adhesions, mucosal destruction) preventing ovum transport or fertilisation; PID is its leading preventable cause.

A collection of pus involving the fallopian tube and/or ovary, representing the severe end of PID; presents with high fever, pelvic pain, and an adnexal mass; requires inpatient IV antibiotics and surgical drainage if no response at 72 hours.

An inflammatory or infectious mass involving both the fallopian tube and ovary; in genital TB, typically a 'cold' (non-tender, no acute inflammatory signs) mass representing chronic caseous or fibrotic involvement of the adnexa.

Surgical reimplantation of the ureter into the bladder, required for repair of ureterovaginal fistula where the damaged segment of ureter is excised and the proximal healthy ureter is anastomosed to the bladder.

An abnormal communication between a ureter and the vaginal wall, typically following surgical injury (hysterectomy); presents with continuous vaginal leakage while normal bladder filling and voiding are preserved.

A non-treponemal serological test for syphilis that detects cardiolipin antibodies; reactive results require confirmation with a treponemal test (TPHA/FTA-ABS); titres correlate with disease activity and are used to monitor treatment response.

An abnormal communication between the posterior wall of the urinary bladder and the anterior vaginal wall, resulting in continuous involuntary leakage of urine per vaginum; the commonest urogenital fistula, predominantly obstetric in origin in developing countries.

Thin, fibrous adhesions between the liver capsule (Glisson's capsule) and the anterior abdominal wall or diaphragm, visible at laparoscopy in Fitz-Hugh-Curtis syndrome; named for their appearance resembling violin strings.