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Fifty percent of women with signs of BV are asymptomatic. The exact etiology of BV is unknown but is thought to be a dysbiosis of normal vaginal flora that is associated with sexual contact. Gardnerella vaginalis and various anaerobes, including Mycoplasma hominis, Bacteroides, and Mobiluncus, interact and proliferate when lactobacilli are decreased or absent. Bacteria adhere to vaginal epithelium, and massive overgrowth occurs and causes a noninflammatory response. Catabolic enzymes degrade proteins into amines.Lymphogranuloma Venereum p. 931The strain of C. trachomatis that causes LGV probably penetrates skin and mucous membranes through tiny abrasions. LGV spreads to genital and rectal lymphatic tissue, where it causes marked inflammation, necrosis, buboes, abscesses of inguinal lymph nodes, and infection of surrounding tissues. Healing occurs by fibrosis after several weeks or months and results in scarring, damaging the lymph nodes and disrupting their function. LGV can cause permanent lymphatic disruption and genital disfigurement. Affected nodes become chronically swollen, hardened, and enlarged. C. trachomatis also spreads systematically through the bloodstream and can enter the CNS. The primary lesion of LGV appears after an incubation period of 5 to 21 days. The lesion is most commonly a herpetiform (multivesicular) ulcer, but it can assume various forms. The ulcer generally is asymptomatic and inconspicuous and heals rapidly, leaving no scar. In men, the lesion is found most commonly on the penis or scrotum; in women, it is found on the vaginal wall, cervix, or labia. Other signs of primary LGV include a large, tender lymphatic nodule or bubo, urethritis, and cervicitis.Molluscum Contagiosum p. 937Molluscum contagiosum is a benign viral infection of the skin in children and adults. Primarily the face, hands, lower abdomen, and genitalia are affected; papules found on other parts of the skin or widely distributed are not uncommon. Molluscum contagiosum also is a symptom of immunosuppression in HIVpositive individuals. Molluscum contagiosum occurs throughout the world and has been a common
childhood disease in the developing world. It is much less common in the United States, where the incidence is highest among young adults. The childhood disease is transmitted by skin-to-skin contact andfomites and affects the face, trunk, and limbs. Adult disease is more commonly sexually transmitted and affects the lower abdomen, genitalia, and perianal area. Molluscum contagiosum in adults is most common in men 20 to 29 years of age and in those with multiple sexual partners. The molluscum contagiosum virus is taken into epithelial cells by phagocytosis and replicates within the cytoplasm, where it produces superficial cytoplasmic inclusions and cellular hyperplasia. After an incubation period of 2 to 7 weeks, white or flesh-colored, round or oval dome-shaped papules appear. The lesions are relatively small (2 to 5 mm) but occasionally may coalesce to form larger lesions up to 15 mm. The surface has a characteristic central umbilication, from which a thick, creamy core material can be expressed.