The exact etiology of bv is unknown but is thought to

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. 931
The 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. 937
Molluscum 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 and
fomites 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.