Cervicovaginal lavage

examination. It often bleeds when touched with a cotton applicator or cervical spatula. A purulent exudate is often observed. cervical cancer can also give this appearance. Most infectious cervicitis is due to sexually transmitted infection, often chlamydia, gonorrhea, or trichomonas. In HIVpositive women, viral infections may be isolated from cervical secretions and may cause local infections including cytomegalovirus, herpes simplex virus, and even HIV itself. All vaginal infections should be treated and followed up.

cervicovaginal lavage (CVL) A technique in which a saline solution is sprayed into the vaginal vault and recovered for testing. CVL can be used to determine HIV viral load in genital tract secretions.

cervix The lower end of the uterus which protrudes into the vagina. Various contraceptive devices, such as the cervical cap and the diaphragm, do their job by blocking off this cervical opening and thus preventing the egg-hunting sperm from entering the uterus. Also called cervix uteri.

cesarean section The removal of a fetus by means of an incision into the uterus, usually by way of the abdominal wall. It may be performed by an extraperitoneal or intraperitoneal abdominal route. Indications for cesarean section include an abnormally large fetus (too large to be delivered through the pelvic outlet), an abnormally small pelvis, or a combination of these factors. A breech presentation of the fetus may also be an indication that a cesarean section is needed.

challenge In vaccine experiments, the exposure of an immunized animal to the infectious agent. Challenge experiments are never done in human HIV vaccine research.

chancre A primary sore or lesion at the site of entry of the bacteria that causes syphilis.

chancroid An ulcerative lesion caused by Haemophilus ducreyi. Chancroids usually begin with a sensitive and inflamed pustule or ulcer with multiple, abrupt edges, a rough floor, and yellow exudate, purulent secretion. The incubation period is approximately three to five days. Chancroids may affect the penis, urethra, vulva, or anus. Multiple lesions may develop by autoinoculation. Types include transient, phagedenic, giant, and serpiginous. Chancroids usually present as painful ulcers accompanied by tenderness and inguinal lymphadenopathy. Women with cervical chancroid tend to have multiple ulcers, with an average of four. Diagnosis based only on history and physical exam is often inaccurate. Culture for H. ducreyi is warranted for both diagnosis and reporting purposes. Syphilis, herpes simplex, and HIV coinfection should also be considered in the differential diagnosis.

Chancroid lesions have been identified as a major risk factor for heterosexual spread of HIV through ulceration. Genital ulcers are thought to act as portals of entry for the virus from male genital secretions. Women may be unaware of the presence of ulcers.

erythromycin or ceftriaxone usually satisfactorily treat chancroid. Treatment failure is more common in HIV-infected patients, especially single-dose treatment. As the susceptibility of H. ducreyi varies by geography, response should be monitored clinically and by susceptibility patterns.

charbon Infection with Bacillus anthracis. See

ANTHRAX.

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