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Infections of the genital tract

The third subsidiary hospital of


Zhengzhou University
Guan Yichun
The normal physiology
acid environment :the healthy vagina is
colonised by the lactobacillus.This
bacteria metabolises glycogen to lactic
acid,thus creating an acid environment in
the vagina. PH ≤4.5

This provides protection against infection ,


together with cervical mucus,maintains the
sterility of the upper genital tract.
Infection of the lower genital tract
 Vulvar infections
 Vaginal infections
 cervicitis

Infection of the upper genital tract


Pelvic inflammatory disease(PID)
Vulvar infection
The common types of vulvar infection:

 Condyloma acuminata
 Non-specific vulvitis
 Bartholin’s cyst and abscess
Condyloma acuminata
 It cuased by human papilloma
virus(HPV) ,most be HPV type 6 or 11.
 Condyloma acuminata may be
discovered in vulva,vagina,cervix.

 It is the most common sexually


transmitted disease .
 Pregnant,immuno-suppressed,and
diabetic patients are at increased risk.
Condyloma acuminata
 Symptoms: multiple small papillary ,soft
and painless.
If infected ,it may cause bleeding,pain,or
ulceration.
 Diagnosis: symptoms + histopathology
 histopathology is the final diagnosis.
 HPV DNA typing should be performed at
the same time.
Condyloma acuminata
 Treatments
 There is no therapy for complete eradication of the virus.
 Common clinical means: medicine or remove lesions
surgically

 (intrferon) INF

 It may recur,particularly when the patient was in the


immuno-compromised condition.
Non-spectic vulvitis
 There is no pathogen.
 Symptoms itch,pain,burning sensation

 Treatment keep the local skin clean and


dry .
 The local skin is dirty or warm moist ,and
diabeta all increase the incidence
Bartholin’s cyst and abscess
 Formation Secretions build up and dilate
the duct to form a painless bartholin’s
cyst,which may reach the size of an egg.
 If the cyst becomes infected an extremely
painful abscess develops.
 Treatment
 surgical drainage and antibiotic use.
 Pus should be sent for culture and
sensitivity.
Urethral orifice
Labium majus
Vaginal Labium minus
orifice

Bartholin gland
(under the skin)

The anatomy of the vular


Vaginal infection
bacterical vaginitis
Common types candidal vaginitis
trichomonas vaginitis
Differentiate them by means of
lab test of vaginal discharge

Note :If patient has never sexual life,it is


banned to be done speculum examination
vaginal discharge
 Normal discharge: yellowish or white in color
and does not cause any irritation or offensive
smell .The PH of discharge ≤4.7

 lab test of discharge should be performed to


make microbiological identification
bacterial,candidasis,trichomonas ,
chlamydia, gardnerella and so on .
Bacterial vaginitis
symptoms
1 Characteristic discharge is thin
,homogeneous,and grey-white and has a fishy
odor.

2 The discharge can be copious and is adherent


to vaginal walls on speculum examination.

3 Vulvar or vaginal pruritus or irritation is rare.


Bacterial vaginitis
Diagnosis:
symptoms and vaginal discharge
microscopic identification of clue cell
lab test The PH of discharge >4.5
signs Positive “whiff” test

 “whiff” test: amine-like(or fishy)odor is released


with the addition of KOH solution(10% to 20%) to
the discharge.
Trichomonas vaginitis
 Sexually transmitted infection.

 The classic discharge is frothy,thin,malodorous,and


copious.The color may be gray,white or yellow-
green.

 Speculum examination may reveal erythema of


vulva and vagina,and the cervix may appear
erythrmatous and friable.
Bacterial vaginitis
 Treatment : put medicine in the vagina or
take medicine orally,and clean vulvar.

 It is not sexually transmitted.


 If it occurs on pregnant women ,the choice
of medicine should be taken care.
Candidal vaginitis
 This is not a sexually transmitted infection.

 Candida is a normal vaginal inhabitant.


 Risk factors for infection include:
immunosuppression,pregnancy,diabetes
mellitus,broad-spectrum antibiotic therapy
and obesity.
Candidal vaginitis
 Symptoms :the severity of symptoms does
not correlate with the number of organisms.
 The predominant symptom is pruritus.
 The classic discharge is white,curd-like,and
without an odor.
 Speculum examination reveals erythema of
the vulva and vaginal walls.
Candidal vaginitis
 Diagnosis is made when a KOH
preparation of vaginal discharge reveals hyphae
and buds.
 Treatment : intravaginal or oral agents

 The recurrence or persisting of candidal infection


is usual.So it is necessary to therapy
successivelly until the patient is ok.
Trichomonas vaginitis
 Sexually transmitted infection.

 The classic discharge is frothy,thin,malodorous,and


copious.The color may be gray,white or yellow-
green.

 Speculum examination may reveal erythema of


vulva and vagina,and the cervix may appear
erythrmatous and friable.
Trichomonas vaginitis
 Diagnosis is made by founding the
trichomonas in the vaginal discharge.

 Treatment:first choice is taking arilin orally

 The patient’s sexual partners should be treated


as well.
Cervicitis
It always cause a chronic persistent vaginal
discharge.
The cervix may appear:
erosion,enlarged,polyp,and Naboth cyst.
 It can be regarded as cervicitis if any of
them is present
 Erosion---red and gravel-like on the cervix
 Naboth cyst---the gland is obstructed.
Cervicitis
Treatmen :local therapy mainly includes
physical ,surgical or medicine therapy)

make the tissue destroyed and


regeneration
Physical therapy includes laser or microwave to
shine to make the tissue destroyed.
PID
 Pelvic inflammatory disease(PID) is
an infection of the upper genital tract.

 It may include the


endometritis,salpingitis,tubo-ovarian
abscess,and peritonitis.
 It is common in females,especially during
the reproductive years.
PID
 The main pathogen are anaerobe ,
chlamydia , gonorrhoea,and mycoplasma.

 Risk fators :
previous history of PID
multiple sex partners
infection by sexually transmitted organism
use of an IUD
PID
 The most common symptoms is abdominopelvic
pain.Other complaints may include fever ,vaginal
discharge or bleeding.
 Classification:
 acute PID:the symptoms is acute, always
companying fever.
 chronic PID:the symptoms is mild and gradual,may
result in infertility or ecto-pregnancy.
PID
 Diagnosis :minimum criteria are as follow

bilateral lower abdominal tenderness


cervical motion tenderness
bilateral adnexal tenderness
All three should be present
PID
 Treatment :antibiotic choice should
target the major etiologic organism.

 Conservative practitioners may consider


hospital admission for all cases of acute
PID.
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