Plenary Discussion

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SCENARIO4:DO NOTWANTMYWHITISH RECOVERED Dina's mother(27years)came to thehealth

centerpacahwaterbecausewhitenessisnotwell healed afterseeing amidwife.From the historythatdoctors getthiswhitish hassufferedsince 3months ago,inthe last weekincreasedalotandsmells. During this timethe motherDinaoftenusing a pair oftightjeansandpantiesonly replace 1xperday.In additionDina's motheralso complainedhehadnot beenmarried2 years are assigned thechild,whenher husbandwhoworkedas abus driverhas donethe analysis spermandfoundnormal.Dina's motherwas alreadydoingan 5/6/12 ultrasoundexaminationandhormonal, Doctors

Doctorsperforminspekuloandfindlots ofyellow-greenmucus in thefornixandvagina,thenthe doctortook themucuswith asterilecottonstickand put itintosterilebottlestobe sent to themicrobiologylaboratory.on thewall foundlittlehiperemisvaginaas well asportionya.then thedoctor Ms.Dinaclean the vaginawithsterilegauzeandantiseptic solution.The doctor then giveantibiotics,antiinflammatoryandvitami ns. On physical examinationthe doctoralsofound aswellinginthe 5/6/12 leftbreastmotherDina painfulandhotto

Terminology

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Identification ofProblems
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1. 2. 3. 4. 5.

Howpredisposingfactorof infectionof the reproductive system? Howinfectiousetiology ofthe reproductive system? Howpathogenesisandpathophysiology ofthe reproductivesystem infection? How isthe diagnosis ofinfectionsof the reproductive system? How isthe management ofreproductivetract infections?

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6. 7. 8. 9. 10. 11.

What is the impactof infectionon thereproductivesystemofinfertility? Howpredisposingfactorsof breastinfection? Howethologybreast infection? How isa diagnosis ofbreast infection? Howpathogenesis ofbreast infection? Howthe management ofbreast infection?

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Analysis of The Problem

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Howpredisposingfactor of infectionof the reproductive system?

Cleanlinessis less Wearingtight jeansthat causesweatingeasy Decreasedimmunesystem HIV/AIDS lifestyle Exchangepartners,frequent sexual intercourse. hormonal Stresshormones:hidrokortisolwhich lowersthe immunesystem Drugs Corticosteroidscansuppress theimmunesystem Antisepticgenitalia anatomical abnormalities urogenitalfistula 5/6/12

Howinfectiousetiology ofthe reproductive system? Bacteria: Gonorrhea = Neisseria gonorrhea

Bacteria:syphilis

= Treponema pallidum Virus:condylomaakuminata = HPV Protozoa:trichomoniasis = Trichomonas vaginalis

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Howpathogenesisandpatho physiology ofthe reproductivesystem infection?

vaginalis Degeneration and squamation => attack PMN => flour albus Gonorrhea Infection can occur in genital tract, eye, uretra. tissue invasionbyleukocytes => chronic invasion => fibrosis Syphillis Primary: ulkus durum secondary: papul, macula tertiary
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Trichomonas

How isthe diagnosis ofinfectionsof the reproductive system? Anamnesis

physical

examination General:important for treatment Special:inspekulo,duhexaminationof the body, check thepH of thevagina

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How isthe management ofreproductivetract infections? Farmacology: antibiotic

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What is the impactof infectionon thereproductivesystem Infection on genital tract => infertility of infertility?

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Howpredisposingfactors of breastinfection?
Usetightbra:breastseasilyscratched

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Howethologybreast infection?
Nipplesaresore:Staphylococcus aureusentry

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How isa diagnosis ofbreast infection?

Anamnesis physical

examination

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Howpathogenesis ofbreast infection?

Staphylococcusaureusbacteriaenter

throughskinabrasions=>localinflammati on andpain=>edema=>abscess

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Howthe management ofbreast infection?

antibiotic

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scheme
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REPRODUCTIVESYSTEMANDBREAST INFECTION
BREAST PREDISPOSI TION ETIOLOGY, PATHOGE NESIS, AND PATHOPHY IMPACT SIOLOGY REPRODU CTIVE SYSTEM MANAGEM ENT

virus bact eria fungi para cite

Nonfarmacolo gy

farmacolo gy

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Learning Objective
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Students are able toexplain thefactorspredisposing toinfection ofthe reproductive systemandbreast Students are able toexplain theetiology ofinfectionsof the reproductive systemandbreast Students are able toexplain thediagnosis ofinfectionsof the reproductive systemandbreast Students are able toexplain thetreatment ofinfectionsof the reproductive systemandbreast Students are able toexplain theimpact 5/6/12 ofthe reproductive

Predisposition factors
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 Trauma

Wounds at the vagina and vulva can become the port d entre for bacteries

Do

a checkup or any actions by using unsterile tools

Can cause infection

After

labour or abortion

Infections can be widely spreaded because:

vGeneral conditions are not optimal

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vMassive wounds in uterus and minor wounds at cervix uteri, vagina, and vulva vLochiaconsists of blood, and desidua residues are good places for the growth of bacteries

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Gonorrhea
Gonorrhea is a sexually transmitted infection (STI) of epithelium and commonly manifests as cervicitis, urethritis, proctitis, and conjunctivitis. If untreated, infections at these sites can lead to local complications such as endometritis, salpingitis, tuboovarian abscess, bartholinitis, peritonitis, and perihepatitis in female patients; periurethritis and epididymitis in male patients; and ophthalmia neonatorum in newborns.

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Phatogenesis
Attachment pili on the surface and the outer membrane protein Opa are responsible for adhesion to cells of the urogenital tract. Opa also directs the invasion processby means of endocytosis. Immune defenses against granulocytes are based on the outer membrane porin Por that prevents the phagosome from fusing with lysosomes, resulting in the survivaland proliferationof phagocytosed gonococci in granulocytes. An IgA1 protease produced by the gonococci hydrolyzes secretory antibodies in the mucosal secretions. The pronounced antigen variability of the attachment pili and the Opa protein make it possible for gonococci to thwart specific immune defense mechanisms repeatedly.
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CLINICAL MANIFESTATIONS Gonococcal Cervicitis Women who either remain asymptomatic or have only minor symptoms may delay in seeking medical attention. These minor symptoms may include scant vaginal discharge issuing from the inflamed cervix (without vaginitis or vaginosis per se) and dysuria (often without urgency or frequency) that may be associated with gonococcal urethritis.

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Gonococcal Vaginitis Gonococcal vaginitis can occur in anestrogenic women (e.g., prepubertal girls and postmenopausalThe vaginal mucosa is red and edematous, and an abundant purulent discharge is present. Infection in the urethra and in Skenes and Bartholins glands often accompanies gonococcal vaginitis. Inflamed cervical erosion or abscesses in nabothian cysts may also occur. Coexisting cervicitis may result in pus in the cervical os. women).

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Lo 2
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shypillis
Definition Shypillis is infection diseases is caused by Treponema pallidum, cronic diseases, systemic, can transmitted to baby Etiology Treponema pallidum is species from Spirochaetaceae, ordo Spirochaetales. Treponema pallidum like spiral, negative gram with leght 11um, diameters 0,09-0,18 um

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Histopatology Vaskular diseases with gumma is hyperimun phenomen. Patologys change : -perivaskular infiltrate -endarteritis obliterans, endoflebitis trombosis

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-Primary Shypillis -SecondaryShypillis - Latent Shypillis -Shypillis continue -Shypillis cardiovaskular -NeuroShypillis

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Herpes simpleks
etiology: VHS type 1: Oral VHS type 2: genital clinical symptoms 1.infeksi primary 2.fase latent 3.infeksi rekurens

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pathogenesis Genital herpes infection can be a primary infection secondary and recurrent infections. Primary infection Primary infection occurs when the virus from outside the entrance to the in the patient's body, the DNA from the patient's body to Merger And hold multiplication. At that time, the body hosts do not yet have specific antibodies, giving rise to more extensive lesions. Furthermore, the virus spread through the nerve fibers toward the sacral sensory ganglion (regional nerve) and silent there. 5/6/12

Secondary infection: infection has been going on but does not cause clinical symptoms, the body has formed an anti-so at the time of infection sekundre abnormalities are not as heavy as a primary infection Recurrent infections Infeksirekurenterjadipadasuatu time when there are certain factors (trigger factor) so that reactivity and the multiplication of the virus have come back.
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Trichomoniasis
Etiology It isa sexually transmitted disease. It is caused by the single-celled protozoan parasite Trichomonas vaginalis. The most common site of infection is the urethra and the vagina in women. Patogenesis T.Vaginaliscaninvadethroughthe wall ofthe urogenitaltract->inflammation ofthe epithelium andsubepithelialtissue. CaseAdvanced ->granulation tissueandnecrosis In thevaginaandurethra, the 5/6/12

Clinical manifestations
painful

urination, painful sexual intercourse, a yellow-green to gray, sometimes frothy, vaginal discharge. The discharge is characteristically malodorous smelling In some cases, there may be vaginal soreness, and abnormal bleeding after sex.

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Diagnose of Reproduction System and Breast Infection

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LO 3

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Generally
Diagnose
Anamn find clinical sign, clinical diagnose = eses Physical Examina tion Supporti ve Examina tion
Fast examination = the most important ! need communication skill

Laborat ory Examin Rapid ation Test

Microsc ope, ect.

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Diagnose of Reproduction System Infection

Gonorrhea Syphilis Condyloma

Acuminata Herpes Simplex (GenitalHerpes) Vulvovaginitis

Trichomoniasis Candidiasis

Etc.

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Gonorrhea (GO)
Diagnose The diagnosis of gonorrhea is best made either with culture or with nucleic acid amplification tests (NAATs). The specimen should be obtained from the discharge in the endocervix As antimicrobial resistance increases among gonococcal strains, culture with sensitivity testing provides an advantage over DNAbased technologies.
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Syphilis
Diagnostic beginning with a nonspecific test

VDRL (Venereal Disease Research Laboratory) RPR (rapid plasma reagin) ART (automated reagin test)

concluding

with a treponeme-specific test for patients screening positive

FTA-ABS (fluorescent treponemal antibody absorbed) TP-PA (Treponema pallidum particle agglutination test)

examination can be done on specimens obtained directly from syphilitic lesions. This may be the diagnostic method of choice for patients with a chancre because the nonspecific and specific serologic tests may be nonreactive 5/6/12

Darkfield

Condyloma Acuminata (Genital Warts)

HPV infection Diagnosis is most often made by visualization of the lesions. Acetic acid examination Colposcopy =>

Histopathology

examination

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Herpes Simplex
HSV Infection Typical lesion Viral culture is the preferred virologic technique for diagnosis. Immunoflouresensi Immunoperoksidase ELISA

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Vulvovaginitis
Infection by : Candida albikans Trichomonas vaginalis Diagnoses by microscopic examination of vaginal secretions

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LO 4

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Rubella (German Measles) There is no specific treatment for rubella Primary prevention relies on comprehensive vaccination vaccine should be offered to nonpregnant women Rubella vaccination should be avoided 1 month before or during pregnancy because the vaccine contains attenuated live virus

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Cytomegalovirus intravenous ganciclovir administered for 6 weeks to neonates with symptomatic central nervous system disease prevents hearing deterioration at 6 months and possibly later antiviral given antepartum is not effective to prevent in utero CMV transmission There is no CMV vaccine Prevention of congenital infection relies on prevention of maternal primary infection, especially in early pregnancy -good hygiene -hand washing have been promoted
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Staphylococcus Aureus Ampicillin plus gentamicin is usually recommended because of synergism. Trimethoprim-sulfamethoxazole can be given to penicillin-allergic women. Maternal treatment may also be effective for fetal infection.

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Toxoplasmosis With IgG antibody confirmed before pregnancy, there is no risk for a congenitally infected fetus Spiramycin is thought to reduce the risk of congenital infection but not to treat established fetal infection Presumptive treatment with pyrimethamine and sulfonamides has been suggested for primary maternal infection in late pregnancy with negative amnionic fluid testing

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fetal infection is diagnosed by prenatal testing, pyrimethamine, sulfonamides, and folinic acid are used to eradicate parasites in the placenta and fetus Prevention cooking meat to safe temperatures peeling or thoroughly washing fruits and vegetables wearing gloves when changing cat litter or delegating this duty avoiding feeding cats raw or undercooked meat and keeping cats indoors

If

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Syphilis Syphilis therapy during pregnancy is given to eradicate maternal infection and to prevent congenital syphilis Parenteral penicillin G remains the preferred treatment for all stages of syphilis during pregnancy Early syphilis _ Benzathine penicillin G, 2.4 million units intramuscularly as a single injectionsome recommend a second dose 1 week later

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 More

than 1-year duration_Benzathine penicillin G, 2.4 million units intramuscularly weekly for three doses Neurosyphilis_ Aqueous crystalline penicillin G, 34 million units intravenously every 4 hours for 1014 days.

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Gonorrhea Ceftriaxone, 125 mg intramuscularly as a single dose Cefixime, 400 mg orally in a single dose Spectinomycin, 2 g intramuscularly as a single dose

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Herpes Simplex Virus Antiviral therapy with acyclovir, famciclovir, or valacyclovir has been used for treatment of first-episode genital herpes in nonpregnant patients Acyclovir appears to be safe for use in pregnant women Primary or first episode infection---Acyclovir, 400 mg orally three times daily for 710 days Symptomatic recurrent infection Acyclovir, 400 mg orally three times daily for 5 days or Acyclovir, 800 mg orally twice daily for 5 days
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Human Papillomavirus Therapy is directed toward minimizing treatment toxicity to the mother and fetus and debulking symptomatic genital warts. Trichloroacetic or bichloracetic acid, 80- to 90-percent solution, applied topically once a week is an effective regimen for external warts Podophyllin resin, podofilox 0.5-percent solution or gel, imiquimod 5-percent cream, and interferon therapy are not recommended in pregnancy because of concerns for maternal and fetal safety
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Vaginitis treatment is with metronidazole, 500 mg twice daily orally for 7 days Alternatives are 0.75-percent metronidazole gel, 250-mg applicator-dose intravaginally three times daily for 7 days 2-percent clindamycin cream, one applicator dose inserted intravaginally at bedtime for 7 days

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