Download inflamation and infections of the female reproductive system

INFLAMATION AND INFECTIONS
OF THE FEMALE
REPRODUCTIVE SYSTEM
COMMON INFECTIOUS CONDITION
 Bartholinitis, Bartholin abscess and Bartholin cysts
 Vaginitis : Bacterial,viral,monilial and atrophic
(postmenopausal)
 Vulvovaginitis
ETIOLOGY
 Specific organisms or non-infective dermatitis
 Irritation from vaginal discharge or menses
 Lack of vulvar hygiene
 Glycouria
VULVAL INFECTIONS
CAUSATIVE ORGANISMS AND CLINICAL
MANIFESTATION
BACTERIAL INFECTIONS
 CAUSES
 caused by sexually transmitted organisms
 CLINICAL FEATURES
 Increased vaginal discharge
 Musty or fleshy odour of discharge following sexual
intercourse
 Homogeneous, gray – white discharge
 MANAGEMENT
 Local antiseptics
 Systemic antibiotics
CAUSATIVE ORGANISMS AND CLINICAL
MANIFESTATION
MONILIASL INFECTION
 CAUSES
 Candida albicans
 CLINICAL FEATURES
 Itching and burning
 Thick – curd like discharge
 Dyspareunia
 Vulvar or vaginal erythema
 Edematous cervix
 MANAGEMENT
 Local fungicidal preparation
(nistatin,clotrimazole,miconazole or econazole
or fluconazole)
CAUSATIVE ORGANISMS AND CLINICAL
MANIFESTATION
VULVAL INFECTIONS
 CAUSES
 Varicella zoster virus
 CLINICAL FEATURES
 Painful eruptions of group of vesicles
 MANAGEMENT
 Analgesics
 Antiviral - Acyclovir
 Antibiotic
CLINICAL FEATURES
 Dryness and soreness
 Itching and burning
 Vulvar and vaginal atrophy
 Pale,thin, friable vaginal mucosa
 Sparse pubic hair
 Dyspareunia
 Yellowish or blood stained discharge
TREATMENT
 Intravaginal applications of estrogen cream
 Systemic estrogen if there is no contraindication
 Treatment of local infection if present
BARTHOLINITIS
BARTHOLINITIS
 Infection of the major vestibular glands
Major vestibular glands (Bartholin’s
glands)
CAUSES

Staphylococcus
 E.Coli
 Streptococcus
 Enterococcus
 Gonococcus
 Chlamydia trachomatis
 Polymicrobial infection is common.
CLINICAL MANIFESTATION
 Local pain and discomfort
 Difficulty in walking or sitting
 Tenderness and induration of the posterior half of the labia
when palpated between thumb outside and the index finger
inside the vagina
 Tenderness and induration of the posterior half of the labia
 Duct opening looks congested and secretion comes out
TREATMENT
 Hot compress and analgesics
 Antibiotics (Ampicillin) in the early stage
 Drain the abscess (excision of an elliptical piece of
skin)
Bartholin’s Cyst
• Marsupialization
for preservation of the
gland function
• Excision for recurrent
cases
BARTHOLIN’S ABCESS
BARTHOLIN’S ABCESS
 Bartholin’s abscess is the end result of acute
bartholinitis
 Bartholinitis
Fibrosis
Exudates pent up inside
Ducts get blocked
Abscess
BARTHOLIN’S ABCESS
CLINICAL FEATURES
 Pain and discomfort
 Patient cannot walk or even sit
 Fever
 Tenderness
 Swelling beneath the posterior half of the labium
majus
BARTHOLIN’S ABCESS
TREATMENT
 Rest
 Analgesics
 Sitz bath
 Antibiotic – Ampicillin or Tetracycline
 Abscess should be drained
 Marsupialisation
VAGINAL INFECTION
(VAGINITIS)
VULVO VAGINITIS IN CHILDHOOD
 Inflammatory condition of the vulva and vagina
 Caused by lack of estrogen
VULVO VAGINITIS IN CHILDHOOD
ETIOLOGY
 Non specific vulvovaginitis
 Presence of foregin body in the vagina
 Associated infection
 Infection caused by candida albicans and gonococcus
VULVO VAGINITIS IN CHILDHOOD
CLINICAL FEATURES
 Pruritis
 Vaginal discharge – scanty to copious
 Painful micturition
 Soreness of the vulva
 Minora may be swollen and red
VULVO VAGINITIS IN CHILDHOOD
INVESTIGATION
 Two smears are taken
One direct examination and the other for gram stain
 Culture to exclude intestinal infection
 Vaginoscopy to exclude foreign body
VULVO VAGINITIS IN CHILDHOOD
TREATMENT
 Perineal hygiene
 Removal of foreign body
 Estrogen ointment
 Ethinyl estradiol vaginal cream
CANDIDA
VAGINITIS(MONILIASIS)
CANDIDA VAGINITIS (MONILIASIS)
ETIOLOGY
 Candida albicans
 Gram positive
 Yeast like fungus
CANDIDA VAGINITIS (MONILIASIS)
CLINICAL FEATURES
 Vaginal discharge with intense vulvovaginal pruritis
 Discharge is thick,curdy white and in flakes ,often adherent
to the vaginal wall
 Vulva may be red and swollen
 Vaginal examination may be tender
 Removal of white flakes reveals multiple oozing spots
CANDIDA VAGINITIS (MONILIASIS)
TREATMENT
 Fungicidal preparation
 Nystatin,clotrimazole,miconazole,econazole are used
in the form of vaginal cream or pessary
 Single dose oral therapy with fluconazole or
itraconazole is also found effective
BACTERIAL VAGINOSIS
BACTERIAL VAGINOSIS
ETIOLOGY
1. Imbalance of normal vaginal flora

Diminution of Doderlein lactobacillus and

Increase in other bacteria, in particular,
anaerobic bacteria.
2. Causative factors of the imbalance are
unknown

Gardnerella vaginalis
BACTERIAL VAGINOSIS
 CLINICAL PICTURE
Symptoms:
 10-40% asymptomatic
 Mild pruritus or burning sensation
 Increased vaginal discharge
and fishy odor
Signs:
 Discharge: thin, greyish-white,
homogenous, but not sticky
 No inflammation reaction
(No epithelial edema or erythema)
BACTERIAL VAGINOSIS
TREATMENT
 Systemic therapy (oral) (80%)
1) Metronidazole 400mg, 2-3 times a day for 7 days
2) Clindamycin 300mg, twice a day for 7 days
 Topical therapy (80%)
1) Effervescent tablets of metronidazole
200mg/day, for 7-10 days
2) 2% Clindamycin cream, once a day for 7 days
 Vaginal washing
1-3% H2O2 , 1% lactic acid, 0.5% acetic acid
ATROPIC VAGINITIS
ATROPIC VAGINITIS(SENILE VAGINITIS)
DEFINITION
Vaginitis in postmenopausal women is called
atrophic vaginitis
ATROPIC VAGINITIS(SENILE VAGINITIS)
CLINICAL FEATURES
 Postmenopausal yellowish or blood stained
vaginal discharge
 Discomfort,dryness,soreness in the vulva
 Dyspareunia
 Evidences of pruritis vulvae
 The character of discharge is yellowish or blood
stained
 Vaginal examination is often painful and the walls
are found inflamed
ATROPIC VAGINITIS(SENILE VAGINITIS)
DIAGNOSIS
 Exclude carcinoma
 EUA
 Diagnostic curettage
 Cervical cytology or biopsy
TREATMENT
 Improvement of general health and treatment
 Systemic estrogen therapy
 Intravaginal application of estrogen cream
ACUTE CERVICITIS
ACUTE CERVICITIS
 It is an infection of the Endocervix
including the glands and the stroma
ACUTE CERVICITIS
ETIOLOGY
 Neisseria gonorrhoeae
 Chlamydia trachomatis
 Staphylococcus

Streptococcus

Enterococcus
ACUTE CERVICITIS
CLINICAL FEATURES
Symptoms
 Asymptomatic
 Mucopurulent vaginal discharge
 Vaginal irritation symptoms:pruritus, burning
sensation
 Lumbosacral pain,
 Intermenstrual bleeding, postcoital bleeding

Symptoms of the lower urinary tract
Signs

Inflammation of the cervix with mucopurulent
discharge (MPC for mucopurulent cervicitis)
ACUTE CERVICITIS
DIAGNOSIS
 Gram’s stain of the cervical discharge for leukocyte
 Tests for gonococcus and chlamydia
 Wet mount microscopy for trichomonads
ACUTE CERVICITIS
TREATMENT
 Systemic medication
 Choice of drugs depends on the pathogens,Examples:
GONORRHEA INFECTION
 Third generation Cephalosporins
 Ceftriaxone Sodium
 Spectinomycin
CHLAMYDIA TRACHOMATIS
 Doxycycline
 Azithromycin
 Erythromycin
 Ofloxacin
CHRONIC CERVICITIS
CHRONIC CERVICITIS
ETIOLOGY
1.
When the stratified epithelium which normally
covers the vaginal portion of the cervix is replaced by
columnar epithelium which is continuous with that
of the cervical canal.
2.
Most erosion are not infected, nor they are the result of
inflammation.
3.
Occurs in the newborns, pregnancy, oral contracepives
CHRONIC CERVICITIS
CLINICAL FEATURES
Symptoms
 The only symptom is a mucoid discharge.
 A slight postcoital bleeding (but malignancy should
be excluded)
Signs
 A red area is seen around the external os.
CHRONIC CERVICITIS
TREATMENT
 Erosion found on routine examination should
not be treated unless it is causing troublesome
discharge.
 A cervical smear is needed before the treatment,
and if necessary, colposcopy and biopsy.
 Cervical ectropion
PHYSICAL THERAPY
 Thermal cauterization,
 Cryotherapy,
 Laser therapy
CERVICAL POLYPS
CERVICAL POLYPS
 Small pedunculated neoplasms of the cervix
ENDOCERVICAL POLYP

Originating from the endocervix
ECTOCERVICAL POLYP

Originating from the vaginal portion
CERVICAL POLYPS
PATHOLOGY
Gross appearance:
 Endocervical polyp: Red or pink, rounded or
tongue-like
 Ectocervical polyp: Pale, flesh-colored, smooth,
rounded with a broad pedicle
CERVICAL POLYPS
CLINICAL FEATURES
 Some are asymptomatic
 Slight postcoital bleeding
TREATMENT
 Cervical polyp should be treated
 Malignant change (<1%) Polypoid cervical cancer
 Twisting off a polyp without an anesthetic and
cauterizing the base
 Recurrent cases are treated with canal dilation and
cauterization of the stalk