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Infection of the genital tract Done by: Tasneem abue tailakh Safaa alijla Infection of the genital tract - Bacterial - Viruses - Fungi - parasite Bacterial Syphilis Syphilis is a sexually transmitted disease caused by the spirochetal bacteria treponema pallidum subspecies pallidum. The primary route of transmission of syphilis is through sexual contact however it may also be transmitted from mother to fetus during pregnancy or at birth resulting in conginetal syphilis. The signs and symptomes of syphilis vary depending on which of the four stages it presents in (primary, secondary, latent, and tertiary). - The primary stage typically presents with a single chancre0 - secondary syphilis with a diffuse rash - latent with little to no symptoms0 - tertiary with gumms, neurological, or cardiac symptoms. Treponema pallidum Treponema pallidum is a species of spirochaete bacterium with subspecies that cause treponemal diseases such as syphylis. It is not seen on a gram stain smear because the organism has a waxy coat around it that does not accept the Gram stain. Chancroid Chancroid, or soft chancre, is a sexually transmitted disease caused by Haemophilus ducreyi, a gram-negative bacillus. It is relatively uncommon in the United States, but is the most common cause of genital ulcers in Africa. The incubation period is 3 to 7 days. The lesion begins as a soft, red papule. Within 1 to 2 days, it becomes pustular, eroded, and ulcerated. The ulcer is usually 1 to 2 cm in diameter, painful, and covered by a yellowish or gray exudates; it bleeds easily when scraped. The edges of the ulcer are ragged and undermined. Chancroid Chancroid does not have a vesicular stage. In males the ulcer is typically located on the distal penis, but may occasionally occur in the urethra and anal orifice. In females, the lesions tend to be localized to the vulva but can also occur in the vaginal, perianal area, and cervix. Painful inguinal lymphadenopathy and over-riding erythema is associated with chancroid in nearly half of all cases in males, less often in female cases. The lymph nodes become fluctuant, can spontaneously rupture, and drain pus. Systemic symptoms can occur but are rare. Chancroid Lesion is located in the anogenital area Lesion is a painful ulcer without eschar Lesion lacks vesicular stage Lymphogranuloma Venereum Lymphogranuloma venereum (LV) is a sexually transmitted disease caused by chlamydia organisms. LV is found most frequently in the tropical and subtropical parts of the world. The incubation period ranges from 3 to 12 days. The primary lesion is a 5- to 8-mm, soft, red, painless erosion or ulcer. The ulcer heals spontaneously in a few days. The secondary stage begins 2 to 6 weeks later and is characterized by the appearance of tender, inguinal adenopathy, which develops with overriding erythema and edema. The lymph nodes coalesce, may fluctuate, and drain spontaneously. Associated fever, chills, and malaise can be severe. The late stage of LV is characterized by anogenital strictures in untreated or under-treated cases. Granuloma Inguinale Granuloma inguinale is a chronic bacterial infection of the genital region, generally regarded to be sexually transmitted. Granuloma inguinale is a relatively rare disease occurring in people living in tropical and subtropical areas. It occurs more frequently in males. In the United States, while homosexuals are at greater risk, it is relatively rare in heterosexual partners of those infected. Granuloma Inguinale Urethral discharge in males Discharge from the male urethra has many causes, but when an adult seeks medical assistance , the cause is often urethritis caused by a sexually transmitted infection . Purulent discharge from the urethra may be caused by either C.tracomatis (serotypes A-K) or N.gonorrhoeae . Although N.gonorrhoeae typically causes a more obviously purulent discharge ,there is overlap in the clinical presentation and a high proportion of dual infection . The patient may have dysuria but some patients have urethritis without a clinically evident discharge . Vaginal discharge Bacterial vaginosis : In bacteria , there is a thin discharge with a distinctive odour , which the patient may well notice . The condition is caused by a distutbance in vaginal flora that results in in an over growth of commensal anaerobic , the metabolic products the metabolic products of these include volatile amines , hence the smell. Species including Gardnerella vaginitis and Mobiluncus sp. have been implicated as possible causes of condition ,but isolation of the organisms does not help in the clinical management of individual patient. cervicitis Inflammation of the uterine cervix is usually caused by sexually transmitted infection with either N.gonorroeae or C.tracomatis . Cervicitis is the female counterpart of urethritis in adult males . Unfortunately , it is not so easily noticed and a large proportion of cases go undiagnosed . The consequence of undiagnosed cervicitis is ascending infection of female genital tract , endometritis , salpingitis tubo-ovarian abscess or disseminated gonococcal infection (DGI) . The most important non-infective sequelae include infertility or , if the fallopian tubes remain patent, an increased risk of tubal pregnancy . Pelvic infgammatory diseases PID is a term used to refer to infection of the female pelvic organs ,it is usually sexually transmitted . Infection of the fallopian tubes , the adjasent structures Douglas usually and abscesses in the pouch of occur as a result of assending sexually transmitted infection from the lower genetal tract . N.gonorreae and C.tracomatis are prominent causes of PID . However, many cases are polymicrobial and feature other species such as anaerobic bacteria ,Sreptococci ,Mycoplasma and Ureplasma spp. Intrauterine infection Infections of the uterus are uncommon and arise in several specific setting . Endometritis may occure as a consequence of ascending infection with N.gonorreae or C. tracomatis but is rarly diagnosed as adistinct entity. Infection may arise postpartum or postabortion , when bacteria from the vaginal flora gain access and establish an acute endometritis . This process is assisted by the presence of retained products of conception . Postpartum ,the patient will have offensive lochia and fever . This was often caused by Streptococcus pyogen , but anaerobic and other bacteria may also be implicated . Extension of infection into the myometrium and spread via the bloodsream may develop rapidly. Pelvic actinomycosis Amore insidious intrauterin infection is pelvic actinomycosis , caused by the bacterium Actinomyces isra . Infection occurs more commonly in women with IUDs . These patient may have any of the features of cervical or uterine infection . The majority of patients who come to medical attention have have had actinomyces – like organism noted in cervical smear . In most cases , these are commensal organisms and don’t signify active infection . Management by removal of IUD ,but penicilline treatment is advised . Epididymitis Is an infection of the epidydimis caused by avariety of bacterial species . In men under the age of 35 years most cases of epididymitis are caused by ascending sexually transmitted infection usually with : N . Gonorreae or C.tracomatis In older men , infection is more often caused by enterobacteriaceas , Staph and Cornebacteria spp The epididymis is tender to palpation and ther e may be local pain . If the infectin has arisen from ascending ,sexually transmitted infection there may be clinical picture of urethritis . The condition may be difficlt to distinguish from testiculer torsion , in which case cergical removal is required . Thank you Safaa Khalil Organisms infect the genital tract Abnormal vaginal discharge watery discharge white discharge thick white chunky discharge (like cottage cheese) swelling of the vulvar skin pain with intercourse painful urination redness of the vulva vaginal and labial itching, burning. These infections are more common after taking an antibiotic. Fungal Candida albicans Tests A history and physical exam will be performed A KOH smear identifies the Candida organism. Treatment Treatment inlcudes over-the-counter vaginal creams such as miconazole clotrimazole butoconazole terconazole . Prescription pills such as fluconazole vaginal suppositories, and creams are also available. is a common sexually transmitted disease that affects both men and women Features of it include pain, itching and Painful blisters in genital area. Systemic symptom including fever & myalgia Genital herpes Herpes simplex virus 1&2 Tests A history and physical exam will be performed. direct fluorescent antibody (DFA) test can be done to establish the diagnosis Culture of a genital lesion may be done. Treatment Treatment includes suppression with medical therapy (acyclovir, famciclovir) pain medications acetaminophen nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil, naproxen/Naprosyn). The most common sexually transmitted disease There are many types that can infect the genital areas of males and females, and some can also infect the mouth and throat Unfortunately most people do not know they are infected with the it since the initial symptoms can be minor. In 90% of people the …. is cleared from the body without any treatment. appear as a small bump or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. They appear within weeks or months after sexual contact with an infected partner. . Cervical cancer usually does not have symptoms until it is advanced and difficult to treat. Symptoms of advanced cervical cancer include vaginal pain, abnormal vaginal intercourse, painful intercourse, and vaginal fullness (VIN) penile intraepithelial neoplasia (PIN) and/or anal intraepithelial neoplasia (AIN). Genital warts HPV Tests A history and physical exam will be done. HPV is diagnosed by the appearance of the genital warts or through a PAP smear for women. Treatment There is no treatment for the virus itself, but there are treatments for the problems that HPV can cause. Most genital warts will go away on their own. Healthcare providers can provide medication or remove the warts directly. There is a vaccine against HPV which can help prevent acquiring the disease. Condoms during sexual intercourse are also recommended to protect against HPV and other sexually transmitted diseases (STDs). Diarrhea fatigue fever frequent vaginal yeast infections headache mouth sores including candidal infection muscular stiffness or aching rash of various types including seborrheic dermatitis sore throat swollen lymph glands Other symptoms may occur when a patient becomes infected with other bacteria or fungi Infection is a life threatening disease The condition gradually destroys the immune system, preventing the body from fighting off infections. Most patients die of an overwhelming infection. There is no cure or vaccine but special anti-viral medications can keep the virus under control. The HIV ELISA/Western blot test is used to detect antibodies to the HIV virus. It is often spread through sexual contact. Men can become infected as well. Both sexual partners need to be treated to eradicate the infection. . Women painful sexual intercourse, vaginal itching, vaginal discharge (greenish-yellow, frothy or foamy), foul smelling discharge, labial swelling, itching of the inner thighs. Men burning after urination, burning after ejaculation, itching of urethra, slight discharge from urethra. Trichomoniasis Trichomonas vaginalis A history and physical exam will be performed A wet prep of the vaginal secretions is done revealing the organisms. Treatment (metronidazole/Flagyl) and the treatment of all sexual partners to prevent recurrence. One must avoid alcohol while taking metronidazole to prevent severe nausea and vomiting. Intense itching that is worse at night Thin pencil mark lines (burrows) that appear between fingers, in arm pits, at the waist, on inner elbows, on bottom of feet, around wrists, on buttocks, on shoulders, on knees, and around breasts A contagious skin disease caused by a small mite called Sarcoptes scabiei The infection can be easily spread through close contact amongst families, schools, child care centers or nursing homes. Tests A history and physical exam will be performed. The diagnosis may be made by the appearance of the rash Treatment involves using a prescription medicated cream. The two most common are permethrin and crotamiton Almost anyone with it will have itching in the area covered by pubic hair (often gets worse at night). This itching may start soon after getting infected with it, or it may not start for up to 2 to 4 weeks after contact. Other symptoms: Skin reaction that is bluish-gray in color Sores (lesions) in the genital area due to bites and scratching Pthirus pubis Tratment is with malathion or an alternative insecticide Thanks