Medical Archive

The normal vagina

Vaginal infections

Harrison
C130 Urinary Tract Infections, Pyelonephritis, and Prostatitis
C131 Sexually Transmitted Infections: Overview and Clinical Approach

Normal vagina: G+ lactobacilli ??? pH<4.5
???! Partner ?? X except trichomonas

Bacterial vaginosis

?????, KOH ??? ???(Whiff test +)
Unlike others, BV causes no vulvovaginal inflammation (eg, erythema, pruritus)
??? ??? ??? ??

• Metronidazole
  • PO, 500mg bid for 7 days
  • Regardless of pregnancy status.
• Chlindamycin
  • Regardless of pregnancy status
• Boric acid vaginal suppositories
  • Adjunct to metronidazole in patients with recurrent BV.

Trichomonas vaginitis

?? ??, strawberry cervix
60%?? ??? ?? ? Whiff ±

• ???? ??
• Metronidazole (PO)

Vulvovaginal candidiasis

Etiology

• Alterations in the vaginal normal flora balance, as C.candida is part of the normal vaginal flora
  • Antibiotic use
  • Immunosuppresion
  • Increased estrogen level (eg, contraceptives, pregnancy)
  • Sexual activity, DM

Clinical manifestations

Vulvovaginal inflammation.
Cheeze like ???
Clotrimazole, nystatin

Inflammatory vaginitis

Atrophic vaginitis

Estrogen ???? ??, ???? ??
???? ?? ? Estrogen ? ??

Cervicitis

Partner ?? ??.
?? ?? ??? ? ? ?? ??. ????? ??.
If untreated -> PID -> scarring of fallopian tubes -> ectopic pregnancy & infertility.

Neisseria gonorrhea

Gram stain: Intracellular G(-) diplococci ? Cefixime

Chlamydia trachomatis

• Azithromycin, Doxycycline
• Erythromycin
  • ?? ? TOC

Pelvic inflammatory disease PID

The inflammation may be present at any point along a continuum that includes endometritis, salpingitis, and peritonitis

IUD ???? ?? actinomyces? ??? – penicillin 12??!

Acute endometritis

Usually due to retained products of conception (e.g., after delivery or miscarriage) which act as a nidus for infection.

Chronic endometritis

Characterized by lymphocytes and plasma cells
Causes include retained products of conception, chronic PID
TRIAD: Pelvic pain, cervical motion tenderness, fever>38°C
+ ?? ??? ??, ??? ? ???

Tubo-ovarian abscess

• Acute PID? end-stage.
• Infection extends to the fallopian tubes and creates an inflammatory exudate, purulent fluid, and wall thickening, which conglomerate into a complex mass to create pyosalpinx (eg, infected fallopian tube) and TOA
• Diagnosis
  • Pelvic mass
  • USG
    • Complex multiloculated adnexal mass with thick walls and internal debris.
• Treatment
  • ???? IV ??? ??? ????.
  • 75%? ?? ?? ??? ??. 
  • 72hr ?? ??? or rupture ? abscess ??

Fitz-Hugh-Curtis Syndrome

PID? ????? ?? ??? ? ? ?? ????
???? ??? ? ??? Anti? ??.
? ??? Chlamydial salpingitis

Management

Neisseria gonorrhea ? Ceftriaxone, oxloxacin
Chlamydia trachomatis ? Doxycycline

??- Parenteral A	Cefotetan + Doxycycline
??- Parenteral B	Clindamycin + Gentamycin
??- Oral regimen	Ceftriaxone + Doxycycline

• ????? Indication
  • Pregnancy
  • Uncertain diagnosis
  • ??? ? ??? ??? ?
    • Suspected pelvic abscess
    • IUD ???
  • Severe clinical disease (eg, high fever, vomiting)
  • Complications (eg, tubo-ovarian abscess, perihepatitis)
  • Questionable compliance with outpatient regimen
• ?????
  • Fever? ??, WBC ???
  • Rebound tenderness? ??
  • ??? pelvic organ tenderness? ??? ??
• ??? ??
  • ???? spiking fever, pelvic exam ? fluctuant mass (+)
  • Unresponsive or Unavailable Tubo-ovarian abscess
  • Ruptured Tubo-ovarian abscess
  • Acute appendicitis? ??? ??? ?
  • Some chronic PID

Other major infections

Genital ulcer disease

Genital warts

Human immunodeficiency virus

Urinary tract infection

Acute cystitis

Recurrent cystitis

Urethritis

Acute pyelonephritis