GYNECOLOGICAL INFECTIONS ppt

Professor.MahmoudYoussefAbdalla. Obstetrics&Gynecology Department. A inShamsUniversity. GYNECOLOGICALINFECTIONS DEFENSIVEMECHANISMSOFTHEFEMALEGENITALTRACT y Thenaturalprotectionofthelowergenitaltract y 1‐ Theva g inaiscoveredwithstratifieds q uamouse p ithelium. g q p y Inyounggirlsandolderwomentheliningofthevaginaisonlyafew cell layersthick. y 2‐ Theacidityofthevagina(pH). y 3 ‐ Thebalancebetweenthenaturalmicro ‐ organisms(vaginalflora). 3 Thebalancebetweenthenaturalmicro organisms(vaginalflora). y NormalVaginalFlora:Thevaginacontainsmanymicro‐organismslivingin  balancewitheach‐otherandtheirhostess. y 1)TheLactobacillusacidophilus(vaginalis):Arodshapedbacteria(bacilli). y Thevaginausuallyhasanacidicenvironment(alowpH).Thisisdueto the i  f h Lbill  h  l   f h  il ll   act i on  o f t h e L acto b ac ill us  on  t h e  g l ycog en  content  o f t h e  vag i na l ce ll s  to  producelacticacid. ThenormalvaginalpHis3.8‐4.2, preventingtheovergro wthofbacteriaand yeast. y ConditionsthatmakesthepHofthevagina alkaline: y ConditionsthatmakesthepHofthevagina alkaline: y 1‐Menstrualblood. y 2‐ Certaininfections,andsemen. y "Lactobacillosis": Abnormalconditionoftoomanylactobacilli.Frequently thereisassociated thereisassociated y symptomssimilartocandidiasis. y Thereisnosymptomaticimprovementif giventreatmentofcandidiasis. y 2)Othertypesofbacterialflora: y Thecoccibelongtothebowelfloraandacceptedina"healthy vaginalenvironment. y Otherbacteriainthenormalflorainclude;Gardnerellavaginalis,E Otherbacteriainthenormalflorainclude;Gardnerellavaginalis,E coliandseveralanaerobicbacteria,andmycoplasma. y Ifthelactobacillidisappear thevaginalpHturnsalkaline,which promotesovergrowthofcoccoidbacteriaoftenresultingin bacterial promotesovergrowthofcoccoidbacteriaoftenresultingin bacterial vaginosis(offensivevaginaldischarge). y Leucorrheaisatermusedintwoways.Usuallyitisusedto  indicatetheflowofexcessivenormalvaginaldischarge. Sti th t i  dt idi t ll bl il S ome ti mes, th e t erm i s  use dt o i n di ca t e  a ll a b norma l vag i na l dischargeexceptblood. y Thecompositionnormalvaginaldischarge: y 1‐ Cervicalsecretions. y 2‐ Vaginalsecretionsasepithelialtransudation. y 3 ‐ Epithelialcells. 3 Epithelialcells. y 4‐ Bacterialflora. Physicalcharacters:Milkywhiteormucoid,hasaspecificsmell,anddoesnot causeitchingorburning. y Theamountofthenormaldischarge variesaccordingto timeofcycle: y 1‐ Itincreasespremenstrual  . y 2‐ Itincreasesduringthemid‐cyclewhenitiswatery,stretchable(theovulatory) whichissometimesbloodtinged. y 3‐ Postmenstrualandinthesecondhalfofthecycle,itisscantyandviscid. y Personalbehaviormayaltervaginaldischarge,promoteinfectionandmaycause irritationthatmaybeconfusedwithinfection. y W oman’sbehaviormayleadtovulvalhypersensitivit y y 1‐ Hygienespraysorperfumes,menstrualpads,launderysoaps,bleaches, fabricsofteners,fabricdy es,syntheticfibers,bathwateradditives,andtoilet tissue. Ll i Siii dl  iid  il y 2‐ L oca l contracept i ves: S ens i t i v i ty  may d eve l op  to  sperm i c id es.  vag i na l lubricantsorcreams,orlatexcondoms ordiaphragms. y 3‐ Fosteringoffungalandbacterialgrowth:Asaresultofwearingtight,non‐ porousunderclothingorpoorhygiene. y 4 Douchingwithirritants(e g povidone iodine)canresultinan y 4 ‐ Douchingwithirritants(e . g ., povidone ‐ iodine)canresultinan overgro wthofvaginalpathogens,leadingtoinfection. y Abnormalvaginaldischargeisthemostcommoncomplainof thefemale y I‐ Infectionofthelower g enitaltract  withoneormoreofthe  g followingorganisms: y 1‐Candidaalbicans. y 2 ‐ Gardnerellavaginalis  2 Gardnerellavaginalis .  y 3‐ Trichomonasvaginalis. y 4‐ Chlamydiatrachomatis. y II‐ Othercausesofabnormalvaginal  discharge: y 1‐ Atrophic(senile)vaginitis. y a‐ Menopause. y b‐ Vulvo‐vaginitisin children. y 2‐ Viralinfection:genitalherpes(e.g.,herpessimplex),andcondyloma acuminata(HPV). y 3 Othersexuallytransmitteddiseases (gonorrhea chlamydia) y 3 ‐ Othersexuallytransmitteddiseases (gonorrhea , chlamydia) . y 4‐ Noninfectiouscauses:Neglectedforeignbodyofthevagina,fistulas, genitaltractneoplasms,andradiation. y III‐ A water y dischar g e,es p eciall y ifblood y ,su gg estsamali g nanc y ,  y g py y gg gy cervicalpolyps(dischargeincreasesaftercoitus). y VULVOVAGINITIS(lowergenitaltractinfection).  y Infectionsofthelowergenitaltractusuallyinvolveboththevagina andthevulva. Vulvova g initiscommonl y  p roducesava g inaldischar g e. g y p g g y Age shouldbeconsideredatassessmentofvulvovaginitis: y 1‐ Youngpatientsbeforepuberty. y 2 Inthereproductiveyears vulvovaginitiisusuallysecondaryto  y 2 ‐ Inthereproductiveyears , vulvovaginitiisusuallysecondaryto  vaginalinfections. y 3‐ Intheperimenopausalandpostmenopausalyears y Themostcommon  microbialagents forvulvovaginitisarethefollowingthree: y (1)Fungal(yeast)vulvovaginitis(Candiasis,Moniliasis) Incidence:30%ofvaginalinfections.Most offungalvulvovaginiytisisdueto  Candidaalbicans(candidalvulvovaginitis). Cli i l i Cli n i ca l presentat i on y Asymptomaticcarrier (withoutactiveinfection):15‐ 20%ofnon‐pregnantand20 ‐ 40%ofpregnantwomen. y Symptomsof fungalvulvovaginitis: 1 ‐ Vaginaldischarge:Massesofthick whitesoapysemisolidmaterial(milky 1 Vaginaldischarge:Massesofthick , white soapysemisolidmaterial(milky curds)thatclingsto thevaginalwalls. y 2‐ Vulvalitchinganddyspareunia,thatmightbesevereandincrease premenstruallv. y 3‐ Infectionofpenileurethrainmale. Eii E xam i nat i on: y 1‐ Thevulvalskin:Red,withlocalizedexcoriation(itchingmarks),erythema, edema,andwithwhite patches. y 2‐ Thegenitocruralskinfoldsmaybeinvolved. y 3 Thevaginalwall:Red studdedwithwhitepatches y 3 ‐ Thevaginalwall:Red , studdedwithwhitepatches . y 4‐ Vaginismusmayprecludethepassageofthespeculum(vaginalpain).