Lecture fourth years genital infection web site

1,827 views
1,240 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,827
On SlideShare
0
From Embeds
0
Number of Embeds
69
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Lecture fourth years genital infection web site

  1. 1. Genital Infection Khalid Sait FRCSC Professor Faculty of Medicine King Abdulaziz University
  2. 2. VAGINAL ECOSYSTEM n  NORMAL FLORA: LACTOBACILLUS STREPTOCCOCCUS STAPH, GARDNERELLA PEPTOSTREPTOCOCCUS BACTERODIDES CANDIDA n  NORMAL pH 3.8 – 4.2
  3. 3. DISTURBANCE OF THE ECHOSYSTEM n  ANTIBIOTICS n  HORMONES n  CONTRACEPTIVES n  DOUCHES n  SEXUAL INTERCOURSE n  STD’S n  STRESS
  4. 4. WET PREPARATION SLIDE TEST
  5. 5. CANDIDAL VAGINITIS n  Main Complaint: Pruritus n  Thick white cottage cheese discharge n  No odor n  Adherent discharge , hyperemic vagina n  Ph less than 4.5 n  KOH- Hyphae and pseudohyphae n  Treatment : Anti Fungal
  6. 6. ANTIFUNGAL CREAMS n  CLOTRIMAZOLE (CANESTEN) n  BUTOCONAZOLE (FEMSTAT) n  MICONAZOLE (MONISTAT) n  TICONAZOLE (GYNECURE) n  TERCONAZOLE (TERAZOL)
  7. 7. CANDIDA RESISTANT STRAINS n  ORAL KETOCONAZOLE (NIZORAL) 200 mg po bid x 5 days n  ORAL FLUCONAZOLE (DIFLUCAN) n 150 MG PO X 1 DOSE
  8. 8. CANDIDA RESISTANT STRAINS n  1% GENTIAN VIOLET n  3% POTASSIUM SORBATE n  BORIC ACID 600 MG GELATIN CAPSULE INTRAVAGINALLY OD X 2 WEEKS
  9. 9. CANDIDA VAGINITIS RECURRENCE n  Different species of Candida n  Insufficient duration of treatment n  Re-infection VS Recurrence n  HIV + Patients n  Post menopausal women
  10. 10. TRICHOMONAS VAGINALIS n  Main complaint: copious D/C n  Yellow, grey, green, frothy D/C n  +Odor n  Pseudomembrane, strawberry cervix n  pH>6 n  Wet mount : flagellated organisms n  Rx: PO Flagyl+ partners
  11. 11. TRICHOMONAS TREATMENT n  METRONIDAZOLE n  500 mg PO BID X 7 DAYS OR n  2 gm. single dose n  TREAT PARTNERS SIMULTANEOUSLY n  RESISTANT STRAINS- HIGH DOSE 2.5 G/ DAY X 10 DAYS OR IV n  CLOTRIMAZOLE CRAM
  12. 12. TRICHOMONAS TREATMENT (CONT’D) n  HYPERTONIC SALINE PROPYLENE GLYCOL n  TREAT IN PREGNANCY: CLOTRIMAZOLE METRONIDAZOLE
  13. 13. BACTERIAL VAGINOSIS n  MAIN COMPLAIN: MALODOROS D/C n  HOMOGENEDUS, THIN-GRAY WHITE D/C n  +++ODOR n  Ph 5-6 n  WET MOUNT CLUE CELLS n  KOH ++ WHIFF TEST( AMINE) n  Rx: FLAGYL / CLINDAMYCIN + PARTNER
  14. 14. BACTERIAL VAGINOSIS n  50% OF VAGINITIS n  GARDNERELLA VAGINALIS, MOBILUNCUS,BACTEROIDES, PEPTOSTREPTOCCOCCUS n  INCREASED INCIDENCE OF PRETERM LABOR PROM, CHORIOAMNONITIS
  15. 15. BACTERIAL VAGINOSIS n  3 OF 4 CRITERIA TO MAKE DIAGNOSIS: pH>4.5 (USUALLY 5-6) CLUE CELLS POSITIVE KOH TEST HOMOGENOUS DISCHARGE
  16. 16. BACTERIAL VAGINOSIS HISTORY OF NOMENCLATURE 1.  Nonspecific vaginitis (1892) 2.  Haemophilus vaginitis (1955) 3.  Corynebacterium vaginitis (1963) 4.  Gardnerella vaginitis (1980) 5.  Anaerobic vaginosis( 1982) 6.  Nonspecific vaginosis (1984) 7.  Bacterial vaginosis (1984)
  17. 17. DISEASES EPIDEMIOLOGICALLY LINKED TO BACTERIAL VAGINOSIS n  GYNECOLOGIC n  Abnormal vaginal discharge n  Mucoprulent cervicitis n  Urinary tract infection n  Postoperative infection n  Cervical dysplasia n  Nonpuerperal endometritis n  Pelvic inflammatory disease n  OBSTETRIC n  Chorioamnionitis n  Premature labor n  Premature rupture of membrane n  Postpartum endometritis
  18. 18. BACTERIAL VAGINOSIS TREATMENT n  ONLY IF SYMPTOMATIC n  TREAT PARTNER? n  RECURRENCES n  TREAT IN PREGNANCY: n  1ST TRIMESTER :-AMOXIL n  -CLINDAMYCIN
  19. 19. BACTERIAL VAGINOSIS TREAMENT n  METRONIDAZOLE n  INTRAVAGINAL GEL 0.75% BID X 5 DAYS n  500 MG PO BID X 7 DAYS n  2 GRAM SINGLE DOSE n  CLINDAMYCIN n  2% CREAM OB X 7 DAYS n  300 MG BID X 7 DAYS n  HYDROGEN PEROXIDE
  20. 20. ACTINOMYCES n  ACTINOMYCES ISRAELI n  WOMEN WITH IUD’S
  21. 21. HERPES SIMPLEX n  PAINFUL ULCER n  TENDER NODE n  SWAB FOR CULTUR FROM THE ULCER IS IMPORTANT n  TREATMENT: ACYCLOVIR FAMCICLOVIR n  TREATMENT OF PARTNER
  22. 22. MOLLUSCUM CONTIOSUM n  Umbilicated papule n  DNA pox virus n  Spont. resoluation may up to 2 years n  Cryo. or laser or excision
  23. 23. CHANCER n  PAINLESS ULCER n  NON TENDER LYMPH NODE n  VDRL n  TPHAT n  EXUDATE FOR DARK FIELD MIC n  PENICILLIN G 2.4- 7.2 U IM n  TREAT PARTNER
  24. 24. Chancroid n  Haemophilis ducreyi n  PAINFUL ULCER n  Treatment Cotrimoxazol or erythromycin
  25. 25. Manifestation of HPV genotypes Genotype Lesions HPV 6 &11 Genital warts HPV 16, 18, 31 Vulval intraepithelial neoplasia squamous cell carcinoma
  26. 26. n  1% of the adult population have symptomatic External Genital Warts. n  Infection occur during the first few years after onset of sexual activity so infection among older women is more likely to reflect persistent infection.
  27. 27. n  Genital human papillomavirus (HPV) infection is the most common sexual transmitted disease. n  10-30% of the population in Canada are infected. n  The prevalence of HPV is highest among sexually active adolescents and young adults.
  28. 28. n  Clinical manifestation of HPV infection include asymptomatic infection and dysplastic cellular changes that range from Koiliocytosis to precancerous and malignant cellular changes. n  Spontaneous clearance of the virus occur in 40-60% because of acquired cellular immune response.
  29. 29. HPV - Treatment n  Observation n  Podophyllin n  Trichloroacetic acid n  Interferon n  Imiquimod ( Aldara) n  Excision /Laser
  30. 30. Treatment n  First line treatment will achieve clearance within 1-6 months, although disease persist in up to one third of patients. n  Home therapy can be proposed in most cases as first line therapy. Acuminate warts respond in 90% but macular and papular lesions in only 50% of cases. n  Lesions occurring in new sites during treatment or after clearance do not necessitate a change of treatment modality n  Other concern.
  31. 31. PID n  NISSERIA GONORRHEAE n  CHLAMYDIA TRACHOMATIS n  G – VE AND ANAEROBIC
  32. 32. PID n  SYMPTOMS AND SIGNS n  CULTURE n  CERVICAL PCR n  TREATMENT CEFXITIN 2 G IV 8 H + DOXYCYCLIN 100 MG IV BID FOR 2-5 DAYS n  TREAT PARTNER WITH CEFIXIME 400 MG + AZITHROMYCIN 1 GM PO SINGLE DOZE
  33. 33. Genital Infection Khalid Sait FRCSC Professor of Gynecological Oncologist Faclty of Medicine King Abdulaziz University Q&A

×