infection of female reproductive system

2. Outlines:
Lower genitalia infections
Trichomonas vaginitis-
Monilial vaginitis-
Bacterial vaginosis-
Infection during pregnancy
- Chlamydia
- Gonorrhea
Cytomegalovirus-
Toxoplasmosis-

3. :genitalia infectionsLower
For sexually active adult women, lower genital tract
infections are one of the most frequent reasons to seek
medical care. In 1971 an estimated 10.8 million women-
visits were made because of vaginitis and cervicitis.
Few women have not had at least one vaginal infection
while a substantial number of women have difficulty with
persistent or frequently recurrent symptoms.
Although the absolute prevalence and the relative proportion
of infectious vaginitis vary, depending on the population,
there are three major causes of vaginitis: bacterial vaginosis
formerly called nonspecific vaginitis (40–50%), candidiasis
(20–30%), and trichomoniasis (20–30%).
An additional 5% of women have vaginitis that has not been
well characterized. The number of women who complain of
a vaginal discharge caused by cervicitis has not been well
studied, but cervicitis is grossly underdiagnosed, and the
addition of cervicitis to these data would further serve to
emphasize the importance of lower genital tract infection.
vaginitis:Trichomonas
Definition:
Trichomoniasis is a sexually transmitted disease (STD)
caused by a small organism called Trichomonas
vaginalis.

4. Women are most often affected by this disease,
ected and pass thealthough men can become inf
infection on to their partners through sexual contact.
Cause:
Trichomoniasis (trich) is caused by a tinyparasite (a
one-celled protozoan) that most commonly is sexually
transmitted from an infected person.
In women, trich organisms usually infect the vagina and
cervix , urethra, bladder, and glands in the genital
area, such as the Bartholin's and Skene's glands.
Symptoms:
• A greenish yellow, frothy vaginal discharge with a
pronounced odor
• Vaginal itching or irritation
• Painful intercourse
• Discomfort during urination
• Vaginal bleeding
• Pain in the lower abdomen
Call Your Doctor About Trichomoniasis If:
You experience any of the symptoms listed
above. Trichomoniasis is contagious and can lead to
serious complications. Women shouldn't assume that
the problem is simple inflammation of the vagina.

5. :Diagnosis
• Your medical history, which will include questions
about your sexual history and practices.
• A physical exam.
o For women, this will include a visual exam of
the genitals,vagina, or cervix to detect patchy
red spots that are caused by trich.
o Any vaginal discharge will be assessed for
color, odor, and texture. A sample of
discharge is taken for a wet mount test.
• Tests to identify the trich organism.
o The most common test for women is a wet
mount, a microscopic evaluation of fluid from
the vagina.
o Other tests available but less commonly used
include:
▪ Culture.
▪ Antigen detection test
(immunochromatographic strip test) that
detects trich.
Treatment:
Trichomoniasis (trich) is treated with an oral
antiprotozoal medicine, such as
metronidazole or tinidazole. The medicine is taken
either as a single dose or as multiple doses.

6. Your sex partner(s) should be treated at the same time
you are being treated.
This increases the cure rate and reduces the possibility
of further transmission or reinfection.
Sexual intercourse should be avoided during treatment
until symptoms are gone and until partners have been
treated. It is best to avoid sex for 1 week after
treatment with a single dose of metronidazole. Male
partners may not have symptoms but still need
treatment.
People who are infected with HIV receive the same
treatment for trich as those who are HIV-negative.
vaginitis:lMoinlia
Definition:
called mycotic vaginitis, is aMonilial vaginitis, which is also
common gynecological disease for many females especially for
pregnant women and patients with diabetes
Causes:
Monilial vaginitis is mainly caused by candida albicans that is
normally found in your vagina. With a candida infection,
vaginitis can be caused by overgrown candida that can upset
the chemical balance of vagina.

7. There are two main conditions that are easy to cause monilial
vaginitis. On the one hand, when the amount of glycogen or
acidity in the vagina increases or the immunity of human body
decreases, it is a high rate to cause monilial vaginitis. On the
other hand, patients who have taken wide-spectrum antibiotics
or adrenocortical hormone are most likely to suffer from this
disease.
Symptoms:
The main symptoms of monilial vaginitis are:
incredible itching of vulva, even ulcerating pain and burning
pain, which are more apparent when you are passing urine.
Some patients may have frequent urination, urinary pain and
pure pain, sticky leucorrhea, with a shape of white bean curd or
curd.
The skin is covered with white pseudo membrane, and the
mucous membrane becomes red after wiping, etc.
In addition, Monilial vaginitis patients may suffer from increase
of leucorrhoea in quantity, itching and burning of genital and
vagina, pain while urinating, redness and swelling around vulva
and the cuticular changes are varied.
Usually, there may form eczema-like erosion, which is
completely similar to acute or subacute eczema, and this is
limited to the vulva or expands to the surrounding and the

8. perineum and around anus and reproductive plica, till the thigh
and skin somewhere else.
Meanwhile, near the labia and clitoris may appear mucosa
thickening. And the skin surface may flush and erose when
contacting other skin. Some individuals can have small white
pustules, even ulcer, vulvar pain and local lymph node
enlargement when it serious.
Diagnosis:
In clinic, there are three ways to diagnose monilial vaginitis.
First, vaginal discharge can be taken onto the glass sheet. Then
add a drop of sodium chloride solution or potassium hydroxide
solution onto the glass sheet and cover it, thought appropriate
heating, the glass sheet can be surveyed under the
microscope.Red blood cells, white blood cells and epithelial
cells can dissolve immediately while mould can be shown as
linear fiber or mycelium. However, the accuracy rate of this
method is just 60%.
Second, the glass sheet with vaginal discharge can be done by
gram stain. Under he microscope, mould can be easily
recognized. And the accuracy rate of this method adds to 80%.

9. Third, Enzyme bacteria culture is the most reliable method. The
disease can be diagnosed if mould is cultivated.
Treatments:
When diagnosed as monilial vaginitis, your doctor may suggest
you use suppository or cream and take antibiotics.
There are several kinds of anti-monilial vaginal creams and
suppositories specific for monilial vaginitis.
For recurrent infection, you can use a suppository or cream in
the vagina 2 times a week, or as directed. Of course, you also
have to take antibiotics under your doctor's guidance.
However, it is better for you not to take antibiotics for a long
time due to its drug resistance.
:vaginosisBacterial
Definition:
Bacterial vaginosis is a mild infection of the vagina caused by
bacteria. Normally, there are a lot of "good" bacteria and some
"bad" bacteria in the vagina. The good types help control the
growth of the bad types. In women with bacterial vaginosis, the
balance is upset. There are not enough good bacteria and too
many bad bacteria.

10. Bacterial vaginosis is usually a mild problem that may go away
on its own in a few days. But it can lead to more serious
problems. So it's a good idea to see your doctor and get
treatment
Causes:
Experts are not sure what causes the bacteria in the vagina to
get out of balance. But certain things make it more likely to
happen. Your risk of getting bacterial vaginosis is higher if you:
Have more than one sex partner or have a new sex partner.
Douche.
You may be able to avoid bacterial vaginosis if you limit your
number of sex partners and don't douche or smoke
Symptoms:
The most common symptom is a smelly vaginal
discharge. It may look grayish white or yellow. A sign of
bacterial vaginosis can be a "fishy" smell, which may be
worse after sex. About half of women who have
bacterial vaginosis do not notice any symptoms.
Many things can cause abnormal vaginal discharge,
including some sexually transmitted infections (STIs).
See your doctor so you can be tested and get the right
treatment.

11. Diagnosis:
Wet mount:
A sample of vaginal discharge is mixed with a salt (normal
saline) solution after placing it on a microscope slide. The
prepared slide is examined to identify the bacteria present, to
look for white blood cells that point to an infection, and to look
for unusual cells called clue cells. The presence of clue cells is
one sign of bacterial vaginosis.
Whiff test:
Several drops of a potassium hydroxide (KOH) solution are
added to a sample of vaginal discharge to find out whether a
strong fishy odor is produced. A fishy odor on the whiff test
suggests bacterial vaginosis.
Vaginal pH:
The normal vaginal pH is 3.8 to 4.5. Bacterial vaginosis usually
causes the vaginal pH to rise above 4.5.
The presence of clue cells, an increased vaginal pH, and a
positive whiff test are enough evidence to treat for bacterial
vaginosis.
Bacterial vaginosis may be found during apelvic exam.
Treatments:
antibioticincludesbacterial vaginosisTreatment for
kill theAntibiotics.medicine (oral or vaginal)
problem bacteria causing bacterial vaginosis

12. symptoms. But symptoms often come back after
antibiotic treatment
The antibiotics metronidazole (such as
Flagyl and MetroGel), clindamycin (such
asCleocin and Clindesse), and tinidazole(such
as Tindamax) are used to treat bacterial vaginosis.
Depending on the antibiotic you are prescribed, you
may take it by mouth or use it vaginally.
During pregnancy, women are usually prescribed oral medicine.
Use oral medicine or medicine inserted into the vagina. Some
women prefer to take pills rather than using a vaginal medicine.
Avoid having sex during the time that you are being treated.
Continue treatment during your menstrual period. Medicine
placed in your vagina is harder to use during your period, but
your doctor may recommend continuing treatment during this
time.
Avoid drinking alcohol during treatment with metronidazole or
tinidazole. These medicines can cause severe nausea and
vomiting if you drink alcohol when you are taking one of them.
Clindamycin does not.
The oil in clindamycin cream and ovules can weaken latex. This
means condoms and diaphragms may break, and you may not
be protected from STIs or pregnancy.

13. :Infection during pregnancy
Viral and bacterial infections can develop in anyone, but certain
infections are more likely to occur in pregnant women.
Pregnancy can also make infections more severe.
Most babies aren’t harmed when the mother acquires an
infection. However, some infections can be transmitted to
babies through the placenta or during birth. This can lead to
complications in the baby.
The type and severity of the infection determine the best
course of treatment. In some cases, treatment may not be
needed. To help prevent infections in pregnancy, wash your
hands regularly, be aware of food-borne illnesses, and practice
safe sex.
Chlamydia during pregnancy:
Definition:
Chlamydia is a curable bacterial infection that can be
transmitted through sexual intercourse. It can also be passed
from a woman to her baby during delivery.
Chlamydia is caused by an infection with the bacterium
Chlamydia trachomatis. It is spread by unprotected (unsafe) sex
.personwith an infected
Chlamydia effects on pregnancy:

14. Women who have chlamydia during pregnancy tend to have
higher rates of infection of the amniotic sac and fluid, preterm
birth, and preterm premature rupture of the membranes
(PPROM), although prompt treatment may reduce the risk.
An untreated chlamydia infection also makes you more
susceptible to HIV and some other sexually transmitted
infections (STIs) if you're exposed to them. It also raises your
risk of a uterine infection after you have your baby.
If you have a chlamydia infection when you go into labor,
there's a chance that you'll pass the bacteria to your baby. In
fact, up to half of babies born vaginally to mothers with
untreated chlamydia (and even some babies born by C-section)
will contract the infection.
Between 25 to 50 percent of these babies will develop an eye
infection (conjunctivitis) a few days to a few weeks after birth.
Symptoms:
Most men and women with chlamydia have no signs or
symptoms, which makes it very easy to spread. Some people
have the infection for many months or years without knowing
it.
Women who get symptoms may have:
Vaginal discharge
Bleeding between periods or after sex
Burning or pain when urinating
Abdominal or pelvic pain

15. Pain during sex.
Before and after pregnancy, chlamydia can travel up from your
cervix to infect your uterus or fallopian tubes, causing pelvic
inflammatory disease (PID). In fact, up to 15 percent of women
end up with PID
Symptoms of PID include pain in your lower abdomen or back,
pain during sex, vaginal bleeding, fever, and nausea.
PID can result in permanent damage to your fallopian tubes
and lead to chronic pelvic pain and infertility, as well as an
increased risk of ectopic pregnancy.
In rare cases, people with chlamydia have sore joints (arthritis)
or inflammation of the eye (uveitis).
Diagnosis:
Screening and diagnosis of chlamydia is relatively simple. Tests
include:
A swab. your doctor takes a swab of the discharge from your
cervix for culture or antigen testing for chlamydia. This can be
done during a routine Pap test during antenatal care.
A urine test. A sample of your urine analyzed in the laboratory
may indicate the presence of this infection.
Treatment:
If you are diagnosed with chlamydia, your doctor will prescribe
or takingazithromycine of. A single dosantibioticsoral

16. doxycycline twice daily for 7 to 14 days are the most common
treatments and are the same for those with or without HIV.
With treatment, the infection should clear up in about a week.
Do not have sex for at least 7 days until you have taken all of
your medication, and do not stop taking the antibiotics even if
you feel better.
Your doctor will also recommend that your partner(s) be
treated as well to prevent reinfection and further spread of the
disease.
Women with serious infections, such as pelvic inflammatory
disease, may require a longer course of antibiotics or
hospitalization for intravenous antibiotics. Some severe pelvic
infections may require surgery in addition to antibiotic therapy.
Gonorrhea during pregnancy:
Definition:
transmitted most often through sexualcontagious diseaseIs a
rrhea may also be spread. Gonopersoncontact with an infected
by contact with infected bodily fluids, so that a mother could
.childbirthduringnewbornpass on the infection to her
, a bacterium thatNeisseria gonorrheaGonorrhea is caused by
can grow and multiply easily in mucus membranes of the body.
Gonorrhea effects on pregnancy:

17. If you have gonorrhea during pregnancy, you may have a
greater risk of miscarriage, infection of the amniotic sac
and fluid, preterm premature rupture of membranes
(PPROM), and preterm birth, although prompt treatment
reduces the risk of these problems.
An untreated gonorrhea infection makes you more
susceptible to HIV and some other sexually transmitted
infections (STIs), if you're exposed to them, and raises
your risk of a uterine infection after you have your baby.
If you know you have a gonorrhea infection when you deliver,
or if your baby is diagnosed with a gonorrheal eye infection at
birth, he'll be treated with systemic antibiotics as well.
If left untreated, a gonorrhea infection in an infant can cause
blindness or spread to other parts of a baby's body, causing
such problems as blood or joint infections and meningitis.
Symptoms:
Gonorrhea doesn't always cause symptoms, so you may not be
able to tell you've been infected.
• Greenish yellow or whitish discharge from
the vagina
• Lower abdominal or pelvic pain
• Burning when urinating
• Conjunctivitis (red, itchy eyes)
• Bleeding between periods
• Spotting after intercourse
• Swelling of the vulva (vulvitis)

18. • Burning in the throat
• Swollen glands in the throat
Diagnosis:
of fluid from the cervix.sampleUse a swab to take a
The specimen will then be sent to a lab to be analyzed.
You also may be given a throat or anal culture to see if
the infection is in your throat or anus. There are other
tests which check a urine sample for the presence of
the bacteria.
Also known as: GC Test; Gonorrhea NAAT or NAT
Formal name: Neisseria gonorrhoeae by Nucleic Acid
Amplification Test (NAAT)
Neisseria gonorrhoeae Culture
Neisseria gonorrhoeae Gram Stain
Neisseria gonorrhoeae DNA Probe
Treatment:
Gonorrhea can be treated with antibiotics that are safe to take
during pregnancy.
Ceftriaxone 250 mg intramuscular (IM) single dose PLUS,
Azithromycin 1 g PO single dose.
Your partner also should be treated. To avoid reinfection, you
should not have sex until you've both completed treatment.

19. Cytomegalovirus during pregnancy:
Definition:
Cytomegalovirus (CMV) is a member of the herpes virus family.
It's the virus most frequently passed on to babies during
pregnancy.
Cytomegalovirus (also called CMV) is a kind of herpes virus.
sexuallyThere are many kinds of herpeviruses. Some are
, some can cause problems like cold sorestransmitted diseases
and some can cause infections like CMV. Many people get CMV
at some point in their lives, most often during childhood.
You can get CMV by coming in contact with bodily fluid from a
person who caries the virus. Bodily fluids include saliva, breast
milk, semen, mucus, urine and blood.
Cytomegalovirus effects on pregnancy:
If you have CMV during pregnancy, you have a 1-in-3 chance
(33 percent) of passing it to your baby. CMV is the most
common virus passed from mothers to babies during
pregnancy. Most babies born with CMV don’t have health
problems caused by the virus. But CMV can cause problems for
.microcephalysome babies, including
You can pass CMV to your baby at any time during pregnancy.

20. It’s more likely to cause problems for your baby if it happens in
the early part of pregnancy. You also can pass CMV to your
. If yourbreastfeedingbaby during labor and birth and during
baby gets the virus during these times, he’s less likely to have
health problems than if he gets the virus during pregnancy.
Symptoms:
Most people with CMV infection have no symptoms and aren’t
aware that they have been infected. In some cases, infection in
healthy people can cause mild illness that may include
• Fever,
• Sore throat,
• Fatigue, and
• Swollen glands.
Some babies may have signs of congenital CMV infection at birth.
These signs include
• Premature birth,
• Liver, lung and spleen problems,
• Small size at birth,
• Small head size, and
• Seizures.
Some babies with signs of congenital CMV infection at birth may
have long-term health problems, such as
• Hearing loss,
• Vision loss,
• Intellectual disability,
• Small head size,
• Lack of coordination,
• Weakness or problems using muscles, and

21. • Seizures.
Diagnosis:
• CMV antibody: IgM and IgG:
Recent CMV infection causes an increased IgM level and
a four-fold increase in IgG.
• PCR is the fastest and most sensitive method used to
detect CMV in blood and tissue samples.
• Shell vial assay: reduces the time required for tissue
culture to 24-48 hours - but viral culture has only modest
sensitivity.
• CXR: findings consistent with pneumonia and positive
CMV serology are a common method for diagnosis.
• CT scan is more sensitive for the identification of lung
infiltrates.
• Biopsy: the histological hallmark of CMV infection is the
finding of intranuclear inclusions consistent with herpes
virus infection.
• All patients who present with clinical features of CMV
should have FBC, serum creatine and LFTs performed.
Treatment:
Most CMV infections don't cause any symptoms and don't need
to be treated.
If you have symptoms after being infected with CMV for the
first time, over-the-counter painkillers such
can help relieve the symptoms ofibuprofenorparacetamolas

22. pain and fever (however, children younger than 16 shouldn't
take aspirin).
Drinking plenty of water will help relieve the symptoms of a
dehydrationfever and sore throat, and will prevent
Ganciclovir (Cymevene) is an antiviral medicine often used to
treat CMV.
Other possible antiviral medicines include foscarnet (Foscavir)
and cidofovir (Vistide).
A course of antiviral medicine will usually be prescribed for a
minimum of 14 days.
During pregnancy:Toxoplasmosis
Definition:
Toxoplasmosis is an infection caused by a
healththat can threaten theToxoplasmagondiicalledparasite
of an unborn child.
You can get the infection from handling soil or cat litter that
contains cat feces infected with the parasite. You can also get it
from eating undercooked meat from animals infected with the
have come in contactparasite or from uncooked foods that
with contaminated meat.
Toxoplasmosis effects on pregnancy:

23. For women who are not immune to toxoplasmosis,
exposure to this parasite just prior to or during
pregnancy may cause the fetus to be infected.
f Teratology InformationAccording to the Organization o
the mother gets infected, whenServices (OTIS)
24, the risk for severe problems in-between weeks 10
6%. Effects on the baby-the newborn is about 5
, low birth weight,premature birthinclude:
, abnormalities of the retina, mentaljaundicefever,
retardation, abnormal head size, convulsions, and brain
calcification.
, a fetus has an increased risktrimester3rdDuring the
to thedamageof becoming infected, but the risk of
since most of the importantdecreasedfetus is
development has already occurred.
Symptoms:
• Fatigue
• Fever
• Swollen lymph nodes
• Sometimes there are no symptoms at all
• Headache
• Confusion
• Poor coordination
• Seizures
• Lung problems that may resemble tuberculosis or
Pneumocystis jiroveci pneumonia, a common
opportunistic infection that occurs in people with AIDS
• Blurred vision caused by severe inflammation of your
retina (ocular toxoplasmosis

24. Diagnosis:
y screen forMost healthcare providers will routinel
toxoplasmosis immunity before pregnancy, or during
.first prenatal visitthe
can determine if you have been exposed.blood testA
is a test that can determine whether anCordocentesis
infection has occurred during pregnancy.
Amniocentesis
Treatment:
• Pyrimethamine (100mg loading dose orally followed by
25-50 mg/day) plus sulfadiazine (2-4 g/day divided 4
times daily) OR
• Pyrimethamine (100-mg loading dose orally followed by
25-50 mg/day) plus clindamycin (300 mg orally 4 times
daily)
• Folinic acid (leucovorin) (10-25 mg/day) should be given
to all patients to prevent hematologic toxicity of
pyrimethamine
• Trimethoprim (10 mg/kg/day) sulfamethoxazole (50
mg/kg/day) for 4 weeks
• Sulfadiazine or clindamycin can be substituted for
azithromycin 500 mg daily or atovaquone 750 mg twice
daily.