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LOWER GENITAL TRACT
INFECTIONS
DR MOTIUR RAHMAN
PGT
Dept of OBG & GYNAE
ESI-PGIMSR & ESIC MEDICAL
COLLEGE , JOKA
 Lower genital tract infections means
infections of VULVA , VAGINA ,&
CERVIX.
 Symptoms caused by lower genital tract
in...
TYPE OF LESIONS
 VAGINITIS :
 ULCERATIVE LESIONS :
 VULVAL INFECTIONS :
 CERVICITIS :
 BARTHOLIN GLAND INFECTION :
COMMON SYMPTOMS
 Pruritus
 Vaginal discharge
 Pain
 Dyspareunia
 Itching
 Odor
 Irritation
 Burning
Ecosystem in vagina
 Estrogen
 pH in vagina: 3.5-4.0
 Vaginal flora: lactobacilli ;acidogenic
corynebacteria
VAGINITIS
 Vaginitis is usually characterized by pruritus,
vaginal discharge and/or vulvar itching and
irritation, vagina...
Bacterial Vaginosis
Bacterial Vaginosis (BV) is the name of a
condition in women where the normal
balance of bacteria in t...
Bacterial Vaginosis
BV is a polymicrobial clinical syndrome
resulting from replacement of the
normal H2O2–producing Lactob...
Bacterial Vaginosis
Diagnostic Considerations
BV can be diagnosed by the use of clinical criteria or Gram
stain. Clinical ...
Bacterial Vaginosis
Diagnostic Considerations
 When a Gram stain is used, determining the relative
concentration of lacto...
Bacterial Vaginosis
Obtaining a sample of the discharge The whiff test
Bacterial Vaginosis
 Treatment
All women who have symptomatic disease require treatment.
Recommended Regimens for nonpreg...
Bacterial Vaginosis
 Management of Sex Partners
The results of clinical trials indicate that a woman’s response to
therap...
Trichomonas Vaginitis
 Trichomoniasis is caused by the
protozoan T. vaginalis.
 Many infected women have symptoms
charac...
Trichomonas Vaginitis
SIGNS AND SYMPTOMS
 About 50% of women infected with trichomoniasis do not
have symptoms. The sever...
Trichomonas Vaginitis
Diagnostic Considerations
Diagnosis of vaginal trichomoniasis is usually performed
by microscopy of...
Trichomonas Vaginitis
Recommended Regimens
Metronidazole 2 g orally in a single dose
OR
Tinidazole 2 g orally in a single ...
Trichomonas Vaginitis
.
 Management of Sex Partners
Sex partners of patients with T. vaginalis should be treated.
Patient...
Vulvovaginal Candidiasis
VVC usually is caused by C. albicans but occasionally is
caused by other Candida sp. or yeasts.
A...
Vulvovaginal Candidiasis
Typical symptoms of VVC include:
pruritus,
vaginal soreness,
dyspareunia,
external dysuria.
None ...
Vulvovaginal Candidiasis
Uncomplicated VVC
 Sporadic or infrequent VVC
 Mild-to-moderate VVC
 Likely to be Candida albi...
Vulvovaginal Candidiasis
Uncomplicated VVC
Diagnostic Considerations in Uncomplicated VVC
Based on
1 Clinical features
ext...
Vulvovaginal Candidiasis
Treatment for Uncomplicated VVC
Short-course topical formulations (i.e., single dose and
regimens...
Vulvovaginal Candidiasis
Recommended Regimens for Uncomplicated VVC
 Intravaginal Agents:
Butoconazole 2% cream 5 g intra...
VULVAR INFECTIONS
GENITAL WARTS
 Caused by Human Papilloma virus(HPV)
, mainly type 6 & 11 .
 Also called condyloma acum...
 Usually multifocal & asymptomatic ,
although itching , burning , bleeding &
pain can occur.
 Usually diagnosed clinical...
MOLLUSCUM
CONTAGIOSUM
 Caused by POX virus infection
 Spread by skin contact ,
autoinoculation,fomites.
 Appearance of ...
PEDICULOSIS PUBIS
 Caused by ectoparasite Phthirus pubis
 Intense pruritus in the affected area ,
sometimes associated w...
SCABIES
 Caused by Sarcoptes scabiei var
hominis.
 Transmitted by close contact
 Insidious onset of severe intermittent...
GENITAL ULCER
 Genital herpes
 Chancre (syphilis)
 Chancroid
 Granuloma inguinale
 Lymphogranuloma venereum
 Tubercu...
GENITAL HERPES
 HSV – 1
 Mostly oro-labial, but increasing cause of
genital herpes
 HSV – 2
 Almost entirely genital
...
 Horizontal Transmission
 Intimate sexual contact (oral/genital)
 Aerosol and fomite transmission is rare
 Vertical Tr...
 Local – clusters of small, painful blisters
that ulcerate and crust outside of
mucous membranes
 Itching, dysuria, vagi...
Recurrent herpes
 Reactivation of virus
 Mild, self-limited
 Localized, lasting 6-7 days
 Shedding: 4-5 days
 Prodrom...
Diagnosis
 Viral isolation (culture)
 High specificity, low sensitivity
 50% for primary infxn
 20% for recurrent infx...
SYPHILIS(CHANCRE)
 Caused by T. pallidum
 Transmitted through contact with
chancre , condyloma lata or mucosal
lesion.
...
 Non tender inguinal lymphadenopathy
frequently present.
 Secondary syphilis may be present as
condyloma lata.
 Diagnos...
CHANCROID
 Caused by Hemophilus ducreyi
 Lesion starts as multiple vesicopustules
over vulva , vagina & cervix . then
sl...
LYMPHOGRANULOMA
VENERUM
 Caused by Chlamydia trachomatis ( L
serotypes)
 Painless papule, pustule or ulcer in vulva
or c...
GRANULOMA INGUINALE
 Caused by Calymmatobacterium
granulomatis
 Hypertrophic ulcer , margins are rolled &
elevated
 Pre...
CERVICITIS
 Two types of cells line of cervix: flat, skin-like
cells (squamous cells) and glandular cells that
secrete mu...
 Two major diagnostic signs characterize acute cervicitis:
1) a purulent or mucopurulent endocervical exudate visible in ...
CLAMYDIA
 Causative agent : C. trachomatis
 75% cases asymptomatic
 Commonly present with abnormal
vaginal discharge, b...
GONORRHEA
 Causative agent : N. gonorrhoeae
 Most common infected site endocervix
 50% asymptomatic
 Present with vagi...
Bartholin’s duct cyst and
abscess
 Causes: obstruction of main duct of
Bartholin’s gland result in retention of
secretion...
Sign and symptoms:
 Some of them have no symptoms, once
the abscess formed, patient will feel
pain, tenderness, and dyspa...
Treatment:
 Drainage of infected cyst or abscess;
 Antibiotics;
 Excision of the cyst may be required in
recurrent case...
THANK
YOU
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Lower genital tract infection

GENITAL INFECTION - FEMALE

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Lower genital tract infection

  1. 1. LOWER GENITAL TRACT INFECTIONS DR MOTIUR RAHMAN PGT Dept of OBG & GYNAE ESI-PGIMSR & ESIC MEDICAL COLLEGE , JOKA
  2. 2.  Lower genital tract infections means infections of VULVA , VAGINA ,& CERVIX.  Symptoms caused by lower genital tract infections are among the most common presenting complaints of gynecological patients .
  3. 3. TYPE OF LESIONS  VAGINITIS :  ULCERATIVE LESIONS :  VULVAL INFECTIONS :  CERVICITIS :  BARTHOLIN GLAND INFECTION :
  4. 4. COMMON SYMPTOMS  Pruritus  Vaginal discharge  Pain  Dyspareunia  Itching  Odor  Irritation  Burning
  5. 5. Ecosystem in vagina  Estrogen  pH in vagina: 3.5-4.0  Vaginal flora: lactobacilli ;acidogenic corynebacteria
  6. 6. VAGINITIS  Vaginitis is usually characterized by pruritus, vaginal discharge and/or vulvar itching and irritation, vaginal odor & dyspareunia might be present. The three diseases most frequently associated with vaginitis are : Bacterial Vaginosis Trichomoniasis Candidiasis
  7. 7. Bacterial Vaginosis Bacterial Vaginosis (BV) is the name of a condition in women where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. It is sometimes accompanied by discharge, odor, pain, itching, or burning.
  8. 8. Bacterial Vaginosis BV is a polymicrobial clinical syndrome resulting from replacement of the normal H2O2–producing Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria (e.g., Prevotella sp. and Mobiluncus sp.), G. vaginalis, and Mycoplasma hominis.  Bacterial Vaginosi s Picture Bacterial Vaginosis homogeneous, thin, white discharge
  9. 9. Bacterial Vaginosis Diagnostic Considerations BV can be diagnosed by the use of clinical criteria or Gram stain. Clinical criteria require three of the following symptoms or signs(Amsel criteria)  homogeneous, thin, white discharge that smoothly coats the vaginal walls;  presence of clue cells (epithelial cells with borders obscured by small bacteria) on microscopic examination;  pH of vaginal fluid >4.5; and  a fishy odor of vaginal discharge before or after addition of 10% KOH (i.e., the whiff test).
  10. 10. Bacterial Vaginosis Diagnostic Considerations  When a Gram stain is used, determining the relative concentration of lactobacilli (long Gram-positive rods), Gram negative and Gram-variable rods and cocci (i.e., G. vaginalis,Prevotella, Porphyromonas, and peptostreptococci), and curved Gram-negative rods (Mobiluncus)  Culture of G. vaginalis is not recommended as a diagnostic tool because it is not specific.
  11. 11. Bacterial Vaginosis Obtaining a sample of the discharge The whiff test
  12. 12. Bacterial Vaginosis  Treatment All women who have symptomatic disease require treatment. Recommended Regimens for nonpregnant woman Metronidazole 500 mg orally twice a day for 7 days OR Metronidazole gel, 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days OR Clindamycin cream, 2%, one full applicator (5 g) Intravaginally at bedtime for 7 days
  13. 13. Bacterial Vaginosis  Management of Sex Partners The results of clinical trials indicate that a woman’s response to therapy and the likelihood of relapse or recurrence are not affected by treatment of her sex partner(s). Therefore, routine treatment of sex partners is not recommended.
  14. 14. Trichomonas Vaginitis  Trichomoniasis is caused by the protozoan T. vaginalis.  Many infected women have symptoms characterized by a diffuse, malodorous, yellow-green vaginal discharge with vulvar irritation. However, some women have minimal or no symptoms. Note the "Frothy" Discharge seen around the cervix.
  15. 15. Trichomonas Vaginitis SIGNS AND SYMPTOMS  About 50% of women infected with trichomoniasis do not have symptoms. The severity of discomfort varies greatly from woman to woman and from time to time in the same woman. Symptoms can be worse during pregnancy or right before or after a menstrual period.  Principle symptom-persistent vaginal discharge (profuse, extremely frothy, greenish, foul smelling)  Vaginal itching, irritation, and pain.  Patchy redness of the genitals, including labia and vagina.  Frequent, painful dysuria, if urine touches inflamed tissue.  Generalized vaginal erythema with multiple small petechiae
  16. 16. Trichomonas Vaginitis Diagnostic Considerations Diagnosis of vaginal trichomoniasis is usually performed by microscopy of vaginal secretions, but this method has a sensitivity of only approximately 60%–70% and requires immediate evaluation of wet preparation slide for optimal results. Culture is the most sensitive and specific commercially available method of diagnosis. In women in whom trichomoniasis is suspected but not confirmed by microscopy, vaginal secretions should be cultured for T. vaginalis. DNA probe test, which detects genetic material (DNA) of the Trichomonas organism. This test is rarely needed to identify trich and is usually available only in research studies.
  17. 17. Trichomonas Vaginitis Recommended Regimens Metronidazole 2 g orally in a single dose OR Tinidazole 2 g orally in a single dose Alternative Regimen Metronidazole 500 mg orally twice a day for 7 days
  18. 18. Trichomonas Vaginitis .  Management of Sex Partners Sex partners of patients with T. vaginalis should be treated. Patients should be instructed to avoid sex until they and their sex partners are cured.
  19. 19. Vulvovaginal Candidiasis VVC usually is caused by C. albicans but occasionally is caused by other Candida sp. or yeasts. An estimated 75% of women will have at least one episode of VVC, and 40%–45% will have two or more episodes. .
  20. 20. Vulvovaginal Candidiasis Typical symptoms of VVC include: pruritus, vaginal soreness, dyspareunia, external dysuria. None of these symptoms is specific for VVC. Abnormal vaginal discharge: White, "curd-like“, cheesy vaginal discharge.
  21. 21. Vulvovaginal Candidiasis Uncomplicated VVC  Sporadic or infrequent VVC  Mild-to-moderate VVC  Likely to be Candida albicans  Nonimmunocompromised women Complicated VVC  Recurrent VVC  Severe VVC  Nonalbicans candidiasis  Women with uncontrolled diabetes, debilitation, or are immunosuppression, or those who are pregnant.
  22. 22. Vulvovaginal Candidiasis Uncomplicated VVC Diagnostic Considerations in Uncomplicated VVC Based on 1 Clinical features external dysuria and vulvar pruritus, pain,swelling, and redness. Signs include vulvar edema, fissures,excoriations, or thick curdy vaginal discharge. 2 Demonstration of candidal mycelia either 1) a wet preparation (saline, 10% KOH) or Gram stain of vaginal discharge demonstrates yeasts or pseudohyphae or 2) a culture or other test yields a positive result for a yeast species. 3 Normal vaginal pH<4.5
  23. 23. Vulvovaginal Candidiasis Treatment for Uncomplicated VVC Short-course topical formulations (i.e., single dose and regimensof 1–3 days) effectively treat uncomplicated VVC. The topically applied azole drugs are more effective than nystatin. Treatment with azoles results in relief of symptoms and negative cultures in 80%–90% of patients who complete therapy.
  24. 24. Vulvovaginal Candidiasis Recommended Regimens for Uncomplicated VVC  Intravaginal Agents: Butoconazole 2% cream 5 g intravaginally for 3 days* OR Clotrimazole 1% cream 5 g intravaginally for 7–14 days* OR Clotrimazole 100 mg vaginal tablet for 7 days OR Miconazole 2% cream 5 g intravaginally for 7 days*  Oral Agent: Fluconazole 150 mg oral tablet, one tablet in single dose
  25. 25. VULVAR INFECTIONS GENITAL WARTS  Caused by Human Papilloma virus(HPV) , mainly type 6 & 11 .  Also called condyloma acuminata.  Peak incidence among 15 -25 yrs , soon after onset of sexual activity.  Soft , sessile, and or verrucous lesions.
  26. 26.  Usually multifocal & asymptomatic , although itching , burning , bleeding & pain can occur.  Usually diagnosed clinically.  Treatment modalities : application of cytotoxic or keratolytic agents , surgical excision ,cytodestructive techniques & immune modulators.
  27. 27. MOLLUSCUM CONTAGIOSUM  Caused by POX virus infection  Spread by skin contact , autoinoculation,fomites.  Appearance of dome shaped papules with central umbilication , 2-5 mm diameter.  Usually asymptomatic but may be pruritic & become inflammed & swollen .  It usually self limited.
  28. 28. PEDICULOSIS PUBIS  Caused by ectoparasite Phthirus pubis  Intense pruritus in the affected area , sometimes associated with maculopapular lesions.  Diagnosis is made by gross visualization of lice , larvae in pubic hair or microscopic identification of crablike lice under oil.
  29. 29. SCABIES  Caused by Sarcoptes scabiei var hominis.  Transmitted by close contact  Insidious onset of severe intermittent pruritus .  Characteristic lesion is burrow , 1-10 mm curving tract that serves to house the mite.  Diagnosed clinically & appearance of burrow
  30. 30. GENITAL ULCER  Genital herpes  Chancre (syphilis)  Chancroid  Granuloma inguinale  Lymphogranuloma venereum  Tubercular ulcer
  31. 31. GENITAL HERPES  HSV – 1  Mostly oro-labial, but increasing cause of genital herpes  HSV – 2  Almost entirely genital  > 95% of recurrent genital lesions  Primary infections  Recurrent infections  Latency
  32. 32.  Horizontal Transmission  Intimate sexual contact (oral/genital)  Aerosol and fomite transmission is rare  Vertical Transmission  Maternal-infant via infected cervico-vaginal secretions, blood or amniotic fluid at birth  Autoinoculation  From one site to another
  33. 33.  Local – clusters of small, painful blisters that ulcerate and crust outside of mucous membranes  Itching, dysuria, vaginal discharge, inguinal adenopathy, bleeding from cervicitis
  34. 34. Recurrent herpes  Reactivation of virus  Mild, self-limited  Localized, lasting 6-7 days  Shedding: 4-5 days  Prodrome: 1-2 days
  35. 35. Diagnosis  Viral isolation (culture)  High specificity, low sensitivity  50% for primary infxn  20% for recurrent infxn  Direct detection of virus (Tzcank smears, PCR)  Serology  Newer tests that are specific for type of virus (HerpesSelect 2, herpes glycoprotein for IgG, ELISA)
  36. 36. SYPHILIS(CHANCRE)  Caused by T. pallidum  Transmitted through contact with chancre , condyloma lata or mucosal lesion.  Primary , secondary , tertiary syphilis stages occur over years to decades , with periods of inactive or latent disease.  Primary syphilis presents as hard , painless , solitary chancre.
  37. 37.  Non tender inguinal lymphadenopathy frequently present.  Secondary syphilis may be present as condyloma lata.  Diagnosed by : dark-field microscopy , VDRL or RPR , FTA-ABS
  38. 38. CHANCROID  Caused by Hemophilus ducreyi  Lesion starts as multiple vesicopustules over vulva , vagina & cervix . then sloughs to form shallow ulcers.  Lesion painful , tender with foul purulent & hemorrhagic discharge may be present.
  39. 39. LYMPHOGRANULOMA VENERUM  Caused by Chlamydia trachomatis ( L serotypes)  Painless papule, pustule or ulcer in vulva or cervix  Classical clinical sign : “groove sign” – a depression between the groups of inflamed nodes.
  40. 40. GRANULOMA INGUINALE  Caused by Calymmatobacterium granulomatis  Hypertrophic ulcer , margins are rolled & elevated  Presence of “Donovan body” confirmatory
  41. 41. CERVICITIS  Two types of cells line of cervix: flat, skin-like cells (squamous cells) and glandular cells that secrete mucus.  The same organisms responsible for vaginitis, can cause cervicitis.  Cervicitis is an inflammation of the cervix  Most cases of cervicitis are caused by infection with sexually transmitted diseases, including gonorrhea and chlamydia
  42. 42.  Two major diagnostic signs characterize acute cervicitis: 1) a purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab specimen and  2) sustained endocervical bleeding easily induced by gentle passage of a cotton swab through the cervical os.  Either or both signs might be present.  Some patients is asymptomatic, but some women complain of an abnormal vaginal discharge and intermenstrual vaginal bleeding.
  43. 43. CLAMYDIA  Causative agent : C. trachomatis  75% cases asymptomatic  Commonly present with abnormal vaginal discharge, burning with urination, spotting, postcoital bleeding.  Diagnosed by NAAT(nucleic acid amplification testing)
  44. 44. GONORRHEA  Causative agent : N. gonorrhoeae  Most common infected site endocervix  50% asymptomatic  Present with vaginal discharge, dysuria, abnormal uterine bleeding  Diagnosed by culture & NAAT
  45. 45. Bartholin’s duct cyst and abscess  Causes: obstruction of main duct of Bartholin’s gland result in retention of secretion and cystic dilatation.  Cause of obstruction: infection , inspissated mucous, congenital narrowing of duct
  46. 46. Sign and symptoms:  Some of them have no symptoms, once the abscess formed, patient will feel pain, tenderness, and dyspareunia.  Surrounding tissues become edematous and inflamed, fluctuant, tender mass is usually palpable.
  47. 47. Treatment:  Drainage of infected cyst or abscess;  Antibiotics;  Excision of the cyst may be required in recurrent cases.
  48. 48. THANK YOU

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