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reproductive tract infections.pptx
- 1. Reproductive tract infections BY DR. MARA ILYAS
- 5. Physiology of vaginal discharge Estrogen acts on stratified squamos epithelium of vagina and proliferates it The normal pH of vagina is 3.5-4.5 with normally present lactobacilli During menstruation, discharge occurs due to progesterone
- 6. Causes of vaginal discharge Leucorrhea To indicate excessive flow of normal vaginal discharge To indicate all abnormal vaginal discharge except when stained with blood Bacterial vaginosis Vulvovaginal candidiasis Trichomoniasis
- 7. Bacterial vaginosis ( BV ) Commonest cause of abnormal vaginal discharge Incidence is 5-50% of females worldwide Cause: Gardnerella vaginalis Depletion of the lactobacilli dominant in the healthy vaginal flora Increase in pH>4.5 Douching Black race Smoking Having a new partner Oral sex
- 8. symptoms Fishy malodour O/E Off white vaginal discharge High pH Diagnosis A gram stain of discharge Hay-ison criteria Nugent criteria Amsels criteria
- 10. Complications of BV PID Post-hysterectomy vaginal cuff cellulitis In pregnancy Preterm labor PPROM and PROM Miscarriage Increased risk to acquire HIV
- 11. treatment Avoid douching Avoid excessive genital washing Oral metronidazole Oral clindamycin
- 12. Vulvovaginal candidiasis Candida sp. Commonly candida albicans causes vulvovaginal inflammation Incidence is 20% rising upto 40% in pregnancy NOT an STI Mostly asymptomatic Symptoms are.. Curdy white discharge Itching and irritation Increased risk in Diabetic Immunocompromised pregnancy
- 14. o/E Curdy white discharge erythema., oedema and fissuring of vulva and vagina Diagnosed by High vaginal swab for microscopy and culture Treatment Imidazale Intravaginal pessaries oral
- 17. Trichomoniasis Flagellate protozoan- trichomonas vaginalis It is an STI Asymptomatic in 50% women and their sexual partners Vaginal discharge Vulvovaginitis
- 20. Pregnancy outcome Preterm labor Low birth weight Maternal Postpartum sepsis
- 21. Diagnosis and treatment Diagnosis Vaginal or endocervical swab or urine Gold standard test is NAAT (nucleic acid amplification test ) Microscopy and culture Treatment metronidazole
- 22. Cervicitis and pelvic inflammatory disease
- 23. Gonorrhea Caused by Neisseria gonorrhea Infection occurs through sexual contact Endocervical infection is asymptomatic in 50% cases Symptoms include (25%) Altered vaginal discharge Lower abdominal pain Rectal infection occurs by receptive anal sex Pharyngeal infection occurs through receptive oral sex- always asymptomatic
- 24. Cervicitis with or without mucopurulent discharge Ascending infection causes PID Hematogenous spread can cause disseminated gonococcal infection with a purpuric non-blanching rash and/or arthralgia or arthritis that is monoarticular in a weight-bearing joint Opthalmic infection occurs d/t inoculation from infected genital secretions Neonatal infection when mother has endocervical infection during delivery
- 25. diagnosis NAAT-highly sensitive and specific If N. gonorrhea identified– culture and sensitivity Screening for other STIs is crucial especially chlamydia trachomatis as dual infection is common.
- 26. Treatment Third generation cephalosporin plus azithromycin Azithromycin is added in an attempt to delay the emergence of further drug resistance
- 27. chlamydia Chlamydia trachomatis The most common bacterial STI Women< 25 yrs age most commonly affected mostly asymptomatic but can result in PID Symptoms can be Altered vaginal discharge Abdominal pain Intermenstrual bleeding Postcoital bleeding
- 28. Cervicitis with mucopurulent discharge Hematogenous spread causing the systemic infection same as gonorrhea but to lesser extent Neonatal conjunctivitis from infected others Reactive arthritis- monoarticular affecting weight bearing joints- common in men
- 29. Diagnosis and treatment Diagnosis NAAT is the gold standard Sample is vulvovaginal swab Treatment Azithromycin or doxycycline Azithromycin is single dose and well tolerated
- 30. Pelvic inflammatory disease(PID) It is a clinical syndrome from the ascending spread of microrganisms from the vagina and endocervix to the endometrium, the fallopian tubes and / or contiguous structures
- 31. Why should it be treated? Systemic upset/tubo-ovarian abscess Chronic pain (15-20) %--- hysterectomy Ectopic pregnancy ( 6-10x) Infertility ( tubal) Recurrence (25%)
- 32. Acute or chronic inflammatory disorders of the female upper genital tract Endometritis Parametritis Salpingitis Oophoritis Tubo-ovrian abscess Pelvic peritonitis
- 35. Typical presentation- acute PID non specific (40-70%) Dull, continuous , bilateral lower abdominal or pelvic pain Indolent to severe Cervical tenderness on moving the cervix Other Fever, tachycardia Vomiting Abnormal vaginal discharge Irregular bleeding Tubo-ovarian abscess Silent PID-- asymptomatic
- 37. Chronic PID Chronic lower abdominal pain General malaise and fatigue Deep dyspareunia, dysmenorrhea Intermittent abnormal vaginal discharge Irregular menstrual periods Lower abdominal/ pelvic tenderness Bulky, tender uterus Infertility ( silent epidemic )
- 38. Risk factors Infection with Neisseria and gonorrhea, mycoplasma genitalium Previous episodes of PID Sexual behaviour ( multiple partners ) Age – more in young females Contraceptive choices Barrier methods are preventive of PID IUDs increase risk douching
- 39. diagnosis Laparoscopy is gold standard – scarring and adhesions, hydrosalpinges Usually a clinical diagnosis Speculum and bimanual exam Cervical motion tenderness and cervicitis Cervical cultures Testing for all STIs USG To r/o other pelvic pathology Beta-HCG To r/o ectopic pregnancy
- 41. Fitz- Hugh Curtis Syndrome Acute perihepatitis Direct extension from fallopian tube to liver capsule and peritoneum Violins string appearance Presents with RUQ pain
- 43. Treatment Empirical therapy if suspected PID Regimen should cover all common pathogens 2 weeks duration Macrolide/tetracyclin PLUS metronidazole PLUS 3rd gen. cephalosporin Sexual partner- screening and empirical treatment with azithromycin
- 45. Genital herpes Cased by herpes simplex virus ( HSV ) Types HSV-1 Causes orolabial herpes Often acquired in childhood Also a common cause of genital herpes alongside HSV-2 HSV-2
- 46. HSV-1 Causes orolabial herpes Often acquired in childhood Also a common cause of genital herpes alongside HSV-2
- 47. Primary infection the first infection of either HSV-1 or -2 Non-primary infection Is the subsequent infection with the other type Majority of initial infections are asymptomatic, although the individual may still be infectious Subsequent recurrences maybe symptomatic Recurrence rates are higher with HSV-2 and reduce in frequency with time
- 48. symptoms Genital pain Dysuria O/E Multiple superficial tender ulcers with reginal lymphadenopathy
- 49. diagnosis Swab from the site of infection Test of choice is Polymerase chain reaction (PCR) test Type specific serology Immunoglobulin IgG and IgM to HSV-1 and -2 To test whether primary , non-primary or recurrent infection
- 50. Neonatal herpes 30% mortality rate Consequent lifelong neurological morbidity in 70% cases Acquired during pregnancy within third trimester especially last 6 wks- 41% infection rate 3% cases IgG to the virus crosses placenta and provides neonatal protection in recurrent maternal infection Mode of delivery In first time infection--- prelabour elective ceaserian section Recurrent infection– vaginal delivery
- 51. treatment Aciclovir Safe and effective in pregnancy Valaciclovir Most effective when gives ASAP after symptoms develop Counselling Lifelong infection Asymptomatic shedding Increased risk to sexual partners Effectiveness of condoms ( upto 50%) Role of antivirals in limiting transmission
- 52. Genital warts Benign epithelial tumors Caused by human papilloma virus ( HPV) Types 6 and 11- 90% of genital warts Types 16 and 18- anogenital dysplasia and cancer
- 53. HPV vaccination As a bivalent for types 16 and 18 As a quadrivalent for types 6, 11, 16 and 18 Diagnosis is by clinical examination Treatments Ablation with liquid nitrogen Surgical techniques Topical therapies- podophyllotoxin-containing preparations/ imiquimod Pregnancy- ablation