lower genital infection, cervicitis, bacterial vaginosis, candidal infection, trichomonas vaginitis, vulvovaginitis, bartholinits, bartholin cyst & abscess, vaginal discharge, clue cell

1. LOWER GENITAL
INFECTIONS
MAGDY ABDELRAHMAN MOHAMED
LECTURER OF OB/GYN
2015

2. Naturalbarriersagainstfemale genitaltract
infections:
•Vulva.
•Vagina.
•Cervix.
•Endometrium.

3. Lower genital infection.
•Vulvitis.
•Vaginitis.
•Cervicitis.

4. Vulvitis.
• The vulva my be involved in variety of
conditions:
• Skin diseases (frunculosis, allergy &
parasitic infection).
• Sexually transmitted diseases
• TB & bilharisiasis.
• 2nd to vaginitis or urinary & rectal
conditions.

5. Infantile & senile vulvitis.
• Aetiology:
• Lack of estrogen…… thin epithelium.
• Foreign body & intestinal parasite. (in
children).
• Treatment:
• Local estrogen.
• Exclude foreign body & intestinal worms.

6. Bartholinitis
• Obstruction of duct lead to accumulation of
secretion.
• May lead to bartholin cyst & abscess formation.
• Treatment:
• Antibiotics.
• Marsupialization of the cyst.
• Excision of gland.

9. Vaginitis (vulvovaginitis)
• Premenarchal
• During reproductive period:
• Trichomonas.
• Bacterial vaginosis.
• Candidal infection.
• Senile vaginitis.

10. Vulvaginitis in reproductive age
•Bacterial Vaginosis (BV) (22-50%).
•Vulvovaginal Candidiasis (17-39%).
•Trichomoniasis (4-35%).
•Undiagnosed - 7-72% .

11. Bacterial Vaginosis
• Characterized by thin, homogenous, malodorous
frothy white-to-grey vaginal discharge, adherent
to the vaginal mucosa.
• Caused by an overgrowth of organisms like
Gardnerella vaginalis, Mobiluncus species,
Mycoplasma hominis, and Peptostreptococcus
species.

12. Bacterial Vaginosis
• For diagnosis of BV, 3 out of the following 4
criteria must be present (amsell’s criteria)
• Homogenous, white, adherent discharge.
• Vaginal pH higher than 4.5.
• Whiff test:Release of fishy odor from vaginal
discharge with potassium hydroxide (KOH).
• Clue cells.

14. http://www.cdc.gov/std/treatmen
t/2006/toc.htm
Bacterial Vaginosis
• Treatment
• Metronidazole 500 mg twice daily for 7 days, or 2
g po single dose
• Metronidazole gel 0.75%, one full applicator (5g)
intravaginally, for 5 days,
• Clindamycin cream 2%, one full applicator (5 g)
intravaginally for 7 days.

15. Vaginal Candidiasis
• Second most common cause of vaginitis.
• Caused by Candida species (albicans, tropicalis,
glabrata)
• Risk Factors- Diabetes, pregnancy, broad
spectrum antibiotic therapy, COCs & steriod
therapy.
• Pruritus is the most common symptom.

16. Vaginal Candidiasis
• Thick, odorless, white vaginal discharge
(cottage cheese like).
• Associated with
• Vulvar candidiasis with vulvar burning,
• Dyspareunia
• Vulvar dysuria.

17. Treatment of Vaginal Candidiasis
• Antifungal Vaginal creams or suppositories can
be prescribed at a variety of doses and durations
of treatment.
• oral single dose treatment, such as
(clotrimazole 500 mg or fluconazol 150 mg) is
adequate.
• Longer courses of treatment are needed when
there are predisposing factors that cannot be
eliminated, such as steroid therapy.

18. Recurrent (resistant) candidiasis
• Non Albican subgroup.
• Other diagnoses, particularly herpes simplex,
which causes localized ulceration and soreness,
and dermatological conditions such as eczema
and lichen sclerosus et atrophicus.
• Management:
• Culture of the organism.
• Revise your diagnosis.
• Extended course of treatment ( 3-6 months)

19. Trichomoniasis
• Third most common.
• Caused by Trichomonas Vaginalis, flagellated
protozoa.
• Sexually transmitted.
• Profuse frothy yellowish grey discharge.
• Vulvar/vaginal erythema and edema.
• Strawberry Cervix .
• Saline wet mount – motile oval or fusiform
protozoa.

21. http://www.cdc.gov/std/treatmen
t/2006/toc.htm
Trichomoniasis
• Recommended Regimen
• Metronidazole 2 g orally in a single dose.
• Alternative Regimen
• Metronidazole 500 mg twice a day for 7 days
• Sex partners of patients with T. vaginalis
should be treated.

23. Complications
• Bacterial vaginosis (BV) result in pelvic
inflammatory disease that result in infertility and
tubal pregnancy increase in adverse outcomes of
pregnancy such as premature labour,
premature rupture of membranes, amniotic fluid
infection and low-birth-weight infants
• Trichomoniasis may increase the risk of
transmission of human immunodeficiency virus,
and may cause delivery of low-birth-weight or
premature infants.

24. Acute cervicitis
• Usually a part of gonorrheal, chlamydial,
postabortive, pueperal infection.
• The cervix is congested, with purulent
discharge coming from the external os.
• The condition may resolve or result in
chronic cervicitis or lead to PID.

25. Chronic cervicitis
• Common (30-80%) of multipara.
• Follow acute cervicitis or infection of traumatic
laceration.

26. Chronic cervicitis (C/P)
• Symptoms:
• Low back pain.
• Congestive dysmenorhea.
• Contact bleeding.
• Dysparonia.
• Signs:
• Hypertrophy.
• Nabothian follicle.
• Erosion.
• Ectropion.
• Mucous polyp.

32. Chronic cervicitis
• Treatment:
• Cautery (electocautery, laser or cryotherapy).
• Trachylorraphy.

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