Bacterial Vaginosis
Dr. Yashika
Causative agent : Gardnerella vaginalis
Clinical features:
Malodorous vaginal discharge.
(Homogenous, greyish white, adherent to vaginal wall)
No vaginal inflammation.
During pregnancy
preterm membrane rupture,
preterm labour,
chorioamnionitis.
Complications:
Recurrent infection leads to PID.
Development of PID following abortion.
Vaginal cuff cellulitis following hysterectomy.
Pregnancy complications.
Diagnosis
Amsel’s criteria :
Homogenous vaginal discharge
Vaginal discharge > 4.5
Positive whiff’s test
Presence of clue cells > 20% of cells.
Whiffs test:
Appearance of fishy (amine) odour when a drop of discharge is mixed with 10% solution of KOH.
Clue cells:
Presence of stippled epithelial cells.
Treatment:
Metronidazole 200 mg TDS x 7 days.
Clindamycin cream.
Metronidazole gel.
Infections of the Genital Tract - Part IHelen Madamba
Lifted from the CDC STD Treatment Guidelines 2015, this is a discussion of infections affecting the vulva, such as infections of the Bartholin's gland, ectoparasites and infections presenting as vulvar ulcers. This was a lecture delivered to an audience of second year medical students at the Cebu Doctors University College of Medicine.
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.
Bacterial Vaginosis
Dr. Yashika
Causative agent : Gardnerella vaginalis
Clinical features:
Malodorous vaginal discharge.
(Homogenous, greyish white, adherent to vaginal wall)
No vaginal inflammation.
During pregnancy
preterm membrane rupture,
preterm labour,
chorioamnionitis.
Complications:
Recurrent infection leads to PID.
Development of PID following abortion.
Vaginal cuff cellulitis following hysterectomy.
Pregnancy complications.
Diagnosis
Amsel’s criteria :
Homogenous vaginal discharge
Vaginal discharge > 4.5
Positive whiff’s test
Presence of clue cells > 20% of cells.
Whiffs test:
Appearance of fishy (amine) odour when a drop of discharge is mixed with 10% solution of KOH.
Clue cells:
Presence of stippled epithelial cells.
Treatment:
Metronidazole 200 mg TDS x 7 days.
Clindamycin cream.
Metronidazole gel.
Infections of the Genital Tract - Part IHelen Madamba
Lifted from the CDC STD Treatment Guidelines 2015, this is a discussion of infections affecting the vulva, such as infections of the Bartholin's gland, ectoparasites and infections presenting as vulvar ulcers. This was a lecture delivered to an audience of second year medical students at the Cebu Doctors University College of Medicine.
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.
Presentation notes about Bacterial Vaginosis for medical students, undergraduate doctors and other health allied courses. It was prepared by medical doctor at Free Medicine.
A brief presentation on vaginal candidiasis under following headings
INTRODUCTION AND CAUSATIVE ORGANISM
ETIOLOGY
RISK FACTORS
CLINICAL SYMPTOMS AND SIGNS
LABORATORY INVESTIGATIONS
TREATMENT
RESISTANT STRAINS
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
Infections of the Genital Tract - Part IIHelen Madamba
Heavily lifted from the CDC STD Treatment Guidelines 2015, this is a discussion on infections affecting the vagina. This was a lecture delivered to an audience of second year medical students at the Cebu Doctors University College of Medicine.
Presentation notes about Bacterial Vaginosis for medical students, undergraduate doctors and other health allied courses. It was prepared by medical doctor at Free Medicine.
A brief presentation on vaginal candidiasis under following headings
INTRODUCTION AND CAUSATIVE ORGANISM
ETIOLOGY
RISK FACTORS
CLINICAL SYMPTOMS AND SIGNS
LABORATORY INVESTIGATIONS
TREATMENT
RESISTANT STRAINS
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
Infections of the Genital Tract - Part IIHelen Madamba
Heavily lifted from the CDC STD Treatment Guidelines 2015, this is a discussion on infections affecting the vagina. This was a lecture delivered to an audience of second year medical students at the Cebu Doctors University College of Medicine.
Infections of the Genital Tract - Part IIIHelen Madamba
Heavily lifted from the CDC STD Treatment Guidelines 2015, this is a discussion of cervicitis, pelvic inflammatory disease and prevention of sexually transmitted infections in victims of sexual assault. This was a lecture delivered to an audience of second year medical students at the Cebu Doctors University College of Medicine.
Yeast infections are generally caused by an organism called Candida albicans. Natural cures are simple, less expensive, and by far the most important point, they actually work. Get few tips for avoiding this disease with ease.
http://www.yeastinfectionheal.com/
Yeast infections are generally caused by an organism called Candida albicans. Natural cures are simple, less expensive, and by far the most important point, they actually work. Get few tips for avoiding this disease with ease.
http://www.yeastinfectionheal.com/
Infection in the couple may lead to failure of fertility treatment ,hence proper screening and management of the condition is mandatory before starting fertility treatment.
Tuberculosis (TB) is a very common disease worldwide including India. Tuberculosis of the female genital tract is
common enough to be found in 1% of women with DUB (Sutherland 1949) and in 4% of adolescent with excessive
menstrual loss (Sutherland 1953). The commonest site of involvement is the fallopian tubes (90e100%). The next
common site is endometrium (60%). The infection is from the tubes either by lymphatics or direct spread through
continuity. Symptoms vary according to the severity site and stage of the disease. Anti tuberculosis chemotherapy is the mainstay of tt. Initially drugs are used for 2 months. These are isoniazid, rifampicin, pyrazinamide and ethambutal. Treatment is continued for another 4 months with isoniazid and rifampicin.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Genital infections are one of the most common reasons
for women of all age groups to present to a medical
practitioner.
Sexually transmitted infections form one subgroup of
infections, however the more common infections are
vulvovaginal candidiasis and bacterial vaginosis.
Chlamydia and gonorrhoea affect the sexually active
woman, with HlV.
These infections can be asymptomatic and can have
serious consequences to a woman’s fertility by causing
tubal infection and damage.
Appropriate diagnosis and treatment are fundamental
not only to provide symptom relief, but also to prevent
recurrences and long-term squeals
3. It is important to differentiate normal
physiological
changes from true infections. Thus, a thorough
history and examination with the back up of
laboratory testing is fundamental before a
diagnosis is made.
However, the sensitivity of clinical diagnosis
and testing in pelvic inflammatory disease
(PID)
can be low, so if there is a clinical suspicion of
PID,
empiric treatment is recommended.
4. Anatomy and physiology:
The vaginal epithelium is lined by stratified squamous epithelium during the
reproductive age group under the influence of oestrogen. The pH is usually
between 3.5 and 4.5 and lactobacilli (Figure 6.1a) are the most common
organisms present in the vagina. Following the menopause, the influence of
oestrogen is diminished making the vaginal epithelium atrophic with a more
alkaline pH of 7.0, the lactobacillus population declines and the vagina is
colonized by skin flora.
Physiological discharge occurs in response to hormonal levels during the
menstrual cycle. It is usually white and changes to a more yellowish colour due
to oxidation on contact with air.
There is increased mucous production from the cervix at the time of ovulation
followed by a thicker discharge/cervical plug under the influence of
progesterone. The discharge mainly consists of mucous, desquamated
epithelial cells, bacteria (lactobacillius) and fluid.
Ascending infection can occur from the vagina and cervix to the uterine cavity
and to the Fallopian tubes through direct spread or via the lymphatics leading
to severe pelvic inflammatory disease and pelvic peritonitis.
Infections can be broadly divided into lower and upper genital tract depending
on the site and affection of the infective organism.
5. Vaginal and cervical
flora (all ><1000
magnified). Normal:
lactobacilli - seen as
large Gram-positive
rods
- predominate.
Squamous epithelial
cells are Gram negative
with a large amount of
cytoplasm. (b)
Cnandidiasis: (c) (d) :
6. Lower genital tract
infections
Vulvovaginal candidiasis
Candida, a commensal organism, is found in
small population densities in the vaginal
ecosystems of nearly one third of healthy
women. Symptomatic infection arises,
however, when proliferation causes a shift
from colonization to frank adherence and
infection. It is caused by Candida albicans in
around 80-92 per cent of cases. Other non
albican species like C.tropicalis, C. glabmta,
C. krusei and C. parupsilosis can also cause
similar symptoms, although sometimes more
severe and recurrent. C. albicans is a diploid
fungus and is a common commensal in the
gut flora.
The patent complain of: Vulval itching and
soreness, thick curdy vaginal discharge
dyspareunia and dysuna. Vulval oedema,
vulvai excoriation, redness and erythema.
Normal vaginal pH,
there are speckled Gram-positive
spores and log pseudohyphae visible.
There are numerous polymorphs
present and the bacterial flora is
abnormal, resembling bacterial
vaginosis.
7. Microscopy of the discharge with
10% KOH will often reveal hyphae
or budding yeast in 50%-70% of
cases albicans organisms are
easiest to identify, as they have
long hyphae with blastospores
along their length and a terminal
cluster of chlamydiaspores . The
"atypical" species of yeast,
however, may only have features
of budding yeast (resembling
small snowmen), which are easily
obscured within surrounding
cellular debris.
8. The trichomonad parasite is a
flagellated protozoan that
causes up to 25% of vaginitis
cases. While trichomonas
infection is asymptomatic up to
50% of the time,when clinical
signs are present they include
irritation and soreness of the
vulva, perineum, and thighs,
with dyspareunia and dysuria.
Typically, the trichomonas
infection is accompanied by a
copious, greenish-yellow frothy
discharge. Unlike bacterial
vaginosis, it seems that
trichomonas is primarily a
sexually transmitted infection.
9. . The diagnosis is made by observation of
the following features (Table I):
A foul-smelling frothy discharge (present
in 35% of cases
Vaginal pH >4.5 (70% of cases)
Punctate cervical microhemorrhages
(25%)
Motile trichomonads on wet mount (50%-
75%)
Papanicolaou smear is quoted to be 70%
sensitive in identifying trichomonads.
The current primary treatment
recommendation is a single 2g dose of
oral metronidazole. For those who cannot
tolerate this single large dose, 500mg bid
for 7 days is equally efficacious if the
patient completes her regimen. The male
partner(s) must also receive treatment.
10. Bacterial vaginosis: there is
an overgrowth of anaerobic
organisms, including
Gardnere/Ia vagina/is (small
Gram-variable cocci), and a
decrease in the numbers of
lactobacilli. A 'clue cell’ is
seen.
On wet preparation of
vaginal fluid, absence of
WBCs and stippling of
epithelial cells support a
diagnosis of bacterial
vaginosis.
11. The diagnosis of BV requires the presence of at least 3 of the following 4 criteria.
A homogenous noninflammatory discharge (not many WBCs).
Vaginal pH >4.5.
Clue cells (bacteria attached to the borders of epithelial cells, >20 % of epithelial cells;
Whiff test positive for fishy or musty odor when alkaline KOH solution added to smear.
For years, oral metronidazole has been the primary indicated regimen. Other systemic options
include oral clindamycin.
Pap smear showing clue cells consistent with bacterial
vaginos
12. According to 2008 WHO estimates,
499 million new cases of curable
sexually transmitted infections (ie,
syphilis, gonorrhoea, chlamydia,
trichomoniasis) occur annually
throughout the world in adults aged 15-
49 years.
Tubal scarring as a result of PID can
cause infertility in 20%, ectopic
pregnancy in 9%, and chronic pelvic
pain in 18% of women[
Complicated PID resulting in tubo-ovarian
or pelvic abscess may
contribute to patient mortality.
13. PID is a complex polymicrobial disease that is
due to the ascending spread of pathogens from
the cervix or vagina, most
commonly Chlamydia, trachomatis or Neisseria
gonorrhoeae (60-75%) , which then spreads
into the endometrium, fallopian tubes, ovaries,
and adjacent structures.
Other pathogens include Mycoplasma
hominis, Haemophilus
influenzae,Streptococcus
pyogenes, Bacteroides species,
and Peptostreptococcus species. Less
commonly, direct spread from a nearby
infection such
as appendicitis ordiverticulitis may occur.
Hematogenous infection is a rare cause of PID
except in cases of tuberculous.
Douching is a potential risk factor for PID as it
can result in a change of the vaginal flora and
introduce bacteria from the vagina into the
upper reproductive organs. Usage of
intrauterine contraceptive device or
gynecologic interventions may also predispose
a patient to PID. Direct extension of infection
from adjacent viscera and uterine
instrumentation are more important risk factors
in postmenopausal PID
14. Abdominal, pelvic pain and
dyspareunla.
Mucopufulent vaginal
discharge
Pyrexia (>38‘C).
Heavy/ime.rmenslrual
bleedlng
Pelvic tenderness and Tender
adnexal or palpable pelvic
mass,
Generalized sepsis in severe
and sysmmic infection
Tubal damage leading to tubal
occlusion, abscess and
hydrosalpinx.
15. Based on clinical findings:
Raised white cell count (neutrophilia
suggestive of acute inflammatory
process)
Reduced white cell count
(neutropenia in severe infections)
Raised C reactive protein and ESR
(erythrocyte sedimentation rate)
Adnexal masses on ultrasound
Laparoscopy is the gold standard to
give a definitive diagnosis, however,
in mild cases it may
not be very obvious.
16. Depending on the severity of the infection, patients with mild/moderate
disease can be managed on an outpatient basis with easy access to hospital
admission if the infection becomes more severe. An intrauterine
contraceptive device, if present, should be removed and alternative
emergency contraception or other modes of contraception (combined pill,
oral/parenteral progesterone) should be offered. A
pregnancy test should be done in all cases to rule out ectopic pregnancy.
There are several differing antibiotic regimes that are used; however, the
following is recommended by the RCOG Green Top Guideline (2008) which
is evidence based.
Mild/moderate infection (outpatient treatment)
Oral ofloxacin 400 mg twice a day + oral
metronidazole 400 mg twice a day x 14 days
Ceftriaxone 250 mg single intramuscular injection + oral doxycycline 100 mg
twice a day
oral metronidazole 400 mg twice a day x 14 days
Single intramuscular dose of ceftriaxone 250 mg azithrornycin 1 g/week x 2
weeks.
The data supporting the use of azithromycin are limited and should not be used
in isolation.
17. Causative organism
Herpes simplex virus type I (usually oral) or
type II (usually genital).
Clinical features
Painful vesicles and multiple ulcerations on
vulva, Retention of urine.
Diagnosis
Swab from ulcer, Serum from vesicle, Virus
seen on electron microscopy, Culture.
Treatment
Acyclovir 200 ml five times/ day
Famciclovir, Valaciclovir,
Analgesics and local unaesthetic gels
18. Causative organism:
Human papillomavirus, HPV6and11, HPV 16 and 18,
linked to cervical caner.
Clinical features:
Warty lesions on the vulva, vagina, cervix and perianal
area.
Also seen around mouth, lips and larynx if orogenital
contact.
Diagnosis:
Clinical examination:
Histology of removed wart Seen on cervical smear and
colposcopy
Treatment:
Podophyllin; local application twice a week, Surgical
excision, Laser, Cryotherapy.
19. Causative organism:
Treponema pallidum
Clinical features:
Primary syphilis: Painless ulcer/ulcers on vulva, vagina or cervix, Enlarged
groin/inguinal lymph nodes
Secondary syphilis: maculopapular, rash on palms and soles. Mucous
membrane ulcers, Generalized lymphadenopath, arthritis
Neurosyphilis: meningitis, strok, tabes dorsalis
Cardiovascular: aortic aneurysm
Congenital syphilis: intrauterine death, interstitial keratitis, VIII nerve
deafness, abnormal teeth
Diagnosis:
TPPA: Treponema pallidum particle agglutination.
TPHA: Treponema pallidum haemagglutinatio assay.
FTA: Fluorescent treponemal antibody.
Dark Held illumination: serum from base of ulcer + saline taken and seen
under the microscope. Spiral organisms with characteristic movements
are diagnostic
Treatment:
Penicillin mainstay of treatment Procaine, penicillin, 1.2 MU daily, i.m. x
12 days, Benzathine penicillin, 2.4 MU i.m. repeated after 7 days.
Doxycycline 100 mg bd x 14 days.
Erythromycin 500 mg qds x 14 days mm.
20. Causative organism:
Mycobacterium tuberculosis.
Clinical features:
Usually following pulmonary tuberculosis through blood and lymphatics,
Amenorrhoea (affects endometrium) Infertility (affects tube), Acute/ chronic pelvic
pain, Frozen pelvis due to severe multiple adhesions.
Diagnosis:
Histological confirmation from endometrium and Fallopian tube, Mantoux test, Heaf
test, Chest x-ray.
Treatment:
Rifampicin, Isoniazid, Pyrazinamide. Treatments can, last from six to 12 months.
21. Causative organism:
Haemophilus ducreyi.
Clinical features:
Painful shallow multiple ulcers, Regional
lymphadenopathy with suppuration.
Diagnosis:
Isolation of Ducrey’s bacillus on biopsy on
biopsy.
Treatment:
Single oral dose of azethromycin, Ceftriaxone,
Erythrofpycin.
22. Causative organism:
Klebsiella grarnulomatoses.
Clinical features:
Painless nodule.
Diagnosis:
Donovan bodies:intracellular inclusions seen in
phagocytes or histiocytes.
Treatment:
Erythromycin.
24. ONE IS TERMED LACTOBACILLOSIS OR
DÖDERLEIN CYTOLYSIS. THIS ENTITY IS
CHARACTERIZED BY AN OVERGROWTH OF
THE COMMENSAL LACTOBACILLI HENCE,
ON SALINE WET MOUNT, ONE FINDS AN
EXCESSIVE NUMBER OF BACILLI AMONG
THE BACKGROUND FLORA. THE PH IS
TYPICALLY LOW-NORMAL. TREATMENT,
THEREFORE, IS DIRECTED AT
CORRECTING THE DISRUPTION OF THE
VAGINAL ECOSYSTEM IN ORDER TO LIMIT
THE EXCESSIVE PROLIFERATION OF
THESE PROTECTIVE ORGANISMS.
INFLAMMATORY VAGINITIS, FEATURES A
VAGINAL PH ABOVE 4.2, LARGE NUMBERS
OF LEUKOCYTES, AND SOME PARABASAL
AND BASAL VAGINAL CELLS, WITH A
PAUCITY OF SUPERFICIAL SQUAMOUS
CELLS. CLINICIANS OFTEN FIND THAT
PATIENTS ARE INFECTED WITH GROUP A
OR GROUP B STREPTOCOCCUS
THEREFORE, BECAUSE INFECTION IS
SUSPECTED TO UNDERLIE THE
INFLAMMATION AND DESQUAMATION,
TREATMENTS DIRECTED AGAINST
BACTERIAL VAGINOSIS ARE
RECOMMENDED.