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.
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 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.
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 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.
Vaginitis- vaginal discharge all medical information martinshaji
Vaginitis is the most common gynaecologic diagnosis in the primary care setting..
In approximately 90% of affected women, this condition occurs secondary to bacterial vaginitis, vulvo vaginal candidiasis or trichomoniasis. this is a study describing all the aspects of vaginal discharge associated with vaginitis , types , infections , treatment , prevention etc
please comment
thank u
Dyspareunia & vulvodynia by dr alka mukherjee dr apurva mukherjee nagpur m.s....alka mukherjee
Pain during or after sexual intercourse is known as dyspareunia. Although this problem can affect men, it is more common in women. Women with dyspareunia may have pain in the vagina, clitoris or labia. There are numerous causes of dyspareunia, many of which are treatable. Common causes include the following:
• Vaginal dryness
• Atrophic vaginitis, a common condition causing thinning of the vaginal lining in postmenopausal women
• Side effects of drugs such as antihistamines and tamoxifen (Nolvadex and other brands)
• An allergic reaction to clothing, spermicides or douches
• Endometriosis, an often painful condition in which tissue from the uterine lining migrates and grows abnormally inside the pelvis
• Inflammation of the area surrounding the vaginal opening, called vulvar vestibulitis
• Skin diseases, such as lichen planus and lichen sclerosus, affecting the vaginal area
• Urinary tract infections, vaginal yeast infections, or sexually transmitted diseases
• Psychological trauma, often stemming from a past history of sexual abuse or trauma
Symptoms
Women with dyspareunia may feel superficial pain at the entrance of the vagina, or deeper pain during penetration or thrusting of the penis. Some women also may experience severe tightening of the vaginal muscles during penetration, a condition called vaginismus.
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
Vaginitis- vaginal discharge all medical information martinshaji
Vaginitis is the most common gynaecologic diagnosis in the primary care setting..
In approximately 90% of affected women, this condition occurs secondary to bacterial vaginitis, vulvo vaginal candidiasis or trichomoniasis. this is a study describing all the aspects of vaginal discharge associated with vaginitis , types , infections , treatment , prevention etc
please comment
thank u
Dyspareunia & vulvodynia by dr alka mukherjee dr apurva mukherjee nagpur m.s....alka mukherjee
Pain during or after sexual intercourse is known as dyspareunia. Although this problem can affect men, it is more common in women. Women with dyspareunia may have pain in the vagina, clitoris or labia. There are numerous causes of dyspareunia, many of which are treatable. Common causes include the following:
• Vaginal dryness
• Atrophic vaginitis, a common condition causing thinning of the vaginal lining in postmenopausal women
• Side effects of drugs such as antihistamines and tamoxifen (Nolvadex and other brands)
• An allergic reaction to clothing, spermicides or douches
• Endometriosis, an often painful condition in which tissue from the uterine lining migrates and grows abnormally inside the pelvis
• Inflammation of the area surrounding the vaginal opening, called vulvar vestibulitis
• Skin diseases, such as lichen planus and lichen sclerosus, affecting the vaginal area
• Urinary tract infections, vaginal yeast infections, or sexually transmitted diseases
• Psychological trauma, often stemming from a past history of sexual abuse or trauma
Symptoms
Women with dyspareunia may feel superficial pain at the entrance of the vagina, or deeper pain during penetration or thrusting of the penis. Some women also may experience severe tightening of the vaginal muscles during penetration, a condition called vaginismus.
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
Vaginitis is an inflammation of the vagina. About 1 in every 3 women will suffer from Vaginitis at some point in her life. Vaginitis affects women of all ages, but is most common during the reproductive years.
It is often caused by infections, which are sometimes linked to more serious diseases.
The most common vaginal infections are:
-- Bacterial Vaginosis
-- Trichomin
-- Vaginal Yeast Infection
Although most vaginal infections are caused by bacterial vaginosis, trichomoniasis, or yeast, there may be other causes as well. These causes include sexually transmitted diseases, allergic reactions, and irritations.
Allergic symptoms can be caused by spermicides, vaginal hygiene products, detergents, and fabric softeners. Inflammation of the cervix (opening to the womb) from these products often is associated with abnormal vaginal discharge, but healthcare providers can tell them apart from true vaginal infections by doing lab tests.
http://www.niaid.nih.gov/topics/vaginitis/Pages/default.aspx
PID and its newer concepts.This presentation is done after grouping information from a variety of textbooks,journals and of course our professors.will definitely enlighten you
This is a lecture given to medical students of Cebu Institute of Medicine under the reproductive module. It contains a discussion of principles of HIV infection screening, diagnosis, staging and management, especially during pregnancy.
Acute pelvic inflammatory disease by dr alka mukherjee dr apurva mukherjeealka mukherjee
Pelvic inflammatory disease (PID), one of the most common infections in nonpregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs. Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal and cervical flora are frequently associated with PID. This includes anaerobic and facultative bacteria, similar to those associated with bacterial vaginosis. Genital tract mycoplasmas, most importantly Mycoplasma genitalium, have recently also been implicated as a cause of acute PID. As a consequence, treatment regimens for acute PID should provide broad spectrum coverage that is effective against these microorganisms.
Pelvic inflammatory disease is ascending infection from the endocervix. There are two main groups of organisms involved. These are STIs and commensals of the female genital tract
The Role of Maternal Immunization in Reducing Infections in InfantsHelen Madamba
A lecture provided for the Immunization for Filipino Women committee of the Philippine Obstetrical and Gynecological Society, Inc (POGS) and the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) to encourage vaccination for pregnant women in the Philippines
COVID-19 and COVID-19 Vaccination in PregnancyHelen Madamba
As an update to the management of COVID-19 in Pregnancy based on the PIDSOG Handbook, we have the POGS Practice Bulletin on COVID19 Vaccination for Pregnant and Breastfeeding Women. Vaccines work!
A lecture orientation to first year medical students, this lecture was lifted from the PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
This is a lecture for medical students of the Cebu Institute of Medicine as an orientation on the prevalence of HIV infection in the Philippines, the basic knowledge on HIV and the program on prevention of mother to child transmission of HIV.
During the time of COVID-19 use of social media in medicine is as relevant than ever and should be maximized by healthcare professionals as a public health tool for health education and promotion to ensure the impact on healthcare is a positive one.
Use of social media for public health promotionHelen Madamba
A short talk with medical technology students of the Velez College for the seminar on "Cyber Etiquette: A Social Responsibility on Health Promotion for the Society" February 15, 2020 from 1pm to 5pm.
This was a lecture given during the CME activitiy for POGS Region 7 by the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) at Casino Espanyol in Cebu City.
As part of the 5th Philippine Healthcare Social Media Summit 2019 #HCSMPH2019 at the Waterfront Hotel in Cebu City, Track B involved choosing platforms for social media depending on one's purpose and based on the target audience.
This is one of the lectures for the POGS Research Forum in Bacolod, mostly based on the chapter on Clinical Practice Guidelines for Ethics Review from the POGS Research Handbook: The Essentials. I hope this can be a guide for residents who are preparing their research proposal for ethical review.
This is a plenary lecture given during the CVCHRD Research and Innovation Conference at CIT-U in Cebu City with the theme "Research innovations for Improved Health and Wellness"
Emerging Issues for Social Workers in dealing with PLHIVsHelen Madamba
This was a talk for ALSWDOPI 2019 at Waterfront Hotel where LGU social workers are challenged to become the government employees who are catalysts of change that the Philippine society needs to address the Philippine HIV epidemic.
These were slides I was not able to use during the lecture I gave for the weekend POGS research workshop because of a mix up in assigned topics. Nevertheless, I think OBGYN residents may find these slides useful in crafting their research proposals.
As a speech during the Public Health Forum 2018, this is a collection of inspirational post from my facebook newsfeed. Talking about how to be a clinical specialist involved in public health, the emphasis is in finding your passion, something you would be willing to do even if you were not paid for it.
This focuses on the Consensus Recommendations on the Prevention and Management of Surgical Site Infections in the Philippine Setting by Saguil, Bermudez, Antonio and Cochon, PJSS 2017.
Public Health Forum - Social Media in Medicine: Etiquettes for the Modern DoctorHelen Madamba
This lecture introduces reasons why healthcare providers should be on social media and the limits of what we should and shouldn't post on social media, remembering that people are on the other end of the public health conversation.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Infections of the Genital Tract - Part III
1. Infections ofInfections of
the Genitalthe Genital
TractTract
Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
Cebu Doctors University College of Medicine
February 2016
@helenvmadamba CDUCM 2016
3. LECTURE OUTLINE
• Infections of the Vulva
• Bartholin’s gland abscess
• Ectoparasites
• Diseases characterized by Ulcers
• HPV and Anogenital Warts
• Infections of the Vagina
• Diseases Characterized by Vaginal Discharge
• Infections of the Cervix
• Diseases Characterized by Cervicitis
@helenvmadamba CDUCM 2016
4. LECTURE OUTLINE
• Infections of the Upper Genital Tract
• Pelvic Inflammatory Disease
• Sexual Assault & STDs
@helenvmadamba CDUCM 2016
5. The Five P’s
1. Partners
2. Practices
3. Prevention of
Pregnancy
4. Protection from
STDs
5. Past history of
STDs
@helenvmadamba CDUCM 2016
8. CERVIX
• The cervix acts as a barrier between the
abundant bacterial flora of the vagina
and the bacteriologically sterile
endometrial cavity and oviducts
@helenvmadamba CDUCM 2016
9. Cervicitis
• Vaginal discharge, deep dyspareunia,
postcoital bleeding
• Cervix that is hypertrophic and
edematous
• Chlamydia trachomatis is the most
common etiologic agent
@helenvmadamba CDUCM 2016
10. Cervicitis
• Vaginal discharge, deep dyspareunia,
postcoital bleeding
• Cervix that is hypertrophic and
edematous
• Majority of women who have
mucopurulent cervicitis are infected by
C. trachomatis or N. gonorrhoeae
• Many women harboring sexually
transmitted pathogens in the cervix are
asymptomatic.
@helenvmadamba CDUCM 2016
11. Mucopurulent Cervicitis
• Gross visualization of yellow
mucopurulent material on a white
cotton swab
@helenvmadamba CDUCM 2016
12. Mucopurulent Cervicitis
• Presence of 10 or more PMN
leukocytes per microscopic field on
Gram-stained smears obtained from
the endocervix
• Erythema and edema in an area of cervical
ectopy
• Associated with bleeding secondary to
endocervical ulceration
• Friability when endocervical smear is
obtained
@helenvmadamba CDUCM 2016
16. Chlamydia
trachomatis
This woman’s cervix has manifested signs
of an erosion and erythema due to
chlamydial infection.
• An untreated chlamydia infection can
cause severe, costly reproductive and
other health problems including both
short- and long-term consequences
@helenvmadamba CDUCM 2016
18. Treatment for nonpregnant
women
Recommended Regimens
• Azithromycin 1g orally in a single dose OR
• Doxycycline 100mg orally twice a day for 7 days
Alternative Regimens
• Erythromycin base 500mg orally four times a day
for 7 days OR
• Erythromycin ethylsuccinate 800mg orally four
times a day for 7 days OR
• Ofloxacin 300mg orally twice a day for 7 days OR
• Levofloxacin 500mg orally once daily for 7 days
@helenvmadamba CDUCM 2016
19. Treatment for pregnant
women
Recommended Regimens
• Azithromycin 1g orally in a single dose OR
• Amoxicillin 500mg orally thrice a day for 7 days
Alternative Regimens
• Erythromycin base 500mg orally four times a day
for 7 days OR
• Erythromycin base 250mg orally four times a day
for 14 days OR
• Erythromycin ethylsuccinate 800mg orally four
times a day for 7 days OR
• Erythromycin ethylsuccinate 400mg orally four
times a day for 14 days
@helenvmadamba CDUCM 2016
21. Neisseria gonorrhoeae
• second most commonly reported
bacterial STD.
• majority of urethral infections caused by
N. gonorrhoeae
• among women, several infections do not
produce recognizable symptoms until
complications (PID) have occurred.
• women aged 25 years or less are at
highest risk for gonorrhea infection.
@helenvmadamba CDUCM 2016
22. Neisseria gonorrhoeae
• Risk factors include previous gonorrhea
infection, other sexually transmitted
infections, new or multiple sex partners,
inconsistent condom use, commercial
sex work, and drug use.
• Diagnostics: a Gram stain of a male
urethral specimen that demonstrates
polymorphonuclear leukocytes with
intracellular Gram-negative diplococci
@helenvmadamba CDUCM 2016
23. Treatment
Ceftriaxone 250 mg IM in a single dose
OR
Cefixime 400mg orally in a single dose
OR
Single dose injectable cephalosporin
regimens
PLUS
Treatment for chlamydia if chlamydial
infection is not ruled out
@helenvmadamba CDUCM 2016
27. Infections of the Upper
Genital Tract
• Pelvic Inflammatory Disease
@helenvmadamba CDUCM 2016
28. Pelvic Inflammatory
Disease
• An infection in the upper genital tract
not associated with pregnancy or
intraperitoneal pelvic operations.
• Salpingitis – infection of the oviducts is
the most characteristic and common
component of PID.
Katz et al. 2007. Comprehensive Gynecology.
@helenvmadamba CDUCM 2016
29. Pelvic Inflammatory
Disease
• A spectrum of inflammatory disorders
of the upper female genital tract,
including any combination of
endometritis, salpingitis, tubo-ovarian
abscess and pelvic peritonitis.
CDC. 2010 STD Treatment Guidelines.
@helenvmadamba CDUCM 2016
31. Acute PID
• ascending infection from the bacterial
flora of the vagina and cervix in >99%
of cases
• <1% of cases, from transperitoneal
spread of infectious material from
perforated appendix or intraabdominal
abscess
• Hematogenous and lymphatic spread
to the tubes or ovaries
@helenvmadamba CDUCM 2016
32. Major Sequelae of PID
• Ectopic pregnancies: ↑6 to 10-fold
• Chronic pain: ↑4-fold
• Infertility: 6% to 60% depending on
severity of the infection, the number of
episodes and the age of the patient
@helenvmadamba CDUCM 2016
33. Reduction of Impact of acute
PID
• Aggressive therapy for LGTI
• Early diagnosis and treatment of UGTI
• Primary prevention: safe sexual
practices
• Secondary prevention: screening for
gonorrhea, chlamydia and active
cervicitis, treatment of partners,
education to prevent recurrent
infection
@helenvmadamba CDUCM 2016
34. Silent or asymptomatic
PID
• CDC emphasized: aggressively treat
women if there is any suspicion of the
disease, because the sequelae are so
devastating and the clinical diagnosis
made from the symptoms, signs and
laboratory data is often incorrect.
@helenvmadamba CDUCM 2016
35. Neisseria gonorrheae
Chlamydia trachomatis
• These two organisms co-exist 25-50%
of the time
• Gonorrheal organisms frequently
cultured during first 24 to 48 hours of
the disease, but often absent later.
@helenvmadamba CDUCM 2016
36. Minimum criteria:
Initiate empiric treatment in the presence of
any ONE of the three:
• Cervical motion tenderness
• Uterine tenderness
• Adnexal tenderness
• Predominance of leukocytes in vaginal
secretions, cervical exudates or cervical
friability increases specificity of diagnosis
CDC 2010 STD Treatment Guidelines
@helenvmadamba CDUCM 2016
37. Additional criteria
• Oral temperature > 38.3 C◦
• Abnormal cervical or vaginal mucopurulent
discharge
• Presence of abundant numbers of WBC on
saline microscopy of vaginal fluid
• Elevated ESR
• Elevated C-reactive protein
• Laboratory documentation of cervical
infection with N. gonorrhoeae or C.
trachomatis
CDC 2010 STD Treatment Guidelines
@helenvmadamba CDUCM 2016
38. Most specific criteria
• Endometrial biopsy with histopathologic
evidence of endometritis
• Transvaginal sonography or MRI showing
thickened, fluid-filled tubes with or
without free pelvic fluid or tubo-ovarian
complex, or Doppler studies suggesting
pelvic infection
• Laparoscopic abnormalities consistent
with PID
CDC 2010 STD Treatment Guidelines
@helenvmadamba CDUCM 2016
39. Indications for
hospitalization
• Surgical emergencies cannot be excluded
• The patient is pregnant
• The patient does not respond clinically to
oral antimicrobial therapy
• The patient is unable to follow or tolerate
an outpatient oral regimen
• The patient has severe illness, nausea and
vomiting, or high fever
• The patient has tubo-ovarian abscess
CDC 2010 STD Treatment Guidelines
@helenvmadamba CDUCM 2016
40. • Cefotetan 2 g IV every 12 hours OR
• Cefoxitin 2 g IV every 6 hours PLUS
• Doxycycline 100 mg orally or IV every 12
hours
CDC 2015 STD Treatment Guidelines
@helenvmadamba CDUCM 2016
44. • Discontinue parenteral therapy 24
hours after clinical improvement:
Doxycycline 100 mg every 12 hours to complete
14 days
• For tubo-ovarian abscess:
• Add oral clindamycin or metronidazole to
provide more effective anaerobic
coverage
CDC 2010 STD Treatment Guidelines
@helenvmadamba CDUCM 2016
45. Follow up
• Clinical improvement within 3 days
after initiation of therapy
@helenvmadamba CDUCM 2016
46. Management of Sex
Partners
• Male partners of women who have PID
caused by C. trachomatis and/or N.
gonorrhoeae frequently are
asymptomatic.
• should be examined and treated if they
had sexual contact during the 60 days
preceding the patient’s onset of symptoms
• If >60 days, must be treated
• Abstain from sexual intercourse until
therapy is completed.
CDC 2010 STD Treatment Guidelines
@helenvmadamba CDUCM 2016
47. Management of Sex Partners
• Abstain from sexual intercourse until therapy is
completed.
CDC 2015 STD Treatment Guidelines
@helenvmadamba CDUCM 2016
49. Adolescents and Adults
• Trichomoniasis, bacterial vaginosis,
gonorrhea, and chlamydial infection are
the most frequently diagnosed
infections among women who have
been sexually assaulted.
• Chlamydial and gonococcal infections in
women are of particular concern
because of the possibility of ascending
infection.
@helenvmadamba CDUCM 2016
50. • HBV infection can be prevented through
postexposure vaccination.
• HPV vaccination is also recommended
for females through age 26 years.
• Reproductive-aged female survivors
should be evaluated for pregnancy.
Adolescents and Adults
@helenvmadamba CDUCM 2016
52. These slides will be uploaded onto
http://www.slideshare.net/HelenMadamba
@helenvmadamba CDUCM 2016
53. Infections ofInfections of
the Genitalthe Genital
TractTract
Helen V. Madamba, MD MPH-TM FPOGS FPIDSOG
Cebu Doctors University College of Medicine
February 2016
@helenvmadamba CDUCM 2016