Seminar VI Obstetric & Gynecology

1. Seminar VIObstetric & Gynecology Prepared & Presented by: Ibrahim Tawhari.

2. SCENARIO I: • A16-year-old female who presents to her private gynecologist’s office. • She is complaining of abdominal pain, perineal itching, and vaginal discharge for 7 days. • Lab. Tests: • DNA probe results: +ve for both: Gonorrha & Chlamydia.

3. SEXUALLY TRANSMITTED INFECTIONS (STIs) & VAGINAL DISCHARGE Prepared & presented by: Ibrahim Tawhari.

4. SEXUALLY TRANSMITTED INFECTIONS (STIs) Prepared & presented by: Ibrahim Tawhari.

5. SEXUALLY TRANSMITTED INFECTIONS: • They are infections whose primary route of transmission is SEXUAL CONTACT. • Sexually transmitted infections (STIs) are one of the most well-recognized health problems worldwide. • However, they are difficult to track: • Asymptomatics. • Non-exposed areas.

6. SEXUALLY TRANSMITTED INFECTIONS: •  Most of the published data on the prevalence and incidence of STIs come from developed countries. • Information about STIs in Islamic, where non-marital sex and homosexuality are forbidden by religion countries are limited. • An assumed low prevalence of STIs and religious and cultural intolerability of non-marital sex and homosexuality in Islamic countries are expected reasons for the limited data.

7. SEXUALLY TRANSMITTED INFECTIONS: • Islamic rules and values are essential and should be of highest priority for policymakers because of the potential of such infections to spread particularly among the youth.

8. SEXUALLY TRANSMITTED INFECTIONS: •   Risk Factors: • Hx of previous STI. • Contact with infected person. • Sexually active individual  25 years. • Multiple sexual partners. • Un-protected sexual intercourse. (No barrier). • Drug abuse,..

9. Causes

10. CAUSES: • HSV. • HPV. • HBV. • HIV. • Chancroid. • Syphilis. • LGV. • Granulomainguinale. • Chlamydia. • Gonorrhea. • Candida albicans • Chlamydia trichomatis.

11. CLASSIFICATION: STIs STIs with Genital Ulcers STIs without Genital Ulcers Painful Painless Warts Drip “Discharge” Others • Syphilis. • LGV. • Graulomainguinale • Chlamydia. • Gonorrhea. • HBV. • HIV. • HSV. • Chancroid. • HPV

12. CLASSIFICATION: STIs STIs with Genital Ulcers STIs without Genital Ulcers Painful Painless • Syphilis. • LGV. • Graulomainguinale • HSV. • Chancroid.

13. CLASSIFICATION: STIs STIs with Genital Ulcers STIs without Genital Ulcers STIs with PAINFUL Genital Ulcers Painful Painless • HSV. • Chancroid. • HSV. • Chancroid.

14. HERPES SIMPLEX VIRUS HSV

15. HSV: • A DNA virus. • The most common cause of genital ulcer disease. • Contagious. • Transmission: • Direct mucus membrane contact.

16. HSV: • Types: HSV I, HSVII. • HSVI usually causes lesions abovethe level of umbilicus. • HSVII usually causes lesions belowthe level of umbilicus. HSV I HSV II

17. HSV: • Symptoms: • Primary: • Systemic: viremia. • Painful skin lesions. Latency Retrograde Transport Stress Reactivation: Anterograde Transport • Recurrent: • Localized. • No systemic manifestations.

18. HSV: • Clinical Examinations: • Primary lesions: • Systemic: fever, flu like,… • Clear vesicles at site of exposure. • Spontaneously rupture  shallow painful inflamed ulcer. • Recurrent lesions: • Localized, milder.

19. HSV: • Diagnosis: • Lab tests: • Viral isolation is the most accurate. • Serology: ELISA for specific antibodies. • Cytology: • Multinucleated Gaint Cells.

20. HSV: • Management: • Acyclovir (200 mg PO q24 hrs for 5 days). • Valacyclovir:  risk of sexual transmission by 50%. • Famciclovir.

21. Chancroid

22. CHANCROID: • Caused by: Hemophilusducreyi. • Facilitates transmission of HIV. Pathophysiology: Painful Ulcer Contact Pastule Ulcerate Develop within 72 hours

23. CHANCROID: • Clinical Examinations: • Characterisically “Ragged Edge Ulcer”. • Shallow and non-indurated. • Seen on vulva, vagina or cervix. • Tender inguinal lymphadenopathy may develop.

24. CHANCROID: • Ragged Edge Ulcer

25. CHANCROID: • Lab Tests: • +ve culture is confirmatory. • However, this organism is slowly growing… Gram stain is not reliable. • Diagnosis is made after ruling out syphilis. • Management: • Azithromycin. • Ceftriaxone.

26. CLASSIFICATION: STIs STIs with Genital Ulcers STIs without Genital Ulcers STIs with PAINFUL Genital Ulcers Painful Painless • HSV. • Chancroid. • HSV. • Chancroid.

27. CLASSIFICATION: STIs STIs with Genital Ulcers STIs without Genital Ulcers STIs with PAINLESS Genital Ulcers • Syphilis. • LGV. • GranulomaInguinale Painful Painless • Syphilis. • LGV. • Graulomainguinale

28. SYPHILIS

29. SYPHILIS: • Caused by: Treponemapallidum. • A motile anerobic spirochete.

30. SYPHILIS: Primary Syphilis (Localized Chancre; painless) Secondary Syphilis • Spirochetemia • CondylomaLata; painless 2/3 1/3 No clinical findings Gumma (CNS, CVS, bone,..) Latent Syphilis Tertiary Syphilis

31. SYPHILIS: • Maternal Syphilis: • Primary Syphilis: Chancre: “Rolled Edge Ulcer” • Usually, disappears spontaneously.

32. SYPHILIS: • Secondary Syphilis: CondylomaLata: • Maculopapular rash. (money spots). • Usually, disappears spontaneously without treatment.

33. SYPHILIS: • Tertiary syphilis: Gumma

34. SYPHILIS: • Diagnosis: • Non specific tests: • VDRL: • If positive, confirmatory tests are requested. • False +ve with some autoimmune diseases; SLE, APL, … • Rapid plasma regain test (RPR test). • Dark field Microscopy: • For exudate lesion of chancre in primary syphilis and condylomalata in secondary syphilis.

35. SYPHILIS: • Diagnosis: • Confirmatory tests: • Fluorescent Titer Antibody-Absorption (FTA-ABS). • Microhemagglutination assay for antibodies to T. Pallidum (MHA-TP).

36. SYPHILIS: • Management: • Penicillin G is the drug of choice. • 2.4 million units of Benzathin Penicillin G are given IM.

37. SYPHILIS: • Non pregnant: Tetracycline. • Pregnant: Penicillin + Desensitization • If a woman is allergic to penicillin??????!!!!!

38. LymphogranulomavenereumLGV…

39. LGV: • Caused by: L serotype of Chlamydia trichomatis. • Clinical Features: • INITIAL lesion is a PAINLESS ulcer that heals spontaneously. • Few weeks later, • Peri-rectal or inguinal painful lymphadenopathy may develop. • Classic clinical sign is: “GROOVE SIGN” or Double Genitocrural Folds. = A depression between two inflamed groups of lymph nodes

40. LGV: GROOVE SIGN

41. LGV: • Lab. Tests: • Culture of aspirated fluid from tender lymph nodes. • Management: • Doxycycline, or • Erythromycine. • Fluctuant nodes SHOULD be ASPIRATED to prevent sinus formation.

42. GranulomaInguinale (DONOVANOSIS)

43. GRANULOMA INGUINALE : • Caused by: Klebsiellagranulomatis. • Not very common: • Not highly contagious. • Chronic exposure is needed. Chalymmmatobacteriumgranulomatis

44. GRANULOMA INGUINALE: • Clinical Features: • Initially: Painless vulvar nodules. •  Later the nodules burst, creating open, fleshy, oozing lesions--- “BEEFY RED ULCER”

45. GRANULOMA INGUINALE: BEEFY RED ULCER

46. GRANULOMA INGUINALE : • Lab. Tests: • Microscopic examination of ulcer smear: “DONOVANBODIES” --- This is why it is also called: “ DONOVANOSIS”.

47. GRANULOMA INGUINALE : • Management: • Doxycycline. • Co-trimoxazole.

48. CLASSIFICATION: STIs STIs with Genital Ulcers STIs without Genital Ulcers Warts Drip “Discharge” Others • Chlamydia. • Gonorrhea. • HBV. • HIV. • HPV

49. CLASSIFICATION: STIs STIs with Genital Ulcers STIs without Genital Ulcers Warts Drip “Discharge” Others • Chlamydia. • Gonorrhea. • HBV. • HIV. • HPV

50. CondylomaAcuminatum