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INFLAMMATION

INFLAMMATION. Tomasz Bączkowski. ANATOMY. ANATOMY. BV and physiological vaginal flora. Normal BV Organisms 10 8 10 11 Anaerobes:aerobes 5:1 1000:1 H 2 O 2 production high low Lactobacillus 96% 35% Gardnerella 5%-60% 95% Mobiluncus 0%-5% 50%-70%

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INFLAMMATION

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  1. INFLAMMATION Tomasz Bączkowski

  2. ANATOMY

  3. ANATOMY

  4. BV and physiological vaginal flora Normal BV Organisms 108 1011 Anaerobes:aerobes 5:1 1000:1 H2O2 production high low Lactobacillus 96% 35% Gardnerella 5%-60% 95% Mobiluncus 0%-5% 50%-70% Mycoplasma hominis 15%-30% 60%-70%

  5. Vaginal smear

  6. Vaginitis Vaginitis- symptoms: -increased vaginal discharge -complains: itching, dyspaurenia, oedema; odor Vaginitis - aetiology: candidiasis, trichomoniasis, bacterial vaginosis.

  7. Candidiasis • Aetiology: • Candida albicans >90% • -others: Candida glabrata, Candida tropicalis etc • Symptoms itching, burning, dysuria, dyspaurenia „cottage cheese” discharge 20% asymptomatic

  8. Candidiasis Discharge: thick, adherent -„cottage cheese” odorless pH <4,5

  9. Candidiasis

  10. Candidiasis Treatment: 3-7 days Local treatment (vaginal tablets/cream/ vaginal suppository): -Polyene (Nystatin) -Imidazole (Clotrimazole, Miconazole , Thioconazole) -Trazole (Terconazole)

  11. Candidiasis -recurrence • Treatment • Local treatment with Terconazole • Oral treatment with Fluconazole (50 mg 1/d –7 days or 150 mg –1 day) Partner: Candidiasis is not STD’s – treatment is not recommendet

  12. Trichomoniasis Aetiology: Trichomonas vaginalis–flagellate protozoan Incubation - 20 days Symptoms: copious discharge, rancid odor, vulvar itching, burning, , dysuria, dyspaurenia The symptoms vary from mild to severe Male infection – usually asymptomatic !!!

  13. Trichomoniasis -diagnosis • Anamnesis • Gynecological examination: • Discharge : copious, „frothy”, thin, green – gray in color, pH >4,5 (usually >6,0) • Erythema on the vulva, oedema • Petechia/strawberry patches on the cervix – by about 10%

  14. Trichomoniasis -diagnosis • Confirmation: • Microscopic examination of vaginal secretion • Wett smear (dark field) – fusiform protoza with 3-5 flagella (active movement)

  15. Trichomonas vaginalis

  16. Trichomoniasis Treatment Metronidazol –2 g orally – single dosis Altenernative : 500 mg orally twice a day 7-10 days The treatment of sexually partners is mandatory (STD’s)

  17. BACTERIAL VAGINOSIS Symbiotic infection of anaerobic bacteria Aetiology: Gardnerella, Mobilunculus, Mycoplasma hominis and others anaerobes Inbalance between anaerobes/aerobes Decreased counts of Lactobacillus

  18. BACTERIAL VAGINOSIS Symptoms: -homogeneous discharge -fischy odor ( especially after coitus)

  19. BV

  20. BACTERIAL VAGINOSIS Diagnosis: The presence of 3 of the following criteria: • Homogeneous discharge • pH>4,5 • Positive „wiff test” • Presence

  21. Test Whiffa

  22. BACTERIAL VAGINOSIS Treatment Metronidazole: 500 mg orally twice a day for 7 days, optionally single dosis 2 g orally Clindamycin: 2% cream- once a day for 7 days Metronidazole gel 0,75% - 7 days – common reccurence

  23. Chlamydia trachomatis • 3 milions new infections (USA) – the most common STD’s. • Asymptomatic by 70% women and 50% man • 40% of women have positive antybodies to chlamydia

  24. Chlamydioza

  25. Chlamydia trachomatis Complications • 15-40% (PID) • 17% infertility • 17% chronic pelvic pain • 9% ectopic pregnancy • Noncgonoccal urethritis • Conjunctivitis • Fith-Hugh-Curtis synrome (perihepatitis)

  26. Chlamydia trachomatis Diagnosis The symptoms are nonspecific Cervicitis, PID, gonnorhea infections – should be evaluated for chlamydia Infertility – chlamydia tests are recommendet

  27. Chlamydia trachomatis Tests: - ELISA (cervical secretion or urethral smear from man) • FISH (80-90% sensitivity and 95 specifity) • Antybodies for chlamydia (blood) - inadequate

  28. Chlamydia trachomatis Treatment: Azithromycyn – 1g single dosis orally Doxycycline – 100 mg twice a day - 7 days Erythromycin – 500 mg 4 x/d – 7 days Follow-up test after 3 – 4 weeks after treatment Treatment of sexually partners are recommendet STD’s !!!

  29. HSV -STD’s -270 000 do 600 000 new cases each year -85%- HSV2, 15% -HSV1 -Cervical cancer – infections promote dyspalstic changes in epithelium

  30. HSV- symptoms • Prodromal phase (parestesia and burning)- 2-5 days after infection • Painful vesicular and ulcerated laesions (3-7 days after exposure)- vulva, vagina, cervix, perianal and perineal skin • Inguinal adenopathy • Dysuria, dyspaurenia • Fever • Hadeache • Rare: aseptic meningitis

  31. HSV

  32. HSV

  33. HSV Diagnosis: • Symptoms (history and physical findings) • Typical appearance of vesicles and ulcers • Viral culture (expencive) • FISH • Cytological smear (giant multinuclated cells with intranuclear inclusions)

  34. HSV Treatment: Syptomatic: anaestetic gel or creams locally (Xylocaine) Acyclovir cream (locally) Acyclovir 200mg 5x/day Recurrence – occur in 30-50% of patient

  35. HPV • Subtypes:16,18,31,45 – associated with cervical cancer • Incubation: 6-12 weeks • Appearance: genital warts or condylomata (16,11) – vulva, perineum or perianal skin, urethral meatus, anus, cervix • Few symptoms

  36. Condylomata accuminata

  37. HPV

  38. Gonnorrhea • Aetiology - Neisseria gonorrhoeae (gram negative intracellular diplococcus) • Incubation: 3 do 5 days • Common asymptomatic by women • Coincidence with infections: C. Trachomatis, Trichomonas vaginalis, HIV • PID (30-70% of etiological factor) • 15-30% of infections develop PID

  39. Gonorrhea

  40. Gonorrhea Treatment: penicilin – resistance -3-10% Cefalosporins: Ceftriaxone 125 mg single dosis or Cefixim 400 mg single dosis, or Ofloxacin 400 mg single dosis + Doxacylinum 100mg 2x/d -7 days

  41. Gonorrhea Treatment • Generalisated infections or complications: • Ceftriaxon 1 g IM lub IV 1/d • Cefotaxim 1 g IV 3x/d Minimum 7 days

  42. Syphilis • Aetiology – Treponema pallidium • Incubation – 9 - 90 days (average 21 days) • Primary chancre appears • Secondary sypfilis –macupapular rash „money spots”, fewer, lymphadenopathy, condylomata lata

  43. Treponema pallidium

  44. Syphilis

  45. Syphilis

  46. Syphilis VDRL – Veneral Disease Research Laboratory) –non specyfic tests • fluorescent treponemal antibody absorption test (FTA-ABS) • the microhemagglutination treponemal serology test (MHA-TPS)

  47. PELVIC INFLAMMATORY DISEASE (PID) • Poliaethiological • Gonnorhea, Chlamydia trachomatis, anaerobes, aerobes

  48. PID Clinical criteria by Hager’s: • Tenderness –ABDOMINAL, ADNEXAL AND BY CERVICAL MOTION –obligatory 3 features • At least one from: • Gram stain –positive • Teperature>38 c • WBC > 10.ooo • Pus on culdocentesis • Adnexal abscess

  49. Bimanual examination

  50. PID

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