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Infections (Pelvic inflammatory disease (PID) (diagnosis (Laparoscopy (It…
Infections
-
Chlamydia trachomatis
- Infection with Gram-negative bacteria - infection of the cervix, urethra, rectum, throat and conjunctiva, urethritis and epidydymis in men
- Complications of untreated infection - inflammation of the uterine cavity mucosa, fallopian tubes, adnexa, peritonitis;
- Sexually transmitted disease, the highest rate of infection occurs in women <26. - In this group testing for Ch. trachomatis as a screening test is recommended;
Asymptomatic urethritis in women, but in serum in men, rare abscess from the urethra + pruritus and painful burning during urination;
- Clinical symptoms:
Asymptomatic urethritis in women, but in serum in men, rare abscess from the urethra + pruritus and painful burning during urination;
The course is asymptomatic in up to 70% of women;
Mucus-purulent vaginal discharge only in about 50% of infected women;
More often intermittent bleeding, itching and burning;
In the gynecological study ectopic cervical vaginal portion.
Adnexitis - most often asymptomatic or minor painful lower abdominal pain with feverishness conditions – complications: impaired patency of fallopian tubes - ectopic pregnancy, infertility (20%), chronic pelvic pain syndrome (20%);
Peripheral and peritoneal inflammation - during laparoscopy, fibrotic membrane is visible between the surface of the liver and the peritoneum.
- Diagnosis - NAAT nucleic acid amplification test - material taken from the cervical canal, urethra in men.
Examine sexual partners of an infected person - persons who have been in contact with the patient within the 60 days preceding the onset of symptoms.
Treatment
- Azithromycin orally for 7 days, or doxycycline, erythromycin, ALWAYS OF SEXUAL PARTNER;
- Pregnant women are advised to have a follow-up visit 3-4 weeks after the end of the treatment to carry out diagnostic tests again.
Health implications
In the absence of treatment in 30-40% of women develop pelvic inflammatory disease;
In case of lack of treatment, the risk of late postpartum infection of uterine cavity mucosa is higher;
In the absence of treatment and concomitant pregnancy the newborn is exposed to the development of conjunctivitis and pneumonia;
In the absence of treatment and exposure to HIV, the probability of HIV infection is five times higher.
Fungal infection
clinical
picture
- Factors that promote infection:
Administration of sex hormones, especially gestagens (contraception),
Diabetes, chronic metabolic diseases, diseases with impaired immunity, requiring treatment with steroids.
- Infectious agents: Candida albicans 75-80%, Candida glabrata 10-15%.
- Clinical manifestations: yellow-white papulous, vaginal discharge ("cottage cheese"), persistent itching, burning, swelling of the vaginal wall, redness.
diagnosis
- clinical picture
- Detection of mycelium specimens in the direct preparation - swabs are taken with a wooden stick on a slide and mixed with saline or 1% methylene blue solution
- At recurrences - vaginal secretions
treatment
- Azole medications for 1-7 days vaginally depending on the medication
- Nystatin intravaginally for 14 days
- Natamycin 100.000 IU vaginally for 3-6 days
In addition, fluconazole 150mg or 200mg 1x orally may be given or for 7 days depending on the clinical picture.
relapses
- Treatment of recurrences - > 3 incidents of vaginal Candida infections during the year, not related to antibiotic therapy
- Fluconazole orally 100mg or 200mg for 3 days + 1x a week for 6 months (treatment of sexual partner also with 1x a week for 6 months).
-
Bacterial vaginosis
- result of replacing properly-living vaginal species of Lactobacillus with large numbers of anaerobic microorganisms Gardnerella vaginalis and Mycoplasma hominis, Mobiluncus.
- Clinical signs (Amsel criteria):
Homogenous, watery, white discharge smoothly covering the walls of the vagina;
The presence of clue cells on microscopic examination
pH of vaginal discharge> 4.5;
Fish smell of vaginal secretions before or after adding 10% KOH (so-called smell test).
- For the diagnosis of BV, the presence of 3 of the 4 clinical signs is necessary.
- Other Recognition Criteria: 10-point Nuget scale (score: 4-6 points with clue cells or 7-10 points) and 3rd stage of Haya-Ison scale.
- Diagnosis: based on culture for Gardnerella vaginalis is not recommended - it is not a specific method; It is recommended to determine lactic acid concentration and Gardnerella vaginalis, Prevotella, peptosterptokin concentrations; test with 10% KOH.
- complications:
Inflammation of the mucous membrane of the uterine cavity, inflammation of the pelvic organs
Pregnancy - premature rupture of membranes, preterm labor, intrauterine infection, postpartum haemorrhagic infection
- Treatment:
Metronidazole orally or vaginally, or clindamycin;
Dequalinium intravaginally (disinfectant, quaternary ammonium compound with bactericidal action).
Trichomoniasis
- Trichomonas vaginalis protozoal infection - sexually transmitted infection
- Clinical manifestations (on average about 50% are asymptomatic):
Stinking, yellowish-green, foamy vaginal secretions;
Redness and swelling of the vulva
Often urethritis coexists
- Diagnosis:
Taking the vaginal discharge into the culture – recommended
PH test, microscopic examination of vaginal secretions - protozoa in direct specimen or in urine sediment - sensitivity 60%.
- Treatment: Metronidazole orally (eg 2 g once) or intravaginally (eg 500 mg for 7 days), ALWAYS OF SEXUAL PARTNER.
Genital herpes
- Type 1 herpes simplex infection (oral infection, most often in childhood) or 2 (infection by sexual contact between teenager and young women).
- HSV (herpes simplex virus) 2 infection is the most common sexually transmitted disease.
- Clinical symptoms:
Asymptomatic course (> 40%);
Two to four days after infection, flu-like symptoms appear first with subepithelial fever, followed by vomiting in the vulva, resulting in burning and pruritus; similar changes occur in the vagina and vaginal part of the cervix; Patients experience pain during urination, the manifestation of primary infection are also enlarged inguinal lymph nodes.
- Recurrent infections - limited herpes lesions on the vulva, in the vagina and vaginal portion of the cervix, most often with no general symptoms.
- Recognition:
Isolation of virus from cell culture (may produce false negative results) - Material - Test fluid should be taken after opening of vulval vesicle;
The polymerase chain reaction polymerase technology - 3-4x more sensitive than the culture, but high test costs;
IgG / IgG test - sensitivity 80-90%, specificity > 96% - but in the early stages of the disease false negative results.
- Treatment: acyclovir, valaciclovir orally.
Bartholin's gland
- The developing agent is E. coli, Staphylococcus species, Streptococcus species, Neisseria gonorrheae, Chlamydia trachomatis, Proteus mirabilis, Bacteroides sp.
- The resolving sign of inflammation is abscess.
- Symptoms: sudden onset, tumor, pain, swelling of the labia, discomfort (walking, sitting).
- The recommended procedure and selection is a wide incision and drainage of the abscess together with its irrigation (discussion of concomitant antibiotic treatment with no general symptoms and in non-pregnant women, but such treatment may reduce inflammation).
- Other, special types of procedures: abscess marsupialisation and gland excision.
Genital warts
- Caused by human papillomavirus (types 6 and 11);
- They belong to a group of sexually transmitted diseases
- They usually require a biopsy to confirm the diagnosis;
- Patients whose genital warts were diagnosed are at increased risk for other sexually transmitted diseases such as chlamydia, gonorrhea, syphilis, type B, type C, herpes, HIV;
- Colposcopy, high-risk HPV (DNA-HPV test);
- Treatment with small changes - podophyllotoxin, imiquimod, cryotherapy in pregnant women;
- Treatment of major lesions - excision, CO2 laser (not recommended in pregnant women), cryotherapyTreatment in pregnant women can also be postponed until after the birth.
Cervical inflammation
- May be a symptom of pelvic inflammatory disease.
- They are caused by various microorganisms, in particular Ch. trachomatis and N. gonorrhoeae.
- Among the symptoms most commonly: abdominal pain, in the speculum: mucus-purulent discharge, spotting or bleeding from the cervix, two-handed examination of pain in the cervix.
- Additional symptoms – urethritis.
- Diagnosis: Chlamydia test from swab or urine (PCR kits), assessment of the presence of anti-chlamydial antibodies in blood, urine.
- Treatment: Because of the multi-bacterial etiology, they should be used as combinations, for example: penicillins with macrolide, tetracyclines with quinolone.
normal flora
- mainly composed of aerobic rods of the genus Lactobacillus but also: Streptococcus, Staphylococcus, Peptostreptococcus, E. coli and anaerobic bacteria: Bacteroides, Gardnerella vaginalis (relative anaerobic).
- Lactobacillus: produce lactic acid from glycogen, thereby maintaining a pH of =<4.5, which in turn affects the adherence of these bacteria to the cells of vaginal mucose.
examination
- General assessment of the vulva - redness, swelling, increased warmth, eczema, vulvar erosions, vulvar sensation resulting from scratching, abrasion of the epidermis
- Evaluation of vaginal secretions and its pH (normal daily production of vaginal discharge is 3-5g at pH 3.8-4.5)
- Evaluation of the vaginal and vaginal vestibule
- Evaluation of the vaginal part of the cervix
treatment
- Treatment should be started as soon as possible after diagnosis of infection, i.e. best during the first visit
endometrium
- Mucosal inflammation of the endometrium
- Various microorganisms - ascending pathway (mostly the same bacteria as in the case of the cervix), less common - local occupation or descent - general risk factors such for infection and gynecological surgery, abortion, miscarriage, or tuberculosis;
- Symptoms: pain, uterine bleeding, purulent discharge;
- Treatment: conservative + initial antibiotic antibiotics such as fluoroquinolons, tetracyclins, later - hormonal + ab-th by antibiogram (> 2 weeks).