infections offemale reproductive system

1. vulvitis and infections of bartholin gland2. vaginitis3. cervicitis4. pelvic inflammatory disease (PID)5. pelvic tuberculosis

vulvitis andinfections of bartholin gland

1. vulvitis2. abscess of bartholin gland3. bartholin cyst

vulvitis

etiology a. increased vaginal discharge b. lack of vulvar hygiene c. stimulation of menstrual fluid d. glycouria of diabetes woman

clinical manifestation

vulvar pruritus, pain, burning sensation,congestion and swelling of vulva

treatment a. keep vulva clean and dry b. remove the cause c. 1/5000 kMnO4 solution bath d. antibiotics ointment

abscess of bartholin gland

etiologystaphylococcus, e.coli, streptococcus, enterococcus,gonococcus, polymicrobial infection is common

infection of gland duct -> block the drainage of pus ->formation of abscess

clinical manifestation

a. pain, swelling of vulva, fever b. red, swelling, hot, tender, fluctuant sensation c. rupture of abscess

treatment

a. rest b. antibiotics c. local hot compress or bath d. operation: incision and drainage marsupialization

bartholin cyst

etiology obstruction of gland duct block the drainage of secretion

clinical manifestation vulvar cyst

treatment marsupialization

vaginitis

* trichomonal vaginitis* candidal vaginitis bacterial vaginosis (BV) senile vaginitis childhood vulvitis and vaginitis

trichomonal vaginitis

etiology trichomonas vaginalis optimal PH value: 5.1-5.4 reduce the glycogen of vagina and reduce the lactic acid

infectious way sexual infection indirect infection

clinical manifestation

symptom tiny, frothy leukorrhea vulvar pruritus

sign congestion of vaginal mucosa petechiae grey, yellow, tiny and frothy leukorrhea yellow, green purulent secretion

carrier

diagnosistrichomonas in vaginal discharge

treatment oral drug Flagyl, 0.2, tid po (7 days) side-effect: nausea, headache contraindication: pregnant and lactating women local drug Flagyl, 0.2, Qd (10 days) 1% lactic acid, vaginal perfusion

candidal vaginitis

etiology candida albicans optimal PH value: 4-5 high risk population: pregnant women diabetic women antibiotics for long time

clinical manifestation

symptom vulvar pruritus and burning pain white, thick and cheesy discharge

sign congestion and swelling of vulvar mucosa small white patches adhering to vaginal wall

diagnosis

candida albicans in vaginal discharge

treatmenttreat the causechange the PH value of vagina 2-4% NaHCO3 perfusionlocal drugoral drug

cervicitis

acute cervicitis *chronic cervicitis

acute cervicitis

etiology gonococcus

clinical manifestation increased purulent leukorrhea congestion and swelling of cervix purulent leukorrhea from cervical orifice

treatment general antibiotics

chronic cervicitis

etiology

after delivery, abortion or cervical laceration pathogen: staphylococcus, streptococcus, et al

pathology

cervical erosion types: simple ~, follicular ~, papillary ~ degree: mild, moderate, severe cervical hypertrophy cervical polyp Naboth cyst endocervicitis

clinical manifestation

symptom increased leukorrhea blood staining leukorrhea contact bleeding infertility

sign

diagnosis cervical smear or biopsy to rule out cervical carcinoma

treatment physical therapy electrocauterization laser therapy cryosurgery drug conization

pelvic inflammatory disease(PID)

*acute PID chronic PID

acute PID

etiology infection after delivery or abortion infection after operation in uterine cavity poor hygiene habit in menstrual period secondary to appendicitis acute attack of chronic PID

pathology acute endometritis or myometritis acute salpingitis, pyosalpinx, abscess of ovary-salpinx acute pelvic paramitritis septicemia, septicopyemia

clinical manifestation

symptom pain in lower part of abdomen, fever general symptom: high fever, headache, nausea peritonitis: nausea, vomiting, abdominal distension formation of abscess

sign

tenderness and rebound tenderness of lower abdomenpelvic examination: large amount of purulent discharge tenderness on motion of cervix tenderness of uterus and adnexal portion adnexal mass

diagnosis blood, uria test culture of cervical secretion

differential diagnosis appendicitis ectopic pregnancy torsion of ovarian cyst rupture of ovarian cyst

treatment

general therapy antibiotics penicillin 8 million units gentamycin 160 thousand units flagyl 1g Qd Chinese herbal medicine

operation

indication: ineffective drug therapy persistent abscess rupture of abscess

principle: remove the abscess for young patients, conservative therapy for old patients, hysterectomy + bilateral adnexectomy incision + drainage

chronic PID

pathology chronic salpingitis and hydrosalpinx infection of salpinx and ovary, tubo-ovarian cyst chronic pelvic paramitritis

clincal manifestation

symptomgeneral symptom: fever, malaise,weaknesspain in lower abdomenmenstruation change and infertility

signthickening of parametrial areaadnexal masstenderness of uterus and adnexal mass

diagnosis

differential diagnosis ectopic pregnancy endometriosis appendicitis ovarian cyst or neoplasm

treatment general therapy Chinese herbal medicine physical therapy drug operation: unilateral adnexectomy hysterectomy + bilateral adnexectomy

pelvic tuberculosissecondary to primary TB of bodycan occur in salpinx, endometrium, cervix, ovary, pelvic peritoneum

clinical manifestation

menstruation changes pelvic pain general symptom infertility sign

diagnosis pathology of endometrium X-ray laparoscopy TB culture

treatment

general therapy anti-TB therapy rifampicin + isoniazid operation