Genital inflammatory diseases 朱芝玲 复旦大学附属妇产科院
Genital inflammatory diseases 朱 芝 玲 复旦大学附属妇产科医院
Female Reproductive Organs Uterine (fallopian) tube Fimbriae Ovary. Uterus rectum Pubic bone Cervix Urinary bladder Vagina Urethra Clitoris Anus Labium Labium minus majus (a) Side view section of female pelvis showing reproductive organs
Female Reproductive Organs
NORMAL VAGINAL FLORA DISCharge HEALTHY VAGINA IS AN ECOSYSTEM DYNAMIC EQUILIBRUM EXIXTS BETWEEN Epithelium Normal Colonizing Organisms (mostly Lactobacilli SPP) Local Secretory and Celluar Immune Factors Vaginal pH maintained o Acidic(3.8-4. 4) o Creates unfavourable environment for Pathogens
NORMAL VAGINAL FLORA & DISCHARGE HEALTHY VAGINA IS AN ECOSYSTEM DYNAMIC EQUILIBRUM EXIXTS BETWEEN: - Epithelium - Normal Colonizing Organisms (mostly Lactobacilli SPP) - Local Secretory and Celluar Immune Factors - Vaginal pH maintained o Acidic (3.8 – 4.4) o Creates unfavourable environment for Pathogens
NORMAL PH MECHANISM Estrogen increases Epithelial Glycogen Lactobacilli Metabolise Glycogen into Lactic Acid Lactic Acid maintains acid pH
NORMAL pH MECHANISM • Estrogen increases Epithelial Glycogen • Lactobacilli Metabolise Glycogen into Lactic Acid • Lactic Acid maintains acid pH
SIMPLE OFFICE ANALYSIS pH-litmus/nitrazine paper (nitrazine turns blue) Whff test-10% KOH-2 drops Microscopy -Wet mount, WBCS. Trichomonas, Monilia If no microscope available o Add hydrogen peroxide 1-2 drops of 5-10% KOH o Foaming bubbles if there are WBCS Wooden stick o No bubbles if no WBCs(BV for mixing under Yeast the nose 1-2 drops of vaginal
SIMPLE OFFICE ANALYSIS • pH – litmus/nitrazine paper (nitrazine turns blue) • “Whff” test – 10% KOH – 2 drops • Microscopy – Wet mount, WBCS, Trichomonas, Monilia • If no microscope available o Add hydrogen peroxide o Foaming bubbles if there are WBCs o No bubbles if no WBCs (BV, Yeast)
PATHOLOGIC VAGINAL DISCHARGE Common causes in lower genital tract 1)Bacterial vaginosis 2)Candidal vulvo vaginitis 3) Trichomonas vaginalis Bacterial Vaginosis Affects 25% of women 50% of women asymptomatic Commonest cause of vaginal complaint. Specific trigger not known, but BV related to o Intercourse- especially new partner, sexual aids o Spermicides, douches o Other infections
PATHOLOGIC VAGINAL DISCHARGE Common causes in lower genital tract 1) Bacterial vaginosis 2) Candidal vulvo vaginitis 3) Trichomonas vaginalis Bacterial Vaginosis ▪ Affects 25% of women ▪ 50% of women asymptomatic ▪ Commonest cause of vaginal complaint. ▪ Specific trigger not known, but BV related to: o Intercourse – especially new partner, sexual aids o Spermicides, douches o Other infections
BACTERIAL VAGINOSIS
BACTERIAL VAGINOSIS
BV DIAGNOSIS )Gray homogenous discharge adherent to vaginal walls -no erythemaledema 2) pH akaline(over 4.5) 3)Presence of"Clue cells o Cells studded with bacteria o Cell wall indistinct 4)Fishy amine odor when 10% KOH added(TV, semen also causes odor releases 5)Paucity of lactobacilli 6)Relative absence of WBCs
BV DIAGNOSIS 1) Gray homogenous discharge adherent to vaginal walls – no erythema/edema. 2) pH akaline (over 4.5) 3) Presence of “Clue cells” o Cells studded with bacteria o Cell wall indistinct 4) Fishy amine odor when 10% KOH added (TV, semen also causes odor releases. 5) Paucity of lactobacilli 6) Relative absence of WBCs
Bacterial Vaginosis
Bacterial Vaginosis
MEDICATION ALTERNATIVES 1)Oral metronidazole 400mg BD for 7 days 2) Oral clindamycin 300mg BD for 7 days 3)Metronidazole Gel (0.75%) BD for 5 days 4)Clindamycin Cream(2%)qid for 7 days 5) Single 3% Hydrogen Peroxide vaginal washout 6)No treatment for partner?(Rx unrelated to recurrence) Recurrence not uncommon-1) Repeat treatment 2)Longer course 7)In pregnancy, use Ampicillin
MEDICATION ALTERNATIVES 1) Oral metronidazole 400mg BD for 7 days 2) Oral clindamycin 300mg BD for 7 days 3) Metronidazole Gel (0.75%) BD for 5 days 4) Clindamycin Cream (2%) qid for 7 days 5) Single 3% Hydrogen Peroxide vaginal washout 6) No treatment for partner? (Rx unrelated to recurrence) Recurrence not uncommon – 1) Repeat treatment - 2) Longer course 7) In pregnancy, use Ampicillin
