GYNECOLOGIC INFECTIONS

NORMAL PHYSIOLOGY OF VAGINA:

VAGINA CONTAINS NORMAL FLORA, MAINLY AEROBIC LACTOBACILLI
THAT PRODUCES HYDROGEN PEROXIDE TO PROTECT AGAINST
HARMFUL MICROORGANISMS
GLYCOGEN STORED IN VAGINAL EPITHELIAL WALL IS CONVERTED
INTO MONOSACCHARIDE TO BE CONVERTED TO LACTIC ACID ->
MAINTAIN PH 3.8-4.2 (<4.5)
BARTHOLINS CYST AND ABCESS:
FORMATION OF A CYST OR ABCESS ON BARTHOLIN GLANDS
LOCATED POSTERIOR LOWER LABIA MAJORA
CYST: ROUND, OVULATED
ABCESS: ERYTHEMA, TENDER ON PALPATION
TX: MARSUPIALIZATION, DRAINAGE, BARTHOLINECTOMY
VAGINAL INFECTIONS: INVASION OF ANAEROBIC MICROORGANISMS
THAT REDUCES LACTIC ACID
BACTERIAL VAGINOSIS- GARDNERELLA/MYCOPLASMA HOMINIS,
CLUE CELLS ON MICROSCOPE, HIGH PH, THIN GREY WHITE
DISCHARGE, WHIFF TEST POSITIVE
TRICHOMONIASIS- TRICHOMONAS VAGINALIS, STRAWBERRY CERVIX,
YELLOW GREEN DISCHARGE, WHIFF TEST POSITIVE, TRICHOMONAS
ON MICROSCOPE, HIGH PH
CANDIDIASIS- CANDIDA ALBICANS, CHEESY WHITE DISCHARGE, PH
NORMAL, BURNING, DYSPAREUNIA, VAGINAL SORENESS, RF:
PREGNANCY, DIABETES,
RECURRENT: FOUR OR MORE TIMES IN A YEAR, PAKE FLUCONAZOLE
WEEKLY FOR 6 MONTHS
ANTIBIOTICS
OTHERSP E COLI, STRES
INFLAMMATORY VAGINITIS: INFLAMM VAGINA AND LOTS OF
EXUDATE, CAUSE UNKNOWN.
ATROPHIC VAGINITIS: DUE TO LACK OF ESTROGEN FROM
MENOPAUSE OR SUREGERY ON OVARY. GIVE ESTROGEN CREAM.
TREATMENT: METRONIDAZOLE!!!
CERVICAL INFECTIONS: CERVICITIS- LOTS O FNEUTROPHILS ON
EXAMINATION. ENDOCERVIX GIVES OUT MUCOPUS- YELLOW OR
GREEN
GONNORRHEA- DIPLOCOCCI ON EXAMINATION. - CEFIXIME

CHLAMYDIA- LARGE ROUND CELLS ON EXAMINATION. AZITHROMYCIN

DIFFERENTIATE USING NUCLEI ACID AMPLIFICATION.
PELVIC INFLAMMATORY DISEASEREPRESENTS AN ASCENDING INFECTION : ENDOMETRITIS,
SALPINGITIS, CERVICITIS
ALSO CAUSED BY GONORRHEA OR CHLAMYDIA
TRIAD SYMPTOMS:
1. PELVIC PAIN
2. CERVICAL TENDERNESS
3. FEVER
TREAT AS INPATIENT IF:
1. DIAGNOSIS IS UNCERTAIN
2. CLINICAL MANIFESTATION IS SEVERE
3. PELVIC ABCESS IS SUSPECTED
DISCHARGE WHEN:
FEVER HAS GONE DOWN FOR AT LEAST 24 HOURS
NO MORE LEUKOCYTOSIS
NO MORE PELVIC TENDERNESS
TREATMENT:
INPATIENT:
A: CEFOXITINE,
CEFTRIAXONE/DOXYCYCLINE/METRONIDAZOLE
B: OFLOXACINE, LEVOFLOXACINE/METRONIDAZOLE
OUTPATIENT:
A: CEFOXITINE, CEFOTETANE/DOXYCYCLINE
B: CLINDAMYCIN/GENTAMYCIN
GENITAL ULCER DISEASE:
GENITAL HSV: BY HSV 1 N 2- SUPERFICIAL AND INFLAMED,
GROUPED VESICLE MIXED WITH ULCERS. TREAT WITH
ACYCLOVIR.
SYPHYLLIS: TREPONEMA PALLIDUM- SMOOTH BORDER
WITH SMOOTH BASE. MINIMALLY PAINFUL WITH NO
INVOLVEMENT OF LYMPH. TREAT WITH PENICILLIN OR
TETRACYCLIN OR DOXYCYCLIN
CHANCROID: HAMEOPHILUS DUCREYI- ROUGH EDGES.
EXTREMELY PAINFUL WITH INVOLVEMENT OF LYMPH. TREAT
WITH AZITHROMYCIN.
LYMPHOGRANULOMA VENEREUM: CHLAMYDIA
TRACHOMATIS. INVOLVEMENT OF LYMPH NODES BUT NO
ULCERS.

DONOVANOSIS: KLEBSIELLA GRANULOMATIS. TREAT WITH

DOXYCYCLIN OR AZITHROMYCIN. GRANULES IN INGUINAL