Non venereal infections

▪ A. Vulval infections-

The vulval and perineal skin is usually resistant to common

infection. But defense is lost following constant irritation by the
vaginal discharge or urine

1. due to specific infection

2. due to sensitive reaction

3. due to vaginal discharge or urinary contamination

▪ Vulvitis due to specific infection
bacterial
▪ Pyogenic
▪ STDs
▪ Tubercular
viral
▪ Condylomata accuminata
▪ Herpes genitalis
▪ Molluscum contagiosum
▪ Herpes zoster
fungal
▪ Moniliasis
▪ Ringworm
parasitic
▪ Pediculosis pubis
▪ Scabies
▪ threadworm
▪ Vulval cellulitis- due to unhygienic condition associated with even minor
scratching on the vulva, agent- staphylococcus aureus, clinical features-
vulva become swollen, red and tender, may be profuse exudation, intense
pain, itching and problem in micturition, treatment- antibiotics, local hot
compress and analgesics
▪ Furunculosis- infections of hair follicles of the mons and labia majora
folliculitis furunculitis. Agent- staphylococcus aureus, treatment-
systemic and local antibiotics and local cleanliness
▪ Infection of sebaceous and apocrine glands
▪ Impetigo- pustular infection, Agent- staphylococcus aureus or streptococcus.
It may be localized to vulva or spread to other parts of the body, face or
hands. Treatment- blebs should be incised or crust be removed, antibiotics
▪ Erysipelas- rare spreading cellulitis caused by invasion of the superficial
lymphatics by beta hemolytic streptococcus. Treatment- spectrum antibiotics
▪ Intertrigo- it is due to irritation and infection of retained secretions in the
skinfolds. It is also result from friction of the undergarments or sanitary
towels. Treatment- hygiene, antibiotics, dusting with starch and zinc oxide
powder
▪ Infection resulting from trauma
▪ Condylomata accuminata ( genital warts)- these are papillary lesions caused by
HPV. Tratment- podophyllotoxin craem or liquid BD 3 days, trichloroacetic acid
solution
▪ Herpes genitalis- caused by herpes simplex virus(HSV) type 1 and 2, treatment-
acyclovir 200mg 5times for 7 days, famciclovir 250mg TID for 7 days

▪ Molluscum contagiosum- caused by a pox virus transmitted by body contact or

towels or clothing. Treatment- tincture of iodine, diathermy or cryosurgery

▪ Herpes zoster- by varicella zoster virus. It produce an inflammatory painful

eruption of groups of vesicles distributed over the skin. Treatment is by
analgesics, acyclovir 800mg P/O
▪ Moniliasis (candida vaginitis)- caused by candida albicans,

predisposing factors- DM, pregnancy, broad spectrum antibiotics,

combined oral pills, immunosuppression, thyroid and parathyroid
disease. Symptoms- discharges, treatment- antifungal drugs, pessary

▪ Ringworm – caused by Tinea cruris. Lesions look like bright red

and circumscribed. Treatment by imidazole and griseofulvin 500mg

BD
▪ Threadworm- agent- Oxyuris vermicularis. Common in children,

Nocturnal perineal itching with evidences of perianal excoriation..

Treatment – mebendazole, local application of gentian violet
▪ 2. due to sensitive reaction

some agents may produce contact dermatitis. They are douche, soap,
powder, detergent or deodorants, condoms, contraceptive creams or
jelly or foam tablets. The vulva become inflamed or swollen, pruritis.
Treatment- innocuous cream, hydrocortisone oinment

▪ due to vaginal discharge or urinary contamination

▪ Acute and recurrent bartholinitis- agent- gonococcus, E coli, staphylococcus,

streptococcus or chlamydia trachomatis. Pathology- epithelium of the gland or the duct

gets swollen. The lumen of the duct may be blocked or remains open through which
exudates escape out. Clinical features- local pain, discomfort, tenderness. Treatment- hot
compress, analgesics, ampicillin 500mg p/o q8h

▪ Bartholin’s abscess- it is the end result of acute bartholinitis. The duct gets blocked by

fibrosis and the exudates pent up inside to produce abscess. Clinical features- pain and
discomfort. Treatment- rest, sitz bath, analgesics, ampicillin 500mg P/O q8h, tetracycline,
drainage, marsupialization( by making an elliptical opening on the medial aspect of the
labium minus not only helps in drainage of pus but prevents recurrence of abscess and
future cyst formation.
▪ Bartholin’s cyst- There is closure of the duct or the opening of an

acinus. The cause may be infection or trauma followed by fibrosis

and occlusion of the lumen. Treatment- marsupialization
▪ B. vaginal infection( vaginitis)

▪ Vulvovaginitis in childhood

▪ Trichomoniasis

▪ Vaginitis due to Chlamydia trachomatis

▪ Atrophic vaginitis

▪ Non specific vaginitis

▪ Toxic shock syndrome

▪Vulvovaginitis in childhood
▪ Due to lack of oestrogen, the vaginal defence is list and the infection occurs

easily.

▪ Etiology- non specific vulvovaginitis, presence of foreign body in the

vagina, associated intestinal infestations

▪ Clinical features- pruritus, vaginal discharge, painful micturition

▪ Investigations- vaginal discharge examination, stool examination,

vaginoscopy

▪ Treatment- hygiene, oestrogen oinment, ethinyl oestradiol vaginal cream

▪ Trichomoniasis(trichomonas vaginitis)

▪ It is caused by trichomonas vaginalis

▪ Transmission- sexual contact, toilet articles

▪ Incubation period- 3-28 days

▪ Pathology- parasites harbor in vagina in asymptomatic state in reproductive period. When local
defence is impaired( during and after menstruation, after sexual stimulation, illness) , the pH of
vagina is raised to 5.5-6.5.

▪ Clinical features- sudden profuce and offensive vaginal discharge, irritations and itching, urinary
symptoms

▪ Diagnosis- culture

▪ Treatment- metronidazole 200mg TID for 1 week

▪ Chlamydial vaginitis

▪ Agent- chlamydia trachomatis

▪ STD, causing vaginitis and urethritis

▪ Features- dysuria, vaginal discharge

▪ diagnosis- tissue culture and serological tests

▪ Complications- pelvic pain, tubal damage, ectopic pregnancy

▪ Treatment- azithromycin 1gm P/O single dose

▪ Atrophic vaginitis( senile vaginitis)

▪ Vaginitis in postmenopausal women

▪ Clinical features- postmenopausal yellowish or blood stained vaginal

discharge, discomfort, dryness, soreness in the vulva, dyspareunia

▪ Diagnosis- EUA, curettage, cervical cytology or biopsy

▪ Treatment- oestrogen therapy

▪ TSS is commonly seen in menstruating women between 15

and 30 years of age following the use of

tampons(polyacrylate)

▪ Other condition associated with TSS is use of female

barrier contraceptives(diaphragm)
▪ It is characterized by the following features of
abrupt onset:
▪ Fever >38.9*C
▪ Diffuse macular rash, myalgia
▪ Gastrointestinal: vomiting, diarrhea
▪ Cardiopulmonary: hypotension, adult respiratory
distress syndrome
▪ Platelets: ≤100,000/mm3
▪ Renal: increased BUN ≥ twice normal
▪ Hepatic: increased bilirubin, SGOT, SGPT
▪ Mucous membrane: hyperaemia
▪ The pathological features are due to liberation of exotoxin

by Staphylococcus aureus. It may lead to multiorgan

system failure. Blood cultures are negative
▪ TREATMENT

▪ Correction of hypovolemia and hypotension- IV fluids and

dopamine infusion

▪ Parenteral corticosteroids

▪ Correction of electrolyte imbalance

▪ Infection can be controlled by beta lactamase resistant anti-

staphylococcal penicillin( cloxacilin, methicillin)- 10-14 days

▪ The tampon should be removed

▪ C. cervicitis

▪ Infection of the endocervix including the glands and the stroma

▪ Types- acute and chronic

▪ Clinical features- mucopurulent discharge

▪ Treatment- antibiotics
▪ D. endometritis- acute and chronic, senile endometritis

▪ E. pyometra

▪ Collection of pus in the uterine cavity

▪ Causes- infection, carcinoma, endometritis

▪ C/F- blood stained purulent offensive discharge, pain on lower abdomen

▪ Diagnosis- dilatation of cervix, curettage

▪ Treatment- drainage
▪ F. salpingitis

▪ Infection of fallopian tube

▪ Types- acute and chronic

▪ Etiology- ascending infection from the uterus, cervix and vagina, direct

spread from the adjacent infection, tubercular

▪ Diagnosis- ultrasound and colour Doppler

▪ Treatment- IP- Ofloxacin 400mg PO BD for 14days+

metronidazole 500mg PO for 14 days

OP- clindamycin 900mg IV q8h+ gentamycin 2mg/kg

IV , then 1.5mg/kg IV q8h. This is followed by
doxycycline 100mg BD PO for 14 days
▪ G. Oophoritis

▪ H. pelvic abscess- encysted pus in the pouch of Douglas

▪ I. Parametritis- inflammation of the pelvic cellular tissue

▪ Etiology- delivery and abortion through placental site or from lacerations of

the cervix, vaginal vault or lower uterine segment,,, acute infections of

cervix, uterus and tubes,,, LSCS and hysterectomy,,, secondary to pelvic
peritonitis,,, carcinoma of cervix or radium introduction

▪ Clinical features- temperature rise(above 102F), pain , dyspareunia

▪ Treatment- same as salpingitis