INFLAMATION AND

INFECTIONS OF THE FEMALE

REPRODUCTIVE SYSTEM
COMMON INFECTIOUS CONDITION

 Bartholinitis, Bartholin abscess and Bartholin cysts

 Vaginitis : Bacterial,viral,monilial and atrophic

(postmenopausal)

 Vulvovaginitis
ETIOLOGY

 Specific organisms or non-infective dermatitis

 Irritation from vaginal discharge or menses

 Lack of vulvar hygiene

 Glycouria
VULVAL INFECTIONS
CAUSATIVE ORGANISMS AND CLINICAL
MANIFESTATION

BACTERIAL INFECTIONS
 CAUSES
 caused by sexually transmitted organisms
 CLINICAL FEATURES
 Increased vaginal discharge
 Musty or fleshy odour of discharge following sexual
intercourse
 Homogeneous, gray – white discharge
 MANAGEMENT
 Local antiseptics
 Systemic antibiotics
CAUSATIVE ORGANISMS AND CLINICAL
MANIFESTATION

MONILIASL INFECTION
 CAUSES
 Candida albicans
 CLINICAL FEATURES
 Itching and burning
 Thick – curd like discharge
 Dyspareunia
 Vulvar or vaginal erythema
 Edematous cervix
 MANAGEMENT
 Local fungicidal preparation
(nistatin,clotrimazole,miconazole or econazole or
fluconazole)
CAUSATIVE ORGANISMS AND CLINICAL
MANIFESTATION

VULVAL INFECTIONS
 CAUSES
 Varicella zoster virus
 CLINICAL FEATURES
 Painful eruptions of group of vesicles
 MANAGEMENT
 Analgesics
 Antiviral - Acyclovir
 Antibiotic
CLINICAL FEATURES

 Dryness and soreness

 Itching and burning

 Vulvar and vaginal atrophy

 Pale,thin, friable vaginal mucosa

 Sparse pubic hair

 Dyspareunia

 Yellowish or blood stained discharge

TREATMENT

 Intravaginal applications of estrogen cream

 Systemic estrogen if there is no contraindication

 Treatment of local infection if present

BARTHOLINITIS
BARTHOLINITIS

Infection of the major vestibular

glands
Major vestibular glands (Bartholin’s
glands)
CAUSES

 Staphylococcus

 E.Coli

Streptococcus

Enterococcus

 Gonococcus

 Chlamydia trachomatis

Polymicrobial infection is common.

CLINICAL MANIFESTATION

 Local pain and discomfort

 Difficulty in walking or sitting

 Tenderness and induration of the posterior half of the labia

when palpated between thumb outside and the index finger

inside the vagina

 Tenderness and induration of the posterior half of the labia

 Duct opening looks congested and secretion comes out

TREATMENT

 Hot compress and analgesics

Antibiotics (Ampicillin) in the early stage

Drain the abscess (excision of an elliptical piece of

skin)
 Bartholin’s Cyst

• Marsupialization
for preservation of the
gland function
• Excision for recurrent
cases
BARTHOLIN’S ABCESS
 BARTHOLIN’S ABCESS

Bartholin’s abscess is the end result of acute

bartholinitis
 Bartholinitis Fibrosis Ducts get blocked
Exudates pent up inside Abscess
BARTHOLIN’S ABCESS

CLINICAL FEATURES
Pain and discomfort

 Patient cannot walk or even sit

 Fever

 Tenderness

 Swelling beneath the posterior half of the labium

majus
BARTHOLIN’S ABCESS

TREATMENT
 Rest

 Analgesics

 Sitz bath

 Antibiotic – Ampicillin or Tetracycline

 Abscess should be drained

 Marsupialisation
VAGINAL INFECTION
(VAGINITIS)
VULVO VAGINITIS IN CHILDHOOD

 Inflammatory condition of the vulva and vagina

 Caused by lack of estrogen

VULVO VAGINITIS IN CHILDHOOD

ETIOLOGY
 Non specific vulvovaginitis

 Presence of foregin body in the vagina

 Associated infection

 Infection caused by candida albicans and gonococcus

VULVO VAGINITIS IN CHILDHOOD

CLINICAL FEATURES
 Pruritis

 Vaginal discharge – scanty to copious

 Painful micturition

 Soreness of the vulva

 Minora may be swollen and red

VULVO VAGINITIS IN CHILDHOOD

INVESTIGATION
 Two smears are taken

One direct examination and the other for gram stain

 Culture to exclude intestinal infection

 Vaginoscopy to exclude foreign body

VULVO VAGINITIS IN CHILDHOOD

TREATMENT
 Perineal hygiene

 Removal of foreign body

 Estrogen ointment

 Ethinyl estradiol vaginal cream

 CANDIDA
VAGINITIS(MONILIASIS)
CANDIDA VAGINITIS (MONILIASIS)

ETIOLOGY

 Candida albicans

 Gram positive

 Yeast like fungus

 CANDIDA VAGINITIS (MONILIASIS)

CLINICAL FEATURES

 Vaginal discharge with intense vulvovaginal pruritis

 Discharge is thick,curdy white and in flakes ,often adherent to

the vaginal wall

 Vulva may be red and swollen

 Vaginal examination may be tender

 Removal of white flakes reveals multiple oozing spots

CANDIDA VAGINITIS (MONILIASIS)

TREATMENT

 Fungicidal preparation

 Nystatin,clotrimazole,miconazole,econazole are used

in the form of vaginal cream or pessary

 Single dose oral therapy with fluconazole or

itraconazole is also found effective

BACTERIAL VAGINOSIS
BACTERIAL VAGINOSIS

ETIOLOGY
1. Imbalance of normal vaginal flora
 Diminution of Doderlein lactobacillus and
 Increase in other bacteria, in particular,
anaerobic bacteria.
2. Causative factors of the imbalance are
unknown
 Gardnerella vaginalis
BACTERIAL VAGINOSIS

 CLINICAL PICTURE
Symptoms:
 10-40% asymptomatic
 Mild pruritus or burning sensation
 Increased vaginal discharge
and fishy odor
Signs:
 Discharge: thin, greyish-white,
homogenous, but not sticky
 No inflammation reaction
(No epithelial edema or erythema)
BACTERIAL VAGINOSIS

TREATMENT
 Systemic therapy (oral) (80%)
1) Metronidazole 400mg, 2-3 times a day for 7 days
2) Clindamycin 300mg, twice a day for 7 days
 Topical therapy (80%)
1) Effervescent tablets of metronidazole
200mg/day, for 7-10 days
2) 2% Clindamycin cream, once a day for 7 days
 Vaginal washing
1-3% H2O2 , 1% lactic acid, 0.5% acetic acid
ATROPIC VAGINITIS
ATROPIC VAGINITIS(SENILE VAGINITIS)

DEFINITION

Vaginitis in postmenopausal women is called

atrophic vaginitis
ATROPIC VAGINITIS(SENILE VAGINITIS)

CLINICAL FEATURES
 Postmenopausal yellowish or blood stained
vaginal discharge
 Discomfort,dryness,soreness in the vulva
 Dyspareunia
 Evidences of pruritis vulvae
 The character of discharge is yellowish or blood
stained
 Vaginal examination is often painful and the walls
are found inflamed
ATROPIC VAGINITIS(SENILE VAGINITIS)

DIAGNOSIS
 Exclude carcinoma
 EUA
 Diagnostic curettage
 Cervical cytology or biopsy
TREATMENT
 Improvement of general health and treatment
 Systemic estrogen therapy
 Intravaginal application of estrogen cream
ACUTE CERVICITIS
ACUTE CERVICITIS

 It is an infection of the Endocervix

including the glands and the stroma

ACUTE CERVICITIS

ETIOLOGY
 Neisseria gonorrhoeae

 Chlamydia trachomatis

 Staphylococcus

 Streptococcus
 Enterococcus
ACUTE CERVICITIS

CLINICAL FEATURES
Symptoms
 Asymptomatic
 Mucopurulent vaginal discharge
 Vaginal irritation symptoms:pruritus, burning
sensation
 Lumbosacral pain,
 Intermenstrual bleeding, postcoital bleeding
 Symptoms of the lower urinary tract
Signs
 Inflammation of the cervix with mucopurulent
discharge (MPC for mucopurulent cervicitis)
ACUTE CERVICITIS

DIAGNOSIS

Gram’s stain of the cervical discharge for leukocyte

Tests for gonococcus and chlamydia

Wet mount microscopy for trichomonads

ACUTE CERVICITIS

TREATMENT
 Systemic medication
 Choice of drugs depends on the pathogens,Examples:
GONORRHEA INFECTION
 Third generation Cephalosporins
 Ceftriaxone Sodium
 Spectinomycin
CHLAMYDIA TRACHOMATIS
 Doxycycline
 Azithromycin
 Erythromycin
 Ofloxacin
CHRONIC CERVICITIS
CHRONIC CERVICITIS

ETIOLOGY
1. When the stratified epithelium which normally
covers the vaginal portion of the cervix is replaced by
columnar epithelium which is continuous with that
of the cervical canal.

2. Most erosion are not infected, nor they are the result of

inflammation.

3. Occurs in the newborns, pregnancy, oral contracepives

CHRONIC CERVICITIS

CLINICAL FEATURES
Symptoms
The only symptom is a mucoid discharge.

A slight postcoital bleeding (but malignancy

should be excluded)
Signs
A red area is seen around the external os.
CHRONIC CERVICITIS
TREATMENT
 Erosion found on routine examination should
not be treated unless it is causing troublesome
discharge.
 A cervical smear is needed before the treatment,
and if necessary, colposcopy and biopsy.
 Cervical ectropion
PHYSICAL THERAPY
 Thermal cauterization,
 Cryotherapy,
 Laser therapy
CERVICAL POLYPS
CERVICAL POLYPS

 Small pedunculated neoplasms of the cervix

ENDOCERVICAL POLYP
 Originating from the endocervix

ECTOCERVICAL POLYP
 Originating from the vaginal portion
CERVICAL POLYPS

PATHOLOGY

Gross appearance:

Endocervical polyp: Red or pink, rounded or

tongue-like

Ectocervical polyp: Pale, flesh-colored, smooth,

rounded with a broad pedicle

CERVICAL POLYPS
CLINICAL FEATURES
 Some are asymptomatic
 Slight postcoital bleeding
TREATMENT
 Cervical polyp should be treated
 Malignant change (<1%) Polypoid cervical cancer
 Twisting off a polyp without an anesthetic and
cauterizing the base
 Recurrent cases are treated with canal dilation and
cauterization of the stalk