REPRODUCTIVE TRACT INFECTIONS AND BENIGN

TUMORS OF FEMALE REPRODUCTIVE SYSTEMS

Samprity ROY
B.Sc Nursing 1st year student
TYPES OF RTI
SEXUALLY TRANSMITTED DISEASE
E.g-Chlamydia,Gonorrhoea,HIV infection
Endogenous
Infections

Over growth of organisms

normally present in the genital
tract

E.g-Bacterial
vaginosis,Vulvovaginal
candidiasis
Iatrogenic infections
Associated with improperly
performed medical procedure
E.g-Unsafe abortion ,Poor delivery
practices
INCIDENCE
It varies from 23% to 52% in different geographical area
GONORRHOEA
SECOND MOST REPORTED STI

CAUSED BY NEISSERIA GONORRHOEA

SPREAD USUALLY DURING SEXUAL ACTIVITY

INCUBATIN PERIOD 3-8 DAY

CLINICAL
MANIFESTATION
MEN
URETHRITIS
DYSURIA
PURULENT URETHRAL
DISCHARGE

PAINFUL OR SWOLLEN
TESTICLES
WOMEN
VAGINAL DISCHARGE

DYSURIA

FREQUENCY OF URINATION

CHANGES IN MENSTRUATION
DIAGNOSIS
HISTORY AND PHYSICAL EXAMINATION

CULTURE FOR NEISSERIA GONORRHOEA

NUCLEIC ACID AMPLIFICATION TEST TO DETECT

N.GONORRHOEA

TESTING FOR OTHER STIS

COLLABORATIVE
THERAPY
DRUG THERAPY
TREATMENT OF SEXUAL CONTACTS
ABSTINENCE FROM SEXUAL INTERCOURSE AND ALCOHOL
COMPLICATION

Prostatitis
Urethral strictures
PID
Bartholin abscess
Ectopic pregnancy
Infertility
Disseminated gonococcal infection
Eye infections in New born
SYPHILIS

Caused by Treponema pallidum a spirochete

It enter the body through small breaks in the skin or mucous
membranes
Spread through contact with infectious lesions and sharing of
needles among intravenous drug users
Transmitted from infected mothers to the fetus
 PRIMARY STAGE
Appearance of a chancre and
lymphadenopathy
Chancre is an oval ulcer with
a raised border
Painless unless infected
Second stage
Gereralized skin rash-Maculopapular
and nonpruritic rash appear on the palms
and soles of the feet
Generalized lymphadenopathy
Mucus patches
Condylomata lata-Broad-based flat
papules
General Flulike symptoms
Alopecia
Latent stage
Absence of sign and symptoms
Late Stage
Devastating irreversal complications such as
chronic bone
joint inflammation
cardiovascular problems
granulomatous lesions(gumma)
Central nervous system problem
Diagnosis

Primary or secondary stage lesions can be scraped and the

causative organismidentified with a darkfield microscope
technique

VDRL test

Fluorescent treponemal anti bedy absorption (FTA-ABS) tests

PHARMACOLOGICAL
MANAGEMENT
Penicillin is the drug of choice for the treatment of
syphilis
Antibiotic therapy
Oral doxycycline or tetracycline
CHLAMYDIAL INFECTIONS

Caused by Chlamydia Trachomatis

Transmitted during vaginal anal or oral sex

Leading cause of ectopic pregnancy and failure to

conceive
CLINICAL
MANIFESTATION
MEN
Urithritis
Prostatitis
Epididymitis
WOMEN

CERVICITIS
URETHRITIS
BARTHOLINITIS
DYSPAREUNIA
PID
PERIHEPATITIS
Risk factors of chlamydial infection
New and multiple sexual partners
History of STI and cervical ectopy

DIAGNOSIS
History and physical examination
Nucleic acid amplification test to detect chlamydia
Direct fluorescent antibody test for chlamydia
Culture for Chlamydia

COLLABORATIVE THERAPY
Doxycycline 100 mg twice a day for 7 days or azithromycin 1gm in a single dose
Alternative regimen-erythromycin,ofloxacin,levofloxacin
Abstinence from sexual intercourse
Treatment of all sexual partners
GENITAL HERPES
Prevalence of genital herpes to be between 1% and 3%
Etiology
The herpes simplex virus (HSV) enters through the mucous membranes or breaks in the skin
HSV then reproduces inside the cell and spreads to the surrounding cells
Next enters the peripheral or autonomic nerve endings and ascends to the sensory or autonomic nerve
ganglion
Viral descends down either the mucous membranes or the skin
Usually persists within the individual for life
Clinical manifestation
HSV type1 causes infection above the waist,involving the gingivae,the dermis,the upper respiratory
tract,and the CNS.
HSV type 2 most frequently infects the genital tract and the perineum(locations below the waist)
Either strain can cause disease disease on the mouth or the genitals
Clinical manifestation

HSV type1 causes infection above the

waist,involving the gingivae,the
dermis,the upper respiratory
tract,and the CNS.

HSV type 2 most frequently infects

the genital tract and the
perineum(locations below the
waist)Either strain can cause disease
disease on the mouth or the genitals
CLINICAL
MANIFESTATION

HSV type 2 most frequently infects

the genital tract and the
perineum(locations below the
waist)Either strain can cause disease
disease on the mouth or the genitals
DIAGNOSIS
History and physical examination
Viral isolation by tissue culture
Antibody assay for specific HSV viral type
COLLABORATIVE THERAPY
Primary infection
Acyclovir 400 mg 3 times a day or acyclovir 200 mg 5 times a day or famciclovir 250 mg 3 times a
day or valacyclovir 1 gm thrice a day,given orally for 7-10 days
Attempt to identify trigger mechanisms
Yearly Pap test
Abstinence from sexual contact while lesions are present
Symptomatic care
Confidential counselling and testing for HIV
WARTS

Genital warts (condylomata acuminata)are caused by the human papilloma virus

It is highly contagious and frequently seen in young sexually active adults
Etiology
Minor trauma during intercourse can cause abrasions that allow HPV to enter the
body.
The epithelial cells infected with HPV undergo transformation and proliferation to
form a warty growth
CLINICAL
MANIFESTATION
Genital warts are discrete single or
multiple papillary growths that are white
to grey and pink-flesh coloured.
They may grow and coalesce to form
large,cauliflower-like masses.
In men,the warts may occur on the penis
and scrotum,around the anus,or in the
urethra
In women the warts may be located on the
vulva,vagina or cervix and in the perianal
area itching may occur with anogenital
warts
Bleeding on defecation may occur with
anal warts
During pregnancy,genital warts tend to
grow rapidly
DIAGNOSTIC STUDIES
A diagnosis of genital warts can be made on the basis of the gross appearance of the lesions
Serologic and cytologic testing should be done to rule out these conditions.

The HPV DNA test helps to determine if women with abnormal Papanicolaou test results need further
follow-up

Collaborative care
The primary goal when treating visible genital warts is the removal of symptomatic warts.
General warts are difficult to treat and often require multiple variety of treatment modalities
Treatment consists of chemical or ablative(removal with laser or electrocautery)methods
80%-90% trichloroacetic acid or bichloroacetic acid applied directly

Podophyllin resin (10-25%) a cytotoxic agent is a recommended therapy for small external genital warts
A vaccine is now available to prevent cervical cancer
VAGINITIS
DEFINITION

ETIOLOGY
There is a change in the normal vaginal flora
Vaginal pH becomes more alkaline
Virulent organisms invade the vagina or
Vaginitis can be caused by mechanical irritation or chemical irritation,vaginal
infection,Overmedication with antibiotics,long term steroid therapy

PATHOPHYSIOLOGY
Vagina is having normal protective flora.E.g-Doderlein bacillus
Normal vaginal function depends on a delicate balance between hormone and
bacteria
CLINICAL MANIFESTATION
Change in vaginal discharge (It becomes profuse, odoriferous and purulent)
Diagnosis
It is diagnosed with pelvic examination
Medical Management
Metronidazole and clindamycin is the drug of choice

CANDIDIASIS

Caused by Candida Albicans

Clinical Manifestation
Inflammation of vaginal epithelium
Producing itching,reddish irritation
White,Cheeselike discharge clinging to epithelium

Management
Antifungal agent-miconazole,clotrimazole
Review other causative factors
Assess for diabetes and human immunodeficiency virus infection
TRICHOMONAS VAGINALIS VAGINITIS

Causative organism are

Trichomonas Vaginalis

Clinical Manifestation
Inflammation of vaginal epithelium producing burning and itching
Frothy yellow,white or yellow green vaginal discharge

Management
Relieve inflammation
Restore acidity
Reestablish normal bacterial flora
Provide oral metronidazole
BARTHOLINITIS (INFECTION OF GREATER VESTIBULAR GLAND)
CAUSATIVE ORGANISM ARE
Escherichia Coli
T.Vaginali
Staphylococcus
Streptococcus
Gonococcus
CLINICAL MANIFESTATION
Erythema around vestibular gland
Swelling and edema
Abscessed vestibular gland
MANAGEMENT
Drain the abscess
Provide antibiotic therapy
CERVICITIS-ACUTE AND CHRONIC

CAUSATIVE ORGANISM ARE

Chlamydia
Gonococcus
Streptococcus
CLINICAL MANIFESTATION
Profuse purulent discharge
Backache
Urinary frequency and urgency
MANAGEMENT

Penicilline,streptomycin or tetracycline
ATROPHIC VAGINITIS

ETIOLOGY
Lack of estrogen
Glycogen deficiency

CLINICAL MANIFESTATION
Discharge and irritation from alkaline pH of Vaginal Secretions

MANAGEMENT

Provide topical vaginal estrogen therapy

Improve nutrition
Relieve dryness through the use of moisturizing medications
PELVIC INFLAMMATORY DISEASE(PID)

It is an infectious condition of the pelvic cavity that may involve infection of the fallopian tubes
(salpingitis),ovaries(oophoritis) and pelvic peritoneum(peritonitis)
ETIOLOGY
Result of untreated cervicitis

Chlamydia trachomatis and Neisseria gonorrhoeae are the most common causative organism of PID

Anaerobes,mycoplasma,streptococci and enteric gram negative rods gain entrance during sexual
intercourse or after pregnancy termination,pelvic surgery or child birth

Presence of tuboovarian abcess

CLINICAL MANIFESTATION
Lower abdominal pain
Pain with intercourse
Spotting after intercourse
Purulent cervical or vaginal discharge
Fever and Chill
Cramping pain with menses,irregular bleeding
DIAGNOSIS
Pelvic Examination
Culture for gonorrhoea and chlamydia are obtained
Ultrasound
COLLABORATIVE CARE
Combination of antibiotics -cefoxitin and doxycycline
No intercourse for 3 weeks
Physical rest ,oral fluid
Tuboovarian abscess may be drained by laparoscopy or laparotomy
Severe cases hysterectomy
COMPLICATION

Septic shock and fitz Hugh –Curtis syndrome

Tubo-ovarian abscesses may leak or rupture resulting in pelvic peritonitis
Septic shock
LONG TERM COMPLICATION
Ectopic pregnancy, infertility and chronic pelvic pain

NURSING MANAGEMENT
History, Physical examination
Implementing drug therapy
Monitoring Pt health status
Provide symptomatic relief, patient teaching
Amount ,color and odour of the vaginal discharge should be recorded

NURSING DIAGNOSIS
Pain related to inflammation and infection of reproductive tract as evidence by facial expression
Hyperthermia related to infection as evidence by increase in body temperature above normal
Knowledge deficit regarding cause,therapy ,complication and transmission of disease to others related to
unfamiliarity with nature and treatment of disease as evidence by asking questions
ENDOMETRIOSIS
Endometriosis is the presence
of normal endometrial tissue
in sites outside the
endometrial cavity
Most frequent sites are in or
near the ovaries,the
uterosacral ligaments and the
uterovesical peritoneum.
Other locations are
stomach,lungs,intestine and
spleen
ENDOMETRIOSIS

ETIOLOGY
Retrograde menstreual flow passes through the fallopian tubes carrying viable endometrial tissues into the
pelvis.The tissue attached to the various sites
Undifferentiated embryonic peritoneal cavity cells remain dormant in the pelvic tissue until the ovaries
produce sufficient hormones to stimulate their growth
Genetic Predisposition
Altered immune function
CLINICAL MANIFESTATIONS
Secondary Dysmenorrhea
Infertility
Pelvic Pain
Dyspereunia
Irregular Bleeding
Backache
Painful bowel movements
Dysuria
DIAGNOSIS
History and Physical examination
Pelvic examination
Laparoscopy
Pelvic ultrasound
MRI
COLLABORATIVE THERAPY
Drugs-Danazol,GnRH agonists,Oral contraceptives,NSAID
SURGICAL THERAPY
Laparotomy to remove implants and adhesions
Total abdominal hysterectomy and bilateral salpingo-oophorectomy
NURSING MANAGEMENT
Conservative and Progressive treatment
 NURSING DIAGNOSIS
Pain related to endometrial pelvic implants as evidence by facial expression
Anxiety related to effect of endometriosis on fertility as evidence by verbalization
Knowledge deficit regarding therapy,cause,complication and transmission of disease to others related tro unfamiliarity with
nature and treatment of disease as evidence by asking questions
BENIGN TUMORS OF THE FEMALE REPRODUCTIVE SYSTEMS
CERVICAL POLYP
Cervical polyps are benign pedunculated lesions that generally arise from the endocervical mucosa and are seen protruding
through the cervical os during a speculum examination
Polyps are a characteristic bright cherry-red and are soft and fragile in consistency
They are gererally small,measuring less than 3 cm in length and may be single or multiple
ETIOLOGY
Chronic irritation and inflammation of the cervix can occur due to untreated sexually transmitted disease
Over long term use of spemicidal gel,condom,cervical diaphragms can induce abnormal alterations in the cells of cervix
CLINICAL FEATURES
Metrorrhagia and bleeding after straining for a bowel movements and coitus can occur
DIAGNOSIS
Routine pelvic examination
Pap smear test

MANAGEMENT
When the polyp is small ,it can be excised in an outpatient procedure.
Polypectomy

Methods to destroy the base of the polyp include the use of

Liquid nitrogen
Electrocautery
Laser surgery
BENIGN UTERINE
TUMORS(LEIOMYOMAS)
Leiomyomas are the benign tumors of
the uterine muscles
INCIDENCE
They occur in more than 20-30% of all
women during their menstrual years
ETIOLOGY
Unknown
They appear to depend on ovarian
hormones because they grow slowly
during the reproductive years and
undergo atrophy after menopause
 BENIGN UTERINE
TUMORS(LEIOMYOMAS)
CLASSIFICATION
Intramural-intramural lesions are found in
the uterine wall,surrounded by myometrium.
Submucosal-Submucosal lesions occur
directlyunder the endometrium,involving the
endometrial cavity
Subserosal-Subserosal lesions are found on
the outer surface (under the serosa) of the
uterus
Wandering or parasitic-These lesions occur
when a pedunculated leiomyoma twists on
its pedicle and breaks off.
Intraligamentary-Intraligamentary lesions
are implants on the pelvic ligaments and they
may displace the uterus or involve the
ureters
Cervical-Cervical lesions occur infrequently
and may obstruct the cervical canal
CLINICAL MANIFESTATION
The majority of women with leiomyomas do not have any symptoms
Abnormal uterine bleedind
Pain
Pressure on surrounding organs may result in rectal bladder and lower abdominal discomfort
Large tumours are sometimes associated with miscarriage and infertility
DIAGNOSTIC ASSESSMENT
History,physical examination
Ultrasonography
MEDICAL MANAGEMENT
Menopause will alleviate the problem
Medication e.g-leuprolide or other gonadotropin-releasing hormone analogues may be prescribed to
shrink the fibroids
SURGICAL MANAGEMENT
Myomectomy
Hysterectomy
TYPES OF HYSTERECTOMY

Subtotal hysterectomy:-All of the uterus except the cervix is removed

Total hysterectomy:- Removal of the uterus and cervix.
Total abdominal hysterectomy with bilateral oophorectomy:-Removal of the uterus cervix,fallopian
tubes and ovaries
Radical hysterectomy:-which is performed only to treat cancer is the same as a TAH-BSO plus removal of
the lymph nodes,upper third of the vagina and parametrium
Several alternatives to hysterectomy have been developed for the treatment of excessive bleeding due
to fibroids.These include
Hysteroscopic resection of myomas:-A laser is used through a hysteroscope passed through the cervix;no
incision or overnight stay is needed
Laparoscopic myomectomy:-Removal of a fibroid through a laparoscope inserted through a small
abdominal incision
Laparoscopic myolysis:-The use of a laser or electrical needles to cauterize and shrink the fibroid
Laparoscopic cryomyolysis:- Electric current is used to coagulate the fibroid
Uterine artery embolization(UAE):-Polyvinyl alcohol or gelatine particles are injected into the blood
vessels that supply the fibroid via the femoral artery,resulting in infarction and resultant shrinkage
Magnetic resonance-guided focused ultrasound surgery:- Ultrasonic energy is passed through the abdominal
wall to target and destroy the fibroid
NURSING DIAGNOSIS

Pain related to dyspareunia and pelvic pain secondary to multiple or enlarged leiomyomas as
evidence by facial expression
Knowledge deficit regarding surgical procedure and possible outcome of surgery related to
unfamiliarity with treatment regimen as evidence by asking questions
Grieving related to loss of reproductive capacity and perceived loss of femininity as evidence by
verbalization