Gynecological Infections

 

Sexually Transmitted Diseases

 

A-BACTERIAL:

Gonorrhea, Syphilis, Chlamydia, H.Ducreyi, Calymmatobacteria.

B-VIRAL:

Herpes simplex, Human Papilloma virus, CMV, Molluscm Contagiosum, AIDS

C-PARASITIC:

Trichomonas vaginalis, Pediculosis, Scabies

D-FUNGAL:

Candida albicans

 

 

Gonorrhea

Chlamydia

Syphilis

Chancroid

Granuloma Inguinale

Aetiology:

Neisseria Gonorrhea

Bacteria contains both DNA,RNA.

Treponema pallidum

Hemophilus Ducreyi

Calymmatobacteria

Organism

Gram -ve diplococci

Obligatory intracellular of serotypes  A to L

Anaerobic Motile spirochete

Gram -ve bacillus

Gram -ve bacillus

Route of infection

1-STD

2-Contaminated toilet seats

 

3-OPhthalmia Neonatorum

3-OPhthalmia Neonatorum

3-Transplacental

 

 

Predisposing factor

Sexual behaviour, Multiple parteners.

Clinical picture:

 

 

 

 

 

Primary Infection

 

Sertypes D => K

Chancre: hard painless nodule that ulcerates (rolled edges)

Multiple papules on the vulva that break forming shallow painful ulcers.

Multiple papules on the vulva that brak forming shallow ulcers.

Vulvitis

Only Bartholinitis

Only Bartholinitis

Vaginitis

No (except if prepubertal)

No (except if prepubertal)

 

Cervicitis

Acute Endocervicitis

Acute Endocervicitis

 

 

 

Endometritis

Transient Endometritis

Transient Endometritis

 

 

 

Salpingitis & PID

Acute PID (Secondary site)

Acute PID (Secondary site)

 

 

 

Other sites

Pelvic:

Urethritis, Proctitis

Skene's adenitis

Extrapelvic:

Tenosynovitis

Endocarditis

Septicemia

Serotypes L1,L2, L3

Lead to LGV:

Papules, macules or vesicles in the posterior vulva which heal rapidly without scarring.

 

 

 

Lymph Nodes

 

enlarged, suppurate with sinus formation in 2ry stage of  LGV

Enlarged, firm, discrete but do not suppurate

Enlarged tender and suppurate

Enlarged but do not  suppurate

Sequale:

Turns Chronic

-Chronic cervicitis

-Chronic PID

-Bartholin Cyst

-Chronic Urethritis

3ry stage of LGV:

Progressive fibrosis and tissue destruction with extensive fibrosis.

2ry Syphilis in 6weeks to 6 months

Tertiary Syphilis after 2 - 20 years.

 

 

Diagnosis:

 

 

 

 

 

-Smear

G -ve intracellular diplococci

Inclusion bodies

From Chancre ex. by dark field illum.

Gram stain (G -ve bacillius)

From ulcer => donovan bodies

-Culture

Chocolate Agar or Thayer Martin Media

Yolk Sac

 

enriched media

 

-Serology

CFT, HAT

CFT, HAT

+ve after weeks of infection

-

 

-Others

 

Frei test

 

 

Biopsy from LN

-Screening for other STDs is advised

Treatment:

 

 

 

 

 

General lines

-Advice sound sexual behaviour                                   -Protective barrier contraception

Active treatment

Antibiotic:

Procaine Penicillin 4.8 million units + 1gm probenecid

Or:

Tetracyclin 300mg initial dose then 150mg x 2 x 7

Or

Spectinomycin 2gm IM single dose

For ttt of PID

Crystalline Penicillin 1million IU / 6hours for 4 days then procaine penicillin 600,000 IU/day for 7 days.

 

Clindamycin 300mg/6 hours x7

Or

Tetracyclin 2 gm / day for 15 days.

 

For LGV

*Incision or drainage of LN is CONTRAINDICATED

*Plastic surgery for excision of scar tissue or sinuses.

Syphilis diagnosed in < 1 year:

Benzathine Penicillin 2.4 million units

Or

Procaine Penicillin 600,000 IU/day x 8

Or

Tetracyclin 500mg x4x15

 

> One year:

Benzathine Penicillin 2.4 millionIU repeated weekly for 3 weeks.

Or

Procaine Penicillin 600,000 IUx1x5

Or

Tetracyclin 2gm /day x 30 days.

Clindamycin 300mg/6 hours x7

Or

Tetracyclin 2 gm / day for 15 days

Clindamycin 300mg/6 hours x7

Or

Tetracyclin 2 gm / day for 15 days

Treatment of the male partener.