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
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Gonorrhea |
Chlamydia |
Syphilis |
Chancroid |
Granuloma Inguinale |
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Aetiology: |
Neisseria Gonorrhea |
Bacteria contains both DNA,RNA. |
Treponema pallidum |
Hemophilus Ducreyi |
Calymmatobacteria |
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Organism |
Gram -ve diplococci |
Obligatory intracellular of serotypes A to L |
Anaerobic Motile spirochete |
Gram -ve bacillus |
Gram -ve bacillus |
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Route of infection |
1-STD 2-Contaminated toilet seats |
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3-OPhthalmia Neonatorum |
3-OPhthalmia Neonatorum |
3-Transplacental |
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Predisposing factor |
Sexual behaviour, Multiple parteners. |
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Clinical picture: |
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Primary Infection |
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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. |
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Vulvitis |
Only Bartholinitis |
Only Bartholinitis |
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Vaginitis |
No (except if prepubertal) |
No (except if prepubertal) |
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Cervicitis |
Acute Endocervicitis |
Acute Endocervicitis |
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Endometritis |
Transient Endometritis |
Transient Endometritis |
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Salpingitis & PID |
Acute PID (Secondary site) |
Acute PID (Secondary site) |
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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. |
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Lymph Nodes |
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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 |
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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. |
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Diagnosis: |
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-Smear |
G -ve intracellular diplococci |
Inclusion bodies |
From Chancre ex. by dark field illum. |
Gram stain (G -ve bacillius) |
From ulcer => donovan bodies |
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-Culture |
Chocolate Agar or Thayer Martin Media |
Yolk Sac |
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enriched media |
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-Serology |
CFT, HAT |
CFT, HAT |
+ve after weeks of infection |
- |
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-Others |
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Frei test |
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Biopsy from LN |
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-Screening for other STDs is advised |
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Treatment: |
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General lines |
-Advice sound sexual behaviour -Protective barrier contraception |
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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 |
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Treatment of the male partener. |
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