Genital System InfectionsThe Third Affiliated Hospital Dr.Zeng Hai-taoGenital System InfectionsExternal genital organs infectionsNon-specific vulvitis Bartholinitis Abscess of Bartholin glandBartholin cyst Internal genital organs infectionsVaginitis, Cervicitis, Vulvovaginal candidiasis, Pelvic inflammatory disease,Genital tuberculosisNon-specific vulvitis Introital pain on vestibular or vaginal entry. Vestibular erythema or inflammation of the vestibular, commonly involving the posterior fourchette.Vestibular tenderless or persistent vaginal discharge and burning.Treatments: 1. depend in the etiology.2. be instructed on proper vulvar hygiene.3. Washing vulvar with medical medium.Infections of Bartholins Glands A normal Bartholins gland cannot be palpated 2% of adult women developThree common causes1. cystic dilation of Bartholins duct2. mechanical obstruction of the duct3. the rare Bartholins gland carcinomaMost women with Bartholins duct cysts are asymptomaticAbscess of Bartholin gland develop rapidly over 2 to 4 days Symptoms include acute vulvar pain, dyspareunia, and pain during walking Local symptoms of acute pain and tenderness are secondary to rapid enlargement, hemorrhage, or secondary infection The signs are those of a classic abscess: erythema, acute tenderness, edema, and occasionally cellulitis of the surrounding subcutaneous tissue, rupture spontaneouslyTreatment of cysts Asymptomatic cysts in women under the age of 40 do not need treatment Simple incision and drainage Use a carbon dioxide laser to produce a neostoma. Antibiotics not necessary unless associated cellulitis Excision of a Bartholins duct and gland is indicated 1. persistent deep infection 2. multiple recurrences of abscesses 3. enlargement of the gland in women over the age of 40Bacterial Vaginosis (BV) The most common form of vaginitis Previously been referred to as nonspecific vaginitis or Gardnella vaginitis triggers the disturbance of normal vaginal floraFrequent sexual intercourseUse of douches an alteration of normal vaginal bacterial flora that results in the loss of hydrogen peroxideproducing lactobacilli and an overgrowth of predominantly anaerobic bacteriaAdverse Sequelae of BV pelvic inflammatory disease (PID) postabortal PID postoperative cuff infections abnormal cervical cytology premature rupture Infections of the membranes preterm labor and delivery Chorioamnionitis postcesarean endometritisDiagnosis of BV A fishy vaginal odor, which is particularly noticeable following coitus, and vaginal discharge are present. Vaginal secretions are gray and thinly coat the vaginal walls. The pH of these secretions is higher than 4.5. Microscopy of the vaginal secretions reveals an increased number of clue cells, and leukocytes are conspicuously absent. In advanced cases of BV, more than 20% of the epithelial cells are clue cells. the addition of KOH to the vaginal secretions (the “whiff” test) releases a fishy, amine-like odor.Treatment of BV Inhibit anaerobes but not vaginal lactobacilli. Metronidazole, an antibiotic with excellent activity against anaerobes but poor activity against lactobacilli . 1. A dose of 500 mg administered orally twice a day for 7 days should be used. Patients should be advised to avoid using alcohol during treatment with oral metronidazole and for 24 hours thereafter.2. Metronidazole gel, 0.75%, one applicator (5 g) intravaginally once or twice daily for 5 days.3. An alternative regimen uses a single, 2g oral dose of metronidazole.Trichomonal Vaginitis Caused by the sexually transmitted Trichomonas vaginalis The transmission rate is high:70% Trichomonal vaginitis often accompanies BV: 60% Symptoms and signs may be much or asymptomaticDiagnosis of Trichomonal Vaginitis Associated with a profuse, purulent, malodorous vaginal discharge that may be accompanied by vulvar pruritus. Vaginal secretions may exude from the vagina. In patients with high concentrations of organisms, a patchy vaginal erythema and colpitis macularis may be observed. The pH of the vaginal secretions is usually higher than 5.0. Microscopy of the secretions reveals motile trichomonads and increased numbers of leukocytes. Clue cells may be present because of the common association with BV. The whiff test may also be positive.Treatment of Trichomonal Vaginitis Morbidity be related to BV, of risk with BV Other sexually transmitted diseases should be testedNeisseria gonorrhoeae and Chlamydia trachomatisSyphilis and human immunodeficiency virus (Serologic testing) Treatment of Trichomonal VaginitisMetronidazole is the drug of choice. Both a ingle-dose (2 g orally) and a multidose (500 mg twice daily for 7 days) regimen are highly effective and have cure rates of about 95%. The sexual partner should also be treated. Metronidazole gel should not be used. Women who do not respond to initial therapy